Mammography Use in Portugal: National Health Survey 2014

Introduction: Understanding the patterns of mammography use and monitoring changes in use are essential to improving national health policy for breast cancer control. We aimed to describe the use of mammography in Portugal and to identify the determinants of its nonuse and underuse by examining data from the National Health Survey 2014. Methods: We analyzed data on 8,758 women aged 30 years or older. We defined women at an eligible age for mammography as women aged 45 to 69. Women who reported a previous mammography test were classified as ever-users and grouped according to time since the most recent test. We computed the prevalence of mammography use, and we used Poisson regression models to obtain age-adjusted and education-adjusted prevalence ratios and 95% confidence intervals. Results: The overall prevalence of mammography use was 80.0%, whereas nonuse was 20.0% and underuse 27.3% among users. The prevalence of nonuse and underuse were lower and associations with sociodemographic characteristics, use of health care services, and behavioral factors were stronger among women aged 45 to 69 than among women aged 30 to 44 and women aged 70 or older. The prevalence of mammography use was generally higher in the northern areas of Portugal than in southern areas and varied by marital status, educational level, and household size. A more frequent use of health care services and healthier behaviors were associated with lower prevalences of both nonuse and underuse. Conclusion: This study illustrates inequalities in mammography use and provides useful information for better allocation of resources in breast cancer screening.The authors thank the Instituto Nacional de Estatística for providing data. The Inquérito Nacional de Saúde 2014 was conducted under the supervision of the Departamento de Estatísticas Demográficas e Sociais/Serviço de Estatísticas das Condições de Vida from Instituto Nacional de Estatística, with the collaboration of the Instituto Nacional de Saúde Doutor Ricardo Jorge and Unit F5 “Education, health and social protection” of Eurostat. The work of B.P. was supported by Fundação para a Ciência e a Tecnologia (grant nos. SFRH/BPD/75918/2011 and SFRH/BPD/108751/2015). Epidemiology Research Unit is funded by the Fundação para a Ciência e a Tecnologia (grant no. UID/DTP/04750/2013). The authors declare no conflicts of interest

Beyond the operating room: do hospital characteristics have an impact on surgical site infections after colorectal surgery? A systematic review

Background: Hospital characteristics have been recognized as potential risk factors for surgical site infection for over 20 years. However, most research has focused on patient and procedural risk factors. Understanding how structural and process variables influence infection is vital to identify targets for effective interventions and to optimize healthcare services. The aim of this study was to systematically review the association between hospital characteristics and surgical site infection in colorectal surgery. Main body: A systematic literature search was conducted using PubMed, Scopus and Web of Science databases until the 31st of May, 2021. The search strategy followed the Participants, Exposure/Intervention, Comparison, Outcomes and Study design. The primary outcome of interest was surgical site infection rate after colorectal surgery. Studies were grouped into nine risk factor typologies: hospital size, ownership affiliation, being an oncological hospital, safety-net burden, hospital volume, surgeon caseload, discharge destination and time since implementation of surveillance. The STROBE statement was used for evaluating the methodological quality. A total of 4703 records were identified, of which 172 were reviewed and 16 were included. Studies were published between 2008 and 2021, and referred to data collected between 1996 and 2016. Surgical site infection incidence ranged from 3.2 to 27.6%. Two out of five studies evaluating hospital size adjusted the analysis to patient and procedure-related risk factors, and showed that larger hospitals were either positively associated or had no association with SSI. Public hospitals did not present significantly different infection rates than private or non-profit ones. Medical school affiliation and higher safety-net burden were associated with higher surgical site infection (crude estimates), while oncological hospitals were associated with higher incidence independently of other variables. Hospital caseload showed mixed results, while surgeon caseload and surveillance time since implementation appear to be associated with fewer infections. Conclusions: Although there are few studies addressing hospital-level factors on surgical site infection, surgeon experience and the implementation of a surveillance system appear to be associated with better outcomes. For hospitals and services to be efficiently optimized, more studies addressing these variables are needed that take into account the confounding effect of patient case mix.The Epidemiology Research Unit (EPIUnit, Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto) is funded by the Portuguese Foundation for Science and Technology (POCI-01-0145-FEDER-006862; Ref. ()

Integral valorization of Acacia dealbata wood in organic medium catalyzed by an acidic ionic liquid

In this work, a novel delignification process was proposed for the fractionation of invasive species such as Acacia dealbata wood. Organosolv process catalyzed with an acidic ionic liquid, 1-butyl-3-methylimidazolium hydrosulfate was evaluated to obtain cellulose-enriched solids and liquid fractions rich in hemicelluloses derived compounds and lignin. Under selected operating conditions (190 °C, 60% ethanol, 60 min of reaction time and 0.6 g 1-butyl-3-methylimidazolium hydrosulfate/g wood), high solubilization of lignin and hemicelluloses and cellulose recovery (87.5%, 88.7% and 88.3%, respectively), with a pulp yield of 43.1% were achieved. Moreover, 62.6 % of lignin was recovered by precipitation from the black liquor (composed mainly by 4.43 g xylose/L, 7.66 g furfural/L and 3.59 g acetic acid/L). In addition, enzymatic digestibility of delignified wood was also assayed. Overall, this work presents an alternative biorefinery scheme based in the use of environmentally friendly solvent and catalyst for selective fractionation of A. dealbata wood.The authors acknowledge the financial support received from the Spanish “Ministry of Economy and Competitiveness” (Project CTQ2017- 82962-R) and from “Xunta de Galicia” (GRC ED431C 2018/47 and Centro Singular de Investigacion ´ Biom´edica “CINBIO”). These projects are partially funded by the FEDER Program of the European Union (“Unha maneira de facer Europa”). A. Romaní thanks BioTecNorte operation (NORTE-01–0145-FEDER-000004) funded by European Regional Development Fund under the scope of Norte2020 – Programa Operacional Regional do Norte.info:eu-repo/semantics/publishedVersio

Impact of the global financial crisis on low birth weight in Portugal: a time-trend analysis

Background: The 2007–2008 global financial crisis had adverse consequences on population health of affected European countries. Few contemporary studies have studied its effect on perinatal indicators with long-lasting influence on adult health. Therefore, in this study, we investigated the impact of the 2007–2008 global financial crisis on low birth weight (LBW) in Portugal. Methods: Data on 2 045 155 singleton births of 1995–2014 were obtained from Statistics Portugal. Joinpoint regression analysis was performed to identify the years in which changes in LBW trends occurred, and to estimate the annual per cent changes (APC). LBW risk by time period expressed as prevalence ratios were computed using the Poisson regression. Contextual changes in sociodemographic and economic factors were provided by their trends. Results: The joinpoint analysis identified 3 distinct periods (2 jointpoints) with different APC in LBW, corresponding to 1995–1999 (APC=4.4; 95% CI 3.2 to 5.6), 2000–2006 (APC=0.1; 95% CI −050 to 0.7) and 2007–2014 (APC=1.6; 95% CI 1.2 to 2.0). For non-Portuguese, it was, respectively, 1995–1999 (APC=1.4; 95% CI −3.9 to 7.0%), 2000–2007 (APC=−4.2; 95% CI −6.4 to −2.0) and 2008–2014 (APC=3.1; 95% CI 0.8 to 5.5). Compared with 1995–1999, all specific maternal characteristics had a 10–15% increase in LBW risk in 2000–2006 and a 20–25% increase in 2007–2014, except among migrants, for which LBW risk remained lower than in 1995–1999 but increased after the crisis. The increasing LBW risk coincides with a deceleration in gross domestic product growth rate, reduction in health expenditure, social protection allocation on family/children support and sickness. Conclusions: The 2007–2008 global financial crisis was associated with a significant increase in LBW, particularly among infants of non-Portuguese mothers. We recommend strengthening social policies aimed at maternity protection for vulnerable mothers and health system maintenance of social equity in perinatal healthcare.Statistics Portugal (INE) is appreciated for providing the database used for the analysis. This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education) (POCI-01-0145-FEDER-016874), under the project “Migrants and Perinatal Health: Barriers, Incentives and Outcomes (baMBINO)” (Ref. FCT PTDC/DTP-SAP/6384/2014) and the Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013)

The occupational risk of Helicobacter pylori infection: a systematic review

The aim of this systematic review was to describe the prevalence of Helicobacter pylori infection in specific occupational groups and to compare them with the general population. We searched PubMedA (R) to identify original studies reporting the prevalence of H. pylori infection in occupational groups. The differences between occupational groups and the general population were analyzed taking into account the direction and statistical significance of the differences observed when comparing each occupational group with a reference group (either recruited in the same study or using an external comparator). A total of 98 studies addressing the prevalence of H. pylori infection in occupational groups were included in the systematic review. Overall, health professionals showed a significantly higher prevalence of H. pylori infection than the general population, especially among those working at gastrointestinal units. Similar results were found in subjects involved in agricultural, forestry and fishery, as well as in sewage workers, miners, and workers at institutions for the intellectually disabled, although differences were less pronounced. Our results show an occupational risk of H. pylori infection supporting the role of oral-oral, fecal-oral, and zoonotic transmission. Studies comparing specific occupational groups with adequate comparators may contribute to better identify groups at higher risk of infection. The recognition of this infection as an occupational disease would result in early detection and treatment, as well as prevention and control of its transmission in workplaces.This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology-FCT (Portuguese Ministry of Science, Technology and Higher Education), under the Unidade de Investigacao em Epidemiologia-Instituto de Saude Publica da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013). Individual PhD Grants attributed to AF (PD/BD/105823/2014), ARC (SFRH/BD/102181/2014) and SM (SFRH/BD/102585/2014), and a Post-Doc Grant attributed to BP (SFRH/BPD/108751/2015) were funded by FCT and the Programa Operacional Capital Humano (POCH/FSE)

Pet ownership during the first 5 years after breast cancer diagnosis in the NEON-BC cohort

Background Although human-animal interactions (HAI) have been associated with health benefits, they have not been extensively studied among cancer patients nor which factors may influence HAI during cancer survivorship. Therefore, this study aims to describe pet ownership in a breast cancer cohort within 5 years post-diagnosis and to identify associated factors. Methods Four hundred sixty-six patients from the NEON-BC cohort were evaluated. Four groups of pet ownership over the 5 years were defined: 'never had', 'stopped having', 'started having' and 'always had'. Multinomial logistic regression was used to quantify the association between the patient characteristics and the groups defined (reference: 'never had'). Results 51.7% of patients had pets at diagnosis, which increased to 58.4% at 5 years; dogs and cats were the most common. Women presenting depressive symptoms and poor quality of life were more likely to stop having pets. Older and unpartnered women were less likely to start having pets. Those retired, living outside Porto, having diabetes or having owned animals during adulthood were more likely to start having pets. Women with higher education and unpartnered were less likely to always have pets. Those living in larger households, with other adults or having animals throughout life, were more likely to always have pets. Obese women had lower odds of stopping having dogs/cats. Women submitted to neoadjuvant chemotherapy and longer chemotherapy treatments were more likely to stop having dogs/cats. Conclusions Pet ownership changed over the 5 years and is influenced by sociodemographic, clinical and treatment characteristics, patient-reported outcomes and past pet ownership, reflecting the importance of HAI during cancer survivorship.This work was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology-FCT (Portuguese Ministry of Science, Technology and Higher Education) under the project 'A five-year prospective cohort study on the neurological complications of breast cancer: frequency and impact in patient-reported outcomes' (POCI-01-0145-FEDER016867, Ref. PTDC/DTP-EPI/7183/2014), and national funding from FCT under the Unidade de Investigacao em Epidemiologia-Instituto de Saude Publica da Universidade do Porto (EPIUnit) (UIDB/04750/2020). Individual grants attributed to NA (SFRH/BD/119390/2016) and FF (SFRH/BD/92630/2013) were funded by FCT and the 'Programa Operacional Capital Humano' (POCH/FSE). Data management activities up to the first year of follow-up were supported by the Chair on Pain Medicine of the Faculty of Medicine, University of Porto and by the Grunenthal Foundation-Portugal

Endothelial Jagged1 promotes solid tumor growth through both pro-angiogenic and angiocrine functions

Angiogenesis is an essential process required for tumor growth and progression. The Notch signaling pathway has been identified as a key regulator of the neo-angiogenic process. Jagged-1 (Jag1) is a Notch ligand required for embryonic and retinal vascular development, which direct contribution to the regulation of tumor angiogenesis remains to be fully characterized. The current study addresses the role of endothelial Jagged1-mediated Notch signaling in the context of tumoral angiogenesis in two different mouse tumor models: subcutaneous Lewis Lung Carcinoma (LLC) tumor transplants and the autochthonous Transgenic Adenocarcinoma of the Mouse Prostate (TRAMP). The role of endothelial Jagged1 in tumor growth and neo-angiogenesis was investigated with endothelial-specific Jag1 gain- and loss-of-function mouse mutants (eJag1OE and eJag1cKO). By modulating levels of endothelial Jag1, we observed that this ligand regulates tumor vessel density, branching, and perivascular maturation, thus affecting tumor vascular perfusion. The pro-angiogenic function is exerted by its ability to positively regulate levels of Vegfr-2 while negatively regulating Vegfr-1. Additionally, endothelial Jagged1 appears to exert an angiocrine function possibly by activating Notch3/Hey1 in tumor cells, promoting proliferation, survival and epithelial-to-mesenchymal transition (EMT), potentiating tumor development. These findings provide valuable mechanistic insights into the role of endothelial Jagged1 in promoting solid tumor development and support the notion that it may constitute a promising target for cancer therapy

Quality of life trajectories in breast cancer patients: an updated analysis 5 years after diagnosis

Letter to the editorThis work was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) under the project ‘A five-year prospective cohort study on the neurological complications of breast cancer: frequency and impact in patient-reported outcomes’ (POCI-01-0145-FEDER-016867, Ref. PTDC/DTP-EPI/7183/2014), and national funding from FCT under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-016867, Ref. PTDC/DTP-EPI/7183/2014), and national funding from FCT under the Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (info:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UIDB/04750/2020/PT). LLC was funded under the scope of the project ‘NEON-PC—Neuro-oncological complications of prostate cancer: longitudinal study of cognitive decline’ (POCI01–0145-FEDER-032358; ref. PTDC/SAU-EPI/32358/2017). Individual grants attributed to NA (SFRH/BD/119390/2016) and FF (SFRH/BD/92630/2013) were funded by FCT and the ‘Programa Operacional Capital Humano’ (POCH/FSE). Data management activities up to the first year of follow-up were supported by the Chair on Pain Medicine of the Faculty of Medicine, University of Porto, and by the Grünenthal Foundation—Portugal

Worldwide Burden of Gastric Cancer Attributable to Tobacco Smoking in 2012 and Predictions for 2020

Background: The heterogeneous patterns and trends in tobacco consumption contribute to regional and gender differences in the burden of gastric cancer attributable to smoking. Aims: To estimate the proportion and absolute number of gastric cancer cases that can be attributed to smoking in different countries, in 2012 and 2020. Methods: Population attributable fractions (PAFs) were computed for 118 countries, using data of smoking prevalence in 2002 and 2011 and published estimates of the magnitude of the association between smoking and gastric cancer, assuming a time lag of ≈10 years. Results: For men, the highest PAF estimates in 2012 were observed in Eastern Asia and the lowest in North America, whereas for women the highest were in Western Europe and the lowest in Africa. Very high Human Development Index (HDI) countries presented the lowest median PAF in men (very high vs. high, medium, and low HDI: 17.2 vs. 20.8 %, p = 0.014) and the highest median PAF in women (very high vs. high, medium, and low HDI: 4.3 vs. 1.8 %, p < 0.001). Estimates for 2020 show a decrease in median PAFs, but the estimated absolute number of cases attributable to smoking in the countries analyzed increased for men (≈154,000 vs. ≈160,000) and decreased for women (≈6200 vs. ≈5600)

Quality of life trajectories during the first three years after diagnosis of breast cancer: the NEON-BC study

Background We aimed to identify and characterize quality of life trajectories up to 3 years after breast cancer diagnosis. Methods A total of 460 patients were evaluated at baseline (before treatments), and after 1- and 3-years. Patient-reported outcomes, including quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, QLQ-C30), anxiety, depression and sleep quality, were assessed in all evaluations. Model-based clustering was used to identify quality of life trajectories. Results We identified four trajectories without intersection during 3 years. The two trajectories characterized by better quality of life depicted relatively stable scores; in the other trajectories, quality of life worsened until 1 year, though in one of them the score at 3 years improved. Sociodemographic and clinical characteristics at baseline did not differ between trajectories, except for mastectomy, which was higher in the worst trajectory. Anxiety, depression and poor sleep quality increased from the best to the worst trajectory. Conclusions The type of surgery and the variation of other patient-reported outcomes were associated with the course of quality of life over 3 years. More research to understand the heterogeneity of individual trajectories within these major patterns of variation is needed.This work was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) under the project ‘A five-year prospective cohort study on the neurological complications of breast cancer: frequency and impact in patient-reported outcomes’ (POCI-01-0145-FEDER-016867, Ref. PTDC/DTP-EPI/7183/2014) and the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2019). LC was also funded under the scope of the project “NEON-PC - Neuro-oncological complications of prostate cancer: longitudinal study of cognitive decline” (POCI01-0145-FEDER-032358; ref. PTDC/SAU-EPI/32358/2017). Individual grants attributed to NA (SFRH/BD/119390/2016) and FF (SFRH/BD/92630/2013) were funded by FCT and the ‘Programa Operacional Capital Humano’ (POCH/FSE). Data management activities up to the first year of follow-up were supported by the Chair on Pain Medicine of the Faculty of Medicine, University of Porto and by the Grünenthal Foundation—Portugal