Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study

BACKGROUND

Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function.

METHODS

Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis.

RESULTS

The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC

CONCLUSION

The prevalence of dyspnoea varies substantially across the world and is strongly associated with lung function impairment. Using the mMRC scale in epidemiological research should be discussed.

Collapse

Key Words

• Breathlessness
• Dyspnoea
• Lung function
• Spirometry

Collapse

MESH Headings Collapse

Grants Collapse

Affiliation(s)

A Müller Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
E F Wouters Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
P Koul Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
T Welte Department of Respiratory Medicine/Infectious Disease, Member of the German Centre for Lung Research, Hannover School of Medicine, Hannover, Germany
I Harrabi Faculté de Médecine, Sousse, Tunisia
A Rashid RCSI and UCD Malaysia Campus, Penang, Malaysia
L C Loh RUMC, Penang, Malaysia
M Al Ghobain King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Science, Riyadh, Saudi Arabia
A Elsony The Epidemiological Laboratory, Khartoum, Sudan
R Ahmed The Epidemiological Laboratory, Khartoum, Sudan
J Potts National Heart and Lung Institute, Imperial College London, London, UK
K Mortimer University of Cambridge, Cambridge, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
F Rodrigues Pulmonology Department, Lisbon North Hospital Centre, Lisbon, Portugal; Institute of Environmental Health, Associate Laboratory TERRA, Lisbon Medical School, Lisbon University, Lisbon, Portugal
S N Paraguas Philippine College of Chest Physicians, Manila, Philippines
S Juvekar KEM Hospital Research Centre, Pune, India
D Agarwal KEM Hospital Research Centre, Pune, India
D Obaseki Department of Medicine, Obafemi Awolowo University, Nigeria; Faculty of Medicine, University of British Columbia, Canada
T Gislason Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
T Seemungal Faculty of Medical Sciences, University of West Indies, St Augustine, Trinidad and Tobago
A A Nafees Aga Khan University, Karachi, Pakistan
C Jenkins Woolcock Institute of Medical Research, Sydney, Australia
H B Dias Escola Superior de Tecnologia da Saúde de Lisboa, Politecnico de Lisboa, Lisbon, Portugal
F M E Franssen Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
M Studnicka Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
C Janson Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
H H Cherkaski Faculty of Medicine, University Badji Mokhtar, Annaba, Algeria
M El Biaze Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, Fes, Morocco
P A Mahesh Department of Respiratory Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
J Cardoso Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; NOVA Medical School, Nova University Lisbon, Lisboa, Portugal
P Burney National Heart and Lung Institute, Imperial College London, London, UK
S Hartl Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria
D J A Janssen Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
A F S Amaral National Heart and Lung Institute, Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK

Collapse

Postpandemic Rebound in Noninvasive Group a Streptococcal Disease is not Synchronous with Winter RSV and Influenza Epidemics

An increase in invasive group A Streptococcus infections was reported in 2022, associated with intense respiratory virus circulation. We describe a marked increase of noninvasive group A Streptococcus infections. Although the rise coincided with epidemics of respiratory syncytial virus and influenza, it continued after detection of these viruses fell to low levels, suggesting that other factors have contributed to this epidemiologic change.

Preliminary Findings on the Salivary Metabolome of Hookah and Cigarette Smokers

The aim of the study was to evaluate the salivary metabolomic profile of patients who habitually smoke hookah and cigarettes. The groups consisted of 33 regular and exclusive hookah smokers, 26 regular and exclusive cigarette smokers, and 30 nonsmokers. Unstimulated whole saliva was collected for the measurement of salivary metabolites by gas chromatography coupled with tandem mass spectrometry (GC-MS/MS). The MetaboAnalyst software was used for statistical analysis and evaluation of biomarkers. 11 smoking salivary biomarkers were identified using the area under receiving-operator curver criterion and threshold of 0.9. Xylitol and octadecanol were higher in cigarette smokers compared to controls; arabitol and maltose were higher in controls compared to cigarette smokers; octadecanol and tyramine were higher in hookah smokers compared to controls; phenylalanine was higher in controls compared to hookah smokers; and fructose, isocitric acid, glucuronic acid, tryptamine, maltose, tyramine, and 3-hydroxyisolvaleric acid were higher in hookah smokers compared to cigarettes smokers. Conclusions: The evaluation of the salivary metabolome of hookah smokers, showing separation between the groups, especially between the control versus hookah groups and cigarette versus hookah groups, and it seems to demonstrate that the use of hookah tobacco is more damaging to health.

International Pediatric COVID-19 Severity Over the Course of the Pandemic

Importance

Multiple SARS-CoV-2 variants have emerged over the COVID-19 pandemic. The implications for COVID-19 severity in children worldwide are unclear.

Objective

To determine whether the dominant circulating SARS-CoV-2 variants of concern (VOCs) were associated with differences in COVID-19 severity among hospitalized children.

Design, Setting, and Participants

Clinical data from hospitalized children and adolescents (younger than 18 years) who were SARS-CoV-2 positive were obtained from 9 countries (Australia, Brazil, Italy, Portugal, South Africa, Switzerland, Thailand, UK, and the US) during 3 different time frames. Time frames 1 (T1), 2 (T2), and 3 (T3) were defined to represent periods of dominance by the ancestral virus, pre-Omicron VOCs, and Omicron, respectively. Age groups for analysis were younger than 6 months, 6 months to younger than 5 years, and 5 to younger than 18 years. Children with an incidental positive test result for SARS-CoV-2 were excluded.

Exposures

SARS-CoV-2 hospitalization during the stipulated time frame.

Main Outcomes and Measures

The severity of disease was assessed by admission to intensive care unit (ICU), the need for ventilatory support, or oxygen therapy.

Results

Among 31 785 hospitalized children and adolescents, the median age was 4 (IQR 1-12) years and 16 639 were male (52.3%). In children younger than 5 years, across successive SARS-CoV-2 waves, there was a reduction in ICU admission (T3 vs T1: risk ratio [RR], 0.56; 95% CI, 0.42-0.75 [younger than 6 months]; RR, 0.61, 95% CI; 0.47-0.79 [6 months to younger than 5 years]), but not ventilatory support or oxygen therapy. In contrast, ICU admission (T3 vs T1: RR, 0.39, 95% CI, 0.32-0.48), ventilatory support (T3 vs T1: RR, 0.37; 95% CI, 0.27-0.51), and oxygen therapy (T3 vs T1: RR, 0.47; 95% CI, 0.32-0.70) decreased across SARS-CoV-2 waves in children 5 years to younger than 18 years old. The results were consistent when data were restricted to unvaccinated children.

Conclusions and Relevance

This study provides valuable insights into the impact of SARS-CoV-2 VOCs on the severity of COVID-19 in hospitalized children across different age groups and countries, suggesting that while ICU admissions decreased across the pandemic in all age groups, ventilatory and oxygen support generally did not decrease over time in children aged younger than 5 years. These findings highlight the importance of considering different pediatric age groups when assessing disease severity in COVID-19.

Sustained increase of paediatric invasive Streptococcus pyogenes infections dominated by M1UK and diverse emm12 isolates, Portugal, September 2022 to May 2023

Since autumn 2022, observed numbers of paediatric invasive group A Streptococcus infections in Portugal (n = 89) were higher than in pre-COVID-19 seasons. Between September 2022 and May 2023, the dominant diagnoses were pneumonia (25/79), mostly with empyema (20/25), and sepsis (22/79). A number of cases required admission to intensive care (27/79) and surgery (35/79), and the case fatality rate was 5.1% (4/79). Genomic sequencing (n = 55) revealed multiple genetic lineages, dominated by the M1UK sublineage (26/55) and more diverse emm12 isolates (12/55).

Task Force for a rapid response to an outbreak of severe acute hepatitis of unknown aetiology in children in Portugal in 2022

On 5 April 2022, the United Kingdom reported an increase of cases of severe acute hepatitis of unknown aetiology in children, several needing hospitalisation and some required liver transplant or died. Thereafter, 35 countries reported probable cases, almost half of them in Europe. Facing the alert, on 28 April, Portugal created a multidisciplinary Task Force (TF) for rapid detection of probable cases and response. The experts of the TF came from various disciplines: clinicians, laboratory experts, epidemiologists, public health experts and national and international communication. Moreover, Portugal adopted the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) case definition and recommendations. By 31 December 2022, 28 probable cases of severe acute hepatitis of unknown aetiology were reported: 16 male and 17 aged under 2 years. Of these cases, 23 were hospitalised but none required liver transplant or died. Adenovirus was detected from nine of 26 tested cases. No association was observed between adenovirus infection and hospital admission after adjusting for age, sex and region in a binomial regression model. The TF in Portugal may have contributed to increase awareness among clinicians, enabling early detection and prompt management of the outbreak.

Endorsement of alternative medicine and vaccine hesitancy among physicians: A cross-sectional study in four European countries

Vaccine hesitancy has become a threat to public health, especially as it is a phenomenon that has also been observed among healthcare professionals. In this study, we analyzed the relationship between endorsement of complementary and alternative medicine (CAM) and vaccination attitudes and behaviors among healthcare professionals, using a cross-sectional sample of physicians with vaccination responsibilities from four European countries: Germany, Finland, Portugal, and France (total N = 2,787). Our results suggest that, in all the participating countries, CAM endorsement is associated with lower frequency of vaccine recommendation, lower self-vaccination rates, and being more open to patients delaying vaccination, with these relationships being mediated by distrust in vaccines. A latent profile analysis revealed that a profile characterized by higher-than-average CAM endorsement and lower-than-average confidence and recommendation of vaccines occurs, to some degree, among 19% of the total sample, although these percentages varied from one country to another: 23.72% in Germany, 17.83% in France, 9.77% in Finland, and 5.86% in Portugal. These results constitute a call to consider health care professionals' attitudes toward CAM as a factor that could hinder the implementation of immunization campaigns.

Healthcare professionals' attitudes to mandatory COVID-19 vaccination: Cross-sectional survey data from four European countries

Mandatory vaccinations are widely debated since they restrict individuals' autonomy in their health decisions. As healthcare professionals (HCPs) are a common target group of vaccine mandates, and also form a link between vaccination policies and the public, understanding their attitudes toward vaccine mandates is important. The present study investigated physicians' attitudes to COVID-19 vaccine mandates in four European countries: Finland, France, Germany, and Portugal. An electronic survey assessing attitudes to COVID-19 vaccine mandates and general vaccination attitudes (e.g. perceived vaccine safety, trust in health authorities, and openness to patients) was sent to physicians in the spring of 2022. A total of 2796 physicians responded. Across all countries, 78% of the physicians were in favor of COVID-19 vaccine mandates for HCPs, 49% favored COVID-19 vaccine mandates for the public, and 67% endorsed COVID-19 health passes. Notable differences were observed between countries, with attitudes to mandates found to be more positive in countries where the mandate, or similar mandates, were in effect. The associations between attitudes to mandates and general vaccination attitudes were mostly small to neglectable and differed between countries. Nevertheless, physicians with more positive mandate attitudes perceived vaccines as more beneficial (in Finland and France) and had greater trust in medical authorities (in France and Germany). The present study contributes to the body of research within social and behavioral sciences that support evidence-based vaccination policymaking.

The relationships between passions, intentions, habit and exercise frequency

There were three purposes to this research. First, we sought to test the differential role of harmonious and obsessive passion in predicting intention and habit for exercise. The second goal of this research was to test the associations between intention, habit and exercise frequency. Last, the third goal was to assess the mediation role of intention and habit in the relationship between both forms of passion and exercise frequency. The sample consisted of 284 participants (140 males, 144 females) aged 18-60 years old (M age = 29.81, SD = 9.16). Regression paths of the structural model indicated significant associations: a) harmonious passion was significantly associated with intentions and habit; b) obsessive passion was significantly associated with habit; c) intentions and habit were significantly associated with exercise frequency. The mediation model variance explained was 17% (p < .001). The total effect via harmonious and obsessive passion was β = .57 (IC95% = .42, .73) and the total indirect effect was β = .11 (IC95% = .02, .24). Having harmonious passion for a fitness activity appears to have the potential to increase regular physical activity among exercisers. Individuals who recognize the significance of physical exercise and participate in activities they enjoy the most can affirm the positive effects on their health from being active.

Biocatalysis for biorefineries: The case of dye-decolorizing peroxidases

Dye-decolorizing Peroxidases (DyPs) are heme-containing enzymes in fungi and bacteria that catalyze the reduction of hydrogen peroxide to water with concomitant oxidation of various substrates, including anthraquinone dyes, lignin-related phenolic and non-phenolic compounds, and metal ions. Investigation of DyPs has shed new light on peroxidases, one of the most extensively studied families of oxidoreductases; still, details of their microbial physiological role and catalytic mechanisms remain to be fully disclosed. They display a distinctive ferredoxin-like fold encompassing anti-parallel β-sheets and α-helices, and long conserved loops surround the heme pocket with a role in catalysis and stability. A tunnel routes H₂O₂ to the heme pocket, whereas binding sites for the reducing substrates are in cavities near the heme or close to distal aromatic residues at the surface. Variations in reactions, the role of catalytic residues, and mechanisms were observed among different classes of DyP. They were hypothetically related to the presence or absence of distal H₂O molecules in the heme pocket. The engineering of DyPs for improved properties directed their biotechnological applications, primarily centered on treating textile effluents and degradation of other hazardous pollutants, to fields such as biosensors and valorization of lignin, the most abundant renewable aromatic polymer. In this review, we track recent research contributions that furthered our understanding of the activity, stability, and structural properties of DyPs and their biotechnological applications. Overall, the study of DyP-type peroxidases has significant implications for environmental sustainability and the development of new bio-based products and materials with improved end-of-life options via biodegradation and chemical recyclability, fostering the transition to a sustainable bio-based industry in the circular economy realm.

Epidemiology of hospitalisations due to chickenpox and quality of life lost in community and hospital settings: protocol for a prospective cohort study across two countries

INTRODUCTION

While still a ubiquitous disease of childhood, chickenpox has been effectively controlled in many countries through the use of vaccination. Previous health economic assessment of the use of these vaccines in the UK were based on limited quality of life data and only routinely collected epidemiological outcomes.

METHODS AND ANALYSIS

This two armed study will carry prospective surveillance of hospital admissions and recruit from community settings to measure the acute quality of life loss caused by paediatric chickenpox both in the UK and in Portugal. The quality of life effects on children and their primary and secondary caregivers will be assessed using the EuroQol EQ-5D with the Child Health Utility instrument (CHU-9) in addition for children. Results will be used to derive quality-adjusted life year loss estimates for cases of simple varicella and the secondary complications.

ETHICS AND DISSEMINATION

We have received National Health Service ethical approval (REC ref: 18/ES/0040) for the inpatient arm, university ethical approval (University of Bristol ref: 60721) for the community arm and 10 sites currently are recruiting in the UK and 14 in Portugal. Informed consent is obtained from the parent(s). Results will be disseminated in peer-reviewed publications.

TRIAL REGISTRATION NUMBER

ISRCTN15017985.

Impact of cafeteria diet and n3 supplementation on the intestinal microbiota, fatty acids levels, neuroinflammatory markers and social memory in male rats

OBJECTIVE

To assess the effects of omega-3 (n3) supplementation on intestinal microbiota, fatty acids profile, neuroinflammation, and social memory of cafeteria diet (CAF)-fed rats.

METHODS

Male Wistar rats were fed with CAF for 20 weeks. Omega-3 (500 mg/kg/day) was supplemented between the 16th and 20th week. Colon morphology, intestinal microbiota composition, short-chain fatty acids (SCFA) and lipopolysaccharide (LPS) in the plasma, fatty acids profile, TLR-4 and claudin-5 expressions in the brain, and social memory were investigated.

RESULTS

CAF reduced colon length, crypts' depth, and microbiota diversity, while n3 increased the Firmicutes/Bacteroidetes ratio. CAF increased SCFA plasma levels, but n3 reduced butyrate and isobutyrate in obese rats. LPS was increased in CAF-fed rats, and n3 decreased its levels. In the cerebral cortex, n3 increased caprylic, palmitic, stearic, tricosanoic, lignoceric, myristoleic, and linoleic acids. CAF increased palmitic acid and TLR-4 expression in the cerebral cortex while decreasing claudin-5 in the hippocampus. In the social memory test, CAF-fed animals showed greater social interaction with no effect of n3.

CONCLUSIONS

The lack of n3 effect in some of the evaluated parameters may be due to the severity of the obesity caused by CAF. However, n3 reduced LPS levels, suggesting its ability to reverse endotoxemia.

Profile of emergency department overuse in hospitalized patients with pulmonary disease and its impact on mortality

INTRODUCTION AND OBJECTIVES

Portugal is one of the countries with the highest number of visits to the emergency department (ED), 31% classified as "non-urgent" or "avoidable." The objectives of our study were to evaluate the size and characteristics of patients with pulmonary disease who overuse the ED, and identify factors associated with mortality.

MATERIALS AND METHODS

A retrospective cohort study was conducted, based on the medical records of ED frequent users (ED-FU) with pulmonary disease who attended a university hospital center in the northern inner city of Lisbon from January 1 to December 31, 2019. To evaluate mortality, a follow-up until December 31, 2020 was performed.

RESULTS

Over 5,567 (4.3%) patients were identified as ED-FU and 174 (0.14%) had pulmonary disease as the main clinical condition, accounting for 1,030 ED visits. 77.2% of ED visits were categorized as "urgent/very urgent." A high mean age (67.8 years), male gender, social and economic vulnerability, high burden of chronic disease and comorbidities, with a high degree of dependency, characterized the profile of these patients. A high proportion (33.9%) of patients did not have a family physician assigned and this was the most important factor associated with mortality (p<0.001; OR: 24.394; CI 95%: 6.777-87.805). Advanced cancer disease and autonomy deficit were other clinical factors that most determined the prognosis.

CONCLUSIONS

Pulmonary ED-FU are a small group of ED-FU who constitute an aged and heterogeneous group with a high burden of chronic disease and disability. The lack of an assigned family physician was the most important factor associated with mortality, as well as advanced cancer disease and autonomy deficit.

Prospective study of loss of health-related quality adjusted life years in children and their families due to uncomplicated and hospitalised varicella

INTRODUCTION AND AIMS

Although usually benign, varicella can lead to serious complications and sometimes long-term sequelae. Vaccines are safe and effective but not yet included in immunisation programmes in many countries. We aimed to quantify the impact on health-related quality of life (HRQoL) in terms of quality-adjusted life years (QALY) in children with varicella and their families, key to assessing cost-utility in countries with low mortality due to this infection.

METHODS

Children with varicella in the community and admitted to hospitals in Portugal were included over 18 months from January 2019. Children's and carers' HRQoL losses were assessed prospectively using standard multi-attribute utility instruments for measuring HRQoL (EQ-5D and CHU9D), from presentation to recovery, allowing the calculation of QALYs.

RESULTS

Among 109 families with children with varicella recruited from attendees at a pediatric emergency service (community arm), the mean HRQoL loss/child was 2.0 days (95 % CI 1.9-2.2, n = 101) (mean 5.4 QALYs/1000 children (95 % CI 5.3-6.1) and 1.3 days/primary carer (95 % CI 1.2-1.6, n = 103) (mean 3.6 QALYs /1000 carers (95 % CI 3.4-4.4). Among 114 families with children admitted to hospital because of severe varicella or a complication (hospital arm), the mean HRQoL loss/child was 9.8 days (95 % CI 9.4-10.6, n = 114) (mean 26.8 QALYs /1000 children (95 % CI 25.8-29.0) and 8.5 days/primary carer (95 % CI 7.4-9.6, n = 114) (mean 23.4 QALYs/1000 carers (95 % CI 20.3-26.2). Mean QALY losses/1000 patients were particularly high for bone and joint infections [67.5 (95 % CI 43.9-97.6)]. Estimates for children's QALYs lost using the CHU9D tool were well correlated with those obtained using EQ-5D, but substantially lower.

CONCLUSIONS

The impact of varicella on HRQoL is substantial. We report the first measurements of QALYs lost in hospitalised children and in the families of children both in the community and admitted to hospital, providing important information to guide vaccination policy recommendations.

International adaptation and validation of the Pro-VC-Be: measuring the psychosocial determinants of vaccine confidence in healthcare professionals in European countries

BACKGROUND

Healthcare professionals (HCPs) play an important role in vaccination; those with low confidence in vaccines are less likely to recommend them to their patients and to be vaccinated themselves. The study's purpose was to adapt and validate long- and short-form versions of the International Professionals' Vaccine Confidence and Behaviors (I-Pro-VC-Be) questionnaire to measure psychosocial determinants of HCPs' vaccine confidence and their associations with vaccination behaviors in European countries.

RESEARCH DESIGN AND METHODS

After the original French-language Pro-VC-Be was culturally adapted and translated, HCPs involved in vaccination (mainly GPs and pediatricians) across Germany, Finland, France, and Portugal completed a cross-sectional online survey in 2022. A 10-factor multigroup confirmatory factor analysis (MG-CFA) of the long-form (10 factors comprising 34 items) tested for measurement invariance across countries. Modified multiple Poisson regressions tested the criterion validity of both versions.

RESULTS

2,748 HCPs participated. The 10-factor structure fit was acceptable to good everywhere. The final MG-CFA model confirmed strong factorial invariance and showed very good fit. The long- and short-form I-Pro-VC-Be had good criterion validity with vaccination behaviors.

CONCLUSION

This study validates the I-Pro-VC-Be among HCPs in four European countries; including long- and short-form tools for use in research and public health.

Burden and severity of children's hospitalizations by respiratory syncytial virus in Portugal, 2015-2018

BACKGROUND

Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infection (ALRI) in young children and is of considerable burden on healthcare systems. Our study aimed to evaluate ALRI hospitalizations related to RSV in children in Portugal.

METHODS

We reviewed hospitalizations potentially related to RSV in children aged <5 years from 2015 to 2018, using anonymized administrative data covering all public hospital discharges in mainland Portugal. Three case definitions were considered: (a) RSV-specific, (b) (a) plus unspecified acute bronchiolitis (RSV-specific & Bronchiolitis), and (c) (b) plus unspecified ALRI (RSV-specific & ALRI).

RESULTS

A total of 9697 RSV-specific hospitalizations were identified from 2015 to 2018-increasing to 26 062 for RSV-specific & ALRI hospitalizations-of which 74.7% were during seasons 2015/2016-2017/2018 (November-March). Mean hospitalization rates per season were, for RSV-specific, RSV-specific & Bronchiolitis, and RSV-specific & ALRI, respectively, 5.6, 9.4, and 11.8 per 1000 children aged <5 years and 13.4, 22.5, and 25.9 in children aged <2 years. Most RSV-specific hospitalizations occurred in healthy children (94.9%) and in children aged <2 years (96.3%). Annual direct costs of €2.4 million were estimated for RSV-specific hospitalizations-rising to €5.1 million for RSV-specific & ALRI-mostly driven by healthy children (87.6%).

CONCLUSION

RSV is accountable for a substantial number of hospitalizations in children, especially during their first year of life. Hospitalizations are mainly driven by healthy children. The variability of the potential RSV burden across case definitions highlights the need for a universal RSV surveillance system to guide prevention strategies.

Which effects had the pandemic in migrants’ health and well-being? A mixed-methods approach

Background

The COVID-19 pandemic affected populations’ health, with a disproportionate impact on those most socially vulnerable such as migrants. The way these populations experienced the pandemic lockdowns and its effects on daily life are yet to be known. This study aimed to understand the effects of the pandemic on health and well-being of migrants in Portugal.

Methods

In a mixed-methods approach, a survey was conducted with a community-based sample of 1126 migrants in the Lisbon Metropolitan Area, assessing sociodemographics, migration-related characteristics and the perceived impact of the pandemic on health. In addition, n = 12 migrants purposively recruited were invited to participate in a photovoice study, sharing photographs about their daily life during the lockdowns. Following semi-structured interviews were conducted. Quantitative data were analysed using multivariable analysis and qualitative data were analysed through content analysis.

Results

A fifth of the participants perceived having worse health condition since the pandemic, which was more likely among women (OR = 1.58, CI95% 1.13-2.20), those &gt;45 years old (OR = 1.78, CI95% 1.02-3.16), with lower education (Basic education: OR = 1.57, CI95% 1.01-2.47) and with lower monthly income (&lt;EUR 650: OR = 1.69, CI95% 1.18-2.44). Two themes emerged from the photovoice: effects of the pandemic lockdowns on daily life (routines, social relations, work) and on health and well-being (eating habits, physical exercise, leisure). Strategies to cope with the adverse effects included social activation and changes in lifestyles.

Conclusions

The pandemic had disproportionate effects on some migrant groups, intensifying social and health inequalities, with consequences for their well-being. Participatory methods can contribute to further understand migrants’ experiences while involving and empowering them for health promotion.

Key messages

• The pandemic had adverse effects on migrants’ health and well-being, disproportionately affecting most socially vulnerable migrant groups.

• Participatory research methods as photovoice are valuable to gain access to individual experiences and perspectives, while involving and empowering participants.

The relationship between past exercise behavior and future exercise adherence: A sequential mediation analysis

The present study explored the mediation role of past exercise adherence, self-reported frequency and intentions in the association between past experience and future exercise adherence. In total, 431 exercisers (female = 216; male = 215) aged 18 and 64 years, engaged in fitness activities such as group fitness classes and resistance training, were included in the analysis. Serial mediation procedures were employed to examine the direct, indirect, and total indirect effects among variables. The predictor variable and all mediators displayed a positive and significant association with future six-month adherence. Past six-month exercise adherence displayed the most significant association with future six-month adherence. The sequential indirect path from exercise experience → past six-months adherence → self-reported frequency → intentions future six-months adherence displayed a positive and significant effect (β = .19 [CI95% = .09, .31]), presenting a partial mediation effect. Past behaviour is the most significant predictor of future adherence, and thus interventions should be based on promoting consistent exercise frequency. Professionals working in the fitness centre context can identify possible dropouts based on their past behaviour and intentions to be physically active in the future.

Dissection of the role of microRNAs in cardiac fibrosis through functional genomics screenings

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FCT, Portuguese Foundation for Science and Technology

Cardiac fibrosis is a maladaptive remodelling process of the myocardium, which results from an over-activation of cardiac fibroblasts into myofibroblasts, excessive deposition of ECM proteins (particularly collagen) and scar formation, ultimately leading to stiffening of the heart wall and greatly compromising heart function.

A deeper knowledge of the molecular and cellular fibrogenic processes is crucial to identify novel targets for therapeutic interventions aimed at diminishing cardiac fibrosis and preventing/reversing cardiac remodelling.

Recent studies have shown that microRNAs control several features of cardiovascular diseases, including cardiac fibrosis. To systematically identify microRNAs that modulate cardiac fibrosis, we performed a series of high-content microscopy functional screenings using a genome-wide library of microRNA mimics (2,588 mature microRNAs). We focused on key phenotypes relevant to cardiac fibrosis, specifically human primary cardiac fibroblast proliferation, myofibroblast differentiation, and deposition of fibrillary collagen under unstimulated and stimulated conditions.

Using this approach, we identified 134 microRNAs that strongly modulate myofibroblast differentiation (4-fold change), as well as a high number of microRNAs that completely block cardiac fibroblast proliferation (166 microRNAs) or that strongly modulate collagen deposition (4-fold change; 227 and 96 microRNAs in unstimulated and stimulated conditions, respectively). Of note, we observed that myofibroblast differentiation is not a pre-requisite for collagen deposition, and that specific microRNAs can modulate these phenotypes independently.

Clustering performed on the global analysis of the phenotypes elicited by each microRNA led to the selection of 92 microRNAs. We confirmed that the phenotypes could be reproduced in human cardiac fibroblasts from different donors and that some of the phenotypes were conserved in fibroblasts isolated from different tissues, including aorta, skin, and lung. Additionally, we performed high-throughput qPCR analysis to identify molecular signatures associated with the effects of these microRNAs on 92 genes implicated in fibrosis-related processes. Based on these data, we selected 8 microRNAs for detailed mechanistic characterization. Seven of these microRNAs strongly block collagen deposition in stimulated conditions, while exhibiting differential effects on cardiac fibroblast differentiation and/or tissue-specific activities, and 1 microRNA increases collagen deposition. Mechanistic studies showed that 3 of these microRNAs target the CDS or 3’UTR of collagen (Col1a1), while the others act through alternative mechanisms.

Overall, our work establishes microRNAs as powerful modulators of multiple processes critical to cardiac fibrosis and offers a unique opportunity for testing different anti-fibrotic approaches based on the differential modulation of these processes by microRNAs.

Examining the Coach Motivation Questionnaire in Fitness Professionals (CMQ-FP): Factor Structure, Invariance, and Predictive Analysis

Purpose: To date, most research on the assessment of motivation has been exerciser-focused and has not considered how fitness professionals' motivations impact their behaviors toward exercisers during training sessions. The purpose of this study was to examine the factor structure of the Coach Motivation Questionnaire in a sample of fitness professionals (CMQ-FP) to ascertain its usefulness for this vocational grouping. Measurement invariance analysis was conducted between female and male fitness professionals, and predictive validity was tested considering need-supportive and need-thwarting behaviors as outcomes. Methods: Participants were 799 fitness professionals (female = 412) aged between 20 and 56 years (M = 28.71, SD = 3.24), who completed a multi-section survey assessing their motivation toward work and their interpersonal behaviors when engaging with exercisers. Results: The results of this research supported all three hypotheses. First, the hypothesized 6-factor measurement model showed acceptable fit to the data. Second, the factor structure of the CMQ-FP was invariant across gender (male and female fitness professionals). Third, fitness professionals' (autonomous or controlled) motivation was a valid predictor of need-supportive or need-thwarting behaviors. Conclusion: This study supported the factor structure of the CMQ-FP, presenting as a valid measure of motivation in fitness professionals. Understanding fitness professionals' perceptions of their coaching motivation can inform professional development activities to assist fitness professionals to increase understanding of what motivates these professionals and how they might be more need-supportive and less need-thwarting in their pedagogical behaviors.

Sensing Technology Applications in the Mining Industry-A Systematic Review

Introduction Industry 4.0 has enhanced technological development in all fields. Currently, one can analyse, treat, and model completely different variables in real time; these include production, environmental, and occupational variables. Resultingly, there has been a significant improvement in the quality of life of workers, the environment, and in businesses in general, encouraging the implementation of continuous improvement measures. However, it is not entirely clear how the mining industry is evolving alongside this industrial evolution. With this in mind, this systematic review aimed to find sensing technology applications within this sector, in order to assist the mining industry in its goal to evolve digitally. Methodology: The research and reporting of this article were carried out by means of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results and discussion: A total of 29 papers were included in the study, with sensors being applied in several fields, namely safety, management, and localisation. Three different implementation phases were identified regarding its execution: prototype, trial, and (already) implemented. The overall results highlighted that many mechanisms are in need of improvement in underground settings. This might be due to the fact that underground mining has particular safety challenges. Conclusions: Ventilation and mapping are primary issues to be solved in the underground setting. With regard to the surface setting, the focus is directed toward slope stability and ways of improving it regarding monitoring and prevention. The literature screening revealed a tendency in these systems to keep advancing in technologically, becoming increasingly more intelligent. In the near future, it is expected that a more technologically advanced mining industry will arise, and this will be created and sustained by the optimisation of processes, equipment, and work practices, in order to improve both the quality of life of people and the health of the environment.

Cauda equina syndrome following combined spinal-epidural anesthesia with levobupivacaine for cesarean section

Cauda equina syndrome (CES) is a rare but possible complication of neuroaxial anesthesia. Damage to the nerve roots may occur due to compression, inflammation, stretching, direct trauma, spinal ischemia or neurotoxicity, usually with lidocaine or bupivacaine. We describe a case of a 33-year-old patient that underwent an uneventful cesarean section with a combined spinal-epidural technique anesthesia, with levobupivacaine. 48 h after the procedure, she presented diminished muscular strength and abolished osteotendinous reflexes in the left lower limb, limited flexion of the right hallux, urinary retention and saddle anesthesia. Imaging exams excluded hematoma, thickening or compression of the cauda equina nerve roots. CES was suspected and treatment was initiated. 9-month follow up revealed diminished osteotendinous reflexes on the left lower limb and perianal hypoesthesia. Despite being unusual, neurological complications require prompt recognition and management to avoid permanent damage.

Parechovirus Genotype 3 Outbreak Among Young Infants in Portugal

INTRODUCTION

Human parechovirus type 3 has been recognized as a cause of pediatric infection, occasionally associated with serious illness, including sepsis and meningitis, particularly among young infants. The aim of this study is to report the first known human parechovirus type 3 outbreak in Portugal.

MATERIAL AND METHODS

Descriptive study of an outbreak that occurred between the 8th June to the 12th August 2016. Laboratory diagnosis was made by reverse transcription - polymerase chain reaction in the cerebrospinal fluid and/or in stools. Genotyping was made by reverse transcription - polymerase chain reaction and sequencing in stool samples from infants and family members.

RESULTS

Human parechovirus type 3 infection was detected in seven infants, of which six were male. Median age was 23 days (5 - 52). One had seizures, with a magnetic resonance imaging scan showing white matter diffusion restriction. The mean duration of admission was 5.6 days (3 - 11), with favourable outcome in all. In three cases there were symptomatic close family members. Human parechovirus type 3 was identified in the stools of three mothers.

DISCUSSION

Even though human parechovirus type 3 infection has been well described in the presented age group, most Portuguese hospitals do not have this laboratory diagnosis. Our results are comparable to those obtained in other countries. Besides detection of the virus in the cerebrospinal fluid, there were no raised local or systemic inflammatory markers.

CONCLUSION

This study reports the first known outbreak, in infants, of human parechovirus type 3 in Portugal. Although there is no specific treatment, this diagnosis can avoid unnecessary empirical antibiotic treatment and prolonged admissions.

Adaptation and Validation of a Portuguese Version of the Sports Motivation Scale-II (SMS-II-P) Showing Invariance for Gender and Sport Type

In the present cross-sectional study, we adapted and examined the validity of a Portuguese version of the Sport Motivation Scale II (SMS-II-P) within a sample of 1148 Portuguese athletes (women = 546, men = 602) with a mean age of 18.45 years (SD = 5.36), participating in a variety of sports (i.e., football, basketball, swimming, and athletics). We conducted confirmatory factor analysis, convergent and discriminant validity analysis, and multigroup analysis across participants' sport type (team and individual) and gender. We also examined the correlations between the SMS-II-P behavioral regulations and basic psychological needs satisfaction. The results supported that the SMS-II-P had good psychometric properties and was invariant across gender and sport type. The scale demonstrated good convergent and discriminant validity, and the subscales achieved adequate internal consistency. Correlations between the six types of regulation measured in the SMS-II supported the distinction between autonomous and controlled behavioral regulations, and the correlations between these subscales and other measures of autonomy, competence, and relatedness satisfaction provided evidence of the self-determination continuum. Implications of this research for assessing Portuguese athletes and conducting future research are discussed.

Impact of COVID-19 on a paediatric emergency service

COVID-19 has significantly affected the use of health care worldwide and, consequently, admissions to hospital emergency services. The aim of this study is to describe the change of the activity of a Paediatric Emergency Service (PES) of a tertiary hospital during the pandemic. A retrospective cohort study with analysis of visits to the PES from March 30 to June 30, 2020, and comparison with homologous periods in the previous 3 years (2017-2019).A total of 53,883 episodes were analysed, with a median age of 5.8 years, and 53% were boys. In 2020, there was a 60% reduction in the number of admissions (p < 0.001). There was a significant increase in referral by the public medical advice phone line of the National Health Service (NHS) (18.5% vs 5.4%) and Emergency Medical Services (EMS) (5.1% vs 4.2%). Urgent patients decreased (31.2% vs 38.3%), and non-urgent patients increased (7.5% vs 1.7%). There was a significant reduction in school (0.4% vs 7.1%) and sports accidents (0.1% vs 1.2%) and an increase in other accidents (falls, wounds, burns, and dog bites) (12.2% vs 6.3%). Hospitalisation rate was higher (5.7% vs 3.1%, p < 0.001). The infection rate for SARS-CoV-2 was 1.1%, all with mild illness or asymptomatic.Conclusion: The pandemic brought a marked reduction in emergency admissions and a decrease in urgent situations but an increase in accidents, such as falls, wounds, burns, and dog bites. Despite the low infection rate for SARS-CoV-2, there were increased referrals by the phone line of NHS and EMS and a higher admission in the ward. What is Known: • The number of admissions to emergency services significantly decreased during the COVID-19 pandemic, particularly in the paediatric population, whom has a milder disease than adults. • Diseases that justify urgent/emergent hospital admission continue to exist and the eventual delay in seeking health care might lead to a worse prognosis. What is New: • Despite the low rate of SARS-CoV-2 infection in children, there was an increase in referrals by the phone line of the National Health Service and Emergency Medical Services. • The global admission rate to the ward increased but there were no admissions to intensive care or deaths.

Anosognosia for memory in dementia with Lewy bodies compared with Alzheimer's disease

OBJECTIVES

Anosognosia is the inability to recognize one's own symptoms. Although dementia with Lewy bodies (DLB) is the second most common degenerative dementia, there is little evidence of memory deficit awareness in this condition. The objectives of this research were to compare anosognosia between individuals with DLB and dementia due to Alzheimer's disease (AD) and to evaluate whether medial temporal atrophy, a marker of AD pathology, could help to explain different rates of anosognosia in DLB and dementia due to AD.

METHODS/DESIGN

This is a cross-sectional study that took place at the Memory Clinic of D'Or Institute for Research and Education (IDOR). Twenty individuals with DLB and 20 with dementia due to AD were included in this study. We assessed anosognosia for memory using an index derived from subjective memory complaints (using the Memory Complaint Questionnaire) and from the performance in memory neuropsychological testing (Rey Auditory Verbal Learning Test). Thirty-one participants also underwent brain Magnetic Resonance Imaging to evaluate hippocampal atrophy with a visual scale (MTA-score [medial temporal atrophy score]).

RESULTS

There was no significant difference between groups regarding age, years of education, sex or time of disease. Individuals with DLB had a higher index of anosognosia than dementia due to AD (2.92 and 1.87; p = 0.024), meaning worse awareness of memory deficits. MTA-score was slightly higher in dementia due to AD than in DLB, albeit without statistical significance.

CONCLUSION

Our study was the first to demonstrate that anosognosia for memory is worse in DLB than in dementia due to AD. This finding supports the hypothesis that anosognosia in DLB is a heterogeneous phenomenon.

Integrated efforts to promote mental health care during the SARS-CoV-2 pandemic: Reflecting on the experience of a university helpline

Introduction

The SARS-CoV-2 pandemic is affecting numerous dimensions of our society since the beginning of the outbreak. A significant increase in emotional distress was expected in the general population, particularly among the high-risk groups such as the oldest, chronic patients, healthcare professionals, and psychopathology vulnerable people. There was an urgent need to adapt and create solutions to promote mental health. Given the recommendations to minimize face-to-face interactions, several helplines were widely developed.

Objectives

In this work, we aim to reflect on the experience of a university helpline, that integrated efforts with the regional mental health care services.

Methods

A University helpline was created to give support to the regional community outside academia. The team was created on an online teamwork platform, to communicate through the chat, carry videoconference meetings, and store useful files. A Manchester screening decision tree was adopted, to define a set of guidelines to provide support to the callers, based mainly on the guidelines defined by the Order of Portuguese Psychologists. Liaison with the mental health care services, including other specific helplines, was established.

Results

Notwithstanding all the efforts, the number of received calls was scarce, similarly to helplines created by other national universities and by other entities.

Conclusions

A new approach to psychological intervention in crisis is needed, maintaining integrated efforts, and taking advantage of the opportunity to foster personalized mental health care in the digital era. It is important to continuously assess the value of integrated efforts in patient care and to the healthcare system.

Kawasaki Disease: Predictors of Resistance to Intravenous Immunoglobulin and Cardiac Complications

BACKGROUND

Kawasaki disease (KD) is the leading cause of acquired cardiac disease in children, in developed countries.

OBJECTIVES

To identify predictive factors for resistance to intravenous immunoglobulin (IVIG), calculate the effectiveness of Japanese predictive models and characterize cardiac complications.

METHODS

Retrospective analysis of KD cases admitted in a Portuguese paediatric hospital between january 2006 and july 2018. ROC curves were used to determine predictive factors for resistance and the multivariate logistic regression analysis was used to develop the predictive model. A significance level of 5% was used.

RESULTS

48 patients with a median age of 36 months were included. The IVIG resistance was 21%. Echocardiographic anomalies were noted in 46%, with coronary involvement in 25% of the sample population. As predictive variable of resistance, the C-reactive protein (CRP) presented an AUC ROC = 0.789, optimal cut-off value 15.1 mg/dL, sensitivity (Sn) 77.8% and specificity (Sp) 78.9%. The erythrocyte sedimentation rate (ESR) presented an AUC ROC = 0.781, optimal cut-off value 90.5 mm/h, Sn 66.7% and Sp 85.7%. The model with the two variables showed p = 0.042 and AUC ROC = 0.790. Predictive strength of Japanese models were: Kobayashi (Sn 63.6%, Sp 77.3%), Egami (Sn 66.7%, Sp 73.1%), Sano (Sn 28.6%, Sp 94.1%).

CONCLUSION

CRP and ESR are independent variables that were related to IVIG resistance, with optimal cut-off points of 15.1 mg/dL and 90.5 mm/h, respectively. About half of the patients had some form of cardiac involvement. The Japanese models appeared to be inadequate in our population. (Arq Bras Cardiol. 2021; 116(3):485-491).

Mild Cognitive Impairment or Attention-Deficit/Hyperactivity Disorder in Older Adults? A Cross Sectional Study

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent neurodevelopmental condition, which may be associated with life-enduring cognitive dysfunction. It has been hypothesized that age-related cognitive decline may overlap with preexisting deficits in older ADHD patients, leading to increased problems to manage everyday-life activities. This phenomenon may mimic neurodegenerative disorders, in particular Mild Cognitive Impairment (MCI). This cross-sectional study aims to assess cognitive and behavioral differences between older subjects with ADHD and MCI. Methods: A total of 107 older participants (41 controls; 40 MCI and 26 ADHD; mean age = 67.60 ± 7.50 years; mean schooling = 15.14 ± 2.77 years; 65.4% females) underwent clinical, cognitive, and behavioral assessments by a multidisciplinary team at the Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil. Mean scores in neuropsychological tasks and behavioral scales were compared across groups. Results: Participants with ADHD showed poorer performances than controls in episodic memory and executive function with large effect-sizes. Performances were comparable between MCI and ADHD for all domains. Discussion: MCI and ADHD in older individuals are dissociated clinical entities with overlapping cognitive profiles. Clinicians ought to be aware of these converging phenotypes to avoid misdiagnosis.

[Urinary Tract Infections Caused by Community-Acquired Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in a Level III Hospital - A Retrospective Study]

INTRODUCTION

The emergence of β-lactamases producing bacteria is a problem worldwide, with increasing importance in communityacquired infections, especially in urinary tract infections. Data regarding the use of non-carbapenem antimicrobials in these infections are scarce. The aim of this study was to analyse the treatment and outcome of urinary tract infections caused by community-acquired β-lactamase-producing bacteria in children.

MATERIAL AND METHODS

Retrospective study performed in a level III paediatric hospital, between June 2007 and December 2017. All children with β-lactamase-producing Enterobacteriaceae identified in aseptically collected urine culture were included.

RESULTS

A total of 175 urinary infections caused by β-lactamases producing bacteria were diagnosed, 34 (19%) were community-acquired: 25 Escherichia coli (74%), 4 Klebsiella pneumoniae (12%), 4 Proteus mirabilis (12%) and 1 Proteus vulgaris (3%). In 30 (88%) cases, it was the first urinary infection. After identification of the microorganism and antimicrobial susceptibility, 33 (97%) children were re-evaluated and 24 (71%) had a repeat urine culture, which was positive in three (13%). In six (18%) cases, antibiotic treatment was modified. Four (12%) children had another UTI in the following month. In 30 (88%) children, imaging was carried out, with no nephrourological malformations detected.

DISCUSSION

In the last decade, about 20% of urinary infections caused by β-lactamase-producing Enterobacteriaceae were community-acquired with a relatively stable number of cases over the years. No nephro-urological malformations were identified in these children.

CONCLUSION

Although the number of cases is small, the clinical and microbiological outcomes showed that most were successfully treated with non-carbapenem antibiotics, with low recurrence of new episodes of urinary tract infections.

MRSA/MSSA causing infections: prevalence of mecA gene

Introduction Staphylococcus aureus is part of the human flora, present in the skin and mucous membranes but can become pathogenic, causing a wide spectrum of infections that were initially treated with penicillin. However, were observed some strains with resistance to this antibiotic and, therefore was developed a new antibiotic, the methicillin. After its introduction, arose the first S. aureus with resistance to methicillin (MRSA) due to the presence of a gene known as mecA that encodes an altered penicillin binding protein (PBP2a). In Europe, it is estimated that MRSA are associated to 44% of hospital acquired infections and its mortality rate is around 20%.

Objectives Prevalence of MRSA strains in different types of infection in Coimbra district.

Methodology Were analysed a total of 539 isolates of S. aureus previously characterized to the antibiotic susceptibility profile in the Hospital and University Center of Coimbra. Through the minimum inhibitory concentration (MIC) of oxacillin we classified our strains into MRSA and S. aureus methicillin-sensitive (MSSA); simultaneously, the mecA gene was detected by Polymerase Chain Reaction (PCR).

Results Of the 539 isolates, 49% were considered MRSA and 51% MSSA. All MRSA isolates express the mecA gene, but from the total of 276 MSSA, 191 show this gene but do not express it. MRSA isolates were mostly from respiratory tract samples (48%) and blood cultures (21%) while MSSA were isolated in skin and soft tissue samples (35%).

Conclusion MRSA are considered one of the primary pathogens for the development of pneumonia and septicaemia due to its highly virulent potential and the increasing expression of genetic determinants of antimicrobial resistance. Therefore, infections caused by MRSA continue with highly representability in the clinical context and their dissemination is a public health problem.

Respiratory infections caused by Haemophilus influenzae β-lactamase positive carrying blaTEM gene

Introduction One of the main etiological agents of respiratory infections is H. Influenzae. The group of antibiotics most used to the treatment of H. influenzae infections is β-lactams. The most common β-lactam resistance is to ampicillin, characterized by the production of TEM (95%) and ROB (5%) β-lactamases, designated enzymatic resistance.

Objectives Characterize the susceptibility profile of H. influenzae to β-lactam antibiotics, to evaluate the enzymatic resistance by the β-lactamase production and to correlate the phenotypic profile with the presence of the blaTEM.

Methodology Total of 152 isolates of H. influenzae from respiratory infections were evaluated: 88 from expectorations, 56 from bronchial aspirates and 8 from bronchoalveolar lavage, collected in Clinical Pathology Service of Centro Hospitalar e Universitário de Coimbra. The results of the antimicrobial susceptibility profile and the β-lactamase screening were also provided. In order to investigate the blaTEM, DNA was extracted from the isolates and the detection was performed using the PCR technique.

Results The prevalence of the blaTEM in the isolates was 31.6%, of these 33.3% showed resistance to ampicillin and 57.9% were positive in β-lactamase activity screening and blaTEM carriers. There was a statistically significance between the presence of the gene with ampicillin resistance and β-lactamase activity screening.

Conclusion β-lactamase TEM production was the main mechanism of enzymatic resistance which demonstrates the high spread of the blaTEM among isolates of H. influenzae. The results found suggest that the negative strains for this β-lactamase but that presented β-lactamases with activity and resistance to β-lactams should have other β-lactamases as ROB or others. However strains with β-lactamase negative should have other mechanisms promoting the resistance as PBP3. This study provides important data on the antibiotic therapy, to minimize the expression of resistance mechanisms and problems associated with treatment.

Sex Differences in Relationships Between Perceived Coach-Induced Motivational Climates, Basic Psychological Needs, and Behavior Regulation Among Young Swimmers

This study analyzed independent and codependent effects of task- and ego-involving motivational climates on basic psychological need satisfaction and behavioral regulation (i.e., autonomous and controlled motivation) among young athletes. Participants were young Portuguese female ( n = 114) and male ( n = 324) swimmers, nested within four different clubs. Participants completed a multisection survey, assessing motivational climates, basic psychological needs satisfaction, and behavioral regulation. We used polynomial regression analysis with surface response methodology to analyze the interactions between these constructs. We found that perceived task- and ego-involving motivational climates were not mutually exclusive; rather, their relationship depended on how athletes perceived coaches’ behaviors and how coaches emphasized one or both climates. Coaches who fostered both motivational climates promoted positive outcomes among male (but not female) athletes.

Subcutaneous emphysema as a complication of the use of a laryngeal mask in a child

The use of supraglottic airway devices has been increasing in popularity, mostly due to their high success rate and low complications. However, there is very little information available about the potential and group specific concerns regarding their use in children. We present the first description of a child that developed subcutaneous emphysema after the use of a laryngeal mask. We believe that more awareness to the risk of perioperative adverse events with laryngeal mask insertion in the paediatric population is needed.

Last Interglacial Iberian Neandertals as fisher-hunter-gatherers

Marine food-reliant subsistence systems such as those in the African Middle Stone Age (MSA) were not thought to exist in Europe until the much later Mesolithic. Whether this apparent lag reflects taphonomic biases or behavioral distinctions between archaic and modern humans remains much debated. Figueira Brava cave, in the Arrábida range (Portugal), provides an exceptionally well preserved record of Neandertal coastal resource exploitation on a comparable scale to the MSA and dated to ~86 to 106 thousand years ago. The breadth of the subsistence base-pine nuts, marine invertebrates, fish, marine birds and mammals, tortoises, waterfowl, and hoofed game-exceeds that of regional early Holocene sites. Fisher-hunter-gatherer economies are not the preserve of anatomically modern people; by the Last Interglacial, they were in place across the Old World in the appropriate settings.

Development of an online digital resource accessible for students with visual impairment or blindness: Challenges and strategies

BACKGROUND

People with visual impairment or blindness face a wide range of daily barriers, both at school and at work.

OBJECTIVE

This article describes the development process of an online resource, addressing Occupational Safety and Health (OSH), accessible for students with visual impairment or blindness.

METHODS

This study was framed in a Design-Based Research methodology involving the analysis, design, development and implementation of a digital resource. In the analysis stage, a first list of accessibility challenges was created allowing the design of strategies and specific technical solutions to approach them.

RESULTS

The development process has shown that online digital resources can be accessible for users with visual impairment or blindness and even the most visual contents and activities (based on images and videos) can be easily adjusted.

CONCLUSIONS

Online accessible resources should be based on the World Wide Web Consortium (W3C) guidelines, allowing the proper description of all contents by screen readers, using audio description, accessible features and providing keyboard navigation. Further research must be conducted to deepen knowledge on the role of educational digital resources for students with visual impairment or blindness, namely regarding OSH barriers that workers with visual impairment or blindness face at the workplace (as visual safety signs and pictogram labels).

Increasing water and energy efficiency in university buildings: a case study

Nowadays, humanity is consuming unsustainably the planet's resources. In the scope of energy resource consumption, e.g., the intense use of fossil fuels has contributed to the acceleration of climate changes on the planet, and the overriding need to increase energy efficiency in all sectors is now widely recognized, aiming to reduce greenhouse gases (GHG) emissions by 69% in 2030. Largely due to climate changes, water has also become a critical resource on the planet and hydric stress risk will rise significantly in the coming decades. Accordingly, several countries will have to apply measures to increase water efficiency in all sectors, including at the building level. These measures, in addition to reducing water consumption, will contribute to the increase of energy efficiency and to the decrease of GHG emissions, especially of CO₂. Therefore, the nexus water energy in buildings is relevant because the application of water efficiency measures can result in a significant contribution to improve buildings' energy efficiency and the urban water cycle (namely in abstraction, treatment, and pumping). For Mediterranean climate, there are few studies to assess the extent and impact of this nexus. This study presents the assessment of water-energy nexus performed in a university building located in a mainland Portugal central region. The main goals are to present the results of the water and energy efficiency measures implemented and to assess the consequent reduction of water, above 37%, and energy (30%) consumption, obtained because of the application of water-efficient devices and highly efficient light systems in the building. The water efficiency increase at the building level represents at the urban level an energy saving in the water supply system of 406 kWh/year, nearly 0.5% of the building energy consumption, with a consequent increase in the energy efficiency and in the reduction of GHG emissions. Complementarily, other energy-efficient measures were implemented to reduce the energy consumption. As the building under study has a small demand of domestic hot water with no hydro pressure pumps and has a small water-energy nexus, it was concluded that the significant reduction of the building energy consumption did not influence the indoor comfort.

Risk management in water supply networks: Aveiro case study

Water supply networks are critical infrastructures essentials to health, safety, economic and social well-being which have to be maintained and preserved to ensure their proper functioning. Considering the importance of these critical infrastructures, the risks to which they are exposed and the consequences of such risks must be analysed. Thus, it is important that companies responsible for the management of these assets incorporate risk management in their activities. In the scope of risk management, this paper intends to identify the vulnerabilities of water supply infrastructures, by analysing the risks they are exposed and identifying the measures that need to be implemented or reinforced. Risk assessment methodologies were analysed to identify the advantages and disadvantages of each one. As a case study, the water supply network of the Aveiro municipality in mainland Portugal was used. This network was analysed resourcing ArcMap, ArcGIS desktop software, which allows a better understanding of the water supply network. Risk management was applied and the probability and possible consequences of six distinct categories of threats were determined in eight scenarios, allowing the development of risk maps concluding that all these scenarios are in a low or medium level of risk. To decrease the vulnerability of the water network, a set of plans and specific measures have to be developed.