Global view of vasomotor symptoms and sleep disturbance in menopause: a systematic review

Studies have shown racial/ethnic differences in the prevalence of vasomotor symptoms (VMS), sleep disturbance and VMS treatment in menopause. To assess the reproducibility of these differences, we systematically reviewed observational studies, published in 2000-2021, reporting the prevalence/incidence of VMS, sleep disturbance or treatment use in menopausal women stratified by race/ethnicity. We screened 3799 records from PubMed and Embase and included 27 papers (19 studies). No incidence data were found. Prevalence data varied widely, but some common patterns emerged. In all five studies comparing VMS between Black women and White, Hispanic and/or East Asian women, the prevalence was highest in Black women and lowest in East Asian women. The prevalence of sleep disturbance overall was compared among Black, White and East Asian women in two study populations, and was highest in White women in both papers. Sleep disturbance was more common than VMS in East Asian women. In all four studies comparing hormone therapy use between White women and Black and/or East Asian women, treatment use was more common in White women. These results highlight the need for individualized counseling and treatment, outreach to under-served minorities, and standardized definitions and outcome measures for VMS and sleep disturbance for future studies.

The 2009-2014 economic crisis and deaths by suicide in Portugal: time series analysis

Introduction

Population health, including mental health, is influenced by its socioeconomic context. After the 2008 global economic crisis, studies found contradicting results: some showed an increased risk for self-harm and suicidal behavior, while others found the opposite association. To the best of our knowledge, there is no research in Portugal on the subject. Thus, our aim was to estimate the impact of the Portuguese economic crisis of 2009-2014 on the death rate by suicide and self-inflicted injury in Portugal.

Methods

A retrospective ecological study with an interrupted time series analysis of deaths by suicide and self-inflicted injury (data from the National Statistics Institute) in mainland Portugal, in 2003-2014, was performed. Resident population data was also retrieved from the National Statistics Institute. Binomial negative generalized linear models were used to compare rates and trends before (2003-2008) and during (2009-2014) the economic crisis. All rates were stratified and adjusted for seasonality.

Results

The economic crisis was associated with 13% a step increase in the death rate due to suicide and self-inflicted injury, with unemployment playing a significant mediating role, being negatively associated to the outcome. Differences between groups exist, with males, working-age groups and the North and Centre regions being the most impacted, globally.

Conclusions

Economic downturns pose risks for suicidal behavior. Unemployment may play a role in this association. Employment protection schemes can prevent this impact, so urgent action is needed to prevent economic crisis leading to additional suicides, especially in the context of the COVID-19 pandemic and the economic crisis it caused.

Key messages

• The Portuguese economic crisis of 2009-2014 was associated with an increased death rate due to suicide, especially in males, working-age groups and the North and Centre regions.

• Unemployment may play a role in this association, and active labour market programmes can prevent the negative impacts of economic crisis leading to additional suicides.

Portuguese Football Federation consensus statement 2020: nutrition and performance in football

Nutrition is an undeniable part of promoting health and performance among football (soccer) players. Nevertheless, nutritional strategies adopted in elite football can vary significantly depending on culture, habit and practical constraints and might not always be supported by scientific evidence. Therefore, a group of 28 Portuguese experts on sports nutrition, sports science and sports medicine sought to discuss current practices in the elite football landscape and review the existing evidence on nutritional strategies to be applied when supporting football players. Starting from understanding football's physical and physiological demands, five different moments were identified: preparing to play, match-day, recovery after matches, between matches and during injury or rehabilitation periods. When applicable, specificities of nutritional support to young athletes and female players were also addressed. The result is a set of practical recommendations that gathered consensus among involved experts, highlighting carbohydrates periodisation, hydration and conscious use of dietary supplements.

The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey

PURPOSE

Up to 30% of women of reproductive age experience HMB, which has a substantial impact on their quality of life. A clinical care pathway for women with HMB is an unmet need, but its development requires better understanding of the factors that characterise current diagnosis and management of the condition.

MATERIALS AND METHODS

This observational, survey-based study assessed the burden, personal experiences, and path through clinical management of women with HMB in Canada, the USA, Brazil, France and Russia using a detailed, semi-structured online questionnaire. After excluding those reporting relevant organic pathology, responses to the questionnaire from 200 women per country were analysed.

RESULTS

Around 75% of women with HMB had actively sought information about heavy periods, mostly through internet research. The mean time from first symptoms until seeking help was 2.9 (Standard deviation, 3.1) years. However, 40% of women had not seen a health care professional about the condition. Furthermore, 54% had never been diagnosed or treated. Only 20% had been diagnosed and received appropriate treatment. Treatment was successful in 69% of those patients currently receiving treatment. Oral contraceptives were the treatment most commonly prescribed for HMB, although the highly effective levonorgestrel-intrauterine system was used by only a small proportion of women.

CONCLUSIONS

This study provides insight into the typical journey of a woman with HMB which may help patients and health care professionals improve the path to diagnosis and treatment, although further research with long-term outcomes is needed.

Impact of the 2009-2014 economic crisis on suicide attempts and self-harm in Portugal

Background

Following the worldwide economic crisis of 2008, studies have found an increased risk for self-harm and suicide attempts, many of which need hospital care. There is no research in Portugal on the matter. Therefore, our goal was to estimate the impact of the Portuguese economic crisis of 2009-2014 on the hospital admission rates by attempted suicide and self-harm in Portugal.

Methods

A retrospective ecological study, with an interrupted time series analysis of hospital admissions by suicide attempts (data from the national Hospital Mobility Database) in mainland Portugal, between 2003 and 2014, was performed. Resident population data over 15 years old was retrieved from the National Statistics Institute. Poisson regression models were used to compare rates and trends before (2003-2008) and during (2009-2014) the Portuguese economic crisis. All rates were adjusted for seasonality.

Results

A total of 35,077 hospital admission episodes by suicide attempt were retrieved. The mean admission rate was 2.947 per 100 000 inhabitants per month before the crisis, falling to 2.798 during the crisis period. Before the crisis, the total admission rate was decreasing 1% per year. After the crisis erupted, there was a level change, with a sudden increase of 7.9%. The suicide and self-harm admission rate, after 2008, was constant and approximately 38.8% higher than expected if the earlier trend had continued.

Conclusions

There was an increase in the total hospital admission rate by suicide attempts and self-harm during the economic crisis period in Portugal, when compared to the previous period.

Key messages

Economic crisis can pose considerable suicide risks. Urgent action is needed to prevent economic crisis leading to additional suicides.

Risk and limits in dental practice: a Portuguese approach to medical-legal evaluation and professional liability

Patient safety and quality of healthcare delivery systems are an objective of WHO. This study aims to present and analyse Portuguese clinical data on risk and malpractice in dental practice. Data from the Forensic Dentistry Laboratory (Faculty of Medicine, University of Coimbra) was analysed, between the years of 2013 to 2018. One hundred and seven technical reports were selected, and seventy nine files were included in the iatrogenic sequelae group. Data included the analysis of the performance of dental professionals. Sequelae were divided in descending order of occurrence:1) mandibular dysfunction (53,2%)[(42)79]; 2) neurological deficit (39,2%)[(31)79]; 3) tooth loss (6,3%)[(5)79]; and 4) opening deficit (1,3%)[(1)79].Three major areas with significant expression in the field of expert evaluations were analysed: 1) orthodontic treatment (51,9%), implant rehabilitation (29,1%), and oral surgery. Given the prevalence of malpractice, the need to assess its causes and recognise standards for its prevention is necessary.

Gastrópodes (Mollusca) presentes no campus Urca da Universidade Federal do Estado do Rio de Janeiro (UNIRIO)

Gastropoda é o grupo mais diverso de Mollusca, contudo ainda existem muitas lacunas no conhecimento, e os moluscos terrestres e de água doce são um exemplo. Desta forma, apresentamos o levantamento dos gastrópodes do campus Urca da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), área limítrofe com o Parque Natural Municipal da Paisagem Carioca e inclusa na área de amortecimento do Monumento Natural dos Morros do Pão de Açúcar e da Urca. Foram selecionados 11 pontos de amostragem e utilizamos uma metodologia direta de coleta. Ao todo foi encontrado um total de 1829 exemplares distribuídos em 18 espécies dentro de 12 famílias. O presente estudo pode mostrar a importância de áreas urbanas protegidas na conservação da fauna, tendo em vista o quantitativo de espécies nativas encontradas e o registro de primeira ocorrência de uma das espécies para o estado do Rio de Janeiro.

Nutrition and Supplementation in Soccer

Contemporary elite soccer features increased physical demands during match-play, as well as a larger number of matches per season. Now more than ever, aspects related to performance optimization are highly regarded by both players and soccer coaches. Here, nutrition takes a special role as most elite teams try to provide an adequate diet to guarantee maximum performance while ensuring a faster recovery from matches and training exertions. It is currently known that manipulation and periodization of macronutrients, as well as sound hydration practices, have the potential to interfere with training adaptation and recovery. A careful monitoring of micronutrient status is also relevant to prevent undue fatigue and immune impairment secondary to a deficiency status. Furthermore, the sensible use of evidence-based dietary supplements may also play a role in soccer performance optimization. In this sense, several nutritional recommendations have been issued. This detailed and comprehensive review addresses the most relevant and up-to-date nutritional recommendations for elite soccer players, covering from macro and micronutrients to hydration and selected supplements in different contexts (daily requirements, pre, peri and post training/match and competition).

Evidence for elevated production of methylmercury in salt marshes

Depth variations of total mercury (Hg) and methylmercury (MeHg) concentrations were obtained in cores from nonvegetated sediments, sediments colonized by Sarcocornia fruticosa, Halimione portulacoides, and Spartina maritima and below-ground biomass in three Portuguese estuaries. Similar analyses were also performed on the above-ground plant tissues. Concentrations in below-ground biomass exceeded up to 9 (Hg) and 44 (MeHg) times the levels in sediments. Mercury and MeHg in below-ground biomass were up to 400 (Hg) and 4700 (MeHg) times higher than those found in above-ground parts, indicating a weak upward translocation. Methylmercury in colonized sediments reached 18% of the total Hg, which was 70 times above the maximum values found in nonvegetated sediments. Concentrations of MeHg in vegetated sediments were not related to plant type but were linearly proportional to the total mercury levels. The analysis of below-ground biomass at high depth resolution (2 cm) provided evidence that Hg and MeHg were elevated. The higher enrichment factors were found where the shifting of redox conditions suggested high microbial activity. Mercury and MeHg in below-ground tissues were a function of total levels in sediments and again were not plant-specific. These results suggest that the bioremediation of mercury-contaminated sediments is likely to increase the formation of methylmercury.

Luria's neuropsychological evaluation in the nordic countries

The publication of Luria's Neuropsychological Investigation (LNI) by Christensen in 1975 introduced Luria's evaluation procedures to worldwide neuropsychology. The LNI demonstrated the benefit of a thorough qualitative analysis of an individual patient's functioning as well as the usefulness of a comprehensive theory of brain functioning. This article reviews the experiences that led to the development of the LNI, discusses its use and extension in Scandinavian countries, and presents clinical and research applications of the LNI in diagnosis and rehabilitation. A series of case examples provides justification and validity for the continued use of the LNI and related procedures. Discussion of the advantages and disadvantages of the LNI and consideration of possible modifications of the procedures and interpretative methods provide the rationale for continued development of Luria's approach.

Psychopathological symptomatology in brain-injured patients before and after a rehabilitation program

The Symptom Checklist-90 revised (SCL-90-R) was used to evaluate subjective experience of psychopathological symptomatology in 30 patients before and after an intensive four-month neuropsychological rehabilitation program and again one year after completion of the program. The patients were all adults and had suffered acute brain injury as a result of head injury (37%), cerebro vascular accident (37%), anoxia (16%) or other causes (10%). Most had entered the program within two years after injury and at that time they showed slight to moderate elevation on all ten scales of the SCL-90-R. At program completion eight of the scales showed significant or near significant reductions. There were only small and non-significant changes in the scales between program completion and one year follow-up. Among the individual items of the SCL-90-R, the most common complaints related to cognitive difficulties and depression. The same pattern of sustained improvement was largely found for these items. Overall the results suggest, first, that the subjectively perceived distress in the brain-injured patient is diminished by the rehabilitation program, and second, that this reduction sustained at least up to one year following the completion of the program.