Does elite European match-play affect salivary immunoglobulin-A and cortisol in soccer players? The influence of playing status and match outcome

Introduction: The aims of this study were to: a) investigate salivary immunoglobulin A (s-IgA) and cortisol (s-Cort) responses to nine competitive fixtures in starting and non- starting soccer players; and b) compare s-IgA and s-Cort responses of starters and non-starters considering match outcome. Methods: Saliva from 19 male outfield players from an elite soccer team (mean ± SD, age 26 ± 4 years; weight 80.5 ± 8.1 kg; height 1.83 ± 0.07 m; body-fat 10.8% ± 0.7%) was collected. Saliva samples were taken on the day before each match (MD-1), 60-min before kick-off (MDpre), 30-min post-match (MDpost), and 72-h post-match (MD+3). There were five wins, one draw and three losses. Results: The mean s-IgA value was found to be significantly lower at MD+3 compared to MDpre and MDpost. s-Cort was significantly higher at MDpost compared to MD-1 and MDpre. When compared to MDpre, a statistically significant decrease in s-Cort was observed at MD+3 compared to MDpost. Starters displayed higher s-Cort values across the nine matches. There was a significant group-by-time interaction for s-Cort. There was a significant increase in s-Cort levels at MDpost compared to MD-1 and from MDpre to MDpost in starting players. At MDpost, starters had significantly higher s-Cort values. s-IgA values of starting and non- starting players following successful and unsuccessful matches did not reveal a significant difference. However, similar analysis of s-Cort in successful matches showed a significant difference between starters and non-starters. s-IgA values at MD-1, MDpre, MDpost and MD+3 in starters and non-starters following successful and unsuccessful matches revealed significant differences at MDpre and MDpost in starters, respectively. Furthermore, s-Cort values at MD-1, MDpre, MDpost and MD+3 in starters and non-starters in successful and unsuccessful matches revealed significant differences at MD+3 in starting players. Discussion: The present study suggests that in elite level soccer players, both starting status and match outcome influence s-IgA and s-Cort responses, particularly starters. Specifically, s-IgA was lower for starters before and after the match following successful outcomes. Moreover, higher s-Cort values were found before the match while lower values occurred after the match for starters in successful matches.

Cost-effectiveness analysis of grass pollen specific immunotherapy in children with allergic rhinitis compared to the standard of care symptomatic treatment in Portugal

Summary

Background. Cost-effectiveness studies evaluating allergen immunotherapy (AIT) in children are scarce. We aim to compare the cost-effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) against standard-of-care (SOC) treatment in children with grass pollen allergic rhinitis. Methods. We created a Markov model to compare the three strategies over a 10-year horizon. SOC was the reference to calculate the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analysis were used to assess models' uncertainty. Results. We obtained an ICER of € 12,605 and € 6,318 for SLIT and SCIT, respectively. In sensitivity analysis, SCIT was more cost-effective than SLIT. Conclusions. AIT is cost-effective in children with grass pollen allergic rhinitis, especially for the subcutaneous route.

Diet quality, asthma and airway inflammation in school-aged children

Summary

Background. Asthma is a major public health problem, with increasing prevalence in most countries, particularly among children. Poor dietary quality is also increasing in children, and evidence of the overall quality of children's food patterns effects on asthma is scarce. Methods. This cross-sectional analysis (660 children: 49.1% females, aged 7-12years) evaluated the association between diet quality and asthma (n = 56) and airway inflammation among school-aged children according to body mass index (BMI). Diet quality was assessed through the Healthy Eating Index (HEI)-2015, and categorized by tertiles. Higher scores represent a healthier diet. A questionnaire was used to enquire about self-reported medical diagnosis of asthma and asthma under medication. Lung function and airway reversibility were measured, and airway inflammation assessed measuring exhaled fractional nitric oxide (eNO). Two categories of BMI were considered: non-overweight/obese (p less than 85^th), (n = 491), and overweight/obese (p ≥ than 85^th), (n = 169). The associations between diet quality and asthma and airway inflammation were estimated using logistic regression models. Results. Non-overweight/obese children in 2^nd tertile of HEI-2015 score had decreased odds of having eNO ≥ 35ppb (OR 0.43, 95%CI 0.19-0.98), medical diagnosis of asthma (OR 0.18; 95%CI 0.04-0.84), and asthma treatment (OR 0.12; 95%CI 0.01-0.95), compared to children in the 1^st tertile. Conclusions. Our findings suggest that a higher diet quality associates with lower levels of airway inflammation and reduced prevalence of asthma among non-overweight/obese school-aged children.

Issue 2 - "Update on adverse respiratory effects of indoor air pollution" Part 1): Indoor air pollution and respiratory diseases: A general update and a Portuguese perspective

OBJECTIVE

To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population.

RESULTS

Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances.

CONCLUSIONS

Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity.

National trends in the use of oral chemotherapy over 13 years

Background: Systemic cancer therapy has traditionally been administered using an intravenous (IV) route, implying patients’ frequent visits to hospitals to access to their therapy. If we consider the actual pipeline in oncology, oral chemotherapy will be the main component of cancer treatment in the next few years. This shift in the administration route requires different care models in order to guarantee treatment efficacy and safety.

Objective: To analyze time trends in oral chemotherapy consumption in Portugal.

Method: Oral chemotherapy consumption over a 13-year period (2008–2020) was analyzed, considering dispensed units by the administration route with respective costs, resorting to the drug regulatory agency (INFARMED I.P.) database. Oral consumption patterns were further explored using common daily doses (CDD) for three conditions, including chronic myeloid leukemia (CML), non-small-cell lung cancer (NSCLC), and breast cancer (BC), to adjust for the effect of varying doses. Data were analyzed descriptively resorting to Microsoft Office Excel 2010.

Results: Overall chemotherapy consumption increased +Δ54.7%, with the highest contribution in units observed in oral forms (+Δ58.8%). The total expenditure increased +Δ96.5%, and despite the increase in oral forms (+Δ221.6%), intravenous forms continued to be the major cost driver, with an important contribution from immunotherapy. Much of the increase was led by the approval of 40 new IV and 48 new oral cancer medications with higher costs introduced in the market. Using CDD as an alternative metric to units had varying impacts by indication. The observed increases seemed to focus on specific cancer sites with varying effect; in CML, there was a 2.39-fold increase, compared to 4.41 for NSCLC and 1.86 for BC. However, for BC, two distinct sub-patterns were observed for hormone therapy (increasing 1.83) and for the novel tyrosine kinase inhibitors (increasing 40.8).

Conclusion: The growing use of oral chemotherapy is obvious and calls for investments in supporting patients in managing medication adherence and adverse events. The shifts in the healthcare system are complex and need to be prioritized. Our data suggest that priority could be attributed to cancer sites driving innovation, namely, advanced breast cancer.

Prognostic value of tumor mutational burden in patients with oral cavity squamous cell carcinoma treated with upfront surgery

Background

Oral cavity is the most prevalent site of head and neck squamous cell carcinomas (HNSCCs). Most often diagnosed at a locally advanced stage, treatment is multimodal with surgery as the cornerstone. The aim of this study was to explore the molecular landscape of a homogenous cohort of oral cavity squamous cell carcinomas (OCSCCs), and to assess the prognostic value of tumor mutational burden (TMB), along with classical molecular and clinical parameters.

Patients and methods

One hundred and fifty-one consecutive patients with OCSCC treated with upfront surgery at the Institut Curie were analyzed. Sequencing of tumor DNA from frozen specimens was carried out using an in-house targeted next-generation sequencing panel (571 genes). The impact of molecular alterations and TMB on disease-free survival (DFS) and overall survival (OS) was evaluated in univariate and multivariate analyses.

Results

Pathological tumor stage, extranodal spread, vascular emboli, and perineural invasion were associated with both DFS and OS. TP53 was the most mutated gene (71%). Other frequent molecular alterations included the TERT promoter (50%), CDKN2A (25%), FAT1 (17%), PIK3CA (14%), and NOTCH1 (15%) genes. Transforming growth factor-β pathway alterations (4%) were associated with poor OS (P = 0.01) and DFS (P = 0.02) in univariate and multivariate analyses. High TMB was associated with prolonged OS (P = 0.01 and P = 0.02, in the highest 10% and 20% TMB values, respectively), but not with DFS. Correlation of TMB with OS remained significant in multivariate analysis (P = 0.01 and P = 0.005 in the highest 10% and 20% TMB values, respectively). Pathological tumor stage combined with high TMB was associated with good prognosis.

Conclusion

Our results suggest that a high TMB is associated with a favorable prognosis in patients with OCSCC treated with upfront surgery.

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High TMB is associated with a favorable prognosis in patients with OCSCC treated with upfront surgery

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Pathological tumor stage combined with high TMB is associated with good prognosis

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TP53 was the most mutated gene (71%). Other frequent molecular alterations included the TERT promoter (50%)

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TGFβ pathway alterations were associated with poor outcomes, although it was only observed in 4% of the patients

Hearing changes after temporomandibular joint arthroscopy: a prospective study

Temporomandibular Joint (TMJ) arthroscopy is considered an effective and safe minimally invasive surgical approach. While the long-term outcomes of arthroscopy tend to be positive and free of secondary effects, patients occasionally complain about their hearing following the treatment. The aim of this prospective study was to investigate possible hearing changes associated with TMJ arthroscopy. Pure-tone audiograms were performed in patients two weeks before TMJ arthroscopy and repeated six weeks after intervention. A total of 15 patients (mean age of 41.73±16.36) were enrolled; 25 TMJ arthroscopies were performed (five unilateral and ten bilateral). Statistically significant differences were found between preoperative and postoperative audiograms in the frequencies 256Hz (P=0.011) and 8kHz (P=0.058, borderline). For the frequency 256Hz the difference was favourable, but not superior to 5dB. For the frequency 8kHz, in three patients the TMJ arthroscopy resulted in a decrease of 10dB. However, no clinical hearing changes or complaints were observed in the involved patients. No differences in audiograms between level 1 or 2 arthroscopy were observed. The study reinforces the safety of the TMJ arthroscopy level 1 and 2 with the reported protocol. The authors recommend larger studies to validate the results, specially for frequency 8kHz.

Association between the density and type of trees around urban schools and exhaled nitric oxide levels in schoolchildren

Summary

Greenspaces in school's neighbourhood represent an important environment to promote healthy development. The aim of this study was to assess the association between the density and type of trees around schools and exhaled Nitric Oxide (NO) levels in schoolchildren. Data on 845 children from 20 primary schools in Porto was analysed. Airway inflammation was assessed by measuring exhaled NO level. The density and type of trees were quantified within a 500 m buffer around schools. Associations were estimated using mixed-effect models. A significant association was observed between non-tree covered areas around schools and exhaled NO levels in schoolchildren (β = - 1.42, 95% CI - 2.84, - 0.001). Our results suggested that the presence of trees in school neighbourhoods may play a role in the biological mechanisms underlying the complex links between environment and airway inflammation.

Importance of health education actions to improve quality of life of vulnerable populations

Introduction

Health Education (HE), which is an integral part of Brazilian basic health care policy, reflects on the actions of a specific service or area. In regions where access to health care is precarious and poor socioeconomic conditions predominates, HE is fundamental for the comprehension of the health-illness process which aims at promoting a better quality of life. This study aims to assess through experiment the viability and adhesion of HE actions conducted in indigenous and Riverside communities in the Brazilian Amazon region.

Methodology

This study aims at reporting field trips during health expeditions between July and August 2019 in communities of the state of Pará, Brazil. The HE was composed by seven students and professors. Throughout patient's medical care, the team selected individuals to participate in different group dynamics at common spaces in the community area. The topics covered had been pre-screened based on epidemiological surveys conducted in previous expeditions. Visual and ludic resources were adapted to match local reality.

Results

2860 medical and dental care consultations were given. The adherence to the dynamics in was significant and covered the majority of them. The topics approached by the HE team were breast-feeding, family-planning, non-transmissible chronic diseases, healthy eating habits, hygiene, and awareness for natural resources. It has been observed that culture was a determinant factor for small a number of individuals in the comprehension of actions taken by the HE team.

Conclusions

Despite the strong cultural influence, HE proves to be a fertile ground and it must be encouraged in indigenous and riverside communities. The actions taken by the HE team should consider the local reality in every step of the process of implementation. In spite of the context in which locals of indigenous and riverside communities are inserted, HE promotes an autonomous development of their quality of life.

Key messages

Health education is one of the pillars of the national policy of basic health care in Brazil and is fundamental to promote better quality of life in vulnerable populations. Encouraging interventions in vulnerable communities contributes directly to the autonomous development of quality of life.

A silent “shipyard eye”: lessons from an epidemic keratoconjunctivitis outbreak in Portugal

Issue

Adenoviral conjunctivitis is the most common cause of conjunctivitis. Its most severe form is epidemic keratoconjunctivitis (EKC). This highly contagious disease is the only form to significantly involve the cornea and may cause visual impairing sequelae that persist for years.

Description

On January 2020, staff members at a childcare facility (CCF) alerted the Public Health Unit of Loures-Odivelas to a suspected conjunctivitis outbreak. The CCF was responsible for 57 children, separated in different rooms: a nursery (4-12 months), a pre-school (1-3 years) and a kindergarten (4-5 years). At the initial assessment, 4 cases of active disease were identified, all of which were at home and under treatment. CCF staff had previously identified 33 cases. Symptom onset of the index case had occurred more than 5 weeks before the alert. Infection control and epidemiological investigation were initiated. CCF staff was instructed to implement preventive measures, including careful disinfection of surfaces and toys, as well as frequent handwashing. Information about the disease and recommendations were sent to the children's caretakers.

Results

A total of 87 cases distributed in 8 weeks were identified: 28 at the CCF (25 children and 3 workers) and 59 close contacts (50 adults and 9 children). Average duration of disease was 14.1 days. In total, 43.9% of the children attending the CFF were affected. The highest attack rate was observed at the pre-school (69.2%, against 38.9% and 17.6% at the nursery and the kindergarten, respectively). 88.0% of the CCF children's households were affected. The average number of affected close contacts per affected child attending the CCF was 2.63. Corneal involvement was observed in 17,4% of cases.

Lessons

EKC outbreaks may go unnoticed by public health services, despite its high contagiousness and impact. Improvement of communication with organizations in the community is essential to secure future early detection and intervention.

Key messages

Epidemic keratoconjunctivitis is a highly contagious disease with potential long-term consequences. Early detection and intervention by public health services are essential to mitigate the impact of outbreaks and depend on well-established communication lines with institutions in the community.

HIV infection and AIDS reported cases in two municipalities near Lisbon between 2015 and 2019

Background

In the WHO European Region, in 2018, there were 16.2 newly diagnosed HIV infections per 100,000. In Portugal, there were 9.5 new cases per 100,000 population. The aim of this study is to analyse HIV/AIDS's notifications in the group of primary healthcare centres of Loures-Odivelas (ACES LO), with 340,000 inhabitants, between 2015 and 2019.

Methods

An observational, descriptive, retrospective, quantitative study was performed. Data was collected in March 2020, from the National System of Epidemiological Surveillance Database. Variables included were age, sex, HIV's presentation, country of probable origin of infection, probable form of transmission, partner characteristics, pregnancy at diagnosis, reason for testing/consultation, anti-retroviral therapy (ART) before diagnostic of AIDS. Descriptive analysis was performed for all variables.

Results

In ACES LO, there were 83 notified cases of HIV infection/AIDS between 2015 and 2019, with 36.1% of cases notified in 2019. The male to female ratio was 1.4. The average age was 41.7 years old. At time of notification, 56.6% of cases were asymptomatic and 25.3% had clinical criteria for AIDS. Guinea-Bissau was the probable origin of infection in 43.0% of cases (n = 23). Men having sex with men (MSM) was the probable form of transmission in 19.3% of cases. In 19.6% of cases of heterosexual contact, the partner was known to have HIV infection. Six women were pregnant at time of diagnosis. Testing was done on a routine basis in 22.2% of cases (n = 54). Among those with clinical criteria for AIDS (n = 21), 5 cases had previously taken ART.

Conclusions

There was an increase in notified cases of HIV infection/AIDS from 2015 to 2019 in ACES LO. The male to female ratio was lower than for Portugal in 2018.The proportion of cases with AIDS at time of notification was higher than for Portugal in 2018. Preventive strategies should be reinforced for people with partners diagnosed with HIV infection and perhaps for people.

Key messages

More than one third of cases were notified in 2019. Preventive strategies should be reinforced for people with partners diagnosed with HIV infection.

Quality of life assement of riverside communities of Tapajós and Cupari Rivers in Pará

Introduction

Riverside population lack basic sanitation infrastructure and access to healthcare. In addition, locals encounter difficulties in accessing basic health care due to climate variability and fluvial activity which results in tidal distortion and attenuation. Quality of life is a broad concept and its measurement should be useful to identify determining and conditioning factors in health-illness process which would be key to the guidance of health public policy measures in a specific community. This study aims at assessing the quality of life of Tapajós and Cupari riverside communities in Pará, Brazil.

Methods

A cross-sectional and descriptive study composed of a group of patients aged 18 and over who have sought care during the volunteer health expedition in the Tapajós and Cupari rivers between mid-July and August 2019. The team of students and professors conducting the survey adopted the WHOQOL-bref questionnaire as a measure of quality of life. The questionnaire consists of 25 questions and 5 domains: physical health, psychological, social relationships, environment, and self-assessment of quality of life. Individual scores vary between 4 and 20. Scores ≤ 10 suggest low quality of life whereas >10 suggest higher quality of life. This statistical analysis was carried out in the SPSS program and was described by means of summary measures: minimum, maximum, median, and standard deviation. Outcomes:The five domains scored >10, with the highest being the psychological domain (16,48, dp = 1,71) and the lowest the environment (14,12 dp = 1,99).

Conclusions

In spite of inherent difficulties generally found in riverside communities, participants reported high perception of quality of life in all domains. The lowest overall perception was the environment domain. This result confirms not only the barriers of physical infrastructure but also access to quality services as a negative health and life determinant.

Key messages

Assessing the quality of life is key to determine which factors influence the health-illness process within a community. Assessing the quality of life is fundamental to guide strategies aimed at intervening in social determinants.

Gentrification, mobility patterns and health in Lisbon: a time series’ analysis from 2008 to 2018

Background

Mobility patterns have a great impact on health. The use of cars is known to be related with increasing air pollution, noise and accidents, and less active transportation, leading to cardiovascular, oncological or respiratory diseases, among others. Gentrification is a process through which the rising value of a geographical area displaces low-income inhabitants, mostly due to rising rents, mortgages and property taxes. This change has the potential for relocating long-time residents and businesses. The aim of this study was to quantify the effect of gentrification in the car influx in the city of Lisbon.

Methods

A time series' analysis was performed using public ecological data, from 2008 to 2018, of habitation costs per square meter (as a proxy of gentrification) and the number of cars that entered Lisbon through accessing highways. The model was adjusted for confounding factors such as Lisbon's gross income and fuel prices.

Results

We verified the effect of seasonality in the car influx, with peaks before and after summer - july and october - and a downward trend until 2013 that then inflected and started an upward trend from 2014 to 2018. Habitation costs were positively correlated with car influx into the city (R2=0.773; p < 0.001). In the model, 1€/m2 of increment in housing prices corresponded to 200 more cars that entered the city.

Conclusions

In Lisbon, gentrification was associated with the increasing number of cars entering the city. These findings may have implications in future policies that regulate housing and mobility. Further research is needed to fully understand the causal pathways of this phenomenon.

Key messages

Mobility patterns have a great influence on health, and gentrification may influence them. The increase of 1€ per square meter in housing prices lead to an increase of the influx of cars of 200.

Notification of sexually transmitted infections: the tip of the iceberg?

Background

Sexually transmitted infections (STIs) are a major public health problem in Europe and in Portugal, their incidence has been increasing since the 90s. Although STIs are among the most frequently reported infections globally, they still go often underdiagnosed. Their under notification is also a problem in Portugal. The aim of this study is to describe STIs' notifications in the area of the groups of primary healthcare centers of Loures-Odivelas (ACES LO), between 2015-2019.

Methods

An observational, descriptive, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included for each STIs notification were age and sex. Univariate descriptive analysis and evolution trends were performed for each variable.

Results

A total of 638 cases of STIs were reported from 2015 to 2019. The number of reported cases increased from 87 to 197 cases (126.4%). The annual mean incidence of HBV and HCV notifications were 8 and 4, respectively. There was an increase in reported cases of syphilis (33 to 57), HIV (13 to 29), chlamydia (13 to 46) and gonorrhea (18 to 51). In 2019, 30.9% of the notified cases were syphilis infections, 23.5% gonorrhea infections, 22.1% chlamydia infections and 13.2% HIV infections.Males comprised 460 cases (72.1%), and, in patients aged between 15 and 44 years old, 484 cases (75.9%) were reported. From 2015 to 2019, the co-infections of gonorrhea and chlamydia increased from 2 to 10 cases (25.0%). In 2019, 17.5% of the notified cases of gonorrhea were co-infections.

Conclusions

The modification of risk behaviors and the appropriate treatment of infected people, including infected partners, are determinant to prevent recurrent infections and to interrupt the transmission cycle. Increasing notification should facilitate the monitoring of STIs' trends, contributing to the implementation of appropriate interventions and for better decision-making in public health.

Key messages

Campaigns about sexual health promotion are important to increase safer sexual health practices. More notifications contribute to better data quality and more robust decision-making.

A retrospective study of an International Vaccination Centre in the Lisbon Metropolitan Area

Background

Vaccination is one of the most cost-effective disease prevention strategies. Trips from Portugal to other countries have increased in the past 5 years. Depending on the destination, certain vaccines are advised to travellers in order to reduce travel-related risk. We analyzed the data of an International Vaccination Centre (IVC) in the Public Health Unit of the Primary Care Centres Group (ACES) of Loures-Odivelas.

Methods

A retrospective observational study comprising data from an IVC database between 2014 and 2018. Variables included were sex, age, destination, purpose, referral, and prescriptions. Descriptive analyses were performed for all variables.

Results

Between 2014 and 2018, there was a total of 4,873 users. Regarding individual characteristics, 51% were female, 80% had between 15 and 64 years of age, and 51% were referred by general practitioners of the ACES. Africa was the leading destination (66% average for all years) with a downward trend (from 82% in 2014 to 47% in 2018) followed by South America (12%) with an upward trend (from 4% to 16% in the same period). The primary purpose of travelling was tourism (74%) followed by work (15%). A total of 7,323 vaccines were administered, with an annual increase from 1,250 administrations in 2014 to 1,862 in 2018. The yellow fever vaccine accounted for 36,9% of all administrations, followed by typhoid fever vaccine (32,3%) and hepatitis A vaccine (10,2%).

Conclusions

African countries are still the most common destination for Portuguese travellers, but changing trends might influence the vaccination strategies in the IVC. Information provided in the IVC can be optimized to suit individual profiles better.

Key messages

As travelling increases, the International Vaccination Centre has an essential role in the prevention of disease. Africa remains the most common destination, requiring pre-travel health counselling and vaccine prophylaxis.

A retrospective study of a pre-travel consultation in the Lisbon Metropolitan Area, Portugal

Background

Travel from Portugal to other countries has increased in the past 5 years. A pre-travel health consultation is advised to all travellers to raise awareness and reduce travel-related risk. We describe the experience of a pre-travel consultation centre in the public health service.

Methods

A retrospective observational study about consultations in an international vaccination centre between 2014-2018. Variables included were: sex, age, destination, purpose, referral, and prescriptions. Descriptive analyses were performed for all variables.

Results

Between 2014 and 2018, there were 1,546 consultations. Regarding individual characteristics, 54% were female, and 80% had between 15 and 64 years of age. There was no referral in 66% of the consultations, followed by 16% from general practitioners in the Primary Care Centres Group. The leading destination was Africa (54%), in a downward trend (74% in 2015 and 32% in 2018) followed by Asia (18%) with an upward trend (12% to 28% in the same period). The primary purpose was tourism (83%), followed by work (9%). In total, 3,287 vaccines were prescribed with typhoid fever vaccine accounting for 26%, hepatitis A vaccine 22%, and yellow fever vaccine 15%. Mefloquine was the primary therapeutic drug prescribed for destinations with risk for malaria (41%). Regarding destinations with low risk for malaria, in 42% of the consultations, personal protective measures were the only recommendation.

Conclusions

Our data show that pre-travel consultations seem to be valued and actively asked for by travellers, but medical referral is still insufficient. Regarding health promotion and prevention of diseases, tracking trends in the most common destinations allows to optimize the information provided in the consultation, effectively capacitating the traveller to recognize and act on the most common travel-related health risks. In further studies, a post-travel follow-up should be carried out to determine the impact of the consultation.

Key messages

Pre-travel consultation is an actively sought-after service by the community, but awareness should be promoted in the medical community. Pre-travel consultation can have an important role in the health literacy of travellers.

Tuberculosis’ surveillance in a group of primary healthcare centres of Lisbon district

Background

Tuberculosis (TB), a communicable disease, is the leading cause of death from a single infectious agent and one of the top 10 causes of death worldwide. Its burden varies among different countries. In the 31 European Economic Area member states, in 2017, the TB notification rate was 10.7/100,000 population; in Portugal, this rate was 17.5/100,000 population and the majority of the notified cases occurred in two districts: Lisbon and Oporto. The aim of this study is to analyse TB's notifications in a group of primary healthcare centres of Loures-Odivelas (ACES LO), between 2015 and 2019.

Methods

An observational, descriptive, retrospective, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included were: age, sex, TB's presentation, antimicrobial susceptibility testing, HIV testing. Descriptive analysis was performed for all variables.

Results

In ACES LO, notified cases of TB dropped 18.0% between 2015 and 2017, having since increased by 54.8% (n = 113), a notification rate of 32.3/100,000 population in 2019. The male to female ratio was 1.7 and the most affected age group was the 30-40 year old group (n = 25). Notified cases in children <10 years old have increased from 0 in 2016 to 7 in 2019. Pulmonary TB was reported in 73.5% (n = 83) of the notified cases; in 56.6% (n = 64), antimicrobial susceptibility testing revealed that first-line treatment would be effective; HIV testing was positive in 10.6% (n = 12).

Conclusions

Surveillance is the first step towards taking action to control and eliminate TB. ACES LO has a high notification rate of TB, therefore effort should be made in order to reduce TB's incidence. More investigation should be performed in order to evaluate the possibility of reintroduction of Bacille Calmette-Guérin (BCG) vaccine to the general population, instead of only risk groups, as it happens in ACES LO since 2016.

Key messages

Surveillance is one of the ten essential Public Health operations, allowing us to measure and analyse health problems in a certain population. Tuberculosis’ incidence is still high in some populations; it is a critical issue to raise awareness about.

Do long-term care services meet the minimal requirements for the elderly?

Background

As the percentage of elderly people (aged over 65) is expected to rise, from 16.0% of the population in 2010 to 29.3% in 2060 in Europe, a quality long-term care system is of increasing priority for governments. The aim of this study is to analyse long-term care services (LTCS) in the geographical area of the group of primary healthcare centres of Loures-Odivelas.

Methods

A retrospective, observational, descriptive study comprising data from public health inspections to LTCS between 2015 and 2019. Variables included were the number of residents, nurses, orderly, cooks, kitchen helpers and medical doctors; licensing status, public health inspection results and the presence of air conditioning. Descriptive analysis was performed for all variables.

Results

Between 2015 and 2019, a total of 200 public health inspections were carried out in 106 LTCS. Only 41 (38.7%) LTCS were licensed. The total number of residents was 2,803, 168 (6.0%) of which were bedridden. Concerning the staff ratio, 79 (74.5%) LTCS fulfilled the ratio of nurse to resident of 1:40 and 67 (63.2%) the ratio of orderly to resident of 1:8. On the first inspection, 11 LTCS (10.4%) complied with the minimal requirements for health care, hygiene, food preparation and facilities conditions. After the implementation of corrective measures proposed by the Public Health Unit, the number of LTCS which had complied for the same criteria was 64 (60.4%).

Conclusions

Society needs to adapt to a growing ageing population. LCTS, while part of the solution, still have deficiencies. In this sample, the majority were illegal and lacked the appropriate conditions. Public Health interventions can contribute to improving these services.

Key messages

In an ageing society, long-term care services are essential but the majority lack the appropriate conditions. Public Health intervention is crucial in implementing corrective measures that will result in better conditions for the elderly.

CT-guided bone marrow aspirations and biopsies: retrospective study and comparison with blind procedures

PURPOSE

To compare the pathology results of CT-guided and blind bone marrow aspirations and biopsies.

METHODS

Ninety-eight consecutive CT-guided biopsies and 98 age- and gender-matched blind (non-CT-guided) posterior iliac crest bone marrow aspirations and biopsies performed in 2017 were reviewed for adequacy of core biopsies and aspirate smears. CT procedure images and CT abdomen/pelvis images were reviewed to evaluate anatomic features of the posterior ilium and soft tissues. Statistical analysis was performed using a T test, Fisher exact test, and Kruskal-Wallis test.

RESULTS

There was no significant difference in the age and gender of the two groups (p > 0.05). However, the CT-guided group had a higher BMI (p = 0.0049) and posterior soft tissue thickness (p = 0.0016). More CT-guided biopsy samples (CT 93 (95%); blind 77 (79%); p = 0.0006) and aspirate smears (CT 90 (92%); blind 78 (80%); p = 0.042) were categorized as adequate. The CT-guided group had longer core lengths (CT 1.4 ± 0.6 (range 0.3-3.5) cm; blind 1.0 ± 0.60 (range 0-2.6) cm; p = 0.0001). Overall, 131/164 (80%) of the cases had at least one of the described features (slanted posterior ilium (angle > 30°), 30%; rounded posterior ilium, 20%; thick posterior ilium cortex, 13%; focal lesion in posterior ilium, 12%; prior procedure in posterior ilium, 5%; posterior soft tissue thickness > 3 cm, 40%).

CONCLUSION

CT-guided bone marrow procedures were more likely to result in both adequate aspirate smears and biopsy samples and longer core lengths when compared with blind procedures.

Airborne food and aeroallergens levels in healthcare settings. An unaccounted but potentially relevant source of exposure?

BACKGROUND AND OBJECTIVE

Exposure to airborne allergens of biological origin associates with the development and exacerbation of allergic asthma and rhinitis. Assessment of allergens exposure in healthcare facilities may contribute to monitor hygiene and survey specific allergens which may cause symptoms in sensitized subjects. Objective: To assess concentration of indoor and airborne food allergens across different healthcare settings.

METHODS

Dust was vacuumed from primary health care centers in Lisbon; and emergency unit, day hospital, internal medicine ward, operating room and the outpatient clinic of a university central hospital in Porto. Samples were sieved, weighed, extracted and concentrations of Nbos d 5, Cor a 9, Gal d 2, Ara h 3, Ara h 6, Der p 1, Fel d 1, Can f 1, Bla g 2, Alt a 1 and Phl p 5 were determined using a multiplex array for allergens (MARIA™).

RESULTS

All airborne food and aeroallergens were found at least in one sampled area, except for Alt a 1. Levels of Der p 1 and Fel d 1 ranged from 13.0 µg/g to 971.0 µg/g and from 7.0 µg/g to 4618.8 µg/g, respectively. The emergency unit revealed the higher levels of food allergens, namely Nbos d 5 (16034.0 µg/g) and Cor a 9 (10649.5 µg/g).

CONCLUSIONS

With the exception of the operating room, exposure levels of dust mite, cat and dog allergens in healthcare facilities were above the values associated with sensitization and occurrence of allergic asthma or rhinitis symptoms in sensitized subjects.

THU0071 CD5L IN RHEUMATOID ARTHRITIS: PROTECTIVE OR PROMOTER?

Background:

Rheumatoid Arthritis (RA) is an aggressive auto-immune disease characterized by synovial hyperplasia and chronic inflammation. The main players of RA pathogenesis are T-cell and B-cell dependent pathways and some myeloid cells are also abundant in the synovial tissue. However, how inflammation is initiated, propagated and maintained remains controversial. Unbiased proteomic reports revealed an enrichment in the scavenger receptor CD5L, a component of serum and synovial tissues of arthritic patients.1 Upon secretion, this blood circulating glycoprotein represses pathogenic Th17 cells, promotes M2 polarization and binds and aggregates Gram-negative and -positive bacteria.2-4 However, its mechanisms of action has not been established either in health or disease.

Objectives:

We intend to clarify whether CD5L is an immune component that helps resolving RA or a factor that aggravates the disease.

Methods:

We analyzed by ELISA the presence of CD5L in samples from RA patients covering different stages of the disease, and correlated with other markers of RA. In parallel, we experimentally induced collagen induced arthritis (CIA) in CD5L knockout (KO) mice to evaluate the incidence and severity of the disease. The differences between the cellular groups in circulation vs the composition on secondary lymph organs using flow cytometry were also investigated in KO and WT mice. The histopathology of the joints was examined, while cytokine concentrations at several timepoints and total Ig levels were measured by ELISA and cytometric bead assays, respectively.

Results:

The samples from RA patients showed increased CD5L levels concomitant with the severity of the disease and a direct correlation with Sharp RTG Score or IL-6 serum levels, and inversely correlated with COMP levels. However, these correlations did not clarify whether CD5L helps to resolve RA or is a component that aggravates the disease. To clarify this aspect, we provoked CIA in CD5L KO mice and observed a higher incidence of RA, higher severity and a much lower recovery rate when compared with WT mice. To corroborate these data, the H&E staining of sagittal section of fore- and hindpaws revealed histopathology consistency with RA, with notable inflammatory signs especially in KO mice. WT animals with RA also showed higher levels of CD5L when compared with the control group, which confirms the observations obtained for human samples. Total serum IgG levels did not correlate with the disease severity but KO mice presented higher quantities of IgG and IL-6 when compared with WT mice.

Conclusion:

Overall, these data imply that CD5L is not a promoter of the disease but rather a fundamental protective molecule against inflammation.

References:

[1]Balakrishnan L et al. (2014) Clin Proteom 11:1

[2]Wang C et al. (2015) Cell 163:1413-27

[3]Sanjurjo L et al. (2018) Front Immunol 9:480

[4]Martinez VG et al. (2014) Cell Mol Immunol 11:343–354

Acknowledgments:

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No683356-FOLSMART

Disclosure of Interests:

None declared

Trade-off in plant-ant interactions: seasonal variations

This work evaluated the effect of seasonality on ant-plant interaction in a Seasonally Dry Tropical Forests, using as an ecological model the species Ipomoea carnea subs. fistulosa (Convolvulaceae). We performed systematic collection of ants, herbivores and leaves in marked plants, evaluated the efficiency of herbivorous capture by ants, and the effects of ant presence over the pollinator behavior and plant fitness in dry and rainy seasons. The presence of ants in the plants reduced the number of herbivores (dry season: F2.27=4.7617, p=0.0166; rainy season: F2.27=5.8655, p=0.0078). However, the capture efficiency was negatively affected by the presence of myrmecophilous larvae, so that the average of ants recruited on termite leaves was 2.06 ants per termite, the average recruitment of ants on larval leaves was 22.4 larva ants. In addition, the presence of ants reduced pollinator visits and promoted fruit reduction during the dry season (ANOVA: F = 3.44; p = 0.0653). In conclusion, the association with ants can result in a balance not always favorable to the host plant, and this result actually depends on abiotic (e.g. precipitation) and biotic factors (e.g. ant species composition and abundance, influence of other trophic levels and identity of associated herbivores).

Tailgut cyst adenocarcinoma

Tailgut cysts (TGCs) are rare congenital entities arising from remnants of the embryological postanal primitive gut. Malignancy in TGCs is rare, with the majority being adenocarcinomas and carcinoid tumors. A search of the published literature yielded only 27 cases of adenocarcinoma developing in TGCs. We described the case of a 54-year-old female who presented with complaints of pelvic and perineal pain of several weeks. After the initial work-up, a mass in the right presacral location was diagnosed. She underwent radical resection of the tumor, using a posterior approach. The lesion was removed en bloc with the middle rectum, coccyx, and sacrum (S4-S5). The histopathologic examination revealed an adenocarcinoma arising in a TGC, and the patient received adjuvant chemoradiotherapy. Our case underlines that diagnosing a TGC is difficult as it is a rare congenital lesion. Clinical examination may be challenging as TGCs present with various symptoms, which can mimic other commonly proctologic disorders. Patients should be referred to a tertiary center with experience in pelvic surgery and must be managed by a multidisciplinary approach to maximize successful treatment. The recommended treatment is surgical excision given the malignant potential of TGCs and their risk of causing local complications.