Healthcare professionals perspectives on tuberculosis barriers in Portuguese prisons-a qualitative study

BACKGROUND

Tuberculosis (TB) remains a significant public health concern, particularly within prison settings, where the confluence of adverse health factors and high-risk behaviors contribute to a heightened risk of transmission. This study delves into the perspectives of medical doctors, regarding the implementation of the 2014 TB protocol in Portugal.

METHODS

The study has a qualitative, descriptive design. Individual semi-structured interviews with medical doctors from TB outpatient centers in Porto and Lisbon were used for data collection. For the analysis thematic analysis method was used.

RESULTS

The study population comprised 21 medical doctors with the majority being female (61.9%) and 57.1% specializing in pulmonology. The results indicate varied perceptions of the protocol's usefulness, with positive impacts on coordination reported by some participants. Improved communication and evolving collaboration between TB outpatient centers and prisons were highlighted, although challenges in contact tracing and resource constraints were acknowledged. The study also sheds light on the role of nurses in patient education.

CONCLUSION

Despite overall positive perceptions, challenges such as sustaining therapy post-symptomatic improvement and delays in diagnostic methods were identified. The findings underscore the importance of continuous collaboration between prisons and TB control programs to address challenges, improve disease control and prevent TB transmission.

Urgent Attention Needed for Mental Health Challenges Arising from Prolonged Grief During and in the Aftermath of COVID-19

N/a.

Characterization of students with high intellectual capacity: the approach in the Portuguese school context and importance of teacher training for their educational inclusion

This paper takes a terminological approach to the concept of high intellectual abilities, highlighting the distinctive aspects of the way it is addressed in the Portuguese educational context. It outlines the existing conceptual differentiation in the field of higher abilities, emphasizing how the main characteristics are described and including the strengths and weaknesses of current teaching and learning processes in Portugal. As we will show, educational work with these students in Portuguese schools is characterized by unequal regulation compared to other educational needs, by an imbalance of educational processes aimed at these gifted students, and by clear underdiagnosis that sometimes leads to them being ignored in the classroom, with the consequent harm that this can cause to their overall development and to their academic and professional careers. The paper emphasizes the importance of teacher training in Portugal as an aspect that could be key to reversing, as far as possible, this gap in educational processes-which currently include educational inclusion for all their students as part of the key action principles in the Portuguese educational system.

Anxiety and Depression Symptoms During the COVID-19 Pandemic: A Cluster Analysis of Individuals Living in Portugal

INTRODUCTION

The COVID-19 pandemic is an illustration of how a physical illness can damage people's minds. In this regard, the goal of this study was to see how different sociodemographic and behavioral factors were linked to anxiety and depression symptoms in a group of individuals living in Portugal.

METHODS

Between November 2020 and February 2021, a cross-sectional, snowball online study was conducted. The study's target population was adults over the age of 18, residents of the country. For the statistical analysis, the clustering technique - K-means algorithm was applied. The chi-squared test was used to determine the relationships between clusters and sociodemographic and behavioral characteristics. Statistical analyses were conducted in R language, with a significance level of 0.05. A total of 453 participants were included.

RESULTS

The majority were female (69.8%), under the age of 40 (60.8%), with a higher education degree (75.3%), and not married (54.4%). Furthermore, the majority were from the country's north region (66%). Cluster 1 (n = 194) was characterized by low or nonexistent levels of anxiety and depression symptoms, which means normal; cluster 2 by severe symptoms (n = 82), meaning case; and cluster 3 by mild symptoms (n = 177), which means borderline. Younger participants (p-value 0.024), female (p-value 0.041), with drinking habits (p-value 0.002), food insecurity (p-value < 0.001), food affordability exacerbation (p-value < 0.001), comorbidity (p-value < 0.001), use of anxiolytics (p-value < 0.001), insufficient household income (p-value 0.017) and income change (p-value < 0.001) were significantly associated with the anxiety-depression clusters. From the three clusters, cluster 2 was mainly represented by younger participants, with more persons stating that their household income was insufficient and that their income has changed as a result of COVID-19 and that they had the highest probability of food insecurity.

CONCLUSION

The impacts of a crisis on mental health extend longer than the event itself. We were able to observe that younger women with insufficient household income who suffered a change in income due to COVID-19 and were classified as food insecure presented higher levels of anxiety and depression symptoms. These results highlight the presence of a social gradient where we saw that people who were less advantaged in terms of socioeconomic position presented worse mental health outcomes, stressing, in this sense, the need to bring the best public health responses for these specific groups of the population.

Calibration Assessment of Low-Cost Carbon Dioxide Sensors Using the Extremely Randomized Trees Algorithm

As the monitoring of carbon dioxide is an important proxy to estimate the air quality of indoor and outdoor environments, it is essential to obtain trustful data from CO₂ sensors. However, the use of widely available low-cost sensors may imply lower data quality, especially regarding accuracy. This paper proposes a new approach for enhancing the accuracy of low-cost CO₂ sensors using an extremely randomized trees algorithm. It also reports the results obtained from experimental data collected from sensors that were exposed to both indoor and outdoor environments. The indoor experimental set was composed of two metal oxide semiconductors (MOS) and two non-dispersive infrared (NDIR) sensors next to a reference sensor for carbon dioxide and independent sensors for air temperature and relative humidity. The outdoor experimental exposure analysis was performed using a third-party dataset which fit into our goals: the work consisted of fourteen stations using low-cost NDIR sensors geographically spread around reference stations. One calibration model was trained for each sensor unit separately, and, in the indoor experiment, it managed to reduce the mean absolute error (MAE) of NDIR sensors by up to 90%, reach very good linearity with MOS sensors in the indoor experiment (r² value of 0.994), and reduce the MAE by up to 98% in the outdoor dataset. We have found in the outdoor dataset analysis that the exposure time of the sensor itself may be considered by the algorithm to achieve better accuracy. We also observed that even a relatively small amount of data may provide enough information to perform a useful calibration if they contain enough data variety. We conclude that the proper use of machine learning algorithms on sensor readings can be very effective to obtain higher data quality from low-cost gas sensors either indoors or outdoors, regardless of the sensor technology.

Correlation between individual autoantibodies and clinical features in primary biliary cholangitis: results of a retrospective longitudinal study

BACKGROUND AND AIMS

Primary biliary cholangitis (PBC) is an immune-mediated liver disease. The immunological profile seems to relate to clinical prognosis. This study aims to determine the role of autoantibodies in the course of liver disease and in the response to ursodeoxycholic acid.

METHODS

Between January 2016 and December 2020, 143 patients with PBC who underwent immunological liver profile evaluation were enrolled. All data were extracted retrospectively from electronic clinical records. Chi-square test, Fisher's exact test and Mann-Whitney test were used to evaluate the relationship between autoantibodies and biochemical parameters, clinical outcomes and therapeutic response scores. A significance level of 0.05 was used.

RESULTS

Antimitochondrial antibodies were present in 91.6%, antiglycoprotein-210 antibody (anti-gp210) in 18.2% and anti-Sp100 in 19.6% of patients. The incidence of liver-related death was higher in patients with autoimmune hepatitis variants. The occurrence of cirrhosis or portal hypertension was not linked to the presence of any of the autoantibodies tested. No relationship was found with the probability of dying or being transplanted. Patients with anti-Sp100 antibodies had higher baseline levels of aspartate aminotransferase and alanine aminotransferase and lower immunoglobulin M levels. Patients with anti-gp210 were more likely to have a lower median transplant-free survival rate and higher median risk of liver transplant or liver-related death using the GLOBE and UK-PBC scores.

CONCLUSION

Our findings confirm a strong association between anti-gp210 antibodies and a worse outcome. The association between anti-Sp100 and hepatic lesions requires further elucidation.

Tuberculosis and COVID-19 related stigma: Portuguese patients experiences

INTRODUCTION

Stigmatization of tuberculosis (TB) patients is well-documented, and several health-related organizations have also reported the stigmatization of COVID-19 patients. Because stigmatization can have many adverse consequences, we performed a qualitative study to evaluate the stigmatization of TB and COVID-19 patients. We examined changes in stigmatization throughout the pandemic; perceptions of stigmatization by patients with these diseases before and during COVID-19 pandemic; and differences in stigmatization perceived by individuals who had both diseases.

METHODS

A semi-structured interview was developed based on the available literature, and was administered to a convenience sample during April 2022. All participants were adults who have/had pulmonary TB and/or COVID-19, and were from a single Portuguese Outpatient TB Center. All participants provided written informed consent. Patients who had latent TB, asymptomatic TB, or asymptomatic COVID-19 were excluded. Data were analyzed using thematic analysis.

RESULTS

We interviewed 9 patients (6 females and 3 males; median age: 51±14.7 years-old). Three had TB and COVID-19, 4 had TB alone, and 2 had COVID-19 alone. Interviews allowed to identify 8 main themes: knowledge and beliefs, with several misconceptions identification; attitudes towards the disease, from social support to exclusion; knowledge and education, assumed to be very important; internalized stigmatization, with self-rejection; experience of stigmatization, with discrimination episodes; anticipated stigmatization, with modifying actions for prevention; perceived stigmatization, in which judgment by others prevailed; and temporal changes in stigmatization.

CONCLUSIONS

Individuals who had TB or COVID-19 reported they were stigmatized. De-stigmatization of these diseases is crucial for improving the well-being of affected patients.

Behavior Guidance during the Covid-19 Pandemic: Health Literacy as a Weapon against the Virus

Portugal was hit by COVID-19 on the 2^nd of March 2020. For almost two months, the country was confined due to the declaration of the emergency state. The confinement was always conveyed by the media, who clearly guided citizens toward preventive behaviors and so became a means of fighting this pandemic by helping the country stay home. Several authors recognize the importance of health communication and health literacy in fighting COVID-19. In a public health crisis like this, media are important actors in the promotion of health and prevention of disease, and they can have a central role in behavior change. To further understand how the media guided citizens toward preventive behaviors we applied a questionnaire survey to Portuguese journalists. More than 90% assumed citizens' behavior guidance. Journalists' perceptions about their work reflect a true concern with the promotion of health literacy, and their assumption of a public service mission was crucial in people's adherence to confinement. Health literacy achieved its maximum during this confinement period, not only because these were extraordinary times but also because Portuguese journalists had an exemplar behavior.

COVID-19 vaccine effectiveness against symptomatic disease and severe outcomes, 2021-2022: a test-negative case-control study

Objectives

This study evaluated the effectiveness of COVID-19 vaccines in preventing symptomatic and severe disease.

Study design

This was an observational test-negative case-control study.

Methods

Study participants were adults with at least one symptom included in the World Health Organization COVID-19 definition who sought healthcare in a public emergency department between 1 November 2021 and 2 March 2022 (corresponding with the fifth pandemic wave in Portugal dominated by the Omicron variant). This study used multivariable logistic regression models to estimate and compare the odds ratio of vaccination between test-positive cases and test-negative controls to calculate the absolute and relative vaccine effectiveness.

Results

The study included 1059 individuals (522 cases and 537 controls) with a median age of 56 years and 58% were women. Compared with the relative effectiveness of the primary vaccination scheme that had been completed ≥180 days earlier, the effectiveness against symptomatic infection of a booster administered between 14 and 132 days earlier was 71% (95% confidence interval [CI]: 57%, 81%; p < 0.001). The effectiveness of the primary series against symptomatic infection peaked at 85% (95% CI: 56%, 95%) between 14 and 90 days after the last inoculation and decreased to 34% (95% CI: −42.6%, 49.5%) after ≥180 days.

Conclusions

Despite the known immunological evasion characteristics of the Omicron variant, results from this study show that vaccine effectiveness increases after booster administration. COVID-19 vaccine effectiveness decreases to less than 50% between 3 and 6 months after completion of the primary cycle; therefore, this would be an appropriate time to administer a booster to restore immunity.

Vehicle-to-infrastructure IEEE 802.11ad Wi-Fi dataset

Despite not being designed for vehicular use, the high bandwidth offered by IEEE 802.11ad makes it an enticing proposition for opportunistic Vehicle-to-Infrastructure (V2I) communication. Because it operates at a high frequency of 60 GHz, 802.11ad suffers from high attenuation. To combat this, it uses antenna directionality to improve communication range. Directionality is primarily achieved by selecting an antenna configuration, or sector, from a list of preconfigured ones. Choosing a good antenna sector is difficult in V2I environments, as the fast mobility involved affects the alignment between communicating nodes. This article describes a dataset that supports analysis of Commercial Off-The-Shelf (COTS) 802.11ad device behavior in an experimental V2I communication scenario. More specifically, the dataset summarizes the results from a set of experiments in which a mobile client drove around a stationary Access Point (AP) while downloading data from it. Information regarding the client's mobility, control frames exchanged, and achieved throughput was collected. This dataset can support realistic analysis of 802.11ad COTS equipment behaviors, such as antenna selection and communication range, in a vehicular communication scenario.

[Promoting Better Indoor Air Quality in Portugal for Disease Prevention and Control]

N/a.

Kaolin particle films disrupt landing, settling behavior and feeding of Trioza erytrae on lemon plants

BACKGROUND

The citrus greening disease or Huanglongbing (HLB) is the most devastating disease of citrus crops. Trioza erytreae is a vector of HLB. Since its introduction in Europe, the insect reached the northern region of Spain and the southern region of Portugal, threatening relevant citrus production areas. Limiting the spread of HLB vectors is mandatory to prevent this disease. In this work, we assessed the effect of kaolin, a white mineral clay, on the landing, settling behavior and feeding behavior of Trioza erytreae on lemon plants.

RESULTS

After kaolin application, the number of plants on which the insect was found was significantly lower than on untreated plants in the laboratory and in the field. Moreover, there were significantly fewer T. erytreae and a shorter duration of phloem-related events on kaolin-treated than untreated plants.

CONCLUSION

The use of kaolin could be a suitable and efficient tool for inclusion into integrated pest management programs or organic production to reduce populations of T. erytreae and subsequently limit the spread of HLB in citrus crops. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Evolving operational guidance and experiences for radiology and nuclear medicine facilities in response to and beyond the COVID-19 pandemic

The resulting pandemic from the novel severe acute respiratory coronavirus 2, SARS-CoV-2 (COVID-19), continues to exert a strain on worldwide health services due to the incidence of hospitalization and mortality associated with infection. The aim of clinical services throughout the period of the pandemic and likely beyond to endemic infections as the situation stabilizes is to enhance safety aspects to mitigate transmission of COVID-19 while providing a high quality of service to all patients (COVID-19 positive and negative) while still upholding excellent medical standards. In order to achieve this, new strategies of clinical service operation are essential. Researchers have published peer-reviewed reference materials such as guidelines, experiences and advice to manage the resulting issues from the unpredictable challenges presented by the pandemic. There is a range of international guidance also from professional medical organizations, including best practice and advice in order to help imaging facilities adjust their standard operating procedures and workflows in line with infection control principles. This work provides a broad review of the main sources of advice and guidelines for radiology and nuclear medicine facilities during the pandemic, and also of rapidly emerging advice and local/national experiences as facilities begin to resume previously canceled non-urgent services as well as effects on imaging research.

Assessment of Potentially Inappropriate Medications Using the EU (7)-PIM List, in a Sample of Portuguese Older Adults' Residents in Nursing Homes

Abstract

Prescription of potentially inappropriate medication (PIM) in older adults is associated with poor clinical outcomes. The EU (7)-PIM list was created for the European market to improve pharmacotherapy in older adults.

Purpose

This work aims to characterize the medication profile and assess the presence of PIM, using the EU (7)-PIM list in older adults’ residents at nursing homes.

Methods

Retrospective data were collected from the anonymized nursing home records. After PIM identification, a descriptive analysis was performed, and a generalized linear model for dependent negative binomial-type variables was constructed to assess the risk of PIM.

Results

Of the 210 participants (mean age 85.10), 82.40% were polymedicated. PIM was observed in 86.4% participants (mean per patient = 2.30± 0.10). The most common PIM were proton pump inhibitors (n = 121, 57.62%), followed by anxiolytics (n = 96, 45.71%). 64.30% of all patients take 2–4 PIM and 5.80% take five or more PIM. The occurrence of PIM is influenced by the number of prescribed medicines (RR 1.14; 95% CI 1.1.-1.17) and the presence of digestive system diseases (RR 1.05; 95% CI 1.0–1.09).

Conclusion

The high prevalence of PIM observations highlights the necessity of the implementation of guidelines to prevent PIM.

Evaluation of the Real-World Effectiveness of Vaccines against COVID-19 at a Local Level: Protocol for a Test-Negative Case-Control Study

Vaccines against COVID-19 approved for use in the EU/EEA have been shown to be highly effective against wild-type SARS-CoV-2. However, their effectiveness against new variants may be reduced. This study aims to evaluate the effectiveness of vaccines against COVID-19 in the prevention of symptomatic and severe disease, during pre- and post-omicron phases. Individuals who sought treatment at the emergency department of a Portuguese hospital with COVID-19-like disease and were tested for SARS-CoV-2 are the subjects of the study. Patients who received a positive result are considered cases, while those with negative results are the controls. The test-negative case–control method is one of the study designs recommended by WHO to estimate the effectiveness of vaccines against COVID-19. The main advantage of this design is that it controls for the healthcare seeking bias, commonly present in traditional cohort and case–control designs. This study may have broad implications for understanding the real-world performance of the COVID-19 vaccines at the local level, which may play a key role in promoting adherence to vaccination. Moreover, this study may contribute to inform decisions regarding booster doses and variant-specific vaccine formulations leading to the control of this and future pandemics.

A qualitative study on the impact of death during COVID-19: Thoughts and feelings of Portuguese bereaved adults

As a global threat, the COVID-19 pandemic has been an important factor in increasing death rate worldwide. As the virus spreads across international borders, it causes severe illness, death, and disruptions in our daily lives. Death and dying rituals and customs aid bereaved people in overcoming their grief. In this sense, the purpose of this study was to access thoughts and feelings of Portuguese adults and the impact of the loss in daily life during COVID-19. A structured online questionnaire was applied (snowball sampling) and qualitative data on death and mourning namely the impact of the loss in daily life, was collected. One hundred and sixty-six individuals have lost someone since the beginning of the pandemic and were included. Analysis was inspired by Braun and Clark's content analysis. Most participants were female (66.9%), the median age was of 37.3 years, and 70.5% had a high education degree. Moreover, 30.7% of the participants present anxiety symptoms and 10.2% depression symptoms. The answers of studied participants gave insights on the extent of the loss in day-to-day life and four thematic themes were found: (1) The perceived inadequacy of the funeral rituality, (2) Sadness, fear and loneliness, (3) Changes in sleeping and concentration and increased levels of anxiety and (4) Concerns regarding the pandemic situation. We found a high prevalence of anxiety and depression symptoms in the study sample. Also, the changes in post mortem procedures, have shown to be of great importance in the mourning procedure of the participants.

Food Insecurity in Portugal during the COVID-19 Pandemic: Prevalence and Associated Sociodemographic Characteristics

Introduction

The current worldwide COVID-19 pandemic has been having a considerable impact not only on health but also on the economy of societies, emphasizing food insecurity as a significant public health concern.

Aim

The objective of this study was to characterize the scenario of food insecurity in Portugal during the COVID-19 pandemic and explore its related sociodemographic characteristics.

Methodology

This is a cross-sectional study, using data from an online survey, performed from November 2020 until February 2021, including 882 residents aged 18 years or older in Portugal. Data on sociodemographics and food security status were collected, the latter was evaluated using the United States Household Food Security Survey Module: Six-Item Short Form. Crude and adjusted logistic regression models were performed (covariates: education, household income perception, and the working status during the COVID-19 pandemic). The odds ratio (OR) and respective 95% confidence intervals (CI) were estimated.

Results

Most participants were women (71.3%), with a mean age of 36.8 years (SD 11.0). Food insecurity prevalence was 6.8%. Less-educated individuals (≤12 years of schooling; OR 2.966; 95% CI 1.250–7.042), and those who were and remained unemployed since the beginning of the pandemic (OR 2.602; 95% CI 1.004–6.742) had higher odds of belonging to a food-insecure household, regardless of education, working status during the COVID-19 pandemic, and household income perception. Moreover, lower odds of belonging to a food-insecure household were observed among those reporting a comfortable household income (OR 0.007; 95% CI 0.001–0.062) than those who perceived their household income as insufficient, independently of education and the working status during the COVID-19 pandemic.

Conclusions

These findings highlight the population groups that are at a greater risk of food insecurity during the current COVID-19 pandemic. Effective public health strategies should be developed aiming to address food insecurity during this crisis, especially among the higher risk groups.

The bad, the ugly and the monster behind the mirror - Food insecurity, mental health and socio-economic determinants

INTRODUCTION

Food insecurity is associated with poor mental health outcomes, including depression and anxiety and COVID-19 could increase these relations. In this sense, we aimed to explore the relationship between food insecurity and mental health features and behaviors in adults from Portugal.

METHODOLOGY

We conducted a cross-sectional online snowball study from November 2020 until February 2021. A total of 882 Portuguese residents 18 years of age or older with food security data were included. Data on socio-demographics, food security status, and anxiety and depression symptoms were collected. Crude and adjusted logistic regression models were performed. Odds ratio (OR) and respective 95% confidence intervals (CI) were estimated.

RESULTS

Most participants were women (71.3%), with a mean (SD) age of 36.8 (10.9) years, three-thirds had a university degree (76.7%), and 65.3% lived in the country's northern region. Regarding the characteristics associated with food insecurity, we observed that less-educated participants (OR = 7.84; 95% CI: 3.67-16.73), with depression symptoms (OR = 5.91; 95% CI: 3.12-11.19) and with anxiety symptoms (OR = 6.41; 95% CI: 3.02-13.59), had a higher odds of belonging to a food-insecure household. After adjustments less educated individuals (OR = 8.37; 95% CI: 3.81-18.35), those who faced a reduction in income (OR = 0.27; 95% CI: 0.13-0.53) and, presenting anxiety symptoms (OR = 7.32; 95% CI: 3.53-15.17) had a higher odds of belonging to a food-insecure household.

CONCLUSIONS

Approaching food insecurity without addressing mental health, and the opposite is making partial and reductive interventions. It is important to have an integrative approach.

The Rise and Fall of SARS-CoV-2 Variants

N/a.

Psychological Impact of the COVID-19 Pandemic and Social Determinants on the Portuguese Population: Protocol for a Web-Based Cross-sectional Study

BACKGROUND

The COVID-19 outbreak and consequent physical distance measures implemented worldwide have caused significant stress, anxiety, and mental health implications among the general population. Unemployment, working from home, and day-to-day changes may lead to a greater risk of poor mental health outcomes.

OBJECTIVE

This paper describes the protocol for a web-based cross-sectional study that aims to address the impact of the COVID-19 pandemic on mental health.

METHODS

Individuals from the general population aged 18 years or more and living in Portugal were included in this study. Data collection took place between November 10, 2020, and February 10, 2021. An exponential, nondiscriminative, snowball sampling method was applied to recruit participants. A web-based survey was developed and shared on social media platforms (eg, Facebook, Instagram, Twitter, LinkedIn, and WhatsApp groups) and through e-mail lists for recruitment of the seeds.

RESULTS

Data analysis will be performed in accordance with the different variables and outcomes of interest by using quantitative methods, qualitative methods, or mixed methods, as applicable. A total of 929 individuals had completed the web-based survey during the 3-month period; thus, our final sample comprised 929 participants. Results of the survey will be disseminated in national and international scientific journals in 2021-2022.

CONCLUSIONS

We believe that the findings of this study will have broad implications for understanding the psychological impact of the COVID-19 pandemic on Portuguese residents, as well as aspects related to the informal economy. We also hope that the findings of this study are able to provide insights and guidelines for the Portuguese government to implement action. Finally, we expect this protocol to provide a roadmap for other countries and researchers that would like to implement a similar questionnaire considering the related conclusions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/28071.

1284Food insecurity and mental health features and behaviours in adults from Portugal

Background

COVID-19 pandemic has been affecting population’s health and economies, in which food insecurity appears as important concern, particularly considering its associations with mental health and adverse behaviours. This study explored the relationship between food insecurity and mental health features and behaviours in adults from Portugal.

Methods

A cross-sectional study using data from an online survey was performed, including Portugal’s residents aged ≥18 years. Data on sociodemographics, behaviours, mental health features and food security status were collected. Food security status was evaluated with the United States Household Food Security Survey Module: Six-item Short Form. Chi-square test or Fisher's exact test, as appropriate, were used to explore the relationship between food security status and categorical variables.

Results

Food insecurity prevalence was 6.8%; showed to be significantly higher among less educated individuals (≤12 years of schooling) (p&lt;0.001), those who were employed and remained since the beginning of the pandemic (p&lt;0.001) and among those reporting need to be careful about expenses (p&lt;0.001). Comparing to individuals who were food secure, food insecure participants were more likely to smoke (p=0.009), to report depressive symptoms (p&lt;0.001) and anxiety (p&lt;0.001), measured by the Hospital Anxiety and Depression Scale.

Conclusions

From the present study, it can be concluded that the COVID-19 pandemic can affect food security in different subpopulations.

Key messages

The findings of this study have several implications for health policy and reinforce the need for investment in contexts of populations vulnerable to food insecurity

Thrombotic events and COVID-19 vaccines

COVID-19 vaccines are considered promising agents in the control of the pandemic. Although their safety was assessed in randomised clinical trials, severe adverse events (AEs) have been reported after large-scale administration. This study aims to evaluate thromboembolic AEs reported after vaccination in a real-world context and how they led to the interruption of vaccination campaigns. We also review the benefits and risks of the vaccines approved in the European Union and provide recommendations. A review of the literature was performed using Medline/PubMed electronic database as well as institutional and pharmacovigilance official reports. Our findings show that vaccine-induced prothrombotic immune thrombocytopenia has been suggested as a very rare AE associated with viral vector vaccines. Unusual thrombotic events combined with moderate-to-severe thrombocytopenia were reported mainly in women under 60 years of age. As safety signals emerged, Vaxzevria and Janssen´s COVID-19 vaccine campaigns have been paused while investigations proceed. On the other hand, the number of deep vein thrombosis and pulmonary embolism reports have not increased. Post-marketing surveillance indicated that mRNA vaccines are safe and should continue to be used. The thrombotic events report rate is not increased in people over 60 years. As they are at greater risk for COVID-19 complications and death, no vaccine restrictions are recommended in this group. Risk factors for vaccine-induced prothrombotic immune thrombocytopenia should be established so that evidence-based decisions can be made. Systematic monitoring of COVID-19 vaccine safety is essential to ensure that the benefits of vaccination outweigh the risks.

1287Grief and mourning and its relation with anxiety and depressive symptoms during COVID-19 pandemic

Background

During these unprecedented times, individuals who experience the sudden death of a family member or friend, already miss the anticipatory grief and are now also prevented from a proper farewell. This study aimed to address prolonged grief disorder since the beginning of the COVID-19 pandemic

Methods

A virtual snowball sampling survey was disseminated through social networking channels. The study enrolled participants from general resident population in Portugal with ≥18 years. Characteristics of the sample were summarized using descriptive statistics. Anxiety and depression symptoms are described by absolute and relative frequencies and compared through the Chi-square test.

Results

A total of 929 participants completed the survey; 17.9% (n = 166) have lost someone since the beginning of the pandemic, making our final sample. Most were female (66.9%); median age of 35 years and 70.5% had a high education degree. Participants who had lost a grandparent consisted of 28.3% of the sample, father and/or mother 9.0%, and a friend 22.3%. We found a prevalence of 30.7% of anxiety symptoms and 10.2% of depression symptoms (p = 0.030). Also, 16.8% have had a high score on the PG13, which show that these people can mourned for longer periods.

Conclusions

Paying the last tribute to a loved one is a mental health gesture that allows individuals to make amends and reconcile with life.

Key messages

The need arises to give timely attention to the psychological consequences due to the COVID-19 pandemic concerning grief

Knowledge and Use of PEP and PrEP Among Key Populations Tested in Community Centers in Portugal

Background: Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) have been increasingly available in Europe. Due to the high burden of HIV in key populations, these could benefit from their use. In 2016, in Portugal, an open, non-interval, prospective cohort study was established in a network of 26 community-based voluntary HIV/STI counseling and testing centers. Data collected included questions on PEP and PrEP knowledge and use. We aimed to estimate the proportion of PEP and PrEP knowledge and its use among key populations, visiting the centers between 2016 and 2019. Method and results: Individuals who self-identify as being among at least one key population for HIV, men who have sex with men (MSM), people who inject drugs (PWID), sex workers (SW), migrants, and male-to-female transgender individuals (MTF), responded to questions on PEP and PrEP knowledge and use while waiting for their test results between 2016 and 2019 (n = 12,893 for PEP; n = 10,973 for PrEP). Reported knowledge was low in all key populations for both tools: 15.7% of respondents reported knowing about PEP and 10.9% about PrEP over the course of 4 years. PEP was used by 1.8% and PrEP by 0.4% of the respondents, MSM being 88.9% of PrEP users, and 52.8% of PEP users. Multivariate logistic regression showed multiple factors associated with knowing the tools, including age, education, country of birth, gender, year of test, having a reactive HIV test in the same visit, reporting an STI or condomless sex in the last 12 months, and identifying with being MSM or SW. Conclusions: Knowledge and use of PEP and PrEP remain low among key populations in Portugal. The need remains to increase knowledge and use among those at risk for HIV infection.

The effect of denudation and injection timing in the reproductive outcomes of ICSI cycles: new insights into the risk of in vitro oocyte ageing

STUDY QUESTION

Does the time elapsed between oocyte pick-up (OPU) and denudation or injection affect the probability of achieving a live birth (LB) in ICSI cycles?

SUMMARY ANSWER

Prolonged oocyte culture before denudation (>4 h) was associated with an increase in clinical pregnancy (CP), LB and cumulative LB (CLB) rates when compared with earlier denudation timings.

WHAT IS KNOWN ALREADY

Oocyte maturation is a complex and dynamic process involving structural and biochemical modifications in the cell necessary to support fertilization and early embryo development. While meiotic competence is easily identifiable by the presence of an extruded first polar body, cytoplasmic maturation cannot be assessed microscopically. Culturing oocytes with their surrounding cumulus cells (CCs) prior to ICSI can enhance the completion of in vitro cytoplasmic maturation; conversely, prolonged culture may induce cell degeneration. The optimal culture intervals prior to oocyte denudation and/or injection have not yet been established and may prove relevant for the improvement of ICSI reproductive outcomes.

STUDY DESIGN, SIZE, DURATION

This is a single-centre retrospective cohort analysis of 1378 ICSI cycles performed between January 2005 and October 2018. Data were categorized according to: (i) the time interval between OPU and denudation (<3 h, 3-4 h and ≥4 h), (ii) the time interval between denudation and ICSI (<1.5 h, 1.5-2 h, ≥2 h) and (iii) the time interval between OPU and ICSI (<5 h, 5-6 h and ≥6 h). The effect of these timings on fertilization, CP, LB and CLB rates were compared. The culture intervals between different procedures were dependent exclusively on laboratory workload.

PARTICIPANTS/MATERIALS, SETTING, METHODS

ICSI cycles performed in women younger than 40 years old using autologous gametes with at least one metaphase II injected oocyte were included. The effect of oocyte culture duration prior to denudation and injection of the oocytes was compared using multivariable regression accounting for potential confounding variables.

MAIN RESULTS AND THE ROLE OF CHANCE

Fertilization and oocyte damage rate after ICSI was found to be independent of the time interval to denudation (<3 h, 3-4 h and ≥4 h) and/or injection (<5 h, 5-6 h and ≥6 h). Extending oocyte culture before denudation significantly improved CP (29.5%, 42.7% and 50.6%, respectively), LB (25.1%, 34.4% and 40.7%, respectively) and CLB rates (26.0%, 36.1% and 42.2%, respectively), particularly if the time interval was at least 4 h. Additionally, LB (31.7%, 35.8% and 27.4%, respectively) and CLB rates (34.2%, 36.6% and 27.7%, respectively) were also dependent on the time from OPU to injection.

LIMITATIONS, REASONS FOR CAUTION

This study is limited by its retrospective nature and potential unmeasured confounding cannot be excluded. Furthermore, the effect of even shorter or longer periods of culture before denudation and/or injection were not evaluated and should not be extrapolated from these results.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings propose new evidence of a previously unrecognized protective effect of the CCs-oocyte interactions in human ART, raising the question of a possible downstream effect in embryogenesis which significantly affects LB rates. Additionally, this is the first study to suggest a negative effect of further extending culture before ICSI on LB and CLB rates, thus potentially allowing for the narrowing of an optimal ICSI time interval. Simple strategies such as the establishment of more effective time frames to perform these procedures and adjusting laboratory practice may prove beneficial, ultimately improving ICSI reproductive outcomes.

STUDY FUNDING/COMPETING INTEREST(S)

None.

TRIAL REGISTRATION NUMBER

N/A.

Different disease, same challenges: Social determinants of tuberculosis and COVID-19

Infectious diseases, such as tuberculosis (TB) and the novel coronavirus (COVID-19) relate to environmental factors, understanding of which is essential to inform policy and practice and tackle them effectively.

The review follows the conceptual framework offered by the World Health Organization Commission on Social Determinants of Health (defined as “all those material, psychological and behavioural circumstances linked to health and generically indicated as risk factors’ in the conventional epidemiological language”). It describes the social factors behind TB and COVID-19, the commonalities between the two diseases, and what can be learned so far from the published best practices.

The social determinants sustaining TB and COVID-19 underline the importance of prioritising health and allocating adequate financial and human resources to achieve universal health coverage and health-related social protection while addressing the needs of vulnerable populations. Rapid and effective measures against poverty and other major social determinants and sources of inequality are urgently needed to develop better health in the post-COVID-19 world.

O JARDIM VENENOSO: A QUÍMICA POR TRÁS DAS INTOXICAÇÕES DOMÉSTICAS POR PLANTAS ORNAMENTAIS

THE POISONOUS GARDEN: THE CHEMISTRY BEHIND THE INTOXICATION BY DOMESTIC ORNAMENTAL PLANTS. In times of the COVID-19 pandemic, despite the fact families have spent more time together, the job demands and commitments that adults have now brought into their homes may mean their attention has been taken away from their children. This, combined with the absence of older family members or domestic helpers that assist in looking after the children has left them potentially more exposed to domestic accidents. Data from the National Toxic-Pharmacological Information System indicate that two-thirds of domestic intoxications with plants (usually the ornamental ones) occur in children. These accidents can be caused either by inhalation, contact with the skin, eyes and mucous membranes, as well as by ingestion. The toxicity of ornamental plants is due to the presence of substances such as oxalic acid and its highly irritating salts, alkaloids, glycosides, flavonoids, and toxic terpenes, among several other classes of secondary metabolites. In the present study, we carried out a survey of the main ornamental plants used in the country and analyzed the toxic substances that can cause numerous conditions from dermatitis in milder cases to death in more severe cases.

Grief and Mourning during the COVID-19 Pandemic in Portugal

N/a.

The 8-item Morisky medication adherence scale: validation of a Portuguese version in HIV patients

Background

Antiretroviral therapy (ART) has the most effective treatment for people with HIV, but its effectiveness depends on the individual medication adherence. Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used scales to assess patient adherence. Thus, we aimed to validate a Portuguese version of MMAS-8 and determine its psychometric properties in HIV positive patients.

Methods

A cross-sectional survey was conducted in Centro Hospitalar Universitário São João (Porto, northern Portugal) at the infectious diseases department. After authorization to use the scale - granted by the author - and, a standard forward-backwards procedure to translate MMAS-8 to Portuguese, the questionnaire was applied to 233 patients with HIV doing ART. Reliability was assessed using Cronbach's alpha and test-retest reliability. Three levels of adherence were considered: 0 to &lt; 6 (low), 6 to &lt; 8 (medium), 8 (high).

Results

In the studied sample, the mean age was 45.03 years (SD = 11.63), 80.3% men, 19.3% women and 1 transgender, and 53.8% had ≤9 years of education. The mean number of prescribed ART per patient was 1.76. The mean score for the medication adherence scale was 7.29 (SD = 6.74). For the reliability analysis, 12 patients were excluded due to missing data (n = 221). Regarding the level of adherence, 22.5% were low adhering, 71.6% medium and 5.9% high. Corrected item-total correlations showed that 1 item does not correlate very well with the overall scale and was dropped. Scale reliability analysis for the remaining 7 items revealed an overall Cronbach's alpha of 0.661. Women had a protective effect on adherence (OR = 0.31;95%CI:0.15-0.66). Number of years doing ART, age of participants, and type of residence didn't show to be correlated with adherence.

Conclusions

MMAS-8 is a reliable and valid measure to detect patients at risk of non-adherence. A satisfactory Cronbach's alfa (0.661) was obtained. In general, adherence to medication was medium or high.

Key messages

This scale can be applied nationwide in other different hospitals, as it could serve as a tool for measuring adherence to ART that can allow for better health care to the ones that are low adhering. A Portuguese version of the MMAS-8 was created for measuring adherence to ART that maintained a similar structure to the original MMAS-8 and good psychometric properties.

HIV test and knowledge of U=U: insights from MSM living in Portugal and participating in EMIS 2017

Recently, it became clear that undetectable equals untransmittable (U=U), stressing the importance of engaging in medical care and adhering to antiretroviral therapy. HIV testing and counselling (HTC) are offered in different settings and can be an opportunity to inform people. We aimed to understand if HIV testing history, including recency, place and, result, was associated with U=U knowledge.

We used data from 2242 MSM living in Portugal participating in EMIS 2017 that answered if they already knew that “A person with HIV who is on effective treatment (called 'undetectable viral load') cannot pass their virus to someone else during sex”, opting of 5 possible answers, dichotomized in “I already knew” vs. any other option. Regarding HIV testing history, participants were categorized as follows:1. HIV positive; 2. HIV negative and last test ≤12 months in a community setting; 3. HIV negative and last test ≤12 months in a medical setting, and 4. never tested for HIV or last test &gt;12 months or tested in other settings (reference). Logistic regression models were fitted to estimate crude and city size and education-adjusted associations.

The median (P25; P75) age of participants was 34 (25; 43) years. No significant statistical association was found with age or current occupation. Those with more years of education and living in a big or very big city were more likely to know that U=U (aOR:1.55; 95%CI:1.20-1.99 and aOR:1.26; 95%CI:1.04-1.53, respectively). Considering HIV testing history and diagnosis, men with diagnosed HIV (aOR:6.33; 95%CI:4.50-8.90), those who had the last test in community setting (aOR:2.44; 95%CI:1.87-3.17) and those who had the last test in a medical setting (aOR: 1.57; 95%CI:1.26-1.95) were more aware of U=U than those not tested in the last 12 months.

Our results suggest that there is a gradient of U=U knowledge associated with HIV testing history among MSM. Efforts should focus on improving counselling about U=U at all HIV testing settings.

Key messages

The knowledge of U=U seems to be associated with the place, recency and result of the last HIV test. Counselling should focus on the best evidence available at all HIV testing settings, to inform and empower the individuals.

Organizational innovation in the context of family farms: lean diagnosis

Family farming has been on the agenda worldwide. Portugal is no exception. Act No. 64/2018, published in 2018, establishes the Family Farming Statute. Its preponderance in food and in the sustainability of families and territories has been reinforced by the sustainable development paradigm. However, competitiveness constraints assigned to the production system is often seen as an obstacle. Combining the theoretical frameworks of integrated agriculture and work organizations, we offer a lean sociological perspective on family farms producing lettuce. We concluded that their production system is characterized by a set of innovative practices very close to a lean approach. However, there is room for improvements in a production system that seems to maintain a family-based workforce and traditional know-how.

Association of prenatal maternal perceived stress with a sexually dimorphic measure of cognition in 4.5-month-old infants

Maternal prenatal stress can adversely impact subsequent child neurodevelopment, but little is known about its effect on cognitive development in infancy. This analysis of 107 infants from a prospective birth cohort assessed whether prenatal stress disrupts sexually dimorphic performance typically observed on a physical reasoning task. Maternal stress was assessed at 8-14 and 33-37 gestational weeks using the Perceived Stress Scale. Stress was defined as: low (scores below the median at both times), medium (scores above the median at one of the two times), and high (scores above the median at both times). At 4.5 months infants saw videos of two events: one impossible and the other possible. In the impossible event a box was placed against a wall without support underneath. In the possible event the box was placed against the wall, supported by the floor. Looking time at each event was recorded via infrared eye-tracking. Previous literature has shown that, at 4.5 months of age, girls typically look significantly longer at the impossible than at the possible event, suggesting that they expect the unsupported box to fall and are surprised when it does not. Boys tend to look equally at the two events suggesting that they do not share this expectation. This sex difference was replicated in the current study. General linear models stratified by sex and adjusted for household income, maternal education, mother's age at birth, infant's age at exam, and order of event presentation revealed that girls whose mothers reported high perceived stress during pregnancy had shorter looking time differences between the impossible and possible events than girls whose mothers reported low perceived stress (β = -7.1; 95% CI: -12.0, -2.2 s; p = 0.006). Similar to boys, girls in the highest stress category spent about the same amount of time looking at each event. For boys, there were no significant looking time differences by maternal stress level. This finding suggests prenatal stress is associated with a delay in the development of physical reasoning in girls.

A Distributed Multi-Tier Emergency Alerting System Exploiting Sensors-Based Event Detection to Support Smart City Applications

The development of efficient sensing technologies and the maturation of the Internet of Things (IoT) paradigm and related protocols have considerably fostered the expansion of sensor-based monitoring applications. A great number of those applications has been developed to monitor a set of information for better perception of the environment, with some of them being dedicated to identifying emergency situations. Current IoT-based emergency systems have limitations when considering the broader scope of smart cities, exploiting one or just a few monitoring variables or even allocating high computational burden to regular sensor nodes. In this context, we propose a distributed multi-tier emergency alerting system built around a number of sensor-based event detection units, providing real-time georeferenced information about the occurrence of critical events, while taking as input a configurable number of different scalar sensors and GPS data. The proposed system could then be used to detect and to deliver emergency alarms, which are computed based on the detected events, the previously known risk level of the affected areas and temporal information. Doing so, modularized and flexible perceptions of critical events are provided, according to the particularities of each considered smart city scenario. Besides implementing the proposed system in open-source electronic platforms, we also created a real-time visualization application to dynamically display emergency alarms on a map, demonstrating a feasible and useful application of the system as a supporting service. Therefore, this innovative approach and its corresponding physical implementation can bring valuable results for smart cities, potentially supporting the development of adaptive IoT-based emergency-aware applications.