Assessing the trophic ecology and migration on the exposure of cape petrels and Wilson's storm petrels from Antarctica to perfluoroalkylated substances, trace and major elements

Chemical pollution is a global concern as contaminants are transported and reach even the remote regions of Antarctica. Seabirds serve as important sentinels of pollution due to their high trophic position and wide distribution. This study examines the influence of migration and trophic ecology on the exposure of two Antarctic seabirds, Wilson's storm petrel (Oceanites oceanicus - Ooc), and Cape petrel (Daption capense - Dca), to chemical elements and perfluoroalkyl substances (PFAS). Our methodology involved assessing the concentration of these pollutants in feather samples obtained from carcasses, offering a practical means for monitoring contamination. Trace and major element concentrations were comparable in both species, suggesting that migratory patterns have a minimal impact on exposure levels. However, Ooc had higher concentration of PFAS compared to Dca (mean, ng g-1dry weight, PFOA: Ooc:0.710, Dca:0.170; PFTrDA: Ooc:0.550, Dca:0.360, and PFTeDA: Ooc:1.01, Dca:0.190), indicating that migration to the more polluted Northern Hemisphere significantly affects PFAS exposure. Furthermore, while no strong associations were found between either trace elements or PFAS and the three stable isotopes (δ13C, δ15N, and δ34S), a negative association was observed between PFUnDA and δ15N, hinting at potential biodilution. The research concludes that the migratory patterns of these seabird species affect their PFAS exposure, underscoring the critical need for further exploration and understanding of these relationships to better inform conservation strategies.

A Preliminary Evaluation of Sex and Dietary Field Pea Effects on Sensory Characteristics of Dry-Cured Loins

Two of the main issues related to cured meat products are castration to avoid boar taint and the hefty reliance on soybean meal to feed pigs. However, data on the effects of immunocastration in pigs and alternative crop protein feeds on the sensory traits and consumers' acceptance of dry-cured loin are still limited. A preliminary study was conducted on the effect of sex type (surgical castrated male pigs and immunocastrated male and female pigs, at approximately 140 kg in weight and 7 months of age) and animal diet (pea vs. soya) on dry-cured loins. The study involved a sensory evaluation of six treatments, with a 3 × 2 factorial design, conducted by trained panellists and untrained consumers in Spain (n = 126) and Portugal (n = 80). The consumers were also checked for their skatole sensitivity using a pure substance. The results showed that the pea-based diet was significantly different (p < 0.001) from the soy-based diet, as determined by a trained panel of surgically castrated male pigs, although the immunocastration treatments were not split. Dry-cured loin from immunocastrated male pigs fed with peas was considered tenderer and juicier (p < 0.05) than those fed soya-based diets. The untrained consumer panel scored higher on the sensory traits (flavour, juiciness, and overall liking) from the loin samples of surgically castrated male pigs fed a pea diet. All consumers scored similarly in boar taint detection. This study demonstrates the applicability of the pea-based diet for the feeding of pigs destined for cured meat and highlights immunocastration as a tool that does not compromise the skatole detection score.

Can Near-Infrared Spectroscopy Replace a Panel of Tasters in Sensory Analysis of Dry-Cured Bísaro Loin?

This study involved a comprehensive examination of sensory attributes in dry-cured Bísaro loins, including odor, androsterone, scatol, lean color, fat color, hardness, juiciness, chewiness, flavor intensity and flavor persistence. An analysis of 40 samples revealed a wide variation in these attributes, ensuring a robust margin for multivariate calibration purposes. The respective near-infrared (NIR) spectra unveiled distinct peaks associated with significant components, such as proteins, lipids and water. Support vector regression (SVR) models were methodically calibrated for all sensory attributes, with optimal results using multiplicative scattering correction pre-treatment, MinMax normalization and the radial base kernel (non-linear SVR model). This process involved partitioning the data into calibration (67%) and prediction (33%) subsets using the SPXY algorithm. The model parameters were optimized via a hybrid algorithm based on particle swarm optimization (PSO) to effectively minimize the root-mean-square error (RMSECV) derived from five-fold cross-validation and ensure the attainment of optimal model performance and predictive accuracy. The predictive models exhibited acceptable results, characterized by R-squared values close to 1 (0.9616-0.9955) and low RMSE values (0.0400-0.1031). The prediction set's relative standard deviation (RSD) remained under 5%. Comparisons with prior research revealed significant improvements in prediction accuracy, particularly when considering attributes like pig meat aroma, hardness, fat color and flavor intensity. This research underscores the potential of advanced analytical techniques to improve the precision of sensory evaluations in food quality assessment. Such advancements have the potential to benefit both the research community and the meat industry by closely aligning their practices with consumer preferences and expectations.

Mercury exposure in Antarctic seabirds: Assessing the influence of trophic position and migration patterns

Although naturally present in the environment, mercury (Hg) input is significantly amplified by anthropogenic activities on a global scale, leading to a growing concern about the recent increase in Hg levels observed in Antarctica. This study investigated total mercury (THg) concentrations in feathers and eggs of resident and migratory Antarctic seabirds. Stable isotope data (δ15N, δ13C, and δ34S) were employed to ascertain the key factors influencing the exposure of these species to Hg. We gathered feathers and eggs from three resident species - Adélie, Gentoo, and Chinstrap penguins, as well as five migratory species - Snowy Sheathbill, Antarctic Tern, Southern Giant Petrel, Kelp Gull, and South Polar Skua. These samples were collected from Admiralty Bay, King George Island, in the Antarctica Peninsula. For all species, THg concentrations were higher in feathers (mean ± SD: 2267 ± 2480 ng g-1 dw) than in eggs (906 ± 1461 ng g-1 dw). Species occupying higher trophic positions, such as the Southern Giant Petrel (5667 ± 1500 ng g-1 dw) and South Polar Skua (4216 ± 1101 ng. g-1 dw), exhibited higher THg levels in their feathers than those at lower positions, like Antarctic Tern (1254 ± 400 ng g-1 dw) and Chinstrap Penguin (910 ± 364 ng g-1 dw). The δ15N values, which serve as a proxy for the trophic position, significantly correlated with THg concentrations. These findings reveal that trophic position influences THg concentrations in Antarctic seabirds. Migration did not appear to significantly affect the exposure of seabirds to THg, contrary to initial expectations. This research highlights the importance of evaluating the impacts of THg contamination on the Antarctic ecosystem by considering a variety of species. This multi-species approach offers critical insights into the factors that may potentially influence the exposure of these species to contaminants.

Intraoperative Coronary Spasm: A Potential Case of Vasospastic Angina

Prinzmetal's angina typically features spasms of the coronary arteries due to the hyperreactivity of the vascular smooth muscle cells of the vessels to a nonspecific stimulus. Reports of coronary spasm during general anesthesia are rare, but in such cases, diagnosis is suggested by a framework of angina at rest and changes in the electrocardiogram (ECG) or coronary reactivity tests with ergonovine or acetylcholine. The present study describes a case of coronary spasm induced by general anesthesia associated with several cardiovascular risk factors and the usage of vasoactive drugs that was documented by angiography without using stimulating drugs and treated with intracoronary nitroglycerin. The patient was a 58-year-old male who was designated for carotid endarterectomy due to the stenosis (70%) of the right internal carotid artery by an atheromatous plaque after visiting the emergency department with a sensorimotor deficit in the left upper limb and bifrontal headaches with sudden onset. During the surgical intervention, after the administration of 10 mg of intravenous ephedrine, cardiorespiratory arrest occurred, with alternation between defibrillable and non-defibrillable heart paces. After the recovery of spontaneous circulation after 50 minutes of resuscitation maneuvers, the patient was transported to the hemodynamics laboratory, where there were recurrent episodes of ventricular fibrillation during the angioplasty of the anterior descending artery. After direct stent implantation, pre- and post-stent spasms were verified and reversed after the administration of intracardiac nitroglycerin. The spasm was a possible complication of anesthesia and responded to treatment with nitrates and calcium channel blockers. We would like to emphasize the importance of cardiac monitoring during surgery and anesthesia.

Novel Approaches to Improve Meat Products' Healthy Characteristics: A Review on Lipids, Salts, and Nitrites

Meat products are a staple of many diets around the world, but they have been subject to criticism due to their potential negative impact on human health. In recent years, there has been a growing interest in developing novel approaches to improve the healthy characteristics of meat products, with a particular focus on reducing the levels of harmful salts, lipids, and nitrites. This review aims to provide an overview of the latest research on the various methods being developed to address these issues, including the use of alternative salts, lipid-reducing techniques, and natural nitrite alternatives. By exploring these innovative approaches, we can gain a better understanding of the potential for improving the nutritional value of meat products, while also meeting the demands of consumers who are increasingly concerned about their health and well-being.

Salmonella spp., Escherichia coli and Enterobacteriaceae Control at a Pig Abattoir: Are We Missing Lairage Time Effect, Pig Skin, and Internal Carcass Surface Contamination?

To provide meat safety and consumer protection, appropriate hygiene control measures at an abattoir are required. This study aimed to evaluate the influence of visual fecal contamination level (VFCL) and lairage time (LT) on pig skin (PS) and external (ECS) and internal (ICS) carcass surfaces. The presence of Enterobacteriaceae, Escherichia coli (E. coli) and Salmonella in PS, ECS, and ICS were evaluated. A total of 300 paired samples were collected from 100 pigs. Results underlined the importance of the skin (Enterobacteriaceae: 3.27 ± 0.68 log CFU/cm2; E. coli: 3.15 ± 0.63 log CFU/cm2; Salmonella: 21% of samples) as a direct or indirect source of carcass contamination. Although VFCL revealed no significant effect (p > 0.05), the increase of LT had a significant impact (p < 0.001) on Enterobacteriaceae and E. coli levels across all analysed surfaces, and Salmonella presence on ICS (p < 0.01), demanding attention to LT. Also, the ICS showed a higher level of these bacteria compared to ECS. These results highlight the need of food business operators to consider ICS as an alternative area to sample for Salmonella, as a criterion for process hygiene based on EC Regulation No. 2073/2005, and as a potential contamination source to be integrated in the hazard analysis critical control point (HACCP) plans.

The effect of TB patient delay on loss to follow-up in Portugal

BACKGROUND: Early identification of TB cases, followed by treatment to completion, are essential for controlling and preventing the disease. Previous studies have found some factors associated with both loss to follow-up (LTFU) and patient delay. We aim to build a causal model to investigate the association between TB patient delay and LTFU.METHODS: Pulmonary TB cases were identified using the national surveillance system in Portugal between 2008 and 2017. A directed acyclic graph was used to identify the minimal set of variables to adjust for when studying the association between delay (exposure) and LTFU (outcome). Crude and adjusted hazard were estimated using Cox regression.RESULTS: Nearly 4% of the patients did not follow up treatment. There was no association between patient delay and LTFU, even after adjustment with the minimal set of covariates. Factors associated with a higher risk of LTFU were being younger, being unemployed, living in urban areas, having HIV and the abuse of alcohol and drugs.CONCLUSION: Patient delay was not associated with LTFU, while social conditions were. Future research should investigate the underlying reasons why patients discontinue TB treatment and use these findings to develop targeted interventions that can support patients in completing their treatment regimen.

Did the Addition of Olive Cakes Obtained by Different Methods of Oil Extraction in the Finishing Diet of Bísaro Pigs Affect the Volatile Compounds and Sensory Characteristics of Dry-Cured Loin and "Cachaço"?

This study was conducted to determine the effects of different types of olive cake in the basal diet of Bísaro pigs on the volatile compounds and sensory characteristics of dry-cured loin and "cachaço". A total of 40 Bísaro breed animals were allocated to four treatments, along with a control group (T1-control, T2-crude olive cake, T3-centrifugation two phases, T4-exhausted, and T5-exhausted with 1% of olive). Various extraction methods (centrifugation, pressing, and exhaustion) were employed for the olive cake used. Furthermore, the extracted olive cake was supplemented with 1% olive oil. Eighty compounds were identified and grouped into eight chemical classes: hydrocarbons, aldehydes, esters, alcohols, ketones, acids, furans, and other compounds. Aldehydes and alcohols were the major groups of compounds, representing 57.06-66.07% and 68.67-75.61% for the loin and "cachaço", respectively. There were no significant differences between treatments for any of the volatile compounds identified. The major aldehydes were hexanal, heptanal, pentanal, and propanal. These compounds were significantly higher (p < 0.001) in "cachaço". This significant difference between the two types of dry-cured products was directly related to the amount of total fat content. The major alcohols were 2.3-butanediol, 1-octen-3-ol, 1-butanol, 3-methyl, 1-hexanol, benzyl-alcohol, and glycidol. Except for compounds 2,3-butanediol and benzyl-alcohol, the majority in this group were significantly different in terms of the type of dry-cured product. As for the sensory evaluation, for both dry-cured products, the trained tasters did not detect significant differences between the different treatments. The results showed that the olive cake obtained by different methods of oil extraction did not negatively affect the sensory and volatile components of the processed meat products; thus, they maintained their appeal to the consumer.

SVM Regression to Assess Meat Characteristics of Bísaro Pig Loins Using NIRS Methodology

This study evaluates the ability of the near infrared reflectance spectroscopy (NIRS) to estimate the aW, protein, moisture, ash, fat, collagen, texture, pigments, and WHC in the Longissimus thoracis et lumborum (LTL) of Bísaro pig. Samples (n = 40) of the LTL muscle were minced and scanned in an FT-NIR MasterTM N500 (BÜCHI) over a NIR spectral range of 4000-10,000 cm^-1 with a resolution of 4 cm^-1. The PLS and SVM regression models were developed using the spectra's math treatment, DV1, DV2, MSC, SNV, and SMT (n = 40). PLS models showed acceptable fits (estimation models with RMSE ≤ 0.5% and R² ≥ 0.95) except for the RT variable (RMSE of 0.891% and R² of 0.748). The SVM models presented better overall prediction results than those obtained by PLS, where only the variables pigments and WHC presented estimation models (respectively: RMSE of 0.069 and 0.472%; R² of 0.993 and 0.996; slope of 0.985 ± 0.006 and 0.925 ± 0.006). The results showed NIRs capacity to predict the meat quality traits of Bísaro pig breed in order to guarantee its characterization.

Multisectoral approach to address Female Genital Mutilation: a case study from Portugal

Issue

Female genital mutilation (FGM) comprises all procedures that injury female genital organs for non-medical reasons, with several health impacts. Due to global migration, FGM has been increasingly recognised as a healthcare issue in Europe, affecting nearly 1 million women. In Portugal it is estimated that 5483 migrant women have undergone FGM in the Lisbon region. Intervention is required to tackle this issue.

Description

Portugal launched the “Healthy Practices: End of FGM”, a multiagency project targeting Lisbon and Tagus Valley region. Project implementation started in Nov 2018 at 5 local public health units (PHU) and was scaled-up to 5 more in Feb 2020. Project comprises 3 main axes: 1) inclusion in public policy instruments; 2) professionals’ education and awareness; and 3) community intervention. We describe inclusion of FGM in public policy, professionals training and changes in FGM recording before and after intervention.

Results

Between 2018-2022, inclusion of FGM in municipalities’ migration policies doubled. Between 2019-2021, 110 training sessions (n = 1722 professionals) were promoted. During pandemic years, only 344 (2020) and 202 (2021) were trained. Raising awareness and empowerment to risk communities happened mainly through local/online open sessions, workshops, flyer distribution, video projections. These occurred in all 10 PHU, mostly through partnerships with Non-Governmental Organizations and municipalities. According to the Portuguese Health Records, until 2018 there were only 300 women registered with FGM. Between 2019-2021, 363 more were added.

Lessons

The multisectoral approach allowed PHU professionals to collaborate directly with external organizations from different society sectors. COVID-19 pandemic posed a challenge to implementation, especially in the community intervention axis. Notification numbers increased after interventions, though causality could not be established and impact evaluation is yet to be performed.

Key messages

• Multisectoral projects for FGM intervention have specific implementation challenges, including how to justify and evaluate them, that must be considered in each setting.

• Training health professionals might increase identification and notification of FGM, but the impact in preventing FGM in the Portuguese reality is still largely unknown.

Multi-drug and β-lactam resistance in Escherichia coli and food-borne pathogens

 

Antimicrobial resistance (AMR) is one of the top ten global public health threats facing humanity by menacing the effective use of available antimicrobials for treatment of an ever-increasing range of infections caused by bacteria. Its potential recognize the transmission to humans by contact with commensal and zoonotic resistant bacteria from animal and food sources. The aim of this study is to describe multi-drug resistance (MDR) profile in Campylobacter (n = 541), Salmonella (n = 919) and commensal Escherichia coli (n = 2777) isolated from animal and food samples between 2014 and 2019 in Portugal. Antimicrobial susceptibility testing results to fluoroquinolones/quinolones, macrolides, 3rd generation cephalosporins, polymyxins, carbapenems, penicillins, aminoglycosides, tetracyclines, sulphonamides, trimethoprim and chloramphenicol were clustered using k-modes. Clusters were described by population (broilers, broilers meat, turkeys, pigs, pig meat), AMR classification (mono/dual-resistance, MDR to 3-4, 5-6 and ≥7), β-lactamases production, sample stage (farm, slaughterhouse, processing plant, retail), season, and year. Overall, the results suggest an escalating MDR behavior from farm to post-farm stages in all bacteria, including E. coli MDR to critically important antimicrobials, and that Salmonella (fluoro)quinolones resistance may be associated with broilers. Most ESBL/AmpC producing E. coli were resistant to both C3G and C4G in isolates from animal and food samples (respectively, 77%; n = 846; and 74%; n = 188). The statistical method, K-modes, offers an overall visualization of the data with the identification of AMR profiles that have been further described using surveillance variables. Our results provide relevant information to support policy and decision making to tackle MDR in farm and post-farm stages.

Key messages

• An escalating multi drug resistance behavior from farm to post-farm stages.

• Escherichia coli multi drug resistance to critically important antimicrobials.

Chemical, Physicochemical and Sensorial Characterization of Nitrite-Free Dry-Cured Bísaro Shoulders

The aim of the current experiment was to characterize and evaluate the effect of the dry-curing process on chemical composition, physicochemical properties, and sensory characteristics of the dry-cured Bísaro shoulders. For this purpose, thirty-eight raw forelegs were used, and no nitrites were added during the dry-curing process. This process increased protein, fat, ash content, and pH, with a decrease in moisture and water activity (p < 0.001). The dry-cured shoulders were darker (L*), less red (a*), and less yellow (b*) than the raw shoulders (p < 0.001), and this may be mainly due to the moisture reduction. The proportion of polyunsaturated fatty acids (PUFA) decreased during processing, whereas the saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) increased (p < 0.001), which could be related with the oxidative degradation. The sensory analysis showed that dry-cured Bísaro shoulders presented similar organoleptic characteristics to other dry-cured meat products. Also, the chemical composition and fatty acid profile of the dry-cured Bísaro shoulder showed results comparable to those of other cured products. This study revealed that it is possible to obtain safer and healthier dry-cured Bísaro shoulder products judging by these characteristics, since nitrites were not added in its preparation. These findings, along with the product’s high sensory attributes similar to more popular products such as ham, would give more advantage for its acceptability and market demand.

Use of Olive and Sunflower Oil Hydrogel Emulsions as Pork Fat Replacers in Goat Meat Burgers: Fat Reduction and Effects in Lipidic Quality

Diversified strategies to incorporate healthier lipids in processed meat products are being developed. Alternative fat sources to replace animal fat associated with the reduction of fat content are some of the methods used to obtain healthier meat products well recognized by consumers. In order to create a healthier product that can also be consumed in the Halal and Kosher consumer markets, an experimental study was developed to assess the effects of replacing the pork fat (4%) with the same amount of hydrogel emulsion incorporating olive oil or sunflower oil. Three burgers were randomly selected from each lot manufactured and analyzed in triplicate. Burgers were physicochemical analyzed for pH, water activity, composition, fatty acid profile, color, yield, texture, oxidative stability, and volatile compounds and compared according to the fat source. Burgers with hydrogel emulsions can be considered reduced-fat meat products with a healthier fatty acid profile than pork fat burgers. The use of hydrogel emulsions did not negatively affect the quality characteristics assessed in the product and improved the oxidative stability during the storage of cooked burgers. By the characteristics and formulations evaluated, the replacement of pork fat with olive oil hydrogel emulsion proved to be the most effective strategy for obtaining a healthier goat meat product.

Abstract 098: Double Deletion Of At 1a Receptors And Na + /h + Exchanger 3 In The Proximal Tubules Attenuates Angiotensin Ii-induced And 2k1c Goldblatt Hypertension In Proximal Tubule-specific Pt- Agtr1a -/- / Nhe3 -/- Mice

We have previously shown that genetic deletion of AT 1 (AT 1a ) receptors or Na + /H + exchanger 3 (NHE3) selectively in the proximal tubules attenuated the development of angiotensin II (Ang II)-induced hypertension in mice. The present study determined whether double deletion of AT 1a receptors and NHE3 selectively in the proximal tubules further attenuates the development of Ang II-induced or 2-kidney, 1-clip (2K1C) Goldblatt Hypertension. Proximal tubule-specific AT 1a receptor and NHE3 double knockout mice, PT- Agtr1a -/- / Nhe3 -/- , were generated using the iL- Sglt2-Cre / LoxP approach. Adult male wild-type (WT), PT- Agtr1a -/- , PT- Nhe3 -/- , and PT- Agtr1a -/- / Nhe3 -/- double knockout mice were treated with vehicle (or sham as time-controls), a slow pressor dose of Ang II infusion for 2 weeks (500 μg/kg body wt./day, i.p.), or induction of 2K1C Goldblatt hypertension by placing a silver clip (0.12 mm) on the left renal artery for 4 weeks, respectively. In WT mice, control systolic blood pressure was 118 ± 3 mmHg (n=9), which increased to ~143 ± 5 mmHg in response to Ang II infusion ( P <0.01, n=10) or to induction of 2K1C Goldblatt hypertension (n=12, P <0.01). By comparison, control systolic blood pressure was 15 ± 2 mmHg lower in age-matched PT- Agtr1a -/- mice ( P <0.01), or 13 ± 3 mmHg lower in PT- Nhe3 -/- mice than WT mice ( P <0.01). Double deletion of AT 1a receptors and NHE3 selectively in the proximal tubules further but only moderately decreased basal blood pressure to 98 ± 2 mmHg in PT- Agtr1a -/- / Nhe3 -/- double knockout mice ( P <0.05, n=10). In response to Ang II infusion, systolic blood pressure increased only to ~126 ± 3 mmHg in PT- Agtr1a -/- or PT- Nhe3 -/- mice ( P <0.01). Interestingly, 2K1C Goldblatt hypertension was markedly attenuated in PT- Agtr1a -/- (108 ± 3 mmHg, P <0.01, n=10), PT- Nhe3 -/- (110 ± 2 mmHg, P <0.01, n=10), or PT- Agtr1a -/- / Nhe3 -/- double knockout mice (103 ± 2 mmHg, P <0.01, n=8), respectively. Taken together, these data strongly support the hypothesis that the intratubular Ang II/AT 1a receptor/NHE3 signaling plays a key role in maintaining basal blood pressure homeostasis and the full development of Ang II-induced or 2K1C Goldblatt hypertension.

Can the Introduction of Different Olive Cakes Affect the Carcass, Meat and Fat Quality of Bísaro Pork?

The present study aimed to evaluate the effect of the inclusion of different olive cakes in the diet of Bísaro pigs on the carcass, meat and fat. The carcasses of 40 animals fed a diet with five treatments (T1—Basic diet and commercial feed; T2—Basic diet + 10% crude olive cake; T3—Basic diet + 10% olive cake, two phases; T4—Basic diet + 10% exhausted olive cake; T5—Basic diet + 10% exhausted olive cake + 1% olive oil) were used to study the effect on carcass traits, physicochemical meat quality and lipid composition of meat and backfat. There were no significant differences between treatments for the conformation measurements performed, except for the length at the seventh and last rib (p < 0.05). The percentage of prime cuts of the carcass in Bísaro pig is within the values indicated by the Portuguese Standard 2931. No significant differences between treatments for body weight, pH and carcass weight were found. The values of ultimate pH (5.7), L* (51−52), b* (11−12) and SF (3.4−4.2) observed confirm a non-exudative and firm meat without quality deviations, such as DFD or PSE. Thus, as a general conclusion, the inclusion of different olive cakes in the diet of Bísaro pigs did not cause any negative consequences on the carcass characteristics and conformation as well as in the meat and lipidic quality. In addition, the inclusion of this olive industry by-product in the animal diet would be an important contribution to solving the problem of the great environmental impact from olive-mill wastewaters from the extractive industries.

Patient and healthcare delays in critical and non-critical pulmonary tuberculosis incidence areas in Portugal: are there differences?

OBJECTIVES

To characterize patient, healthcare, and total delay in diagnosing pulmonary tuberculosis (PTB) in critical (higher PTB incidence) and non-critical (lower PTB incidence) areas and their determinants considering clinical and sociodemographic factors.

STUDY DESIGN

Retrospective cohort study.

METHODS

Data was retrieved from the Portuguese National Tuberculosis Surveillance System (SVIG-TB). Were included in the study all active PTB patients (n = 11,762) notified between 2008 and 2017. Spatial analysis was used to define critical and non-critical areas. Kaplan-Meier estimator, logrank test, and Cox regression were conducted, stratified by area.

RESULTS

PTB cases in critical areas (n = 6594, 56.1%) presented longer patient median delay (41 vs 31days), shorter healthcare median delay (7 vs 10 days), and longer total median delay (63 vs 61days) t.han non-critical areas. Patient and total delay increased in both areas over time, while healthcare delay only increased in non-critical areas. Icn both areas, being from a high TB incidence country and alcohol abuse were associated with longer patient delays. Being female, older age, and oncologic diseases were associated with longer healthcare delays. Respiratory diseases were only associated with a longer healthcare delay in non-critical areas. Being female, older, and from a high TB incidence country were associated with a longer total delay in both areas.

CONCLUSIONS

Patient delay was significantly longer in critical areas, and healthcare delay was significantly longer in non-critical areas. Several factors associated with longer delays have been identified, most of which are shared by critical and non-critical areas. Differences in patient and healthcare delay, for example, by sex, age, or country of birth, highlight the need for targeted public health interventions to help reduce these differences.

Relation between depression and chronic physical disease and healthcare utilisation in the Portuguese

Background

Previous studies show high chronic physical disease/depression comorbidity and higher healthcare use in these patients. Most studies focus on a single physical disease and do not consider number of diseases or depression severity. We aimed to characterise the chronic physical disease/depression relation in the Portuguese and analyse its association with healthcare use.

Methods

We undertook a cross-sectional study, using data (2019/2020) from an existing family panel (Em Casa Observamos Saúde), with “chronic physical disease” as exposure and “depression” and “healthcare use need” as outcomes. The sociodemographic characteristics of the sample were described. Logistic and multinomial regression analysis between depression (presence/severity) and chronic physical disease (presence/type/number) and between this comorbidity and healthcare use need were conducted. Adjusted odds ratio (OR) and 95% confidence intervals (CI95%) were calculated for each analysis. Analyses were weighted to account for complex sample design.

Results

1068 individuals were included. In the population, 8.9% had depression and 72.1% had chronic physical disease. There was no statistically significant relation between general physical disease and depression (OR = 1.68 [CI95%:0.55;5.15]), but there was between allergy (OR = 2.08 [CI95%:1.02;4.25]) and COPD (OR = 3.04 [CI95%:1.21;7.61]). The risk of depression was smaller in those with two physical diseases (vs. three or more, OR = 0.32 [CI95%:0.15;0.68]). A relation between chronic physical disease and depression with healthcare use need was not observed with wide confidence intervals.

Conclusions

This study suggests a relation between COPD, allergy and a higher number of physical diseases and depression in the Portuguese. No evidence of an increased need for healthcare services was identified. Clinicians should be aware of this relation and more research needs to be conducted after the pandemic context.

Key messages

Depression is common in patients with physical diseases and should be treated. Improving coordination between services should be prioritised. No evidence of an increased need for healthcare services was identified but research outside the pandemic context should be pursued.

Risk factors associated with Salmonella specific antimicrobial resistance: animal and meat samples

 

The food system is seen as a major source of antimicrobial resistance (AMR), a threat that has led to an increase of the global burden of infectious diseases. Thus, AMR occurrence was studied in animals and derived meat from Portugal, 2014-2018. AMR surveillance data from Portugal was used. Salmonella AMR was estimated for broilers, laying hens, broiler and pig meat. AMR associated factors were studied: population, year, season, sampler, (HACCP, industry, official, official/industry). AMR occurrence in more than half isolates was assessed using a multivariate logistic regression and a backward stepwise method for each antimicrobial class model, presenting adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). This study included 832 Salmonella isolates. Resistance to more than half isolates was observed to (fluoro)quinolones (broilers:52%; broiler meat:53%), penicillins (pig meat:56%), tetracyclines (pig meat:80%), sulphonamides (pig meat:62%). AMR was more likely to occur to penicillins, tetracyclines, sulphonamides in broiler meat (respectively, aOR 3.18;95%CI 1.95-5.18, 3.38;95%CI 1.27-9.19, 2.46;95%CI 1.44-4.19) and pig meat (respectively, aOR 9.39;95%CI 6.01-14.51, 53.84;95%CI 21.61-144.91, 14.58;95%CI 9.16-23.66), compared to broilers. A lesser AMR chance was observed to (fluoro)quinolones in 2017 and 2018 (respectively, aOR 0.07;95%CI 0.00-0.36, 0.13;95%CI 0.06-0.24) while a higher chance was found to tetracyclines in 2016 and 2018 (respectively, aOR 8.08;95%CI 2.25-30.74, 2.56;95%CI 1.14-6.00), compared to 2014. A higher chance for resistance was detected in spring to (fluoro)quinolones (aOR 2.32;95%CI 1.23-4.46) and penicillins (aOR 2.11;95%CI 1.20-3.78) and summer to (fluoro)quinolones (aOR 2.77;95%CI 1.46-5.35), compared to winter. These results indicate a need to reinforce biosecurity and disease prevention during spring and summer to tackle penicillins, tetracyclines and sulphonamides AMR in animal meat, but also (fluoro)quinolones in broilers.

Key messages

Biosecurity and prevention measures need to be reinforced during spring and summer to mitigate Salmonella AMR occurrence across the food system. Critical AMR occurrence to (fluoro)quinolones was found to be more associated with broilers.

Abstract 17: Genetic Deletion Of Angiotensin Ii AT 1a Receptors Selectively In The Proximal Tubules Of The Kidney Attenuates Two-kidney, One-clip Goldblatt Hypertension In Pt- Agtr1a -/- Mice

The activation of the renin-angiotensin system (RAS) in the clipped kidney plays a critical role in the development of two-kidney, one-clip Goldblatt hypertension (2K1C), but the roles of angiotensin II (Ang II) and AT 1a receptors in the proximal tubules has not been determined previously. The present study tested the hypothesis that genetic deletion of AT 1a receptors selectively in the proximal tubules attenuates the development of 2K1C Goldblatt hypertension via AT 1a receptor-mediated, Na + /H + exchanger 3 (NHE3)-dependent mechanisms. To test the hypothesis, 2K1C Goldblatt hypertension was induced by placing a silver clip, 0.2 mm internal diameter, on the left renal artery for 4 weeks in adult male wild-type (WT), global AT 1a receptor knockout ( Agtr1a -/- ), proximal tubule (PT)-specific Agtr1a -/- (PT- Agtr1a -/- ), or PT- Nhe3 -/- mice, respectively. In WT mice, systolic blood pressure increased in a time-dependent manner reaching a maximal response by Week 3 (Basal: 112 ± 2 vs. 2K1C: 149 ± 4 mmHg, n=12, P <0.01). 2K1C Goldblatt hypertension in WT mice was associated with significant increases in renin mRNA expression in the clipped kidney (Control: 2366 ± 255 vs. Clipped: 3144 ± 569 copies/ng RNA, P <0.01) and decreases in renin mRNA expression in the nonclipped kidney (1738 ± 341 copies/ng RNA, P <0.05). Plasma Ang II levels were significantly increased in WT mice with 2K1C Goldblatt hypertension (Control: 50.2 ± 7.2 vs. 2K1C: 109.7 ± 17.2 pg/ml, P <0.05). Glomerular and tubulointerstitial fibrotic responses were also significantly increased in the clipped kidney ( P <0.01). In contrast to WT mice, the development of 2K1C hypertension was completely attenuated in Agtr1a -/- (Basal: 88 ± 4 vs. 2K1C: 92 ± 2 mmHg, n=9, n.s .), PT- Agtr1a -/- mice (Basal: 101 ± 2 vs. 2K1C: 104 ± 3 mmHg, n=12, n.s .) and PT- Nhe3 -/- mice (Basal: 103 ± 3 vs. 109 ± 5 mmHg, n=12, n.s .). Renin mRNA expression was not different in clipped and nonclipped kidney of Agtr1a -/- mice, but it was decreased in the nonclipped kidney of PT- Agtr1a -/- mice ( P <0.05). Taken together, these data suggest that genetic deletion of AT 1a receptors selectively in the proximal tubules attenuates the development of 2K1C Goldblatt hypertension via AT 1a receptor-mediated, Na + /H + exchanger 3 (NHE3)-dependent mechanisms.

Physicochemical Composition and Sensory Quality of Goat Meat Burgers. Effect of Fat Source

Several strategies for producing healthier meat products have been developed. Reducing fat content, using different fat sources, modifying and improving the fatty acid profile or even replacing saturated fat with oleogels are some of the methods used. Goat meat mainly from animals out of quality brands with low commercial value can be valorized when processed, giving the opportunity to increase its consumption and acceptability. Thus, the aim of this study was to study the effect of the replacement of pork as a source of fat with an olive oleogel in burgers manufactured with goat meat and to compare the goat meat burgers with the most common commercial burgers made with beef. Two replications of the burgers were manufactured at different times, and three samples of each burger type (GOO-goat meat burgers with olive oil; GPF-goat meat burgers with pork fat) were randomly selected from each lot manufactured. Each sample was analyzed in triplicate for each physicochemical analysis. At the time, the manufactured burgers were analyzed simultaneously with the commercial burgers. The burgers with olive oil (GOO) showed higher a* and b* than the burgers with pork fat (GPF) and consequently had lower h° and C*. The ashes, protein and collagen contents of the GOO and GPF burgers were similar to those of the other goat meat products. The effect of the incorporation of oleogel on the physicochemical composition of the burgers in relation to the pork fat was expressed in the fat content, 4 and 2.78% for GOO and GPF, respectively. CH burgers have significantly higher fat content (13.45%) than GOO and GPF burgers. The replacement of pork backfat with a vegetable oleogel modified the fatty acids profile, since the GOO burgers had the highest MUFA and PUFA and the lipidic quality, defined by the IA and IT indices, was 0.38 and 0.99, respectively. Globally, goat burgers were sensorially harder and presented a more difficult chewiness than CH. The replacement of the pork back fat with oleogel significantly decreased hardness and chewiness.

Abstract P011: Novel Roles Of Global, Intestinal, And Kidney Proximal Tubule Sodium And Hydrogen Exchanger 3 In Angiotensin Ii-induced Hypertension

The present study used global ( Nhe3 -/- ), kidney-selective (tg Nhe3 -/- ), and proximal tubule-specific Na + /H + exchanger 3 (NHE3)-deficient mice (PT- Nhe3 -/- ) to test the hypothesis that NHE3 is required for the full development of angiotensin II (Ang II)-induced hypertension in mice. Four groups of adult male, age-matched wild-type (WT), global Nhe3 -/- , kidney-selective tg Nhe3 -/- and proximal tubule-specific Nhe3 -/- mice were infused with: a) saline; b) Ang II (10 pmol/min, i.v.); Ang II via an osmotic minipump for 2 weeks (1.5 mg/kg/day, i.p.); or treated with Ang II and losartan concurrently for 2 weeks (20 mg/kg/day, p.o.). Under basal conditions, global Nhe3 -/- , kidney-selective tg Nhe3 -/- and proximal tubule-specific Nhe3 -/- mice all showed significantly lower systolic, diastolic, and mean arterial pressure than wild-type mice (~15 ± 3 mmHg, P <0.01). The hypotensive phenotype in both global Nhe3 -/- and kidney-selective tg Nhe3 -/- mice was associated with abnormal intestinal structures, diarrhea, increased 24 h fecal Na + excretion, and salt wasting ( P <0.01). By contrast, there were no differences in intestinal structures and fecal Na + excretion between wild-type and PT- Nhe3 -/- mice. PT- Nhe3 -/- mice showed significant diuretic and natriuretic responses compared with wild-type mice ( P <0.01). Acute infusion of Ang II markedly increased arterial blood pressure in a time-dependent manner in wild-type mice, as expected ( P <0.01), but the pressure response was attenuated in global Nhe3 -/- , kidney-selective tg Nhe3 -/- , and PT- Nhe3 -/- mice ( P <0.01). Furthermore, the chronic pressor response to 2-week Ang II infusion was also significantly attenuated in Nhe3 -/- , tgNhe3 -/- , and PT- Nhe3 -/- mice, compared with wild-type mice ( P <0.01). Finally, concurrent treatment with losartan completely blocked the acute and chronic pressor responses to Ang II in wild-type, Nhe3 -/- , tg Nhe3 -/- , and PT- Nhe3 -/- mice (p<0.01). Taken together, these data support the proof of concept that NHE3 in the small intestines and the proximal tubules of the kidney is required for maintaining basal blood pressure homeostasis and for the development of Ang II-induced hypertension. Supported by NIH grants, 2R01DK102429-03A1, 1R56HL130988-01, and 2R01DK067299-10A1.

Assessing the implementation of population based cervical cancer screening in Amadora, Portugal

Background

Population-based cervical cancer screening (CCS) are deemed to be more cost-effective than opportunistic screening and to reduce inequalities. Implementation in Portugal has been heterogeneous, at the regional level. In Amadora healthcare cluster (Lisbon area), implementation started in April 2018 in a pilot unit and was scaled-up. We aimed to assess population-based CCS implementation in Amadora.

Methods

Population-based CCS targets women aged 30-65, and utilises liquid-based cytology with partial HPV genotyping (HPV16/18 and other high-risk HPV - hrHPV). Samples positive for other hrHPV undergo a cytology. HPV16/18+ and other hrHPV+ with ≥ASCUS (atypical squamous cells of undetermined significance) are referred to colposcopy. We assessed implementation according to key indicators extracted from our information system: geographic coverage, number of tests, positive results, positive predictive value of referral (number of cervical intraepithelial neoplasia-CIN/number colposcopies).

Results

As of 30 August 2019, CCS were in place in 4 of the 9 units, potentially covering 20904 women (48.4% of the target population). 1797 womem performed screening within the programme. Invitation for screening is currently implemented in 1 of the 4 units. Screening results were available for 1702 women, 11,1% were HPV+. From these, 26,5% were HPV 16/18+ and 86.2% positive for other hrHPV. Among the latter, 63.2% were negative for intraepithelial lesion and 36.8% were ≥ASCUS. Overall, of these 189 women, 51.3% (n = 97) were referred for colposcopy. Colposcopy results were available for 37 women, of which 13 had a CIN. PPV of referral was 35.1% (95%confidence interval: 20.7;52.6).

Conclusions

Despite being a population-based screening most tests are still opportunistic. There is still a limited number of colposcopies results but the current PPV of referral is low and requires further investigation. Implementation towards a full population-based screening in Amadora should continue.

Key messages

Implementation of a population-based cervical cancer screening in Amadora, Portugal is underway but most screening tests are still applied in an opportunistic manner. A limited number of results is avaliable to estimate positive predictive value of referral to colposcopy. Results available indicate a value of 35.1%, which requires further investigation.

Zoonotic bacteria in the food chain: antimicrobial resistance and associated factors in Portugal

Antimicrobial resistance (AMR) poses a threat to public health and animal food-production plays a crucial role in AMR spread. We thus aimed to characterize AMR profiles and associated factors in zoonotic bacterial isolates in Portugal.

Data from the Portuguese AMR surveillance program on animal populations and derived food, 2014-2018, was used. AMR frequency was described in E coli, Campylobacter and Salmonella isolates from poultry and pigs, according to antibiotic and samples tested. For Salmonella, AMR associated factors were studied: animal populations (broilers, laying hens, pigs) and derived meat, sampling stage (farm, slaughterhouse, processing plant), sample type (environmental, carcase, food), sampler (HACCP, industry, official, official and industry), sample context (control and eradication programmes, monitoring), year (2014-2018) and season. Logistic regression was applied to estimate crude (OR) and adjusted odds ratio (aOR) with 95% confidence intervals (95%CI). The final model was obtained using a backward stepwise method.

We assessed 2157 E Coli, 561 Campylobacter and 826 Salmonella isolates. AMR rates were higher to cefepime (91-98%) in E coli in all sample types; cefotaxime (100%) in E coli in broiler's meat; nalidixic acid (79-96%) in E coli and Campylobacter in poultry and derived meat; ciprofloxacin (50-98%) in all bacteria isolates from poultry and derived meat. For Salmonella, AMR was more likely in pig's meat (OR 3.66; 95%CI:1.19-2.82), slaughterhouses (OR 10.18; 95%CI:4.69-26.70), carcases (OR 5.90;95%CI:3.74-9.69). The final model indicated a lesser chance of AMR in laying hens (aOR .21; 95%CI:.11-.37), industry sampling (aOR .25; 95%CI:.07-.73), 2018 (aOR .24; 95%CI:.13-.42), and a higher chance in summer (aOR 2.39; 95%CI:1.34-4.28).

The findings support the need for control measures on the use of key antibiotics in veterinary medicine. AMR occurrence in Portugal seems to be related to summer, although less in laying hens and in 2018.

Key messages

AMR in bacterial isolates suggests the need for integrated actions to mitigate and control the use of 3rd and 4rd generation cephalosporins, fluoroquinolones and quinolones in animal production. AMR occurrence in Portugal seems to be further related to summer conditions, while comparing to other seasons.

Bias correction in self-reported high blood pressure prevalence based on objectively measured data

Background

Reliable and precise estimates of high blood pressure (HBP) prevalence are essential to inform decision-making and policies evaluation. Self-reported HBP may be underestimated by surveys due to misclassification of health status by participants. Misclassification may lead to inaccurate inference. We aimed to assess a feasibility of correcting misclassification bias in self-reported HBP in the Portuguese component of the European Health Interview Survey (INS2014) using data on objective blood pressure measurements from a smaller health examination survey (INSEF).

Methods

We assumed that “true” measured HBP status was missing at random for INS2014 participants (n = 13937). Using a multiple imputation method of logistic regression for monotone missing data patterns, HBP was imputed for INS2014 sample. Auxiliary data on measured HBP from INSEF (n = 4910) was used. Crude and corrected HBP prevalence rates stratified by sex and age group were calculated.

Results

HBP prevalence based on INS2014 increased significantly after multiple imputation correction, from 22.0% [CI95%:20.6-23.5%] to 38.8% [35.4-41.9%] for men and from 26.8% [25.3-28.3%] to 33.0% [30.5-35.4%] for women. Corrected estimates were similar to the objectively measured from INSEF, 39.6% for men and 32.7% for women. Corrected HBP prevalence in INS2014 increased from 4.1% [2.9-5.9%] to 7.9% [4.0-11.8%] in 25-34 years old (yo); from 9.3% [7.8-11.0%] to 17.6% [14.0-21.3%] in 35-44 yo; from 22.5% [20.3-24.8%] to 38.7% [34.2-43.2%] in 45-54 yo; from 39.8% [37.2-42.4%] to 53.8% [49.1-58.5%] in 55-64 yo and from 54.3% [51.5-57.1%] to 67.7% [63.1-72.3%] in 65-74 yo. Corrected rates were similar to the obtained by INSEF (5.7%, 17.0%, 35.8%, 54.8% and 71.3%, respectively).

Conclusions

Our results highlight the importance of bias analysis when using self-reported data on HBP. Multiple imputation is a feasible approach to adjust misclassification bias in health outcomes collected by population surveys.

Key messages

The magnitude and direction of misclassification bias in self-reported health outcomes should be investigated. Multiple imputation is a feasible approach to misclassification bias correction in self-reported survey data.

Delays in the diagnosis of pulmonary tuberculosis in critical and non-critical areas in Portugal

Background

Delays in diagnosing tuberculosis lead to longer infectious periods, posing a challenge in tuberculosis control. This is particularly relevant in high incidence areas (critical). Thus, the objectives of this work were to characterize tuberculosis diagnosis delay and its components (patient delay and health delay) in incidence critical and non-critical areas in Portugal, as well as associated factors.

Methods

Notified cases of pulmonary tuberculosis diagnosed due to symptoms (passive screening) in the Portuguese Tuberculosis Surveillance System were analysed (2008-2017). Patient, health and overall delays were calculated. Factors associated with each delays' components were identified utilising Cox regression, while adjusting for sex, age and education level. Analyses were stratified by area type (critical and non-critical).

Results

Median (1st-3rd quartile - Q1-Q3) delays in patient, health and overall delay in critical areas were: 40 (Q1-Q3: 21-76), 8 (Q1-Q3:1-31), and 65 (Q1-Q3: 40-105) days, respectively; similar delays in non-critical areas were 32 (Q1-Q3:16-63); 9 (Q1-Q3: 1-34) and 58 (Q1-Q3: 35-98), respectively. More recent cases, adults younger than 65 years and alcoholic presented longer patient delays (both areas); healthcare professionals and patients with HIV infection presented shorter patient delays (only critical areas). Tuberculosis high-risk groups (males, alcohol dependency, homelessness, community residency) presented shorter health delays in both areas; drug use also presented shorter health delays but only in critical areas. Existing comorbidities was associated with longer health delays in both areas.

Conclusions

Patient delays increased between 2008 and 2017. Groups with longer/shorter delays differed between delay type and area type. Intervening in tuberculosis diagnosis delays requires different action for critical and non-critical areas, targeting health literacy from the general population and training of healthcare professionals.

Key messages

Delays in diagnosing in Portugal are mainly driven by delays in patient seeking care and are longer in areas of higher tuberculosis incidence. Intervening in tuberculosis diagnosis delays in Portugal requires different action in different areas, targeting health literacy in the general population and training of professionals.

First year of implementation of a drug consumption room in Lisbon: the client’s profile

Issue

Drug consumption rooms (DCR) are in place for more than three decades in Europe and have been proven to be effective as a public health response. However, their implementation remains slow and controversial in many countries. In Portugal, despite being legal since 2001, the first DCR only came into reality in 2019 by the initiative of the City Council of Lisbon.

Description of the Problem

These Programs are aimed at high risk users with a very fragile social and health situation and for that reason usually they adopt a integrate model of care, offering other services behind supervised consumption: basic healthcare, social support, rapid testing and referral to other services. In context of the first year of implementation of a mobile DCR in Lisbon, we intend to investigate if the program was able to reach those at higher risk. Service data collected between April and December 2019 was used to define the client's profile.

Results

The data collected by the program indicates that the vast majority of registered users are men, over 40 years old and homeless. Most users have already been tested for HIV and viral hepatitis in their lifetime, however, there are still barriers in accessing and utilizing specialized care. We also observed high risk practices: injecting in public spaces, groin injection and high rates of benzodiazepine injection.

Lessons

The mobile DCR in Lisbon was able to reach those users at greater risk, both by the pattern of consumption, and by the social and health situation in which they find themselves.

Key message

DCR combined with other harm reduction responses and health services can contribute to improve the health of a very marginalized group of users.

Assessing the use and understanding of the Portuguese heat-health warning system (ÍCARO)

BACKGROUND

Heatwaves can lead to increased mortality. In the Portuguese heat-health warning system (HHWS), ÍCARO, a daily report with heat-related mortality prediction is sent to heat-health action plan (HHAP) practitioners. HHAP practitioners assess risk and implement measures to prevent heatwave-related impact, but ÍCARO's use and understanding are unknown. We assessed ÍCARO's use and understanding by key HHAP practitioners.

METHODS

We conducted semi-structured interviews with national/regional HHAP practitioners. Interviews were recorded, transcribed and analysed using thematic content analysis. To maximize credibility a validation process was implemented through researcher triangulation; a sample of 30 segments was recorded by independent researchers.

RESULTS

We conducted six interviews with nine professionals (mean time 52 min) from five regions. We identified four categories: report's content and presentation, report's reception and communication, ÍCARO and risk assessment and other issues. Practitioners use ÍCARO and perceived it as relevant; they raised issues on its interpretation and felt these were not fully addressed, given researchers' use of statistical/epidemiological terms. We identified the need for improved communication and report's clarity.

CONCLUSIONS

Our study stresses the need for collaboration between experts within HHWS/HHAP. Despite ÍCARO's understanding being challenging, practitioners consider it a relevant tool. Researchers should use less statistical language and clarify ÍCARO's interpretation. Practitioners' needs should be considered when developing/revising tools.

Influence of disease phase on embitterment and emotional dysregulation in psoriatic patients

This study aimed to evaluate the psychosocial differences between patients with psoriasis in different phases of the disease. Seventy-one patients in exacerbation and 83 in remission were evaluated regarding sociodemographic, clinical and psychological variables, on the premise that the visibility of lesions (exacerbation phase) may impact the emotional regulation and embitterment. A regression analysis was performed to identify the variables that contribute to explain embitterment: a diagnosis of anxiety and/or depression and psoriasis severity are the identified ones. The results point to higher values of emotional dysregulation and embitterment, as well as more critical clinical variables in patients with active disease, namely, alcohol and coffee consumption, smoking and less satisfaction with current treatment, more diagnoses and more family history of anxiety and depression, more psychology/psychiatry consultations and more use of anxiolytics and antidepressants. However, only the results referring to alcohol consumption and embitterment are significantly higher in subjects in the exacerbation phase of the disease. Particular clinical attention should be provided to patients in exacerbation phase regarding psychotherapeutic approach.

Thyroid Function and the Risk of Non-Alcoholic Fatty Liver Disease in Morbid Obesity

BACKGROUND

An association between hypothyroidism and the risk of Non-alcoholic Fatty Liver Disease (NAFLD) has been suggested. This association remains to be elucidated in patients with morbid obesity.

AIM

To evaluate the association between thyroid function and parameters of liver function and hepatic scores in patients with morbid obesity.

METHODS

Patients with morbid obesity followed in our center between January 2010 and July 2018 were included. The ones without evaluation of liver and thyroid functions were excluded. Fatty Liver Index (FLI) and BARD scores were used as predictors of hepatic steatosis and fibrosis, respectively.

RESULTS

We observed a positive association between TSH and both BARD (OR 1.14; p = 0.035) and FLI (OR 1.19; p = 0.010) in the unadjusted analysis. We found a negative association between free triiodothyronine levels and BARD (OR 0.70; p<0.01) and a positive association between free triiodothyronine levels and FLI (OR 1.48; p = 0.022). Concerning liver function, we found a positive association between total bilirubin and free thyroxine levels (β = 0.18 [0.02 to 0.35]; p = 0.033) and a negative association between total bilirubin and free triiodothyronine levels (β = -0.07 [-0.14 to -0.002]; p = 0.042).

CONCLUSION

Higher levels of TSH and free triiodothyronine may be associated with a higher risk of NAFLD, particularly steatosis, in patients with morbid obesity.

Local Tuberculosis Georeference: a tool to define BCG vaccination in high-incidence area in Portugal

Issue

Tuberculosis (TB) incidence in Portugal is &lt; 20/100000 people, with high-incidence municipalities in urban areas such as Amadora. In 2016, the national vaccination programme moved the BCG vaccine from universal to restricted risk groups. Amadora, due to the higher-incidence area, maintained a universal vaccination policy. Recently, it was hypothesized that vaccination could be applied to specific parishes even in high incidence counties.

Description

We aimed to identify specific geographic areas with higher risk of TB to help redefine the local BCG vaccination policy. We proposed to georeference active TB cases between 2015 and 2017, in Amadora, to then assess the incidence per parish and statistical section. We also aimed at identifying geo-clusters and density of cases.

Methods

(1) notified TB cases from 1 January of 2015 to 31 December 2017 were extracted from TB surveillance system; (2) cases of latent TB infection (LTBI), cases out of Amadora’s bounds and without national ID were excluded; (3) ArcGis®Online and associated maps were used to provide populational estimates; (4) cumulative incidence was calculated per year and averaged for the 3-year period; (5) Clusters were determined using distance and simple density of cases was calculated using Kernel algorithm.

Results

Considering the 6 parishes of Amadora, the 3-year cumulative incidence varied from 19.58 to 38.3 per 100000 hab. The highest incidence was found on the parish with the best socio-economic profile. 14 geo-clusters were mapped; 3 matched known deprived neighborhoods. Overall density was higher in these neighborhoods.

Lessons

With this approach we found that deprived neighborhoods had higher levels of case density, but 3-year cumulative incidence was higher on the parish considered to have low occurrence of TB. As such, and due to the intense population flows in Amadora, the local public health unit recommended the persistence of BCG vaccination to all residents of the municipality.

Key messages

Georeferecing supported our recommendation to mantain a universal BCG vaccination policy. Georeferencing associated to surveillance systems is highly useful to ensure evidence based public health practices, even at the local level.

Assessing the use and understanding of the Portuguese Heat–Health Warning System (ÍCARO)

Background

Heatwaves can lead to increased mortality. Portugal has a Heat-Health Warning System (HHWS) in place (ÍCARO system). Researchers at the Instituto Ricardo Jorge send a daily report with heat-related mortality forecasts to key stakeholders (e.g. Heat-Health Action Plans (HHAP) staff). HHAP practitioners issue warnings and implement measures to prevent heatwaves-related mortality. ICARO is amongst the recommended data sources to assess risk and issue warnings but its use and understanding is unknown. Therefore, we aimed to assess ÍCARO’s use and understanding by key HHAP practitioners.

Methods

We conducted semi-structured interviews with national and regional HHAP practitioners. Interviews were recorded, transcribed, and analysed using thematic content analysis. Intercoder reliability was applied to a sample of segments from 5 of 6 interviews.

Results

We conducted 6 interviews with 9 professionals (mean time 52 minutes). We identified 4 categories: Report’s content and presentation, Report’s reception and communication, ÍCARO and risk assessment, Other issues. Practitioners use ÍCARO and perceived it as very relevant tool. However, they mentioned several questions on its interpretation. Practitioners also felt their questions were not fully answered, given researchers’ use of statistical terms. Finally, practitioners referred the need to assess risk at the local level, information not currently provided. We also identified the need for improved communication and report’s clarity.

Conclusions

Our study stresses the need for an integrated collaboration between experts within HHWS and HHAP. Despite ICARO’s understanding being challenging, practitioners consider it a relevant tool. Researchers should use less statistical language and clarify ÍCARO interpretation. Practitioners’ needs should be considered when developing or revising tools. We are currently implementing some of these recommendations in an attempt to close the gap between researchers and practitioners.

Key messages

Portuguese Heat–Health Action Plans practitioners use heat-related mortality forecasts (ICARO) and perceived it as very relevant instrument. However there find ICARO’s interpretation challenging. Portuguese Heat/Health Action Plans Practitioners’ needs should be considered when revising or developing tools, and notes should be added to clarify statistical/technical concepts.

Benefits from a tabletop exercise in a Heat-Health Action Plan in Amadora, Portugal

Issue

National guidelines for Heat-Health Action Plans (HHAP) in Portugal exist since 2004. These guidelines are further developed and implemented at Local Public Health Units (LPHU) together with local partners. Tabletop exercises are a useful tool to improve preparedness. Despite the long experience with HHAP there has not been any tabletop exercise in Amadora.

Description

Amadora’s LPHU organized a tabletop exercise with local partners to improve HHAP preparedness (12th July 2018). It included: LPHU, city hall, civil protection services, local social services, primary healthcare services, local public hospital, and firefighters. The exercise hypothesized a scenario of an unprecedented increase of temperature for an extended period of time, activating the highest level of warning (red) and action in the HHAP.

Results

During the exercise several issues were identified. Some partners were not clear about the pathway established for red warnings and partners were not aware of relevant HHAP activities. Also, from the 8 sites listed as climate shelters, only 2 were deemed as adequate for using in this scenario, even though they have been listed for several HHAP. Due to the exercise, it was possible to conduct an inspection of said shelters, which hadn’t took place yet due to the lack of resources. It was possible to find out that only one shelter was fit for purpose. Additional private facilities were identified as desirable shelter locations during the exercise. A few weeks later, a red warning was issued and clarification arising from the tabletop exercise was useful to properly implement measures.

Lessons

Despite the perceived frequent and good communication among partners of the HHAP, several issues - mainly regarding the adequacy of shelters - were identified with a tabletop exercise. It also improved preparedness for the following HHAP warning. As such, tabletop exercises should be promoted within HHAP.

Key messages

Despite developing heat-health action plans for several years, with the involvement of community partners, unidentified constraints existed in Amadora, Portugal. Tabletop exercises should be used more frequently, as we were able to identify and solve constraints within our heat-health action plan using one.

Evaluating implementation of an Heat-health action plan during 2018 heatwave in Amadora, Portugal

Issue

Heatwave-health effects are preventable. Heat-health action plans (HHAPs) include preventive measures aimed at protecting population. In Portugal, HHAPs exist since 2004 and have been operationalized at local level. Heatwaves occur infrequently, thus experience with HHAPs is relevant to countries implementing their own HHAPs.

Description

In the summer of 2018, Amadora (Lisbon, Portugal) issued a warning from the 2nd-6th August (highest level:4th-6th). Before/during the warning we implemented: 1.climatized shelter opened available upon request;2.text messages with recommendations and information on the walk-in clinic services available;3.information to nursing homes regarding available services (walk-in services/shelter);4.contact with individuals receiving home support and identified as vulnerable. Nationwide media publicity of individual protection measures was also ongoing. We aimed at evaluating these HHAP measures. We compared demand of walk-in clinic (primary care) and emergency department with existing capacity, updated during the heatwave. Mortality was analysed using an observed-expected ratio (O/E) of week 32 (following the heatwave) and 95% confidence interval (95%CI) under a Poisson distribution. Expected deaths were the average deaths in week 32 of the previous 4 years (2014-17).

Results

In the primary care walk-in clinic the demand was ½ of capacity; hospital emergency services demand did not increase. We had no requests for the shelter unit. Regarding mortality, O/E was 1.57 (95%CI:1.12-2.14). These results are preliminary; we are producing more detailed analyses of mortality data.

Lessons

We have no counterfactual to assess the effect of our HHAP but our results indicate the possibility to reduce heatwaves-mortality further and thus the need for additional measures. We did not observed the expected surge in service demand; the adequacy of supply-based measures is currently under debate. More detailed mortality analysis will provide further insights.

Key messages

We implemented several measures during a heatwave in Amadora, Portugal with no increased demand in available health services in the area. We detected an increased mortality following the heatwave, suggesting the need to implement further measures.

EPR and 51V NMR studies of prospective anti-diabetic bis(3-hydroxy-4-pyridinonato)oxidovanadium(iv) complexes in aqueous solution and liposome suspensions

EPR/⁵¹V-NMR parallel studies of [VO(3,4-HPO)₂] complexes in MOPS buffer and POPC liposome suspensions provide information regarding solvents for oral administration.