Increase in the influenza vaccination rates in Portugal: comparing 2020-2021 to the last 10 years

Background

Annual influenza vaccine uptake is recommended by the Portuguese General-Directorate of Health to certain priority groups. In 2020, amidst the COVID-19 pandemic, some exceptional measures were adopted to operationalize the Portuguese influenza vaccination campaign, like the extension and phasing of the vaccination period. No major changes were introduced in the vaccination of healthcare workers. In Baixo Tâmega health cluster (Portugal), it was perceived that these workers' vaccine uptake had markedly increased in 2020-2021. This study aims to compare their influenza vaccination coverage rates in 2020-2021 to the last 10 seasons.

Methods

A cross-sectional study of the vaccine uptake among the health workers of Baixo Tâmega health cluster was developed. A descriptive analysis was carried out, calculating annual influenza vaccination coverage rates from 2010-2011 to 2020-2021, in doctors, nurses and other health workers. Inferential analysis was performed through chi-squared tests in IBM SPSS Statistics 27.0.1.0., considering significant p-values<0.05.

Results

The difference between health workers 2020-2021's influenza coverage rate and the last season's average rates was 22.81%. Before 2020-2021, average vaccination coverage rates were 51.60% (standard deviation 7.34%, 44.26-58.94%), 60.44% (standard deviation 4.12%, 56.32-64.56%) and 51.20% (standard deviation 7.66%, 43.54-58.86%), in doctors, nurses and other health workers, respectively. In 2020-2021, vaccination rates significantly increased to 79.34%, 79.52% and 74.24% in doctors, nurses and others, respectively (p < 0.001).

Conclusions

Influenza vaccination uptake increased in 2020-2021 among health workers. Further studies should be developed to evaluate this tendency on a larger scale and to better understand its associated factors, which could have been unstructured awareness-raising campaigns, perception of protection against COVID-19 or avoidance of COVID-19-like symptoms and coinfection.

Key messages

Influenza vaccination coverage rates increased in 2020-2021 among the healthcare workers of a Portuguese health cluster. The COVID-19 pandemic may have contributed to the increase in the influenza vaccination coverage rates.

Burden of high sodium diet in Brazilian population: Global Burden of Disease 2017 estimates

High-sodium diet leads to significant health problems such as high blood pressure, chronic kidney disease, ventricular hypertrophy and stroke. In Brazil, 2008 survey data have shown an average intake of 4.7 g/day of sodium, equivalent to 12 g/day of salt. In 2014, the average ofsalt intake estimated was 9.3 g/day. In both surveys, the numbers are higher than the international recommendation of 5g/day of salt. Considering this excessive consumption and the invisibility of the major consequences of such lifestyle, the aim of this study was to estimate the burden of diseases due to a high-sodium diet in Brazil.

We used the high-sodium diet attributable disability-adjusted life-years (DALYs) and deaths estimates of the Global Burden of Disease study in 2017 among Brazilian. The burden of high-sodium diet was assessed using a comparative risk assessment approach, which allows the calculation of the population attributable fraction of each disease that has an established relation with this behavior. Input data from Brazil to reach such estimates have included surveys that report the dietary sodium. Data on disease occurrence and mortality were obtained from health information systems and health surveys.

In 2017, high-sodium diet contributed with a significant number of deaths (51,434, 95% U.I.: 9,266-105,118) and DALYs (988,258, 95% U.I.: 139,943-2,149,179) in Brazil. The states of Northern Region presented lower mortality rates (Roraima: 11.1/100,000; 95% U.I.: 1.5-24.0 and Amapa: 10.6/100,000; 1.5-23.5), while those in the Southeast have higher mortality rates (Rio de Janeiro: 33.2/100,000; 95% U.I.: 5.4-68.1 and São Paulo: 32.0/100,000; 95% U.I.: 3.5-49.6). The same pattern by states was observed for DALYs.

These findings are significant and support the urgent necessity of strategies to reinforce the promotion of a healthy diet, restricted in ultra-processed foods high in sodium, among the Brazilian population in order to prevent early morbidity and mortality.

Key messages

Salt consumption in Brazil is high and contributes to a significant number of deaths and DALYs. It is necessary to increase and reinforce actions that promote the Brazilian traditional food, such as the Brazilian Food Guide, and also the sodium reduction agreements with industries.

Epidural catheter anchored in the posterior lateral epidural space: How to manage it

We describe a case of an epidural catheter entrapment without knotting, kinking, shearing or breakage confirmed by CT scan and how to manage it. A patient was admitted for tibial fracture repair under general anesthesia with an epidural. At discharge day, multiple attempts to retrieve the catheter were made. Contrast CT scan showed the catheter anchored in the left posterior-lateral epidural space. Despite the absence of guidelines regarding epidural catheter entrapment, all the methods described in the literature were used. This is a rare complication and it may be associated with neurological and infectious complications. Radiologic imaging should be obtained to better characterize the catheters' position and plan removal. In this case, tension in the paraspinal muscles or in the supraspinous and intraspinous ligaments could explain the entrapment. General anesthesia with the non-depolarising muscle relaxant allowed muscles and ligaments to relax and we were able to retrieve the catheter intact.

Advanced Parkinson disease patients have impairment in prosody processing

BACKGROUND

The ability to recognize and interpret emotions in others is a crucial prerequisite of adequate social behavior. Impairments in emotion processing have been reported from the early stages of Parkinson's disease (PD). This study aims to characterize emotion recognition in advanced Parkinson's disease (APD) candidates for deep-brain stimulation and to compare emotion recognition abilities in visual and auditory domains.

METHOD

APD patients, defined as those with levodopa-induced motor complications (N = 42), and healthy controls (N = 43) matched by gender, age, and educational level, undertook the Comprehensive Affect Testing System (CATS), a battery that evaluates recognition of seven basic emotions (happiness, sadness, anger, fear, surprise, disgust, and neutral) on facial expressions and four emotions on prosody (happiness, sadness, anger, and fear). APD patients were assessed during the "ON" state. Group performance was compared with independent-samples t tests.

RESULTS

Compared to controls, APD had significantly lower scores on the discrimination and naming of emotions in prosody, and visual discrimination of neutral faces, but no significant differences in visual emotional tasks.

CONCLUSION

The contrasting performance in emotional processing between visual and auditory stimuli suggests that APD candidates for surgery have either a selective difficulty in recognizing emotions in prosody or a general defect in prosody processing. Studies investigating early-stage PD, and the effect of subcortical lesions in prosody processing, favor the latter interpretation. Further research is needed to understand these deficits in emotional prosody recognition and their possible contribution to later behavioral or neuropsychiatric manifestations of PD.

A frequent LRRK2 gene mutation associated with autosomal dominant Parkinson's disease

Mutations in the LRRK2 gene have been identified in families with autosomal dominant parkinsonism. We amplified and sequenced the coding region of LRRK2 from genomic DNA by PCR, and identified a heterozygous mutation (Gly2019 ser) present in four of 61 (6.6%) unrelated families with Parkinson's disease and autosomal dominant inheritance. The families originated from Italy, Portugal, and Brazil, indicating the presence of the mutation in different populations. The associated phenotype was broad, including early and late disease onset. These findings confirm the association of LRRK2 with neurodegeneration, and identify a common mutation associated with dominantly inherited Parkinson's disease.