Universidade Lusófona do Porto

BACKGROUND: For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. METHODS: The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. FINDINGS: Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). INTERPRETATION: Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. FUNDING: Gates Foundation and Bloomberg Philanthropies.

BACKGROUND: Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. METHODS: GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. FINDINGS: The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. INTERPRETATION: We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. FUNDING: Gates Foundation.

Abstract The available techniques for strength prediction of bonded joints have improved over the years. Cohesive zone models (CZM) coupled to finite element method (FEM) analyses surpass the limitations of stress/strain and fracture criteria, and simulate damage growth. CZMs require the instantaneous energy release rates in tension (G n) and shear (G s) along the fracture paths and respective fracture energies in tension (G n c) and shear (G s c), and crack growth is ruled by traction-separation laws that are established at the failure paths. Additionally, the cohesive strengths must be defined (t n 0 for tension and t s 0 for shear) relating to the onset of damage. A few techniques are available for the estimation of these parameters (e.g., the property identification technique, the direct method and the inverse method) that differ in complexity and expected accuracy of the results. In this work, the influence of the cohesive law parameters of a triangular CZM used to model a thin adhesive layer in bonded joints is studied, to estimate their effect on the predictions. Some conclusions were established to provide important data for the proper selection of the estimation technique and expected accuracy of the simulation results. KEYWORDS: Bonded jointsCohesive zone modelsFinite element methodStructural adhesive Notes Presented in part at the 1st International Conference on Structural Adhesive Bonding (AB2011), Porto, Portugal, 7–8 July 2011.

The availability of wearable devices (WDs) to collect biometric information and their use during activities of daily living is significantly increasing in the general population. These small electronic devices, which record fitness and health-related outcomes, have been broadly utilized in industries such as medicine, healthcare, and fitness. Since they are simple to use and progressively cheaper, they have also been used for numerous research purposes. However, despite their increasing popularity, most of these WDs do not accurately measure the proclaimed outcomes. In fact, research is equivocal about whether they are valid and reliable methods to specifically evaluate physical activity and health-related outcomes in older adults, since they are mostly designed and produced considering younger subjects' physical and mental characteristics. Additionally, their constant evolution through continuous upgrades and redesigned versions, suggests the need for constant up-to-date reviews and research. Accordingly, this article aims to scrutinize the state-of-the-art scientific evidence about the usefulness of WDs, specifically on older adults, to monitor physical activity and health-related outcomes. This critical review not only aims to inform older consumers but also aid researchers in study design when selecting physical activity and healthcare monitoring devices for elderly people.

Teacher job satisfaction is an essential factor for teachers’ and school effectiveness and students’ academic and educational achievement. The present research aims to identify variables that contribute to job satisfaction in a Portuguese sample of lower secondary education teachers, using data from the Teaching and Learning International Survey (TALIS) 2013. Two questionnaires were used to collect data: a school principal’s questionnaire, and a teacher questionnaire. Hierarchical linear modelling was used to study the relation of school-level and teacher-level variables to job satisfaction. The results show that teacher-level variables are better predictors of teacher job satisfaction than school-level variables, except for the variable public/private school. In addition, variables related to interpersonal relations emerge as the most significant predictors of job satisfaction. The results suggest that, in order to improve, schools must take care of interpersonal relations, mainly at the classroom level, where most of the perceived job satisfaction seems to rest.

The aim of this study was to identify post-divorce coparenting profiles and examine whether these profiles differentiate between levels of parents' well-being, parenting practices, and children's psychological problems. Cluster analysis was conducted with Portuguese heterosexual divorced parents (N = 314) to yield distinct post-divorce coparenting patterns. Clusters were based on parents' self-reported coparenting relationship assessed along four dimensions: agreement, exposure to conflict, undermining/support, and division of labor. A three cluster solution was found and replicated. Parents in the high-conflict coparenting group exhibited significantly lower life satisfaction, as well as significantly higher divorce-related negative affect and inconsistent parenting than parents in undermining and cooperative coparenting clusters. The cooperative coparenting group reported higher levels of positive family functioning and lower externalizing and internalizing problems in their children. These results suggested that a positive coparenting alliance may be a protective factor for individual and family outcomes after parental divorce.

Abstract There has been a growing requirement in the last years, particularly in the aerospace industry, for adhesives to withstand high temperatures. The most important factor to consider when studying the effect of temperature on adhesively-bonded joints is the variation of adhesive mechanical properties with temperature such as the stress–strain curve and the toughness. Adhesive strength and strain show temperature dependence, especially near the glass transition temperature (T g) of the adhesive. Similarly, the fracture toughness is expected to show temperature dependence. In this work, an experimental study was performed to evaluate the effect of the temperature on the adhesive strength and fracture toughness of a high temperature epoxy adhesive. Bulk specimens of cured adhesive were produced and tested in tension at room temperature (RT), 100, 150 and 200°C, in order to obtain a strength profile of the adhesive over this temperature range. Results showed that as the temperature increases the adhesive tensile strength reduces but the ductility increases. Pure mode I adhesive fracture toughness (G Ic) tests were performed on double cantilever beam (DCB) specimens at room (RT) and high temperatures (100, 150 and 200°C) and the fracture toughness G Ic as a function of temperature was obtained. It is shown that at temperatures below T g, the fracture toughness, G Ic, is relatively insensitive to temperature, while above T g (at 200°C) a drastic decrease in fracture toughness was observed.

BACKGROUND: This research sought to review studies that examined the factor structure of the PHQ-9 using a confirmatory factor analysis approach (Study 1); to review studies that tested the measurement invariance of the PHQ-9 (Study 2); to examine the psychometric properties of the European Portuguese version in the general population (Study 3). METHODS: Using PRISMA guidelines, a search was performed on Web of Science, PsycINFO, and Scopus from 2001 to August 2019. Assessment of eligibility criteria and data extraction were conducted by two independent researchers (Studies 1 and 2). In Study 3, data were collected from 1479 Portuguese adults, using a cross-sectional design. The BDI-II and the GDS-15 were administered to examine convergent validity. RESULTS: The systematic review identified four-factor models of the PHQ-9 (Study 1). Nineteen studies supported a one-factor model, whereas 12 found evidence for a two-factor model. Both models were supported in general, clinical, psychiatric, and international samples. Study 2 identified ten studies that examined PHQ-9 measurement invariance across 18 groups. The PHQ-9 measurement invariance was fully supported across studies. Study 3 revealed that a two-factor model showed a close fit to data in the European Portuguese version of the PHQ-9. Measurement invariance, reliability, and convergent and divergent validity were also established. LIMITATIONS: Study 3 did not include a gold standard measure of depression to evaluate PHQ-9 diagnostic properties. CONCLUSIONS: Conceptual implications of the findings are discussed, and recommendations for using the Portuguese version of the PHQ-9 as a screening measure in community settings are also highlighted.

The variation of the mechanical properties of adhesives with temperature and strain rate is one of the most important factors to consider when designing a bonded joint due to the polymeric nature of adhesives. It is well known that adhesive strength generally shows temperature dependence. Moreover, in many structural applications, the applied loads can be dynamic and the design of the joint requires the knowledge of the high loading rate mechanical behaviour of the adhesive. In this study, the combined effect of the temperature and test speed on the tensile properties of a high temperature epoxy adhesive was investigated. Tensile tests were performed at three different test speeds and various temperatures (room temperature (RT) and high temperatures (100, 125 and 150°C)). The glass transition temperature (T g) of the epoxy adhesive investigated is approximately 155°C. The ultimate tensile stress decreased linearly with temperature (T) while increased logarithmically with the loading rate, which is in the accord with the Airing's molecular activation model.

Adhesive bonding of components has become more efficient in recent years due to the developments in adhesive technology, which has resulted in higher peel and shear strengths, and also in allowable ductility up to failure. As a result, fastening and riveting methods are being progressively replaced by adhesive bonding, allowing a big step towards stronger and lighter unions. However, single-lap bonded joints still generate substantial peel and shear stress concentrations at the overlap edges that can be harmful to the structure, especially when using brittle adhesives that do not allow plasticization in these regions. In this work, a numerical and experimental study is performed to evaluate the feasibility of bending the adherends at the ends of the overlap for the strength improvement of single-lap aluminium joints bonded with a brittle and a ductile adhesive. Different combinations of joint eccentricity were tested, including absence of eccentricity, allowing the optimization of the joint. A Finite Element stress and failure analysis in ABAQUS® was also carried out to provide a better understanding of the bent configuration. Results showed a major advantage of using the proposed modification for the brittle adhesive, but the joints with the ductile adhesive were not much affected by the bending technique.

BACKGROUND & AIMS: Cardiac dysfunction has been described in patients with cirrhosis. Conventional echocardiographic methods are frequently unable to detect abnormalities at rest and have limitations. We aimed to evaluate cardiac function in cirrhosis patients assessing: (i) left ventricular systolic function using speckle-tracking imaging; (ii) diastolic function using a tissue-Doppler based algorithm and comparing it with previously proposed definition of diastolic dysfunction (DD). METHODS: We included 109 hospitalized and ambulatory patients with cirrhosis and 18 healthy controls. Detailed echocardiographic evaluation was performed including tissue-Doppler and speckle-tracking analysis. RESULTS: Peak systolic longitudinal strain (PLS) was lower in patients [-19.99% (-21.88 to -18.71) vs -22.02% (-23.10 to -21.18), P = 0.003]. Ejection fraction was similar in patients and controls [64% (59-67) vs 61% (60-65), P = 0.42)]. Based on mitral-flow pattern, DD was present in 44 patients (40.4%). Patients without DD had higher cardiac output compared with those with DD [6.4 L/min (5.4-7.2) vs 5.6 L/min (4.6-6.8), P = 0.02]. Using a tissue-Doppler based definition, the prevalence of DD was 16.5%. No differences in haemodynamic variables were found in patients with and without this definition of DD. The agreement between the two definitions of DD was weak (kappa = 0.24, P = 0.003). Echocardiographic abnormalities in systolic and diastolic function were not different in compensated vs decompensated patients in different Child-Pugh classes or cirrhosis aetiologies. CONCLUSIONS: Patients with cirrhosis have systolic and diastolic cardiac dysfunction at rest. Newer echocardiographic techniques may identify patients with functional impairment more accurately than conventional methods, which are more influenced by flow conditions.

HFE C282Y is an example of a mutant protein that does not fold correctly, is retained in the endoplasmic reticulum, and was found previously to diminish surface expression of MHC class I (MHC-I). We now show that its expression in 293T cells triggers an unfolded protein response (UPR), as revealed by the increased levels of H chain binding protein, GRP94, and C/EBP homologous protein. Elevated levels of these proteins were also found in HFE C282Y homozygous PBMCs. Following the UPR induction, a decrease in MHC-I cell surface expression was observed. This defect in MHC-I could be mimicked, however, by overexpression of transcriptionally active isoforms of activating transcription factor-6 and X box-binding protein-1, which induced the UPR, and reversed in HFE C282Y-expressing cells by using dominant-negative constructs that block UPR signaling. The present results provide evidence to the finding that stimulation of an UPR affects MHC-I expression.

BACKGROUND: Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking. METHODS: Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures. FINDINGS: 21,027 mothers were included in the analysis. Among those who experienced labour (N=18,063), 41·8% (26·1%- 63·5%) experienced difficulties in accessing antenatal care, 62% (12·6%-99·0%) were not allowed a companion of choice, 31·1% (16·5%-56·9%) received inadequate breastfeeding support, 34·4% (5·2%-64·8%) reported that health workers were not always using protective personal equipment, and 31·8% (17·8%-53·1%) rated the health workers' number as "insufficient". Episiotomy was performed in 20·1% (6·1%-66·0%) of spontaneous vaginal births and fundal pressure applied in 41·2% (11·5% -100%) of instrumental vaginal births. In addition, 23·9% women felt they were not treated with dignity (12·8%-59·8%), 12·5% (7·0%-23·4%) suffered abuse, and 2·4% (0·1%-26·2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes. INTERPRETATION: Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed. FUNDING: The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. STUDY REGISTRATION: ClinicalTrials.gov Identifier: NCT04847336.

Extract: The emergence of multidrug-resistant tuberculosis (MDR-TB), defined as bacillary resistance to at least rifampicin and isoniazid, threatens global TB control. The number of patients notified with MDR-TB worldwide has increased by 261% from 2009 to 2014, and more than one-third of these patients currently live in the European Region of the World Health Organization (WHO). Management of patients with MDR-TB is challenging owing to the long duration of therapy required to achieve a relapse-free cure, complex drug regimens, frequent drug-related adverse events, high costs, suboptimal adherence, and overall low cure rates. [...]

Preeclamptic pregnancies seem to be associated with a higher extent of inflammation compared with normal ones. We intended to test this proposal and also to clarify the contribution of some variables in such inflammatory process. We measured total and differential leukocyte count, serum C-reactive protein (CRP), and plasma levels of lactoferrin, elastase, and granulocyte-macrophage colony-stimulating factor (GM-CSF). Uric acid was also evaluated and used as an indicator of the severity of the disease. A cross-sectional study was performed by evaluating healthy and preeclamptic women in the third trimester of gestation (n = 67 and n = 51, respectively) and 24 to 48 h postpartum (n = 32 and n = 26, respectively). When comparing the third trimester of normal and preeclamptic pregnancies, we found significantly higher levels of uric acid, CRP, and elastase, and a significantly higher elastase to neutrophil ratio in the pathologic group. However, for CRP, statistical significance was lost after adjustment for maternal weight. No significant differences were found in total leukocyte count, plasma levels of GM-CSF, and lactoferrin between groups. In preeclampsia, a significant positive correlation was found between elastase and lactoferrin and these neutrophil activation products correlated positively with uric acid level. Considering the analysis of all variables in the postpartum period, only CRP and uric acid levels were significantly elevated in the pathologic group. However, CRP differences obtained in the puerperium seem to be influenced by the increased number of dystocic deliveries in the preeclamptic group. In conclusion, our data suggest that inflammation is further pronounced in preeclampsia and that the extent of neutrophil activation correlates with the severity of this syndrome.

The role of digital literacy in strengthening citizens’ resilience to misinformation and ‘fake news’ has been the subject of research projects and networking and academic and policy discourses in recent years, given prominence by an escalation of the perceived crisis following election and referendum results in the US and UK respectively. This special issue sets out to take forward critical dialogue in the field of media and digital literacy education by publishing rigorous research on the subject. The research disseminated in this collection speaks to the political and economic contexts for ‘fake news’, the complex issue of trust and the risks of educational solutionism; questions of definition and policy implementation; teaching about specific subgenres such as YouTube and clickbait; international comparisons of pedagogic approaches and challenges for teachers in this changing ecosystem.

A Escala Multidimensional de Suporte Social Percebido (MSPSS), originalmente desenvolvida por Zimet, Dahlem, Zimet, e Farley (1988), foi criada para avaliar subjectivamente o suporte social proveniente da família, dos amigos e de outros significativos. Neste trabalho apresentam-se as características psicométricas da versão portuguesa da MSPSS. A escala foi avaliada num grupo de estudantes (n = 454), num grupo da população geral (n = 261) e num grupo de doentes com depressão major (n = 100). A análise factorial demonstrou a existência de três factores (Família, Amigos e Outros Significativos). Igualmente apresentou uma boa consistência interna, entre .85 e .95, considerando os três factores, os três grupos e ambos os géneros; apresentou uma adequada validade de construto e a estabilidade teste-reteste no grupo de estudantes e população geral apresentou valores entre .40 e .91. Os alfas de Cronbach no reteste oscilaram entre .87 e .95. A presente versão da MSPSS mostrou ter qualidades psicométricas adequadas para ser utilizada em estudantes, em sujeitos da população geral bem como em populações com psicopatologia depressiva, sendo necessária agora a continuação da investigação em outras amostras e utilizando estudos de seguimento.

Firefighters experience a wide range of traumatic events while on duty and are at risk to develop psychopathology and posttraumatic stress disorder (PTSD). According to cognitive models, the person's interpretation of the traumatic event is responsible for the development of PTSD rather than the traumatic event itself. This cross-sectional study aimed to explore the contribution of perceived threat to explain PTSD symptoms in Portuguese firefighters, after adjusting for potential confounding factors. A sample of 397 firefighters completed self-report measures of exposure to traumatic events, psychopathology, and PTSD. Perceived threat explained unique variance in PTSD symptoms, R(2) = .40, ΔR(2) = .02, F(10, 367) = 24.55, p < .001, Cohen's f(2) =.03, after adjusting for psychopathology, number, recency, and frequency of the events, and other potential confounding variables. The association between psychopathology and PTSD was also moderated by perceived threat, R(2) = .43, ΔR(2) = .03, F(11, 366) = 25.33, p < .001, Cohen's f(2) =.05. Firefighters may benefit from interventions that focus on perceived threat to prevent PTSD symptoms.

This cross-sectional study investigated the association of physical fitness with cognitive function, functional capacity and quality of life among institutionalized older adults with dementia. One hundred and two older adults aged 78.0 ± 8.4 years, predominantly female (67.6%), with neurocognitive disorder due to Alzheimer's disease (AD) (49.2%), vascular dementia (14.7%), Parkinson's disease (2%), dementia with Lewy bodies (2%) or unspecified dementia (32.1%) participated in the present study. Regression analyses were used to examine associations between physical fitness components (Senior Fitness Test) and cognitive function (Mini-Mental State Examination), functional capacity (Katz Index of Independence in Activities of Daily Living) and Quality of Life (QoL)-Alzheimer's Disease scale. Univariate regression indicates that strength, flexibility, agility/dynamic balance and aerobic endurance are relevant for cognitive function, physical capacity and perceived QoL in institutionalized older people with dementia. After multiple regression analyses, adjusted for body mass index (BMI), results showed that aerobic endurance had a significant positive association with Total Katz Index. For both, caregiver perception of QoL-AD and global QoL-AD, BMI remained significantly and positively associated. Agility-dynamic balance presented a significant negative relation with global QoL-AD. Overall, our findings suggest that better physical fitness is important for cognition and autonomous functional capacity and that it has positive repercussions on the QoL in institutionalized older adults with dementia. Consequently, exercise-based therapeutic strategies aiming to improve physical fitness should be implemented.

Research has shown that coparenting is a vital family mechanism in predicting mental health in children and adolescents. Considering the increasing prevalence of marital dissolution in Western societies, the objective of this systematic review was to summarize the key results of empirical studies that tested the association between mental health of children and coparenting after marital dissolution. The studies were obtained from three databases (PsycInfo, PubMed, and Web of Knowledge), published between January 2000 and October 2014. The titles, abstracts, and key words of the generated citations were independently reviewed by two investigators to consensually select the articles that met the inclusion criteria. Articles that used psychometrically valid tools to measure at least one mental health indicator and at least one dimension of coparenting in samples with divorced parents were included in the review. Of the 933 screened articles, 11 met the inclusion criteria. Significant positive associations were found between coparental conflict and behavioral problems and symptoms of anxiety, depression, and somatization. Significant positive associations were also found between other specific dimensions of coparenting (coparental support, cooperation, and agreement), overall mental health, self-esteem, and academic performance. The integrated analysis of these studies suggests that coparenting is a key mechanism within the family system for the prediction of child mental health after marital dissolution, and thus, it is recommended that pediatricians, psychologists, and other health professionals consider coparenting as a psychosocial variable for children's mental health assessment and diagnosis. A investigação tem demonstrado a coparentalidade como um dos mecanismos familiares centrais na predição da saúde mental em crianças e adolescentes. Considerando o aumento da prevalência da dissolução conjugal nas sociedades ocidentais, o objetivo desta revisão sistemática foi sumariar os resultados-chave de estudos empíricos que testaram a associação entre a saúde mental das crianças e a coparentalidade pós-dissolução conjugal. Foram triados estudos de três bases de dados (PsycInfo, Pubmed e Web ofKnowledge), publicados entre janeiro de 2000 e outubro de 2014. Os títulos, resumos e palavras-chave das citações geradas foram independentemente analisados por dois investigadores para selecionar consensualmente os artigos que cumpriam os critérios de inclusão. Foram incluídos artigos que utilizassem instrumentos psicometricamente válidos para medir pelo menos um indicador de saúde mental e pelo menos uma dimensão da coparentalidade em amostras com pais divorciados. Dos 933 artigos triados, 11 cumpriram os critérios de inclusão. Foram encontradas associações significativamente positivas entre o conflito coparental e problemas de comportamento e sintomas de ansiedade, depressão e somatização. Foram também encontradas associações significativamente positivas entre outras dimensões específicas da coparentalidade (suporte, cooperação e acordo coparentais) saúde mental global, autoestima e rendimento acadêmico. A análise integradora destes estudos sugeriu que a coparentalidade é um mecanismo-chave dentro do sistema familiar para a predição da saúde mental infantil pós-dissolução conjugal, sendo recomendado que pediatras, psicólogos e outros profissionais de saúde considerem a coparentalidade como uma variável psicossocial na avaliação e diagnóstico da saúde mental em crianças.