Building Bridges between People with Stroke, Families, and Health Professionals: Development of a Blended Care Program for Self-Management.

Evidence-informed interventions for stroke self-management support can influence functional capability and social participation. People with stroke should be offered self-management support after hospital discharge. However, in Portugal, there are no known programs of this nature. This study aimed to develop a person-centered and tailored blended care program for post-stroke self-management, taking into account the existing evidence-informed interventions and the perspectives of Portuguese people with stroke, caregivers, and health professionals. An exploratory sequential mixed methods approach was used, including qualitative methods during stakeholder consultation (stage 1) and co-production (stage 2) and quantitative assessment during prototyping (stage 3). After ethical approval, recruitment occurred in three health units. Results from a literature search led to the adaptation of the Bridges Stroke Self-Management Program. In stage one, 47 participants were interviewed, with two themes emerging: (i) Personalized support and (ii) Building Bridges through small steps. In stage two, the ComVida program was developed, combining in-person and digital approaches, supported by a workbook and a mobile app. In stage three, 56 participants evaluated prototypes, demonstrating a strong level of quality. Understandability and actionability of the developed tools obtained high scores (91-100%). The app also showed good usability (A-grade) and high levels of recommendation (5 stars).

The Effects of Perinodular Features on Solid Lung Nodule Classification.

Lung cancer is the most lethal malignant neoplasm worldwide, with an annual estimated rate of 1.8 million deaths. Computed tomography has been widely used to diagnose and detect lung cancer, but its diagnosis remains an intricate and challenging work, even for experienced radiologists. Computer-aided diagnosis tools and radiomics tools have provided support to the radiologist's decision, acting as a second opinion. The main focus of these tools has been to analyze the intranodular zone; nevertheless, recent works indicate that the interaction between the nodule and its surroundings (perinodular zone) could be relevant to the diagnosis process. However, only a few works have investigated the importance of specific attributes of the perinodular zone and have shown how important they are in the classification of lung nodules. In this context, the purpose of this work is to evaluate the impact of using the perinodular zone on the characterization of lung lesions. Motivated by reproducible research, we used a large public dataset of solid lung nodule images and extracted fine-tuned radiomic attributes from the perinodular and intranodular zones. Our best-evaluated model obtained an average AUC of 0.916, an accuracy of 84.26%, a sensitivity of 84.45%, and specificity of 83.84%. The combination of attributes from the perinodular and intranodular zones in the image characterization resulted in an improvement in all the metrics analyzed when compared to intranodular-only characterization. Therefore, our results highlighted the importance of using the perinodular zone in the solid pulmonary nodules classification process.

Clinical implications of using non-invasive haemoglobin monitoring for red blood cell transfusion decision in hip arthroplasty.

INTRODUCTION: The decision to transfuse red blood cells requires accurate haemoglobin concentration values. In this study, we evaluated if continuous non-invasive haemoglobin (SpHb) measurement could substitute laboratory determined haemoglobin (LabHb) in patients undergoing elective hip replacement. As secondary objective, we analyzed the trend of the difference between techniques. MATERIALS/METHODS: LabHb measurements were done using an automated analyser and SpHb measurements were acquired using Radical-7®. In randomly selected patients undergoing hip replacement, whenever blood was collected for LabHb, concomitant SpHb was recorded. Correlation, bias and accuracy of SpHb were calculated in comparison with LabHb. RESULTS: 108 paired measurements were obtained from 43 patients. The Pearson R of the correlation between SpHb and LabHb was 0.7 (p < 0.001). Bland-Altman test revealed a bias of 1 ± 1.4 g dL-1, meaning Lab Hb was recurrently higher than SpHb. Limits of agreement were [-1.7; 3.8]. Considering RBC transfusion threshold of 8 g dL-1, we found that in two situations transfusion decision would differ based on the measurement considered. Trending ability of SpHb study showed a significant difference between preoperative and postoperative LabHb-SpHb. DISCUSSION: There was a good correlation between SpHb and LabHb, while bias and limits of agreement were higher than those in literature. There was a limited trending ability of SpHb during the perioperative period. Despite this, using SpHb instead of LabHb for decision making regarding transfusion would only change the decision in 1.9 % of our cases. Our findings suggest that this device could be used as a reference but cannot replace venous puncture as gold standard.

Measuring Health Vulnerability: An Interdisciplinary Indicator Applied to Mainland Portugal.

Health promotion and inequality reduction are specific goals of the United Nations 2030 Agenda, which are interconnected with several dimensions of life. This work proposes a composite index SEHVI-socioeconomic health vulnerability index-to address Portuguese population socioeconomic determinants that affect health outcomes. Variables composing SEHVI are aligned with the sustainable development goals considering data and times series availability to enable progress monitoring, and variables adequacy to translate populations' life conditions affecting health outcomes. Data for 35 variables and three periods were collected from official national databases. All variables are part of one of the groups: Health determinants (social, economic, cultural, and environmental factors) and health outcomes (mortality indicators). Variables were standardized and normalized by "Distance to a reference" method and then aggregated into the SEHVI formula. Several statistical procedures for validation of SEHVI revealed the internal consistency of the index. For all municipalities, SEHVI was calculated and cartographically represented. Results were analyzed by statistical tests and compared for three years and territory typologies. SEHVI differences were found as a function of population density, suggesting inequalities of communities' life conditions and in vulnerability to health.

Social support network and quality of life in multiple sclerosis patients.

OBJECTIVE: To analyse the relationship between the social support network (SSN) and health related quality of life (HRQOL) in multiple sclerosis (MS) patients. METHODS: The sample comprised 150 consecutive MS patients attending our MS clinic. To assess the socio-demographic data, a specifically designed questionnaire was applied. The HRQOL dimensions were measured with the Short-Form Health Survey Questionnaire-SF36 and the SSN with the Medical Outcomes Study Social Support Survey. Spearman's correlation was used to compare the magnitude of the relationship between the SSN and HRQOL. RESULTS: The mean patient age was 41.7 years (± 10.4; range: 18-70 yr); the mean Expanded Disability Status Score was 2.5 (±2.4; range: 0-9). There was a statistically significant correlation between the structure of the SSN and the HRQOL. CONCLUSION: The composition of the SSN, social group membership and participation in voluntary work have an important role in the HRQOL of patients with MS.

Social support network and quality of life in multiple sclerosis patients / Rede de apoio social e qualidade de vida de pacientes com esclerose múltipla

ABSTRACT Objective To analyse the relationship between the social support network (SSN) and health related quality of life (HRQOL) in multiple sclerosis (MS) patients. Methods The sample comprised 150 consecutive MS patients attending our MS clinic. To assess the socio-demographic data, a specifically designed questionnaire was applied. The HRQOL dimensions were measured with the Short-Form Health Survey Questionnaire-SF36 and the SSN with the Medical Outcomes Study Social Support Survey. Spearman’s correlation was used to compare the magnitude of the relationship between the SSN and HRQOL. Results The mean patient age was 41.7 years (± 10.4; range: 18–70 yr); the mean Expanded Disability Status Score was 2.5 (±2.4; range: 0–9). There was a statistically significant correlation between the structure of the SSN and the HRQOL. Conclusion The composition of the SSN, social group membership and participation in voluntary work have an important role in the HRQOL of patients with MS.

RESUMO Objetivo Analisar a relação entre a rede de apoio social (RAS) e a qualidade de vida relacionada com a saúde (QVRS) em pacientes com esclerose múltipla (EM). Métodos Foram avaliados consecutivamente 150 pacientes na consulta de esclerose múltipla. As dimensões da QVRS foram medidas com Short-Form Health Survey Questionnaire-SF36 e a RAS com o Medical Outcomes Study Social Support Survey. A correlação de Spearman foi utilizada para comparar a magnitude da relação entre a RAS e a QVRS. Resultados A idade média dos pacientes foi 41,7 anos (± 10,4; intervalo: 18–70 anos); a média da EDSS foi 2,5 (± 2,4; intervalo: 0–9). Foi encontrada uma correlação estatisticamente significativa entre a estrutura da RAS e a QVRS. Conclusão A composição da RAS, a pertença a um grupo social e a participação em trabalho voluntário têm um papel importante na QVRS dos pacientes com MS.

Are physicians aware of their role in tobacco control? A conference-based survey in Portugal.

BACKGROUND: The crucial role of physicians in tobacco control (TC) is widely recognized. In 2008, Portugal implemented a non-comprehensive smoke-free policy (SFP). In 2009, a conference-survey was carried out to explore Portuguese physicians' engagement in tobacco control, by evaluating the following: 1) attendance at TC training and awareness of training needs; 2) participation in TC activities; 3) attitudes and beliefs regarding SFPs. METHODS: Questionnaire-based cross-sectional study conducted during two major national medical conferences targeting GPs, hospitalists, and students/recent graduates. Descriptive analysis and logistic regression were performed. RESULTS: Response rate was 63.7% (605/950). Of the 605 participants, 58.3% were GPs, 32.4% hospitalists, 9.3% others; 62.6% were female; mean age was 39.0 ± 12.9 years. Smoking prevalence was 29.2% (95% CI: 23.3-35.1) in males; 15.8% (95% CI: 12.1-19.5) in females, p < 0.001. While the overwhelming majority of physicians strongly agreed that second-hand smoke (SHS) endangers health, awareness of SFP benefits and TC law was limited, p < 0.001. A significant minority (35.5%) believed that SHS can be eliminated by ventilation systems. Most physicians lacked training; only a minority (9.0%) participated regularly in TC. Training was the most consistent predictor of participation in TC. General agreement with SFP was high; but significantly lower for indoor leisure settings, outdoors bans in healthcare/schools settings and smoking restrictions in the home/car, p < 0.001. Smoking behaviour strongly predicted support for smoking restrictions in restaurants and bars/discos, healthcare outdoors and private settings. CONCLUSIONS: The findings suggest that Portuguese physicians are not aware of their role in tobacco control. Poor engagement of physicians in TC may contribute to the current lack of comprehensive policies in Portugal and Europe and undermine social norm change. Medical and professional continuing education on tobacco control should be made top priorities.

Compliance and enforcement of a partial smoking ban in Lisbon taxis: an exploratory cross-sectional study.

BACKGROUND: Research evaluating enforcement and compliance with smoking partial bans is rather scarce, especially in countries with relative weak tobacco control policies, such as Portugal. There is also scarce evidence on specific high risk groups such as vehicle workers. In January 2008, Portugal implemented a partial ban, followed by poor enforcement. The purpose of this study was to explore the effectiveness of a partial smoking ban in a pro-smoking environment, specifically transportation by taxi in the city of Lisbon. Ban effectiveness was generally defined by ban awareness and support, compliance and enforcement. METHODS: Exploratory cross-sectional study; purposive sampling in selected Lisbon streets. Structured interviews were conducted by trained researchers while using taxi services (January 2009-December 2010). PARTICIPANTS: 250 taxi drivers (98.8% participation rate). Chi-square, McNemar, Man Whitney tests and multiple logistic regression were performed. RESULTS: Of the participants, 249 were male; median age was 53.0 years; 43.6% were current smokers. Most participants (82.8%) approved comprehensive bans; 84.8% reported that clients still asked to smoke in their taxis; 16.8% allowed clients to smoke. Prior to the ban this value was 76.9% (p < 0.001). The major reason for not allowing smoking was the legal ban and associated fines (71.2%). Of the smokers, 66.1% admitted smoking in their taxi. Stale smoke smells were detected in 37.6% of the cars. None of the taxi drivers did ever receive a fine for non-compliance. Heavy smoking, night-shift and allowing smoking prior the ban predicted non-compliance. CONCLUSIONS: Despite the strong ban support observed, high smoking prevalence and poor enforcement contribute to low compliance. The findings also suggest low compliance among night-shift and vehicle workers. This study clearly demonstrates that a partial and poorly-enforced ban is vulnerable to breaches, and highlights the need for clear and strong policies.

Social characteristics and quality of life of portuguese multiple sclerosis patients.

INTRODUCTION: Few studies have analyzed the importance of socio-demographic variables on the perception of health-related quality of life (HRQoL) in patients with multiple sclerosis (MS). METHODS: The sample was composed of 150 patients with MS. Statistical analysis was performed using Mann-Whitney U and Kruskal-Wallis H non-parametric tests comparing socio-demographic items with HRQoL. RESULTS: We found statistically significant differences between age, education levels, employment status, disability and all dimensions of HRQoL. DISCUSSION: This study contributes to a more systematic knowledge about the relationship between social characteristics and HRQoL, which is important to improve the planning of health care in MS patients. CONCLUSION: We found that younger patients, those with higher education level, those who were employed, and with lower disease progression and lower disability, had better HRQoL.

Initial brazilian experience in the treatment of localized prostate cancer using a new generation cryotechnology: feasibility study.

INTRODUCTION: The objective of our study is to present the first Brazilian cryoablation experience in the treatment of low and intermediate risk localized prostate cancer using 3rd generation cryoablation and real-time biplanar transrectal ultrasonography. MATERIALS AND METHODS: Ten Brazilian patients underwent primary cryoablation for localized prostate cancer between October 2010 and June 2011. All patients consented for whole gland primary cryotherapy. The procedures were performed by 3rd generation cryoablation with the Cryocare System ® (Endocare, Irvine, California). Preoperative data collection included patient demographics along with prostate gland size, Gleason score, serum prostate specific antigen, and erectile function status. Operative and post--operative assessment involved estimated blood loss, operative time, complications, serum PSA level, erectile function status, urinary incontinence, biochemical disease free survival (BDFS), and follow-up time. RESULTS: All patients in the study successfully underwent whole gland cryoablation. The mean of: age, prostate size, PSA level, and Gleason score, was 66.2 years old; 40.7 g; 7.8 ng/mL; and 6 respectively. All patients were classified as low or moderate D' Amico risk (5 low and 5 moderate). Erectile dysfunction was present in 50% of patients. The estimated blood loss was minimal, operative time was 46.1 minutes. All patients that developed erectile dysfunction post-treatment responded to oral or intracavernosal medications with early penile rehabilitation. All patients maintained urinary continence by the end of a 10 months evaluation period and none had biochemical relapse within the mean follow-up of 13 months (7-15 months). CONCLUSION: Our initial experience shows that cryoablation is a minimally invasive option for the treatment of localized prostate cancer. Short term data seems to be promising but longer follow-up is necessary to verify oncological and functional results.

Initial Brazilian experience in the treatment of localized prostate cancer using a new generation cryotechnology: feasibility study

INTRODUCTION: The objective of our study is to present the first Brazilian cryoablation experience in the treatment of low and intermediate risk localized prostate cancer using 3rd generation cryoablation and real-time biplanar transrectal ultrasonography. MATERIALS AND METHODS: Ten Brazilian patients underwent primary cryoablation for localized prostate cancer between October 2010 and June 2011. All patients consented for whole gland primary cryotherapy. The procedures were performed by 3rd generation cryoablation with the Cryocare System® (Endocare, Irvine, California). Preoperative data collection included patient demographics along with prostate gland size, Gleason score, serum prostate specific antigen, and erectile function status. Operative and post-operative assessment involved estimated blood loss, operative time, complications, serum PSA level, erectile function status, urinary incontinence, biochemical disease free survival (BDFS), and follow-up time. RESULTS: All patients in the study successfully underwent whole gland cryoablation. The mean of: age, prostate size, PSA level, and Gleason score, was 66.2 years old; 40.7g; 7.8ng/mL; and 6 respectively. All patients were classified as low or moderate D'Amico risk (5 low and 5 moderate). Erectile dysfunction was present in 50% of patients. The estimated blood loss was minimal, operative time was 46.1 minutes. All patients that developed erectile dysfunction post-treatment responded to oral or intracavernosal medications with early penile rehabilitation. All patients maintained urinary continence by the end of a 10 months evaluation period and none had biochemical relapse within the mean follow-up of 13 months (7-15 months). CONCLUSION: Our initial experience shows that cryoablation is a minimally invasive option for the treatment of localized prostate cancer. Short term data seems to be promising but longer follow-up is necessary to verify oncological and functional results.

Effectiveness of bivalent vaccines against Aeromonas hydrophila and Lactococcus garvieae infections in rainbow trout Oncorhynchus mykiss (Walbaum).

Lactococcus garvieae and Aeromonas hydrophila are bacterial pathogens affecting salmonids and other fish species and cause of heavy losses in aquaculture. Diseases caused by these bacteria can be controlled satisfactory by immunization using monovalent vaccines. In this study, the protective efficacy of two bivalent vaccines against L. garvieae and A. hydrophila was evaluated in rainbow trout (Oncorhynchus mykiss). Bivalent formulations, containing formalin-inactivated bacteria, were prepared as an aqueous bacterin and as an adjuvanted vaccine using montanide ISA-763. Protection against L. garvieae and A. hydrophila was tested at day 30 and 90 post-vaccination. High levels of protection were achieved for the aqueous and adjuvanted bivalent vaccines against L. garvieae (RPS of 100% and 95.3%) and A. hydrophila (RPS of 100% and 95.3%) at day 30 post-vaccination. Significant differences (p < 0.05) were found between the RPS at days 30 and 90 post-immunization with a decrease in the protection levels for the aqueous bivalent vaccine against L. garvieae (RPS 76.2%) and A. hydrophila (RPS 85%), but not for the adjuvanted vaccine (RPS of 90% against L. garvieae and 95% against A. hydrophila). In addition, high antibody levels were observed in the vaccinated fish at day 15 post-immunization using both vaccines. Our results demonstrate that these bivalent vaccines can effectively protect rainbow trout against L. garvieae and A. hydrophila and could offer an appropriate strategy to prevent these infections in rainbow trout farms.

The effect of social support on the quality of life of patients with multiple sclerosis.

OBJECTIVE: To determine the predictive value of social support on health related quality of life (HRQoL) in multiple sclerosis (MS) patients. METHODS: The sample is composed by 150 MS consecutive patients. We used the Medical Outcomes Study Social Support Survey to assess social support and the Health Status Questionnaire to assess HRQoL. For inferential analysis, we used the Multiple Linear Regression with stepwise selection of variables. RESULTS: The age, basic education, psychological support and disability explains 41.6% of the variance in physical function, 29.4% in physical performance and 30.6% in emotional performance. Age and psychological support explains 23.1% of the variance in physical function and 29.4% in vitality. CONCLUSION: This study demonstrated that social support is a predictor with a significant effect on HRQoL in MS.

The effect of social support on the quality of life of patients with multiple sclerosis / Efeito do apoio social na qualidade de vida de pacientes com esclerose múltipla

OBJECTIVE: To determine the predictive value of social support on health related quality of life (HRQoL) in multiple sclerosis (MS) patients. METHODS: The sample is composed by 150 MS consecutive patients. We used the Medical Outcomes Study Social Support Survey to assess social support and the Health Status Questionnaire to assess HRQoL. For inferential analysis, we used the Multiple Linear Regression with stepwise selection of variables. RESULTS: The age, basic education, psychological support and disability explains 41.6 percent of the variance in physical function, 29.4 percent in physical performance and 30.6 percent in emotional performance. Age and psychological support explains 23.1 percent of the variance in physical function and 29.4 percent in vitality. CONCLUSION: This study demonstrated that social support is a predictor with a significant effect on HRQoL in MS.

OBJETIVO: Determinar o valor preditivo do apoio social na qualidade de vida relacionada com a saúde dos doentes com esclerose múltipla (HRQoL). MÉTODO: Cento e cinquenta doentes foram consecutivamente avaliados na consulta de esclerose múltipla. Usamos o Medical Outcomes Study Social Support Survey para avaliar o apoio social e o Health Status Questionnaire para avaliar a qualidade de vida. Na análise inferencial, utilizamos a regressão múltipla linear com a seleção de variáveis passo a passo. RESULTADOS: A idade, a educação básica, o apoio psicológico e a incapacidade explicam 41,6 por cento da variância na função física, 29,4 por cento da variância no desempenho físico e 30,6 por cento da variância no desempenho emocional. Idade e apoio psicológico explicam 23,1 por cento da variância na função física e 29,4 por cento na vitalidade. CONCLUSÃO: Este estudo demonstrou que o apoio social é o preditor com um efeito significativo sobre HRQoL.

[The effect of social support on the symptoms of depression experienced by Portuguese patients with multiple sclerosis]. / Efecto del apoyo social en los síntomas depresivos de pacientes Portugueses con esclerosis múltiple.

INTRODUCTION: The prevalence of depressive symptoms is high among patients with multiple sclerosis (MS). Despite being associated with low levels of social support, few studies showing the importance of the buffer effect on depressive symptoms. The aim is to analyze the effect of social support on depressive symptoms. PATIENTS AND METHODS: The sample is composed by 150 MS consecutive patients attending the MS Outpatient Clinic of Hospital S. Joao, Porto, that gave written consent; illiterate subjects were excluded. The disease parameters, as duration, clinical course and disability (Expanded Disability Status Scale) were collected in the clinical protocols. In the comparison of socio-demographic variables and parameters with the depressive symptoms we used the Mann-Whitney U and Kruskal-Wallis H. In interferential analysis we used the MLR with stepwise selection of variables. RESULTS: Age, education emotional social support, disability, duration of illness and the primary and secondary forms determine together 42.4% of depressive symptoms. Gender, marital status, be unskilled worker, have material social support and relapsing- remitting form does not determine any change in depressive symptoms. CONCLUSIONS: The emotional social support is a predictor of depressive symptoms. This study reinforces the need for professionals to be sources of social support in promoting programs that reduce the risk of depressive symptoms.

Efecto del apoyo social en los síntomas depresivos de pacientes portugueses con esclerosis múltiple / The effect of social support on the symptoms of depression experienced by Portuguese patients with multiple sclerosis

Introducción. La prevalencia de síntomas depresivos es elevada entre los pacientes con esclerosis múltiple (EM). A pesar de aparecer asociada a bajos niveles de apoyo social, hay pocos estudios que evidencien la importancia del efecto buffer de ese apoyo sobre los síntomas depresivos. El objetivo es analizar el efecto del apoyo social sobre los síntomas depresivos. Pacientes y métodos. La muestra se compone de 150 pacientes de la consulta de esclerosis múltiple del Hospital S. João, de Oporto. Usamos un cuestionario para recoger los datos sociodemográficos, la Medical Outcomes Study-Social Support Survey para evaluar el apoyo social y el inventario de depresión de Beck para evaluar los síntomas depresivos. Los parámetros de la EM y de la Expanded Disability Status Scale fueron recogidos a partir de las historias clínicas. En la comparación de las variables sociodemográficas y de los parámetros de la EM con los síntomas depresivos, usamos los tests U de Mann-Whitney y H de Kruskall-Wallis. En el análisis inferencial, utilizamos la regresión lineal múltiple con selección de variables stepwise. Resultados. La edad, la enseñanza básica, el apoyo social afectivo y emocional, la discapacidad, el tiempo de evolución de la enfermedad y las formas primariamente progresiva y secundariamente progresiva determinan juntas el 42,4% de los síntomas depresivos. Conclusiones. El apoyo social afectivo y emocional es un predictor de los síntomas depresivos. Este estudio refuerza la necesidad de que los equipos de tratamiento se constituyan como una de las fuentes de apoyo social en la promoción de programas que reduzcan el riesgo de síntomas depresivos (AU)

Introduction. The prevalence of depressive symptoms is high among patients with multiple sclerosis (MS). Despite being associated with low levels of social support, few studies showing the importance of the buffer effect on depressive symptoms. The aim is to analyze the effect of social support on depressive symptoms. Patients and methods. The sample is composed by 150 MS consecutive patients attending the MS Outpatient Clinic of Hospital S. João, Porto, that gave written consent; illiterate subjects were excluded. The disease parameters, as duration, clinical course and disability (Expanded Disability Status Scale) were collected in the clinical protocols. In the comparison of socio-demographic variables and parameters with the depressive symptoms we used the Mann-Whitney U and Kruskal- Wallis H. In interferential analysis we used the MLR with stepwise selection of variables. Results. Age, education emotional social support, disability, duration of illness and the primary and secondary forms determine together 42.4% of depressive symptoms. Gender, marital status, be unskilled worker, have material social support and relapsing- remitting form does not determine any change in depressive symptoms. Conclusions. The emotional social support is a predictor of depressive symptoms. This study reinforces the need for professionals to be sources of social support in promoting programs that reduce the risk of depressive symptoms (AU)

Smoking behaviour predicts tobacco control attitudes in a high smoking prevalence hospital: a cross-sectional study in a Portuguese teaching hospital prior to the national smoking ban.

BACKGROUND: Several studies have investigated attitudes to and compliance with smoking bans, but few have been conducted in healthcare settings and none in such a setting in Portugal. Portugal is of particular interest because the current ban is not in line with World Health Organization recommendations for a "100% smoke-free" policy. In November 2007, a Portuguese teaching-hospital surveyed smoking behaviour and tobacco control (TC) attitudes before the national ban came into force in January 2008. METHODS: Questionnaire-based cross-sectional study, including all eligible staff. SAMPLE: 52.9% of the 1, 112 staff; mean age 38.3 ± 9.9 years; 65.9% females. Smoking behaviour and TC attitudes and beliefs were the main outcomes. Bivariable analyses were conducted using chi-squared and MacNemar tests to compare categorical variables and Mann-Whitney tests to compare medians. Multilogistic regression (MLR) was performed to identify factors associated with smoking status and TC attitudes. RESULTS: Smoking prevalence was 40.5% (95% CI: 33.6-47.4) in males, 23.5% (95% CI: 19.2-27.8) in females (p < 0.001); 43.2% in auxiliaries, 26.1% in nurses, 18.9% among physicians, and 34.7% among other non-health professionals (p = 0.024). The findings showed a very high level of agreement with smoking bans, even among smokers, despite the fact that 70.3% of the smokers smoked on the premises and 76% of staff reported being frequently exposed to second-hand smoke (SHS). In addition 42.8% reported that SHS was unpleasant and 28.3% admitted complaining. MLR showed that smoking behaviour was the most important predictor of TC attitudes. CONCLUSIONS: Smoking prevalence was high, especially among the lower socio-economic groups. The findings showed a very high level of support for smoking bans, despite the pro-smoking environment. Most staff reported passive behaviour, despite high SHS exposure. This and the high smoking prevalence may contribute to low compliance with the ban and low participation on smoking cessation activities. Smoking behaviour had greater influence in TC attitudes than health professionals' education. Our study is the first in Portugal to identify potential predictors of non-compliance with the partial smoking ban, further emphasising the need for a 100% smoke-free policy, effective enforcement and public health education to ensure compliance and promote social norm change.

Short-term association between exposure to ozone and mortality in Oporto, Portugal.

Exposures to air pollution in developed countries have generally decreased over the last two decades. However, many recent epidemiological studies have consistently shown positive associations between low-level exposure to air pollutants and health outcomes. In Portugal, very few studies have analysed the acute effect of air pollutants on health. The present study evaluates the association between exposure to air pollution and daily mortality in the Oporto Metropolitan Area, Portugal. Generalised additive models were used for this analysis. Pollutants assessed were ozone, nitrogen dioxide, and particulate matter (PM(10)). Models were adjusted for time trend, seasonality, and weather. We report that an increase of 10 µg/m(3) in the daily ozone 8-h maximum moving-average corresponds to an increase of 0.95% (95%CI: 0.30, 1.60) and 1.58% (95%CI: 0.45, 2.73) in non-accidental mortality and cardiovascular mortality, respectively, in the summer season. A significant effect of 0.67% (95% CI: 0.03:1.32) was also found for the association between PM(10) and non-accidental mortality in the summer season. Associations with ozone and PM(10) exposures were higher in the elderly people. No significant effects on mortality were observed during the summer season with nitrogen dioxide exposures. Our analyses provide the first significant evidence in Oporto that exposures to O(3) and PM(10) have adverse effects on the health of the general population in the summer months.

Effects of apparent temperature on daily mortality in Lisbon and Oporto, Portugal.

BACKGROUND: Evidence that elevated temperatures can lead to increased mortality is well documented, with population vulnerability being location specific. However, very few studies have been conducted that assess the effects of temperature on daily mortality in urban areas in Portugal. METHODS: In this paper time-series analysis was used to model the relationship between mean apparent temperature and daily mortality during the warm season (April to September) in the two largest urban areas in Portugal: Lisbon and Oporto. We used generalized additive Poisson regression models, adjusted for day of week and season. RESULTS: Our results show that in Lisbon, a 1 degrees C increase in mean apparent temperature is associated with a 2.1% (95%CI: 1.6, 2.5), 2.4% (95%CI: 1.7, 3.1) and 1.7% (95%CI: 0.1, 3.4) increase in all-causes, cardiovascular, and respiratory mortality, respectively. In Oporto the increase was 1.5% (95%CI: 1.0, 1.9), 2.1% (95%CI: 1.3, 2.9) and 2.7% (95%CI: 1.2, 4.3) respectively. In both cities, this increase was greater for the group >65 years. CONCLUSION: Even without extremes in apparent temperature, we observed an association between temperature and daily mortality in Portugal. Additional research is needed to allow for better assessment of vulnerability within populations in Portugal in order to develop more effective heat-related morbidity and mortality public health programs.

Second hand smoke (SHS) exposure in children. An evaluation of a preventative measure.

AIMS: To evaluate the effectiveness of the preventative programme "Smoke-free Homes" undertaken in 4th year children and their parents or guardians, aiming to reduce children's exposure to second hand smoke (SHS) in the home. MATERIAL AND METHODS: This was a pre- and post-test pre-experimental study, in students from 32 Braga district primary schools 2007/08. A self-administered and structured questionnaire was given out to 795 students in the classroom before and after the programme. In analysing data, we used the chi-squared test for the categorical variables. RESULTS: The rate of children exposed to regular or occasional SHS due to living with at least one smoker dropped from 42.2% to 32.6% (p=0.001). The percentage of students, children of smokers who stated that their father smoked regularly or occasionally at home, dropped from 68.0% pre-test to 51.6% posttest (p=0.000). No significant reduction was seen in mothers. CONCLUSION: Based on the data, we can conclude that the "Smoke-free Homes" programme was effective in preventing smoking in the home, and therefore reducing the rate of children exposed to SHS by about 10%. However, it appears that about a third of children are still exposed, which highlights the need for further measures in this area. Healthcare professionals, particularly those working in Paediatrics, should advise parents to quit smoking, especially in the home.