Health Literacy among Older Adults in Portugal and Associated Sociodemographic, Health and Healthcare-Related Factors.

Although the health literacy level of the general population was described recently, little is known about its specific levels among older adults in Portugal. Therefore, this cross-sectional study aimed to investigate the levels of health literacy demonstrated by older adults in Portugal and explore associated factors. Using a randomly generated list of telephone numbers, adults aged 65 years or more living in mainland Portugal were contacted in September and October 2022. Sociodemographic, health and healthcare-related variables were collected, and the 12-item version of the European Health Literacy Survey Project 2019-2021 was used to measure health literacy. Then, binary logistic regression models were used to investigate factors associated with limited general health literacy. In total, 613 participants were surveyed. The mean level of general health literacy was (59.15 ± 13.05; n = 563), whereas health promotion (65.82 ± 13.19; n = 568) and appraising health information (65.16 ± 13.26; n = 517) were the highest scores in the health literacy domain and the dimension of health information processing, respectively. Overall, 80.6% of respondents revealed limited general health literacy, which was positively associated with living in a difficult household financial situation (4.17; 95% Confidence Interval (CI): 1.64-10.57), perceiving one's own health status as poorer (7.12; 95% CI: 2.02-25.09), and having a fair opinion about a recent interaction with primary healthcare services (2.75; 95% CI: 1.46-5.19). The proportion of older adults with limited general health literacy in Portugal is significant. This result should be considered to inform health planning according to the health literacy gap of older adults in Portugal.

Impact of Mechanical Complications on Success of Dental Implant Treatments: A Case-Control Study.

OBJECTIVE: This study aimed to investigate the impact of mechanical complications on outcome measures for implant dentistry. MATERIALS AND METHODS: This case-control study included 282 patients with mechanical complications occurring in fixed prosthetic rehabilitation supported by immediate function implants with external connection (cases) and 282 individuals without mechanical complications (control). Pairing was performed for sex, age (range = 3 years), and follow-up months (range = 11 months). The primary outcome measure was implant survival, while the secondary outcome measures were marginal bone loss and biological complication parameters (peri-implant pathology, soft tissue inflammation, fistula formation, and abscess formation). STATISTICAL ANALYSIS: Cumulative implant survival was estimated by using life tables. Descriptive statistics with 95% confidence intervals (CI) and inferential statistics (Chi-square test) were performed to evaluate differences between cases and controls. The significance level was set at 5%. RESULTS: The average follow-up duration was 8.5 years. Mechanical complications included prosthetic fracture (n = 159), abutment loosening (n = 89), prosthetic screw loosening (n = 20), milled abutment (n = 12), milled prosthetic screw (n = 1), and decemented crown (n = 1). Implant failure occurred in one patient from the control group, with survival rates of 100 and 99.6% for cases and controls, respectively (p = 0.317). The average marginal bone loss was 1.72 (95% confidence interval [CI]: 1.60-1.84) for cases and 1.55 (95% CI: 1.45-1.65) for controls (p = 0.068). Biological complications were observed in 90 patients, with significant differences between cases (n = 54) and controls (n = 36; p = 0.038). CONCLUSION: Mechanical complications did not significantly influence survival or marginal bone loss; nevertheless, there is a need for studies with longer follow-up duration. Mechanical complications also significantly influence the incidence of biological complications.

Measles outbreak after 12 years without endemic transmission, Portugal, February to May 2017.

We report a measles outbreak in two Portuguese health regions (Algarve and Lisbon and the Tagus Valley) since February 2017, and which by 31 May resulted in 28 confirmed cases, of which 16 were unvaccinated. Thirteen cases were healthcare workers. One unvaccinated teenager died. Genotype B3 was identified in 14 cases from both regions. This outbreak occurs after 12 years without endemic measles transmission, and in a context of high measles vaccination coverage and immunity.

Ten years of hospital admissions for liver cirrhosis in Portugal.

BACKGROUND AND AIMS: More data on epidemiology of liver diseases in Europe are needed. We aimed to characterize hospital admissions for liver cirrhosis in Portugal during the past decade. PATIENTS AND METHODS: We analyzed all hospital admissions for cirrhosis in Portugal Mainland between 2003 and 2012 registered in the national Diagnosis-Related Group database. Cirrhosis was classified according to etiology considering alcohol, hepatitis B, and hepatitis C. RESULTS: Between 2003 and 2012, there were 63,910 admissions for cirrhosis in Portugal Mainland; 74.4% involved male patients. Etiologies of admitted cirrhosis were as follows: 76.0% alcoholic, 1.1% hepatitis B, 1.4% hepatitis B plus alcohol, 3.6% hepatitis C, and 4.0% hepatitis C plus alcohol. There was a significant decline (P<0.001) in admissions for alcoholic cirrhosis, whereas hospitalizations for cirrhosis caused by hepatitis C or hepatitis C plus alcohol increased by almost 50% (P<0.001). Patients admitted with alcoholic plus hepatitis B or C cirrhosis were significantly younger than those with either alcoholic or viral cirrhosis (53.1 vs. 59.4 years, respectively, P<0.001). Hospitalization rates for cirrhosis were 124.4/100,000 in men and 32.6/100,000 in women. Hepatocellular carcinoma and fluid retention were more common in viral cirrhosis, whereas encephalopathy and variceal bleeding were more frequent in alcoholic cirrhosis. Hepatorenal syndrome was the strongest predictor of mortality among cirrhosis complications (odds ratio 12.97; 95% confidence interval 11.95-14.09). In-hospital mortality was 15.2%. CONCLUSION: Despite the decline in admissions for alcoholic cirrhosis and the increase in those related to hepatitis C, the observed burden of hospitalized liver cirrhosis in Portugal was essentially attributable to alcoholic liver disease.

Adaptive evolution of the Chlamydia trachomatis dominant antigen reveals distinct evolutionary scenarios for B- and T-cell epitopes: worldwide survey.

BACKGROUND: Chlamydia trachomatis is one of the most disseminated human pathogens, for which no vaccine is available yet. Understanding the impact of the host pressure on pathogen antigens is crucial, but so far it was only assessed for highly-restricted geographic areas. We aimed to evaluate the evolutionary picture of the chlamydial key antigen (MOMP), which is one of the leading multi-subunit vaccine candidates, in a worldwide basis. METHODOLOGY/PRINCIPAL FINDINGS: Using genetics, molecular evolution methods and mathematical modelling, we analyzed all MOMP sequences reported worldwide, composed by 5026 strains from 33 geographic regions of five continents. Overall, 35.9% of variants were detected. The evolutionary pattern of MOMP amino acid gains/losses was found to differ from the remaining chromosome, reflecting the demanding constraints of this porin, adhesin and dominant antigen. Amino acid changes were 4.3-fold more frequent in host-interacting domains (P<10⁻¹²), specifically within B-cell epitopes (P<10⁻5), where 25% of them are at fixation (P<10⁻5). According to the typical pathogen-host arms race, this rampant B-cell antigenic variation likely represents neutralization escape mutants, as some mutations were previously shown to abrogate neutralization of chlamydial infectivity in vitro. In contrast, T-cell clusters of diverse HLA specificities are under purifying selection, suggesting a strategy that may lead to immune subversion. Moreover, several silent mutations are at fixation, generating preferential codons that may influence expression, and may also reflect recombination-derived 'hitchhiking-effect' from favourable nonsilent changes. Interestingly, the most prevalent C. trachomatis genotypes, E and F, showed a mutation rate 22.3-fold lower than that of the remainder (P<10⁻²°), suggesting more fitted antigenic profiles. CONCLUSIONS/SIGNIFICANCE: Globally, the adaptive evolution of the C. trachomatis dominant antigen is likely driven by its complex pathogenesis-related function and reflects distinct evolutionary antigenic scenarios that may benefit the pathogen, and thus should be taking into account in the development of a MOMP-based vaccine.

Chlamydia trachomatis diversity viewed as a tissue-specific coevolutionary arms race.

BACKGROUND: The genomes of pathogens are thought to have evolved under selective pressure provided by the host in a coevolutionary arms race (the 'Red Queen's Hypothesis'). Traditionally, adaptation by pathogens is thought to rely not on whole chromosome dynamics but on gain/loss of specific genes, yielding differential abilities to infect distinct tissues. Thus, it is not known whether distinct host organs differently shape the genome of the same pathogen. We tested this hypothesis using Chlamydia trachomatis as model species, looking at 15 serovars that infect different organs: eyes, genitalia and lymph nodes. RESULTS: We analyzed over 51,000 base pairs from all serovars using various phylogenetic approaches and a non-phylogenetic indel-based algorithm to study the evolution of individual and concatenated loci. This survey comprised about 33% of all single nucleotide polymorphisms in C. trachomatis chromosomes. We present a model in which genome evolution indeed correlates with the cell type (epithelial versus lymph cells) and organ (eyes versus genitalia) that a serovar infects, illustrating an adaptation to physiologically distinct niches, and discarding genetic drift as the dominant evolutionary driving force. We show that radiation of serovars occurred primarily by accumulation of single nucleotide polymorphisms in intergenomic regions, housekeeping genes, and genes encoding hypothetical and cell envelope proteins. Furthermore, serovar evolution also correlates with ecological success, as the two most successful serovars showed a parallel evolution. CONCLUSION: We identified a single nucleotide polymorphism-based tissue-specific arms race for strains in the same species, reflecting global chromosomal dynamics. Studying such tissue-specific arms race scenarios is crucial for understanding pathogen-host interactions during the course of infectious diseases, in order to dissect pathogen biology and develop preventive and therapeutic strategies.