Tuberculosis inequalities and socio-economic deprivation in Portugal.

OBJECTIVE: To analyse the geographical distribution of tuberculosis (TB) in Portugal and estimate the association between TB and socio-economic deprivation. METHODS: An ecological study at the municipality level using TB notifications for 2010-2014 was conducted. Spatial Bayesian models were used to calculate smoothed standardised notification rates, identify high- and low-risk areas and estimate the association between TB notification and the European Deprivation Index (EDI) for Portugal and its component variables. RESULTS: Standardised notification rates ranged from 4.41 to 76.44 notifications per 100 000 population. Forty-one high-risk and 156 low-risk municipalities were identified. There was no statistically significant association between TB notification rate and the EDI, but some of its variables, such as the proportion of manual workers and the percentage unemployed, were significantly and directly associated with TB notification, whereas the variable 'proportion of residents with low education level' showed an inverse relationship. CONCLUSION: Wide inequalities in TB notification rates were observed, and some areas continued to exhibit high TB notification rates. We found significant associations between TB and some socio-economic factors of the EDI.

Tuberculosis among the homeless: should we change the strategy?

BACKGROUND: Tuberculosis (TB) is a major concern among high-risk populations such as the homeless. OBJECTIVES: To evaluate TB incidence and treatment outcomes among homeless patients in Portugal and to identify predictors of unsuccessful TB treatment outcomes among the homeless. DESIGN: This was a retrospective cohort study of all TB patients notified in Portugal from 2008 to 2014. Characteristics of homeless TB patients were assessed and predictors of unsuccessful TB treatment were determined using logistic regression. RESULTS: TB incidence among the homeless was 122/100,000 homeless persons and was positively correlated with TB incidence among non-homeless persons. Homeless TB patients had a higher prevalence of alcohol and/or drug use, human immunodeficiency virus (HIV) co-infection, cavitary TB and smear positivity. The rate of unsuccessful treatment outcomes among the homeless was 28.6%, and was significantly associated with increased age, injection drug use (IDU) and HIV co-infection. CONCLUSION: TB incidence among homeless persons was five times that among the non-homeless, and higher in regions with greater TB incidence among non-homeless persons. The successful treatment outcome rate was lower. Predictors of unsuccessful treatment were age, IDU and HIV co-infection. Integrated TB programmes targeting homeless and non-homeless patients, with measures targeting specific characteristics, may contribute to TB elimination in Portugal.

Relationship between waist circumference and supine abdominal height measured at different anatomical sites and cardiometabolic risk factors in older women.

OBJECTIVES: To measure waist circumference (WC) and supine abdominal height (SAH) at different anatomic sites and to assess the relationship with cardiometabolic risk factors in women aged >60 years. METHODS: The present study included 113 women from Viçosa, Minas Gerais, Brazil. The evaluations comprised anthropometric, biochemical and haemodynamic measurements. Different anatomical sites were used to measure WC: (i) the midpoint between the last rib and iliac crest; (ii) umbilical level; (iii) immediately above the iliac crests; and (iv) the narrowest point between the last rib and the iliac crest. Measurements were also taken at different anatomic sites for SAH: (i) the midpoint between the iliac crests; (ii) umbilical level; (iii) higher abdominal diameter; and (iv) the narrowest point between the last rib and the iliac crest. RESULTS: It was found that 35.4% of women were overweight, and the area (SE) body mass index was 25.8 (4.2) kg/m(2). WC at the umbilical level [area (SE) area under the curve (AUC) = 0.694 (0.079)] and SAH at the midpoint between the iliac crests [AUC = 0.747 (0.076)] showed the largest areas under the receiver operating characteristic curve (P < 0.05) with respect to the identification of cardiometabolic risk factors associated with the metabolic syndrome (MS) where, of the two measures, SAH showed the greatest predictive potential. CONCLUSIONS: The results obtained in the present study suggest that, for the assessment of older women, the umbilical level and the midpoint between the iliac crests should used to measure WC and SAH, respectively. SAH showed the greatest predictive power for cardiometabolic risk factors associated with the MS in older women.

Sarcoma de Kaposi iatrogénico con afectación cutánea exclusiva / Iatrogenic Kaposi’s sarcoma with exclusive skin involvement

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Peroxisome proliferator-activated receptor: effects on nutritional homeostasis, obesity and diabetes mellitus.

The obesity and the metabolic disorders associated characterize the metabolic syndrome, which has increased at an alarming rate around the world. It is known that environmental and genetic factors are involved in the genesis of obesity. Peroxisome Proliferator-Activated Receptors (PPARs) stand out among these factors. They compose the nuclear receptor superfamily and there are in three isoforms (PPARα,PPARß/δ and PPARγ), which play an important role in the regulation of the metabolism of carbohydrates, lipids and proteins. The present review aims to understand the relationship between the diet, the PPARs and the control of the blood glucose and body weight, since the understanding about the mechanisms by which these receptors act may benefit the development of the strategies aiming at prevention and elaboration of therapeutics actions which are more effective for the treatment of obesity and diabetes.

Peroxisome proliferator-activated receptor: effects on nutritional homeostasis, obesity and diabetes mellitus / Receptores activados por los proliferadores de peroxisomas: implicaciones sobre la homeostasis nutricional, en la obesidad y en la diabetes mellitus

The obesity and the metabolic disorders associated characterize the metabolic syndrome, which has increased at an alarming rate around the world. It is known that environmental and genetic factors are involved in the genesis of obesity. Peroxisome Proliferator-Activated Receptors (PPARs) stand out among these factors.They compose the nuclear receptor superfamily and there are in three isoforms (PPARα, PPARβ/δ andPPARγ), which play an important role in the regulation of the metabolism of carbohydrates, lipids and proteins.The present review aims to understand the relationship between the diet, the PPARs and the control of the blood glucose and body weight, since the understanding about the mechanisms by which these receptors act may benefit the development of the strategies aiming at prevention and elaboration of therapeutics actions which are more effective for the treatment of obesity and diabetes (AU)

La obesidad y los trastornos metabólicos asociados, que caracterizan el cuadro del síndrome metabólico, han aumentado de manera alarmante en todo el mundo. Se sabe que factores genéticos y ambientales están implicados en la génesis de la obesidad. Entre estos se destacan los Receptores Activados por los Proliferadores de Peroxisomas (PPAR), los cuales componen la super familia de los receptores nucleares que poseen tres isoformas de PPAR (PPARα,PPARβ/δ y PPARγ) que desempeñan importante papel en la regulación del metabolismo de los hidratos de carbono,de los lípidos y de las proteínas. El presente trabajo de revisión contribuye a clarificar la interrelación existente entre la dieta, los PPAR y el control de la glucemia y peso, ya que el conocimiento de los mecanismos por los cuales estos receptores actúan, puede beneficiar el desarrollo de estrategias de prevención y elaboración de procedimientos terapéuticos más eficaces para el tratamiento de la obesidad y de la diabetes (AU)