Carla Henriques

Objectives: This study aimed to derive and validate a cut-off for severe disease activity (SDA) using the SLE Disease Activity Score (SLE-DAS) and compare its accuracy and impact on health-related quality of life (HR-QoL) with the British Isles Lupus Assessment Group 2004 (BILAG-2004) and SLE Disease Activity Index 2000 (SLEDAI-2K). Methods: We performed a post hoc analysis of pooled placebo arm data from the MUSE (A Phase II, Randomized Study to Evaluate the Efficacy and Safety of MEDI-546 in Subjects with Systemic Lupus Erythematosus), TULIP-1 and TULIP-2 (Treatment of Uncontrolled Lupus via the Interferon Pathway) trials, including 438 patients with moderate-to-severe SLE. SLE-DAS was scored retrospectively, and a cut-off for SDA was derived using receiver operating characteristic (ROC) curves against the BILAG-2004 numerical score >11 as gold standard. Multiple linear regression analysis and Cohen’s d effect size were applied to evaluate the effectiveness of SLE-DAS, BILAG-2004 and SLEDAI-2K SDA classifications in capturing HR-QoL patient-reported outcomes (PROs). Results: The optimal SLE-DAS cut-off for SDA was >9.90 (area under the ROC curve=0.847, sensitivity=77.8%, specificity=79.6%). Patients classified as SDA by both SLE-DAS and BILAG-2004 or only by SLE-DAS exhibited similar disease activity, while those classified by BILAG-2004 alone had less severe disease and better HR-QoL. The SLE-DAS cut-off was associated with worse HR-QoL across multiple PROs more consistently than BILAG-2004 or SLEDAI-2K. Conclusion: The SLE-DAS cut-off for SDA provides an accurate definition of SDA in SLE, with good discriminative power and consistent associations with worse HR-QoL. This SLE-DAS definition enhances disease activity classification and offers a practical tool for guiding treatment decisions in clinical practice, as well as selecting patients with SDA for inclusion in clinical trials.

Objective: Our objective was to evaluate the ability of Systemic Lupus Erythematosus Disease Activity Score (SLE‐DAS) remission and low disease activity (LDA) to discriminate active drug from placebo and to discriminate outcomes in the patients’ perspective (health‐related quality of life [HR‐QoL]) in SLE trials.Methods: This was a post hoc analysis of the pooled Belimumab in Subjects With SLE (BLISS)‐52 (NCT00424476) and BLISS‐76 (NCT00410384) trials data. SLE‐DAS remission and LDA attainment and discrimination between belimumab and placebo at 52 weeks were compared using chi‐square tests. At week 52, 36‐item Short Form Health Survey (SF‐36) and Functional Assessment of Chronic Illness Therapy Fatigue (FACIT‐F) scores were compared between patients attaining SLE‐DAS remission versus nonremission and SLE‐DAS LDA versus non‐LDA using the t‐test and Mann‐Whitney test. Mean changes from week 0 to 52 in SF‐36 and FACIT‐F scores were compared between groups using multivariate regression analysis adjusted for baseline scores.Results: At week 52, significantly more patients attained SLE‐DAS LDA taking belimumab 1 mg/kg (17.9% vs 13.0%; P = 0.023; odds ratio [OR] 1.459; relative risk [RR] 1.377; number needed to treat [NNT] 20.4) and 10 mg/kg (21.7% vs 13.0%; P < 0.001; OR 1.853; RR 1.668; NNT 11.5) compared with placebo. Likewise, more patients attained SLE‐DAS remission taking belimumab 10 mg/kg compared to placebo (14.7% vs 10.1%; P = 0.019; OR 1.532; RR 1.454; NNT 21.7). At week 52, patients attaining SLE‐DAS remission and LDA presented higher SF‐36 domain and summary scores (all P < 0.001) and FACIT‐F scores (both P < 0.001). Mean improvements from baseline in SF‐36 and FACIT‐F scores were significantly higher in patients achieving SLE‐DAS remission and LDA.Conclusion: SLE‐DAS remission and LDA showed discriminant ability for identifying patients receiving active drug in SLE clinical trials. Attainment of these SLE‐DAS targets are associated with better HR‐QoL.

Given the sustained growth that Geotourism has experienced worldwide, it is crucial to gain a better understanding of geotourists. Therefore, this study aims to examine visitors’ motivations for visiting geoparks, segment them accordingly, and characterize each segment. An online questionnaire was developed to collect information from visitors of the Arouca Geopark—UNESCO Global Geopark and was completed by 607 who had visited this park at least once. Respondents were asked about their motivations for visiting the park using 18 items that were combined into five dimensions through exploratory factor analysis. These dimensions (Escape, Relaxation and Enjoyment, Novelty Seeking and Nature, Knowledge, Socialization, and Sports and Adrenaline) were the basis for a cluster analysis that revealed four segments of visitors: the Want it All Geotourists (representing 27% of the sample), that have the highest levels for all motivations; the True Geotourists (19.9%) which highest levels of motivations were on the three motivations that typically define a geotourist: nature/adventure, knowledge seeking, and socialization; the Sensation Seekers (34.4%) whose strongest motivations were sports/adrenaline and escape from routine; the Accidental Geotourists (18.6%) who scored lowest for all motivations and are motivated essentially by the escape from routine and by nature/adventure. These segments were then further profiled based on other variables such as age, gender, satisfaction, and quality of experience. The segmentation and description of each segment found in this study provide a better understanding of the typology of visitors to geoparks, which is crucial for better management of such places.

Resumo Objetivo Descrever e analisar a eficácia das intervenções levadas a cabo pelos enfermeiros para reduzir a dor dos doentes com lesões traumáticas. Métodos Estudo de coorte prospetivo realizado junto das Ambulâncias de Suporte Imediato de Vida em Portugal, entre 1 de março de 2019 e 30 de abril de 2020. Foram recolhidos dados sobre o tipo de intervenções implementadas e sobre o tempo que durou a aplicação dos procedimentos de salvamento. De forma a poder estudar a evolução das [...] Resumo Objetivo Descrever e analisar a eficácia das intervenções levadas a cabo pelos enfermeiros para reduzir a dor dos doentes com lesões traumáticas. Métodos Estudo de coorte prospetivo realizado junto das Ambulâncias de Suporte Imediato de Vida em Portugal, entre 1 de março de 2019 e 30 de abril de 2020. Foram recolhidos dados sobre o tipo de intervenções implementadas e sobre o tempo que durou a aplicação dos procedimentos de salvamento. De forma a poder estudar a evolução das

Food behaviour is governed by different kinds of motivations, some of individual nature and others related with the external food environment. This study investigated the eating motivations in sixteen countries with respect to commercial and marketing influences on food choices. The questionnaire survey was developed between September 2017 and June 2018, via online tools, targeting a convenience sample of residents in sixteen countries (Argentina, Brazil, Croatia, Egypt, Greece, Hungary, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Serbia, Slovenia and the United States of America). The number of valid responses received was 11,919 participants. The data were treated using SPSS software, and the main statistical techniques used included exploratory factor analysis, evaluation of internal reliability through Cronbach’s alpha, cluster analysis (hierarchical and k-means) and logistic regression. The results obtained showed two groups of people: low motivated and notably motivated consumers. The results showed high asymmetries between countries, with highest percentage of highly motivated consumers in Egypt and the lowest percentage of highly motivated in Portugal. It was further observed that consumers more influenced by commercial and marketing aspects (the notably motivated) tend to be women, young, single, less educated, less likely to be professionally active, and those who live mostly in rural or suburban areas. Less exercise and overweight are also factors associated with greater propensity for commercial and marketing motivations. Furthermore, health problems such as shellfish or gluten intolerance, hypertension and high cholesterol confer less propensity to be in the segment of the notably motivated consumers. In conclusion, this work highlighted the role of geographic, sociodemographic and lifestyle factors as food choice determinants.

Background: Hypothermia in trauma patients causes increased morbidity and mortality. Swift recognition and treatment are important to prevent any further heat loss. In addition, patient discomfort from cold decreases satisfaction with care. The administration of active and passive rewarming measures is important in the prevention and treatment of hypothermia, but their use in prehospital trauma patients in Portugal has not been previously reported. Objective: To assess the prevalence of hypothermia, the impact of rewarming measures, and the management of the discomfort caused by cold. Methods: This is a prospective cohort study conducted in Immediate Life Support Ambulances in Portugal between March 1, 2019, and April 30, 2020. Results: This study included records of 586 trauma patients; of whom, 66.2% were men. Cranioencephalic trauma was the most common trauma observed, followed by lower limb and thoracic traumas. Mean body temperature increased 0.12 °C between the first and last assessments (p < .05). Most patients experiencing a level of discomfort of 5 or more on a 0–10 scale reported improvement (from 17.2% to 2.4% after nurses' intervention). Warmed intravenous fluids proved to be effective (p < .05) in increasing body temperature, and passive rewarming measures were effective in preventing hypothermia. Conclusions: Hypothermia management has to consider the initial temperature, the season, the available rewarming measures, and the objectives to be achieved. The optimization of resources for the monitoring and treatment of hypothermia should be a priority in prehospital assistance. The implementation of rewarming measures improves patients' outcomes and decreases the discomfort caused by cold in prehospital care.

Object The timing of definitive management of ruptured intracranial aneurysms has been the subject of considerable debate, although the benefits of early surgery (until 72 hours postictus) are widely accepted. The aim of the present study is to evaluate the potential benefit of ultra-early surgery (until 24 hours) when compared with early surgery, in those patients who were treated by surgical clipping at the Neurosurgery Department of the Coimbra Hospital and University Centre. Methods A 17-year database of consecutive ruptured and surgically treated intracranial aneurysms was analyzed. Outcome was measured by the Glasgow Outcome Scale (GOS). Baseline characteristics were analyzed by the Fisher exact test, the chi-squared and Mann-Whitney tests. Logistic regression was used to assess the impact of good grade according to the World Federation of Neurological Surgeons (WFNS) scale and ultra-early surgery in a good GOS outcome. Results 343 patients who were submitted to surgical clipping in the first 72 hours post-ictus were included, 165 of whom have undergone ultra-early surgery. Demographics and preoperative characteristics of ultra-early and early surgery patients were similar. Good-grade patients according to the WFNS scale submitted to ultra-early surgery demonstrated an improved GOS at discharge and at 6 months. Poor-grade patients according to the WFNS scale submitted to ultra-early surgery demonstrated an improved GOS at discharge. Conclusions Ultra-early surgery for aneurysmal subarachnoid hemorrhage patients improves outcome mainly on good-grade patients. Efforts should be made on the logistics of emergency departments to consider achieving treatment on this timeframe as a standard of care. Objetivos O timing de tratamento dos aneurismas intracranianos rotos tem sido objeto de debate considerável, embora os benefícios da cirurgia precoce (até 72 horas após ictus) sejam amplamente aceitos. O objetivo do presente estudo é avaliar o potencial benefício da cirurgia ultra precoce (até 24 horas) sobre a cirurgia precoce nos pacientes tratados por abordagem cirúrgica no Departamento de Neurocirurgia do Centro Hospitalar e Universitário de Coimbra. Métodos Foi usada uma base de dados de 17 anos de aneurismas intracranianos que sofreram rotura e que foram tratados cirurgicamente. O resultado foi avaliado pela Escala de Glasgow de desfecho (GOS, na sigla em inglês). As características da população foram analisadas pelo teste de Fisher, qui-quadrado e Mann-Whitney. A regressão logística foi usada para avaliar o impacto do bom estado clínico à admissão (World Federation of Neurological Surgeons [WFNS]) e da cirurgia ultra precoce sobre o bom desfecho (GOS). Resultados Foram incluídos 343 pacientes submetidos a clipagem cirúrgica nas primeiras 72 horas pós-ictus, 165 dos quais foram submetidos a cirurgia ultra precoce. As características demográficas e pré-operatórias dos pacientes submetidos a cirurgia ultra precoce e precoce foram semelhantes. Pacientes com bom WFNS submetidos a cirurgia ultra precoce demonstraram melhoria do desfecho na alta e aos 6 meses. Os pacientes com WFNS de baixo grau submetidos a cirurgia ultra precoce demonstraram melhoria do desfecho na alta. Conclusões A cirurgia ultra precoce para pacientes com hemorragia subaracnoidea aneurismática melhora o resultado principalmente em pacientes com bom estado clínico à admissão (WFNS). Esforços devem ser feitos na logística dos departamentos de emergência, a fim de considerar o tratamento nesse período como timing preferencial. Ethical approval was obtained from the Coimbra Hospital and University Centre ethical commission. ^* Dr. António Canotilho Lage and Dr. Miguel T. Carvalho contributed equally to this research and should be considered as joint first authors.

A criação de valor na indústria em países desenvolvidos está a ser direcionada pela quarta etapa de industrialização, denominada Indústria 4.0. As oportunidades são ilimitadas, mas os desafios são inúmeros criando dificuldades para as empresas na adoção dessas tecnologias. Este artigo, para além de uma revisão da literatura sobre a evolução das recentes tecnologias e respetivas aplicabilidades, pretende definir as principais medidas de atratividade regional como fatores de crescimento, suportando os líderes nas suas decisões de atração de empresas que perseguem a indústria 4.0. Para este objetivo apresentamos o resultado de catorze entrevistas aos principais responsáveis de empresas da região Dão-Lafões (Portugal) que já aplicam e/ou têm capacidades ou apetências de utilização das novas tecnologias nas suas indústrias. Os resultados mostram que as empresas têm já efetuado algum investimento em tecnologias da indústria 4.0, essencialmente ao nível do processo produtivo, com tendência para abranger diferentes áreas.