Publications by authors named "Raquel Lucas"

70 Publications

Urban Rail Transportation and SARS-Cov-2 Infections: An Ecological Study in the Lisbon Metropolitan Area.

Front Public Health 2021;9:611565. Epub 2021 Feb 3.

EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.

The large number of passengers, limited space and shared surfaces can transform public transportation into a hub of epidemic spread. This study was conducted to investigate whether proximity to railway stations, a proxy for utilization, was associated with higher rates of SARS-CoV-2 infection across small-areas of the Lisbon Metropolitan Area (Portugal). The number of SARS-CoV-2 confirmed infections from March 2 until July 5, 2020 at the parish-level was obtained from the National Epidemiological Surveillance System. A Geographic Information System was used to estimate proximity to railway stations of the six railway lines operating in the area. A quasi- generalized linear regression model was fitted to estimate the relative risks (RR) and corresponding 95% confidence intervals (95%CI). Between May 2 and July 5, 2020, there were a total of 17,168 SARS-CoV-2 infections in the Lisbon Metropolitan Area, with wide disparities between parishes. Overall, parishes near any of the railway stations of the line presented significantly higher SARS-CoV-2 infection rates ( = 1.42, 95%CI 1.16, 1.75) compared to parishes located farther away from railway stations, while the opposite was observed for parishes near other railway stations ( and lines), where infection rates were significantly lower than those observed in parishes located farther away from railway stations ( = 0.66, 95%CI 0.50, 0.87). The associations varied according to the stage of the epidemic and to the mitigation measures enforced. Regression results also revealed an increasing influence of socioeconomic deprivation on SARS-CoV-2 infections. No consistent association between proximity to railway stations and SARS-CoV-2 infection rates in the most affected metropolitan area of Portugal was observed, suggesting that other factors (e.g., socioeconomic deprivation) may play a more prominent role in the epidemic dynamics.
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http://dx.doi.org/10.3389/fpubh.2021.611565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887317PMC
March 2021

History of work-related health problems in a population-based sample of women: An exploratory factor analysis.

Work 2021 ;68(3):563-576

EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.

Background: Beyond the health-enhancing effects, work also has the potential of causing or worsening different health conditions in the same individual. However, research on within-worker aggregation of work-related health problems is scarce.

Objective: To describe the history and aggregation of work-related health problems in a population-based sample of women.

Methods: A total of 4330 women were asked whether they had ever had "a physical or mental health problem that was caused or made worse by your work". The aggregation of work-related health problems was assessed using an exploratory factor analysis.

Results: Five groups were identified. Factor 1 included all items on musculoskeletal disorders - lower socioeconomic position, higher BMI, smokers and history of occupational accidents. Factor 2 included mental disorders together with headache and/or eyestrain - higher socioeconomic position. Factor 3 included the other disorders item with some loading from digestive disorders - older and public sector workers. Factor 4 included respiratory disorders - lower socioeconomic position and history of occupational accidents. Factor 5 included hearing and ear problems - blue-collar workers.

Conclusion: There was a relevant aggregation of work-related health problems, which may inform the selection of specific components for interventions that aim to improve women's work-related health.
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http://dx.doi.org/10.3233/WOR-203394DOI Listing
January 2021

Remission and low disease activity matrix tools: results in real-world rheumatoid arthritis patients under anti-TNF therapy.

Acta Reumatol Port 2020 Oct-Dec;45(4):245-252

Centro Hospitalar e Universitário de São João ; Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

Background: Remission/ low disease activity (LDA) are the main treatment goals in rheumatoid arthritis (RA) patients. Two tools showing the ability to predict golimumab treatment outcomes in patients with RA were published.

Objectives: To estimate the real-world accuracy of two quantitative tools created to predict RA remission and low disease activity.

Methods: Multicenter, observational study, using data from the Rheumatic Diseases Portuguese Register (Reuma.pt), including biologic naïve RA patients who started an anti-TNF as first-line biologic and with at least 6 months of follow-up. The accuracy of two matrices tools was assessed by likelihood-ratios (LR), sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and area under the ROC curve (AUC).

Results: 674 RA patients under first-line anti-TNF (266 etanercept, 186 infliximab, 131 adalimumab, 85 golimumab, 6 certolizumab pegol) were included. The median (IQR) age was 53.4 (44.7-61.1) years and the median disease duration was 7.7 (3.7-14.6) years. The majority were female (72%). Most patients were RF and/or ACPA positive (75.5%) and had erosive disease (54.9%); 58.6% had comorbidities. At 6-months, 157 (23.3%) patients achieved remission (DAS28 ESR < 2.6) and 269 (39.9%) LDA (DAS28 ESR ≤ 3.2). Area under the curve for remission in this real-world sample was 0.756 [IC 95% (0.713-0.799)] and for LDA was 0.724 [IC 95% (0.686 -0.763)]. The highest LR (8.23) for remission state was obtained at a cut-off ≥ 67%, with high specificity (SP) (99.6%) but low sensitivity (SN) (3.2%). A better balance of SN and SP (65.6% and 73.9%, respectively) was observed for a cut-off >30%, with a LR of 2.51, PPV of 43.3% and NPV of 87.6%.

Conclusion: In this population, the accuracy of the prediction tool was good for remission and LDA. Our results corroborate the idea that these matrix tools could be helpful to select patients for anti-TNF therapy.
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January 2021

Mother-reported pain experience between ages 7 and 10: A prospective study in a population-based birth cohort.

Paediatr Perinat Epidemiol 2020 Nov 23. Epub 2020 Nov 23.

Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.

Background: Trajectory studies suggest considerable stability of persistent or recurrent pain in adolescence. This points to the first decade of life as an important aetiologic window for shaping future pain, where the potential for prevention may be optimised.

Objectives: We aimed to quantify changes in mother-reported pain experience in children between ages 7 and 10 and describe clusters of different pain experiences defined by complementary pain features.

Methods: We conducted a prospective study using data from 4036 Generation XXI birth cohort participants recruited in 2005-06. Pain history was reported by mothers at ages 7 and 10 using the Luebeck pain screening questionnaire. We tracked changes in six pain features over time using relative risks (RRs) and their 95% confidence intervals (95% CIs). Clusters were obtained using the k-medoids algorithm.

Results: The risk of severe pain at age 10 increased with increasing severity at age 7, with RRs ranging from 2.18 (95% CI 1.90, 2.50) for multisite to 4.43 (95% CI 3.19, 6.15) for high frequency pain at age 7. A majority of children (59.4%) had transient or no pain but two clusters included children with stable recurrent pain (n = 404, 10.2% of the sample). One of those (n = 177) was characterised by higher probabilities of multisite pain (74.6% and 66.7% at ages 7 and 10, respectively), with psychosocial triggers/contexts (59.3% and 61.0%) and daily-living restrictions (72.2% and 84.6%). Most children in that cluster (58.3%) also self-reported recent pain at age 10 and had more frequent family history of chronic pain (60.5%).

Conclusions: All pain features assessed tracked with a positive gradient between ages 7 and 10, arguing for the significance of the first decade of life in the escalation of the pain experience. Multisite pain and psychosocial attributions appeared to be early markers of more adverse pain experiences.
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http://dx.doi.org/10.1111/ppe.12730DOI Listing
November 2020

Work-life prevalence of self-reported occupational injuries in mothers of a birth cohort.

Int J Occup Saf Ergon 2020 Nov 5:1-11. Epub 2020 Nov 5.

EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal.

. This study investigated self-reported occupational injuries among mothers in a large birth cohort study and the relation of their characteristics to different injury outcomes: occurrence, severity, temporal proximity and recurrence. . We asked 4338 women whether they had been in 'an accident at work, even if it did not require medical treatment', and the number of accidents throughout their working life, type of injury and whether it occurred within the last 12 months. . Over one-fifth (21.8%) of working-age mothers reported having at least one occupational injury throughout their working life. Wounds and superficial injuries were the most frequently reported types of occupational injuries (11.0%), followed by dislocated bones and joints, sprains and strains (10.7%). Women who reported a history of occupational injuries also had a higher likelihood of reporting a work-related health problem (adjusted odds ratio [OR] = 2.64; 95% confidence interval [CI] [2.27, 3.07]) and of having a partner who also reported an occupational injury throughout their working life (adjusted OR = 1.86; 95% CI [1.33, 2.62]). Associations remained fairly stable across all outcomes. . Our findings point towards a broadened understanding of occupational injury consequences and research focusing on family-level factors that account for the embeddedness of workers in households.
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http://dx.doi.org/10.1080/10803548.2020.1832353DOI Listing
November 2020

Predictors of Mortality and Refracture in Patients Older Than 65 Years With a Proximal Femur Fracture.

J Clin Rheumatol 2020 Sep 18. Epub 2020 Sep 18.

From the Rheumatology Department, Centro Hospitalar e Universitário do São João EPE, Alameda Professor Hernâni Monteiro, Porto.

Objectives: To evaluate potential predictors of subsequent fracture and increased mortality in a population 65 years or older who suffered a proximal femur fragility fracture.

Methods: This was a longitudinal study that included patients with a proximal femur fragility fracture, referred from the Orthopedics Inpatient Department to the Rheumatology Department's Fracture Liaison Service, from March 2015 to March 2017.

Results: Five hundred twenty-two patients were included, with a median age (IQR) of 84 years (interquartile range [IQR], 11 years), 79.7% (n = 416) female. Nine percent (n = 47) suffered a new fracture, with a median time to event of 298 days (IQR, 331 days). Cumulative probability without refracture at 12 months was 93% (95% confidence interval [CI], 90.2%-95.0%); 22.8% (n = 119) patients died, with median time to death of 126 days (IQR, 336 days). Cumulative survival probability at 12 months was 81.7 (95% CI, 77.9-84.8). Neurologic disease (hazard ratio [HR], 2.30; 95% CI, 0.97-5.50; p = 0.06) and chronic obstructive pulmonary disease (HR, 3.61; 95% CI, 1.20-10.9; p = 0.022) were both predictors of refracture. Age older than 80 years (HR, 1.54; 95% CI, 0.99-2.38; p = 0.052), higher degree of dependence (HR, 1.24;95% CI, 1.09-1.42; p = 0.001), male sex (HR, 1.55; 95% CI, 1.03-2.33; p = 0.034), femoral neck fracture (HR, 0.45; 95% CI, 0.24-0.88; p = 0.018), Charlson score (HR, 2.08; 95% CI, 1.17-3.69; p = 0.012), heart failure (HR, 2.44; 95% CI, 1.06-5.63; p = 0.037), hip bone mass density (HR, 3.99; 95% CI, 1.19-13.4; p = 0.025), hip T score (HR, 0.64; 95% CI, 0.44-0.93; p = 0.021), and β-crosslaps (HR, 1.98; 95% CI, 1.02-3.84; p = 0.042) all predicted a higher mortality.

Conclusions: Neurologic disease and chronic obstructive pulmonary disease may increase the risk of subsequent fracture after a hip fracture. Male sex, age, autonomy degree, femur bone mass density/T score, fracture type, Charlson score, diabetes mellitus, heart failure, and β-crosslaps had significant impact on survival. The authors highlight β-crosslaps as a potential serological marker of increased mortality in clinical practice.
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http://dx.doi.org/10.1097/RHU.0000000000001581DOI Listing
September 2020

Early-life programming of pain sensation? Spinal pain in pre-adolescents with pain experience in early life.

Eur J Pediatr 2019 Dec 20;178(12):1903-1911. Epub 2019 Nov 20.

Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Oster Farimagsgade 5, bd. 24, Box 2099, DK-1014, Copenhagen K, Denmark.

Neurobiological mechanisms can be involved in early programming of pain sensitization. We aimed to investigate the association between early-life pain experience and pre-adolescence spinal pain. We conducted a study of 29,861 pre-adolescents (age 11-14) from the Danish National Birth Cohort. As indicators of early-life pain, we used infantile colic and recurrent otitis media, reported by mothers when their children were 6 and 18 months. Self-reported spinal pain (neck, middle back, and/or low back pain) was obtained in the 11-year follow-up, classified according to severity. Associations between early-life pain and spinal pain in pre-adolescents were estimated using multinomial logistic regression models. To account for sample selection, inverse probability weighting was applied. Children experiencing pain in early life were more likely to report severe spinal pain in pre-adolescence. The association appeared stronger with exposure to two pain exposures (relative risk ratio, 1.31; 95% CI, 1.02-1.68) rather than one (relative risk ratio, 1.14; 95% CI, 1.05-1.24). We observed similar results when using headache and abdominal pain as outcome measures, underpinning a potential neurobiological or psychosocial link in programming of pain sensitization.Conclusion: Experience of early-life pain is seemingly associated with spinal pain in pre-adolescence. The study highlights that early-life painful experiences can influence programming of future pain responses.What is Known:• Spinal pain in pre-adolescents is common, causes marked discomfort and impairment in everyday life, and may be an important predictor of spinal pain later in life.• Neurobiological mechanisms have been suggested as involved in early programming of pain sensitization.What is New:• Pain exposure in early postnatal life in terms of infantile colic and recurrent otitis media is associated with spinal pain in pre-adolescence; thus, experience of such painful conditions in the early postnatal period may seemingly influence programming of future pain sensation.
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http://dx.doi.org/10.1007/s00431-019-03475-9DOI Listing
December 2019

Coronary artery calcium score in female rheumatoid arthritis patients: Associations with apolipoproteins and disease biomarkers.

Int J Rheum Dis 2019 Oct 29;22(10):1841-1856. Epub 2019 Aug 29.

Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.

Aims And Methods: In rheumatoid arthritis (RA), cardiovascular (CV) comorbidities are a major cause of mortality. Coronary Calcium Score (CCS) assessed by computed tomography has been associated with RA prognosis. In this work, we aimed to assess CCS in female RA patients and determine CCS association with different clinical, laboratory and imaging disease parameters.

Results: We evaluated 60 female patients, with a mean age of 53.6 ± 10.4 years, a mean Disease Activity Score of 28 joints (DAS28) (4v) and Health Assessment Questionnaire (HAQ) of 4.542 ± 1.317 and 1.488 ± 0.631, respectively, and a disease duration of 14.7 ± 10.3 years. Mean CCS value was 35.192 ± 117.786. CCS > 10 was significantly associated with CV risk factors (age: odds ratio [OR] = 1.120; P = .002, body mass index [BMI] ≥ 25 kg/m : OR = 0.271; P = .025, high-density lipoprotein [HDL]: OR = 0.011; P = .025, low-density lipoprotein/ HDL ratio: OR = 2.084; P = .030, apolipoprotein A1 [ApoA1]: OR = 0.965; P = .014, apolipoprotein B/ApoA1 [ApoB/ApoA1] ratio: OR = 59.834; P = .011, homocysteine: OR = 1.287; P = .045, diabetes: OR = 10.400; P = .043, and anti-diabetic therapy: OR = 10.667, P = .041), disease parameters (C-reactive protein [CRP]: OR = 1.038; P = .046, DAS[4v]: OR = 1.900; P = .009, DAS28[4v; CRP]: OR = 1.700; P = .019, DAS[3v]: OR = 1.947; P = .010, DAS28[3v; CRP]: OR = 1.696; P = .022, HAQ: OR = 3.299; P = .023, erosion score: OR = 1.015; P = .012, and total modified Sharp/van der Heijde Score: OR = 1.008; P = .035), biomarkers (osteoprotegerin: OR = 1.505; P = .022), and bone mineral density (femoral: OR = 0.005; P = .018, lumbar spine: OR = 0.001; P = .002, left hand: OR = 7.9 × 10 ; P = .005, and osteoporosis: OR = 6.628; P = .007). After adjustment for age and BMI, significant associations were maintained with ApoA1, ApoB/ApoA1 ratio, homocysteine, CRP, DAS(4v), DAS(4v; CRP), DAS(3v) and DAS(3v; CRP). A sensitivity analysis undertaken after excluding the 6 diabetics yielded similar results.

Conclusions: Our work reinforces the hypothesis that in RA, CCS may be a useful tool in CV risk assessment, particularly valuable in poorer controlled patients with certain lipoprotein profiles.
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http://dx.doi.org/10.1111/1756-185X.13685DOI Listing
October 2019

Bone formation and resorption markers at 7 years of age: Relations with growth and bone mineralization.

PLoS One 2019 22;14(8):e0219423. Epub 2019 Aug 22.

EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.

Purpose: We aimed to describe bone formation and resorption markers in generally healthy prepubertal children using total alkaline phosphatase (tALP), osteocalcin (OC) and β-isomerized C-terminal telopeptides of type I collagen (β-CTx) serum concentrations and to estimate markers' correlations with anthropometric growth (height, weight, body mass index and trajectories of weight gain) as well as bone mineral content (BMC) and areal density (aBMD).

Methods: We assessed 395 7-year-old children from the Generation XXI cohort with tALP, OC and β-CTx concentrations determined from a fasting venous blood sample and BMC/aBMD measured by dual-energy X-ray absorptiometry. Gender-specific reference intervals for tALP, OC and β-CTx in 7-year-old children were established by calculating the 2.5th and 97.5th percentiles. Pearson and partial correlation coefficients (controlling for sex, age, body size and season) between bone markers and growth measures were computed.

Results: tALP increased with height (rpartial controlled for sex = 0.26, 95%CI: 0.17, 0.35), was higher in overweight than in healthy weight children, and in children who gained weight above average during infancy. No correlations were found between OC or β-CTx and growth. In girls, OC was slightly correlated with subtotal BMC (rpartial = 0.22, 95%CI: 0.08, 0.35), subtotal aBMD (rpartial = 0.20, 95%CI: 0.06, 0.33) and lumbar spine aBMD (rpartial = 0.23, 95%CI: 0.09, 0.36). tALP and β-CTx were not correlated with any of the DXA-derived bone measures.

Conclusion: This study contributed to the description of bone turnover at 7 years of age and suggested that bone metabolism markers measured in a single point in time have limited ability to describe anthropometric growth and overall bone status in generally healthy prepubertal children.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219423PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6705799PMC
March 2020

Sagittal standing posture and relationships with anthropometrics and body composition during childhood.

Gait Posture 2019 09 3;73:45-51. Epub 2019 Jul 3.

ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.

Background: Anthropometry and body composition are plausible influences on pediatric sagittal standing posture. Despite that, the relationship of anthropometrics since birth and body composition with individual postural parameters in children has never been assessed.

Research Question: To assess the associations between anthropometrics since birth and body composition parameters, and angles of sagittal standing posture in children.

Methods: The sample included 1021 girls and 1096 boys, evaluated in the population-based birth cohort Generation XXI, Portugal. Weight and height were obtained at birth, 4 and 7 years of age. At age 7, total body less head fat/fat-free mass and bone properties were estimated from whole body dual energy X-ray absorptiometry scans and posture was assessed through right-side photographs during habitual standing with retro-reflective markers placed on body landmarks.

Results: Girls showed increased values of lumbar angle, head and neck flexion, and craniocervical angle with the largest mean (standard deviation) difference in lumbar angle [281.7° (7.4) vs. 276.8° (7.1) in boys, p < 0.001]. In both genders, weight and body mass index were weakly associated with lumbar angle: 0.24 ≥ r ≤ 0.31 in girls and 0.16 ≥ r ≤ 0.26 in boys, all p < 0.001. Fat and fat-free mass and bone mineral density were weakly associated with lumbar angle in both genders.

Significance: Our study showed clear postural heterogeneity between girls and boys in early ages. Lumbar angle is likely to be the single most relevant proxy of overall posture based on the associations with the exposures reported in this study.
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http://dx.doi.org/10.1016/j.gaitpost.2019.07.130DOI Listing
September 2019

Early childhood as a sensitive period for the effect of growth on childhood bone mass: Evidence from Generation XXI birth cohort.

Bone 2019 10 3;127:287-295. Epub 2019 Jul 3.

EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.

Background: To identify sensitive periods for the effect of early life growth on childhood bone mass we compared the associations between weight and length/height velocities from birth to age six and bone mineral content (BMC) and areal density (aBMD) at 7 years of age.

Methods: We analyzed data from 1853 participants from the Generation XXI birth cohort scanned with a whole body dual-energy X-ray absorptiometry system. Velocities of growth in weight and length/height were obtained through linear spline multilevel models on the basis of data collected during routine health examinations. Using linear regression we computed associations of birth weight, birth length, five weight velocities ("early neonatal": 0-10 days, "early infancy": 10 days-3 months, "late infancy": 3-12 months, "early childhood": 1-3 years, and "later childhood": 3-6 years) and four length/height velocities ("early infancy": 0-3 months, "late infancy": 3-12 months, "early childhood": 1-3 years, and "later childhood": 3-6 years) with outcomes BMC, aBMD, height and height-adjusted BMC at age seven. Confounding by maternal and child characteristics was addressed and effects of growth velocities were adjusted to preceding growth.

Results: Weight and length/height velocities up to the age of six were associated with increased bone mass, areal density and height at 7 years with the strongest associations observed for growth in early childhood. In this age period, after concurrent height and confounder adjustment, one standard deviation (SD) increase in weight velocity was associated with higher BMC z-scores: 0.27 (95%CI: 0.22, 0.32) in girls and 0.24 (95%CI: 0.19, 0.29) in boys. Height velocity was also associated with greater height-adjusted BMC z-score: 0.12 (95%CI: 0.07, 0.17) per SD in girls and 0.11 (95%CI: 0.06, 0.16) in boys. The pattern of associations was similar, albeit attenuated, after adjusting for preceding growth.

Conclusion: Growth in second and third years of life may represent a sensitive period for the effect of growth on childhood bone mass, partly through their effect on concurrent body size.
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http://dx.doi.org/10.1016/j.bone.2019.07.002DOI Listing
October 2019

Food Insecurity in Portugal Among Middle- and Older-Aged Adults at a Time of Economic Crisis Recovery: Prevalence and Determinants.

Food Nutr Bull 2019 12 4;40(4):504-513. Epub 2019 Jul 4.

EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal.

Background: To characterize the scenario of food insecurity in Portugal at a time of economic crisis recovery is of the utmost relevance.

Objective: This study aimed to estimate the prevalence and to identify the determinants of food insecurity during economic crisis recovery in a population-based urban sample of middle- and older-aged Portuguese adults.

Methods: A cross-sectional study including 604 participants of the EPIPorto cohort was conducted. Data on sociodemographic characteristics and on food security status were collected. Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Logistic regression models, crude and adjusted for sex, age, education, and household income perception, were performed.

Results: The prevalence of food insecurity was 16.6%. Women (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 1.09-3.54), those less educated (OR = 5.46; 95% CI: 2.84-10.46), and those who had the perception of an insufficient household income (OR = 10.39; 95% CI: 5.00-21.56) were more likely to belong to a food insecure household. Unmarried individuals (OR = 1.79; 95% CI: 1.05-3.06) and lower white-collar workers (OR = 2.22; 95% CI: 1.03-4.77) were also more prone to live within a food insecure household, regardless of sex, age, education, and household income perception.

Conclusions: The obtained information is valuable for the development of intervention strategies to reduce food insecurity in middle- and older-aged adults, suggesting that women, unmarried, less educated individuals, less skilled workers, and lower income families should be targeted.
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http://dx.doi.org/10.1177/0379572119858170DOI Listing
December 2019

Household food insecurity and socio-demographic determinants in young adults: findings from a Portuguese population-based sample.

Int J Public Health 2019 Jul 16;64(6):887-895. Epub 2019 Apr 16.

EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600, Porto, Portugal.

Objectives: This study evaluated the prevalence and the socio-demographic determinants of food insecurity among young adults at a time of economic crisis recovery.

Methods: A cross-sectional study including 954 young adults (26 years old) from the EPITeen cohort (Porto, Portugal) was conducted. Food security status was evaluated using the US Household Food Security Survey Module: Six-Item Short Form. Associations between socio-demographic characteristics (sex, education, occupation, household size and structure and household income perception) and food insecurity were estimated using logistic regression.

Results: At a time of economic crisis recovery, 11.0% of young adults experienced food insecurity. A higher odds of belonging to a food insecure household was observed in participants reporting an insufficient household income (OR = 23.3; 95% CI 11.3-47.8), those with less education (OR = 1.7; 95% CI 1.0-2.8), lower white-collar workers (OR = 2.3; 95% CI 1.2-4.2) and those living within a nuclear family including a partner and/or children (OR = 2.0; 95% CI 1.1-3.7).

Conclusions: Our findings support the need for interventions targeting those from lower income, from nuclear families of young adults with a partner and/or descendants, less educated and with non-manual unskilled occupations, to reduce food insecurity, particularly in economic vulnerable settings.
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http://dx.doi.org/10.1007/s00038-019-01243-yDOI Listing
July 2019

Nonselective beta-blockers and the risk of portal vein thrombosis in patients with cirrhosis: results of a prospective longitudinal study.

Aliment Pharmacol Ther 2019 03 22;49(5):582-588. Epub 2019 Jan 22.

Clichy, France.

Background: Nonmalignant portal vein thrombosis is a significant event in the course of cirrhosis that can contraindicate liver transplantation and even impact survival after the surgical procedure. Risk factors are not completely known or validated and are still debated.

Aim: To identify in patients with cirrhosis the risk factors for portal vein thrombosis that are assessable in clinical practice.

Methods: Between January 2014 and February 2017, 108 outpatients with cirrhosis and no portal vein thrombosis (78% Child A) were enrolled. Doppler ultrasound was performed every 3 or 6 months, for a median follow up of 19 months.

Results: Portal vein thrombosis developed in 11 patients. Nonselective beta-blockade (hazard ratio [HR] 10.56; 95% confidence interval [CI]: 1.35-82.73; P = 0.025), and medium or large-sized oesophageal varices (HR 5.67; 95% CI: 1.49-21.63; P = 0.011) at baseline were associated with portal vein thrombosis development. Although heart rate (P < 0.001) and portal blood flow velocity at baseline (P = 0.005) were significantly reduced by nonselective beta-blockers, they were not related to portal vein thrombosis development.

Conclusions: Our findings confirm an association between portal vein thrombosis development and oesophageal varices at baseline, but suggest that the association could be explained by exposure to nonselective beta-blockers, independently from effects on heart rate and portal blood flow velocity. The mechanisms that explain portal vein thrombosis development in patients on nonselective beta-blockers require elucidation in order to optimise targeting of nonselective beta-blockade in patients with cirrhosis.
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http://dx.doi.org/10.1111/apt.15137DOI Listing
March 2019

Determinants of non-nociceptive pain in Rheumatoid Arthritis.

Acta Reumatol Port 2018 Oct-Dec;43(4):291-303

BG University Hospital Bergmannsheil GmbH.

Introduction: Features suggestive of neuropathic pain (NP) have been described in RA in addition to nociceptive pain. We aimed to determine the clinical predictors of NP in RA patients and study its association with radiographic structural damage.

Methods: Cross-sectional study was performed with RA patients followed at our Rheumatology department. Patients with diagnosed neuropathy of other origin, non-RA related risk factors for NP (e.g. diabetes mellitus) or fibromyalgia according to expert opinion were excluded. Demographic and clinical data were collected and disease activity/functional measures were evaluated. Two questionnaires were applied to assess NP: the Leeds Assessment of Neuropathic Symptoms (LANSS) and the painDETECT questionnaire (PDQ). Radiographs performed in up to 12 months before/after the evaluation were classified according to the modified van der Heijde Sharp´s method. Univariate and multivariate logistic regression were performed to identify the predictors of NP.

Results: 112 patients were included. 86 (77%) were women, with a mean (SD) age of 55.1 (10.8) years and median disease duration of 13 [2-41] years. 45 (40%) patients had NP by the LANSS (≥12) and 28% had a possible/likely NP in the PDQ (≥13). Female sex was predictive of NP by both tests and disease duration was inversely associated with LANSS NP. After adjusting for those two variables, pain VAS and TJC were positive predictors of NP by both tests. The same was not true for SJC, ESR or CRP levels. DAS28-CRP was significantly associated with PDQ NP, losing its statistical significance after adjustment for TJC and pain VAS. The HAQ score increased the odds of NP for both tests, independently of DAS 28-CRP. Positivity for ACPA and previous/current hydroxychloroquine treatment had lower odds of NP. 90 patients performed radiographic evaluation. Joint narrowing score was a significant negative predictor of LANSS NP. After adjusting for global radiographic score, current methotrexate treatment had lower odds of LANSS NP and previous/current leflunomide was a positive predictor of NP by both tests.

Conclusion: NP was associated with disease activity/functional scores but not with objective inflammatory measures. Greater structural damage, increased disease duration and ACPA positivity did not seem to increase the odds of NP. Possible association of NP and underlying csDMARD treatment was uncovered.
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August 2019

Gestational Weight Gain and Offspring Bone Mass: Different Associations in Healthy Weight Versus Overweight Women.

J Bone Miner Res 2019 01 6;34(1):38-48. Epub 2018 Nov 6.

Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.

Weight management strategies during pregnancy reduce child cardiometabolic risk. However, because maternal weight has an overall positive correlation with offspring bone mass, pregnancy weight management could adversely affect child bone health. We aimed to estimate associations between gestational weight gain (GWG) and bone mineralization in the offspring at 7 years of age, and test early pregnancy body mass index (BMI) as an effect modifier. We analyzed prospective data from 2167 mother-child pairs from the Generation XXI birth cohort who underwent whole-body dual-energy X-ray absorptiometry at 7 years of age. GWG was analyzed as a continuous measure and using the Institute of Medicine categories. In the whole sample and for each early pregnancy BMI category (under/normal weight and overweight/obese), relationships between GWG and offspring bone measures (bone mineral content [BMC], bone areal density [aBMD], size-corrected BMC [scBMC], and height) at 7 years were fitted through local polynomial regression and smoothing splines. The magnitude of associations was estimated through linear regression coefficients (95% CIs), crude and adjusted for maternal age, height, educational level, and child gestational age. In under/normal weight mothers, GWG was associated with slightly increased bone measures at 7 years (per 5 kg of GWG, BMC: 0.07 SD [95% CI, 0.01 to 0.12]; aBMD: 0.10 SD [95% CI, 0.05 to 0.15], scBMC: 0.11SD [95% CI, 0.06 to 0.16], and height: 0.05 SD [95% CI, 0.00 to 0.10]), while in overweight/obese mothers no effect of GWG on bone was observed (BMC: 0.02 SD [95% CI, -0.04 to 0.09]; aBMD: 0.02 SD [95% CI, -0.04 to 0.08], scBMC: 0.01 SD [95% CI, -0.06 to 0.08], and height: 0.02 SD [95% CI, -0.04 to 0.08]). Also, no advantageous effect of gaining weight above the Institute of Medicine recommendations was observed in either early pregnancy BMI group. Our results suggest that adherence to Institute of Medicine recommendations for pregnancy weight gain is unlikely to have a negative repercussion on offspring bone health, particularly in women with excess weight in early pregnancy. © 2018 American Society for Bone and Mineral Research.
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http://dx.doi.org/10.1002/jbmr.3587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354939PMC
January 2019

The population impact of rheumatic and musculoskeletal diseases in relation to other non-communicable disorders: comparing two estimation approaches.

Rheumatol Int 2018 May 8;38(5):905-915. Epub 2018 Feb 8.

EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135-139, 4050-600, Porto, Portugal.

The aim of this study was to quantify the population impact of rheumatic and musculoskeletal diseases (RMDs) with other non-communicable diseases (NCDs), using two complementary strategies: standard multivariate models based on global burden of disease (GBD)-defined groups vs. empirical mutually exclusive patterns of NCDs. We used cross-sectional data from the Portuguese Fourth National Health Survey (n = 23,752). Six GBD-defined groups were included: RMDs, chronic obstructive pulmonary disease or asthma, cancer, depression, diabetes or renal failure, and stroke or myocardial infarction. The empirical approach comprised the patterns "low disease probability", "cardiometabolic conditions", "respiratory conditions" and "RMDs and depression". As recommended by the outcome measures in rheumatology (OMERACT) initiative, health outcomes included life impact, pathophysiological manifestations, and resource use indicators. Population attributable fractions (PAF) were computed for each outcome and bootstrap confidence intervals (95% CI) were estimated. Among GBD-defined groups, RMDs had the highest impact across all the adverse health outcomes, from frequent healthcare utilization (PAF 7.8%, 95% CI 6.2-9.3) to negative self-rated health (PAF 18.1%, 95% CI 15.4-20.6). In the empirical approach, patterns "cardiometabolic conditions" and "RMDs and depression" had similar PAF estimates across all adverse health outcomes, but "RMDs and depression" showed significantly higher impact on chronic pain (PAF 8.9%, 95% CI 7.6-10.3) than the remaining multimorbidity patterns. RMDs revealed the greatest population impact across all adverse health outcomes tested, using both approaches. Empirical patterns are particularly interesting to evaluate the impact of RMDs in the context of their co-occurrence with other NCDs.
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http://dx.doi.org/10.1007/s00296-018-3990-8DOI Listing
May 2018

Weight Trajectories from Birth and Bone Mineralization at 7 Years of Age.

J Pediatr 2017 12 21;191:117-124.e2. Epub 2017 Oct 21.

Instituto de Saúde Pública, Universidade do Porto (Epidemiology Research Unit [EPIUnit], Institute of Public Health of the University of Porto), Porto, Portugal; Department of Public Health, Forensic Sciences and Medical Education, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal.

Objective: To assess whether different trajectories of weight gain since birth influence bone mineral content (BMC) and areal bone mineral density (aBMD) at 7 years of age.

Study Design: We studied a subsample of 1889 children from the Generation XXI birth cohort who underwent whole-body dual-energy radiograph absorptiometry. Weight trajectories identified through normal mixture modeling for model-based clustering and labeled "normal weight gain," "weight gain during infancy," "weight gain during childhood," and "persistent weight gain" were used. Differences in subtotal BMC, aBMD, and size-corrected BMC (scBMC) at age 7 years according to weight trajectories were estimated through analysis of covariance.

Results: Compared with the "normal weight gain" trajectory, children in the remaining trajectories had significantly greater BMC, aBMD, and scBMC at age 7 years, with the strongest associations for "persistent weight gain" (girls [BMC: 674.0 vs 559.8 g, aBMD: 0.677 vs 0.588 g/cm, scBMC: 640.7 vs 577.4 g], boys [BMC: 689.4 vs 580.8 g, aBMD: 0.682 vs 0.611 g/cm, scBMC: 633.0 vs 595.6 g]). After adjustment for current weight, and alternatively for fat and lean mass, children with a "weight gain during childhood" trajectory had greater BMC and aBMD than those with a "normal weight gain" trajectory, although significant differences were restricted to girls (BMC: 601.4 vs 589.2 g, aBMD: 0.618 vs 0.609 g/cm).

Conclusion: Overall, children following a trajectory of persistent weight gain since birth had clearly increased bone mass at 7 years, but weight gain seemed slightly more beneficial when it occurred later rather than on a normal trajectory during the first 7 years of life.
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http://dx.doi.org/10.1016/j.jpeds.2017.08.033DOI Listing
December 2017

Do we need bone mineral density to estimate osteoporotic fracture risk? A 10-year prospective multicentre validation study.

RMD Open 2017 26;3(2):e000509. Epub 2017 Sep 26.

Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Clínica Universitária de Reumatologia, University of Coimbra, Coimbra, Portugal.

Objective: Evaluate the performance of FRAX®, with and without bone mineral densitometry (BMD), in predicting the occurrence of fragility fractures over 10 years.

Methods: Participants aged ≥40 years at baseline, with a complete set of data and a minimum of 8.5 years of follow-up were identified from three cohorts (n=2626). Ten-year fracture risk at baseline were estimated with FRAX® and assessed by comparison with observed fractures and receiver operating characteristic analysis.

Results: During a mean (SD) follow-up of 9.12 (1.5) years, 178 participants suffered a major osteoporotic (MOP) fracture and 28 sustained a hip fracture. The predictive performance of FRAX® was superior to that of BMD alone for both MOP and hip fractures. The area under the curve (AUC) of FRAX® without BMD was 0.76 (95% CI 0.72 to 0.79) for MOP fractures and 0.78 (95% CI 0.69 to 0.86) for hip fractures. No significant improvements were found when BMD was added to clinical variables to predict either MOP (0.78, 95% CI 0.74 to 0.82, p=0.25) or hip fractures (0.79, 95% CI 0.69 to 0.89, p=0.72). AUCs for FRAX® (with and without BMD) were greater for men than for women. FRAX®, with and without BMD, tended to underestimate the number of MOP fractures and to overestimate the number of hip fractures in females. In men, the number of observed fractures were within the 95% CI of the number predicted, both with and without BMD.

Conclusion: FRAX® without BMD provided good fracture prediction. Adding BMD to FRAX® did not improve the performance of the tool in the general population.
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http://dx.doi.org/10.1136/rmdopen-2017-000509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623321PMC
September 2017

Serum serotonin levels and bone in rheumatoid arthritis patients.

Rheumatol Int 2017 Nov 9;37(11):1891-1898. Epub 2017 Oct 9.

Unit of Biochemistry, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.

In rheumatoid arthritis (RA), a disease characterized by bone loss, increased levels of serotonin have been reported. Recent studies have demonstrated a role for circulating serotonin as a regulator of osteoblastogenesis, inhibiting bone formation. Thus, we measured serum serotonin levels (SSL) in a Portuguese sample of 205 RA patients and related these to anthropometric variables, disease parameters, serum bone biomarkers, and bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry at several sites (total proximal femur, lumbar spine, left hand, and left second proximal phalange). SSL were inversely associated with body mass index (BMI) in RA women (r = - 0.218; p = 0.005), independent of exposure to biologics and/or bisphosphonates. Among biologic naïves, there was an inverse association between SSL and osteoprotegerin in RA women (r = - 0.260; p = 0.022). Serum β-CTX and dickkopf-1 were strongly associated with SSL in RA men not treated with bisphosphonates (r = 0.590; p < 0.001/r = 0.387; p = 0.031, respectively). There was also an inverse association between SSL and sclerostin in RA men (r = - 0.374; p < 0.05), stronger among biologic naïve or bisphosphonates-unexposed RA men. In crude models, SSL presented as a significant negative predictor of total proximal femur BMD in RA women as well as in postmenopausal RA women. After adjustment for BMI, disease duration, and years of menopause, SSL remained a significant negative predictor of total proximal femur BMD only in postmenopausal RA women. Our data reinforce a role, despite weak, for circulating serotonin in regulating bone mass in RA patients, with some differences in terms of gender and anatomical sites.
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http://dx.doi.org/10.1007/s00296-017-3836-9DOI Listing
November 2017

Associations of anthropometry since birth with sagittal posture at age 7 in a prospective birth cohort: the Generation XXI Study.

BMJ Open 2017 Jul 26;7(7):e013412. Epub 2017 Jul 26.

ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal.

Objectives: Adult sagittal posture is established during childhood and adolescence. A flattened or hypercurved spine is associated with poorer musculoskeletal health in adulthood. Although anthropometry from birth onwards is expected to be a key influence on sagittal posture design, this has never been assessed during childhood. Our aim was to estimate the association between body size throughout childhood with sagittal postural patterns at age 7.

Design: Prospective cohort study.

Setting And Participants: A subsample of 1029 girls and 1101 boys taking part in the 7-year-old follow-up of the birth cohort Generation XXI (Porto, Portugal) was included. We assessed the associations between anthropometric measurements (weight, height and body mass index) at birth, 4 and 7 years of age and postural patterns at age 7. Postural patterns were defined using latent profile analysis, a probabilistic model-based technique which allows for simultaneously including anthropometrics as predictors of latent profiles by means of logistic regression.

Results: Postural patterns identified were sway, flat and "neutral to hyperlordotic"in girls, and "sway to neutral", flat and hyperlordotic in boys; with flat and hyperlordotic postures representing a straightened and a rounded spine, respectively. In both girls and boys, higher weight was associated with lower odds of a flat pattern compared with a sway/"sway to neutral"pattern, with stronger associations at older ages: for example, ORs were 0.68 (95% CI 0.53 to 0.88) per SD increase in birth weight and 0.36 (95% CI 0.19 to 0.68) per SD increase in weight at age 7 in girls, with similar findings in boys. Boys with higher ponderal index at birth were more frequently assigned to the hyperlordotic pattern (OR=1.44 per SD; p=0.043).

Conclusions: Our findings support a prospective sculpting role of body size and therefore of load on musculoskeletal spinopelvic structures, with stronger associations as children get older.
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http://dx.doi.org/10.1136/bmjopen-2016-013412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577869PMC
July 2017

Quantitative modelling of hip fracture trends in 14 European countries: testing variations of a shared reversal over time.

Sci Rep 2017 06 16;7(1):3754. Epub 2017 Jun 16.

EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.

Qualitative similarities between hip fracture trends in different countries suggests variations of the same epidemic. We tested a single statistical shape to describe time trends in Europe, while allowing for country-level variability. Using data from 14 countries, we modelled incidence rates over time using linear mixed-effects models, including the fixed effects of calendar year and age. Random effects were tested to quantify country-level variability in background rates, timing of trend reversal and tempo of reversal. Mixture models were applied to identify clusters of countries defined by common behavioural features. A quadratic function of time, with random effects for background rates and timing of trend reversal, adjusted well to the observed data. Predicted trend reversal occurred on average in 1999 in women (peak incidence about 600 per 100 000) and 2000 in men (about 300 per 100 000). Mixture modelling of country-level effects suggested three clusters for women and two for men. In both sexes, Scandinavia showed higher rates but earlier trend reversals, whereas later trend reversals but lower peak incidences were found in Southern Europe and most of Central Europe. Our finding of a similar overall reversal pattern suggests that different countries show variations of a shared hip fracture epidemic.
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http://dx.doi.org/10.1038/s41598-017-03847-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473829PMC
June 2017

Biocommentary-ECI highlight September 2017.

Authors:
Raquel Lucas

Pediatr Res 2017 Sep 28;82(3):372. Epub 2017 Jun 28.

EPIUnit, ISPUP - Institute of Public Health, Universidade do Porto, Rua das Taipas 135, 4050 600 Porto, Portugal.

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http://dx.doi.org/10.1038/pr.2017.142DOI Listing
September 2017

Myocardial Perfusion in Rheumatoid Arthritis Patients: Associations with Traditional Risk Factors and Novel Biomarkers.

Biomed Res Int 2017 3;2017:6509754. Epub 2017 May 3.

Department of Medicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.

. Cardiovascular (CV) diseases are a major cause of death in rheumatoid arthritis (RA) patients. Novel biomarkers [B-type natriuretic peptide (BNP); osteoprotegerin (OPG)/receptor activator of nuclear factor-kappa B ligand (RANKL) ratio; and dickkopf-1 (DKK-1)] have been used in CV risk assessment. We analysed, in established RA patients, the presence of silent myocardial ischemia and its association with clinical variables, BNP, and bone and atheroma biomarkers. . From a single-center tertiary referral hospital, RA patients asymptomatic for CV disease were submitted to myocardial perfusion scintigraphy (MPS) under adenosine stress and biomarkers measurements. Logistic regression was used to estimate crude odds ratios (OR) and 95% confidence intervals (CI). . In 189 patients, perfusion defects were frequent (25%) and associated with BNP ≥ 100 pg/mL (OR = 5.68; 95% CI: 2.038-15.830), fourth log OPG/RANKL ratio quartile (OR = 2.88; 95% CI: 1.091-7.622), and DKK-1 ≥ 133 pmol/L (OR = 2.69; 95% CI: 1.058-6.840). Similar associations were confirmed in those with C-reactive protein > or ≤ 3 mg/L. No relationship was found with the majority of traditional CV factors nor with disease variables. . Our results corroborated the hypothesis that MPS could reveal subclinical CV dysfunction, supported the utility of BNP measurements as a screening tool, and put in perspective the potential usefulness of complementary approaches in CV risk assessment in RA patients.
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http://dx.doi.org/10.1155/2017/6509754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434312PMC
March 2018

A shared biomechanical environment for bone and posture development in children.

Spine J 2017 10 4;17(10):1426-1434. Epub 2017 May 4.

ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas 135, Porto 4050-600, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal.

Background Context: In each specific habitual standing posture, gravitational forces determine the mechanical setting provided to skeletal structures. Bone quality and resistance to physical stress is highly determined by habitual mechanical stimulation. However, the relationship between bone properties and sagittal posture has never been studied in children.

Purpose: This study aimed to investigate the association between bone physical properties and sagittal standing postural patterns in 7-year-old children. We also analyzed the relationship between fat or fat-free mass and postural patterns.

Study Design: Cross-sectional evaluation.

Patient Sample: This study was performed in a sample of 1,138 girls and 1,260 boys at 7 years of age participating in the Generation XXI study, a population-based cohort of children followed since birth (2005-2006) and recruited in Porto, Portugal.

Outcome Measures: Sagittal standing posture was measured through photographs of the sagittal right view of children in the standing position. Three angles were considered to quantify the magnitude of major curves of the spine and an overall balance measure (trunk, lumbar, and sway angles). Postural patterns were identified using latent profile analysis in Mplus.

Methods: Weight and height were measured. Total body less head fat or fat-free mass and bone properties were estimated from whole-body dual-energy X-ray absorptiometry scans. The associations of fat or fat-free mass and bone physical properties with postural patterns were jointly estimated in latent profile analysis using multinomial logistic regressions.

Results: The identified patterns were labeled as Sway, Flat, and "Neutral to Hyperlordotic" (in girls), and "Sway to Neutral," Flat, and Hyperlordotic (in boys). In both genders, children in the Flat pattern showed the lowest body mass index, and children with a rounded posture presented the highest: mean differences varying from -0.86 kg/m to 0.60 kg/m in girls and from -0.70 kg/m to 0.62 kg/m in boys (vs. Sway or "Sway to Neutral"). Fat and fat-free mass were inversely associated with a Flat pattern and positively associated with a rounded posture: odds ratio (OR) of 0.23 per standard deviation (SD) fat and 0.70 per SD fat-free mass for the Flat pattern, and 1.85 (fat) and 1.43 (fat-free) for the Hyperlordotic pattern in boys, with similar findings in girls. The same direction of relationships was observed between bone physical properties and postural patterns. A positive association between bone (especially bone mineral density) and a rounded posture was robust to adjustment for age, height, and body composition (girls: OR=1.79, p=.006 fat-adjusted, OR=2.00, p=.014 fat-free mass adjusted; boys: OR=2.02, p=.002 fat-adjusted, OR=2.42, p<.001 fat-free mass adjusted).

Conclusions: In this population-based pediatric setting, there was an inverse association between bone physical properties and a Flat posture. Bone and posture were more strongly positively linked in a rounded posture. Our results support that both bone properties and posture mature in a shared and interrelated mechanical environment, probably modulated by pattern-specific anthropometrics and body composition.
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http://dx.doi.org/10.1016/j.spinee.2017.04.024DOI Listing
October 2017

Cohort study shows that peripheral dual-energy X-ray absorptiometry is of limited epidemiologic use in prepubertal children.

Acta Paediatr 2017 Aug 14;106(8):1336-1340. Epub 2017 Jun 14.

EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.

Aim: Peripheral methods are increasingly used to assess bone health, despite little evidence on their predictive ability. We aimed to evaluate the usefulness of forearm dual-energy X-ray absorptiometry in prepubertal children, by estimating the agreement between peripheral and central measures and the ability to predict fracture history.

Methods: In 2012/2014, we assessed 1177 seven-year-old children from the Generation XXI cohort who were recruited at birth in all five public hospitals with maternity wards in Porto, Portugal. Subtotal and lumbar spine bone mineral density (BMD) and content, left-arm BMD and peripheral forearm BMD were measured. Parents reported the child's lifetime fracture history. We estimated agreement using Bland-Altman's method and Cohen's kappa. Fracture prediction ability was calculated using area under the receiver operator characteristic curve (ROC-AUC).

Results: The limits of agreement were very wide, ranging from -2.20/2.20 to -1.87/1.87 standard deviations for the comparison between peripheral and central measures. Categorical agreement was also poor, with all kappa values below 0.40. In addition, none of the measures predicted fractures, because all the ROC-AUCs were close to 0.50.

Conclusion: This study suggests that forearm BMD has limited use for bone health research or as a basis for clinical decisions in prepubertal children.
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http://dx.doi.org/10.1111/apa.13904DOI Listing
August 2017

Do bone mineral content and density determine fracture in children? A possible threshold for physical activity.

Pediatr Res 2017 Sep 24;82(3):396-404. Epub 2017 May 24.

EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.

BackgroundRelations between bone parameters, physical exertion, and childhood fractures are complex. We aimed to estimate the associations between fracture history and bone mineral content (BMC) and areal bone mineral density (aBMD) at 7 years of age, by levels of physical activity, as a proxy for trauma frequency.MethodsWe used data collected from 2,261 children of the Generation XXI birth cohort, assembled in 2005/6 in Porto, Portugal. At the age of 7 years (2012/4), fracture history, time spent per week in active play, and sports practice were reported by parents. Subtotal and lumbar spine (LS) BMC and aBMD were measured using whole-body dual-energy X-ray absorptiometry.ResultsBoys and girls in the highest categories of time spent in sports practice or active play generally had higher BMC and aBMD. Among girls, BMC and aBMD were protective of fracture only in the highest quarter of active play (>660 min/week)-odds ratios (OR; 95% confidence interval (95% CI)) for subtotal BMC=0.27 (0.11-0.67), subtotal aBMD=0.18 (0.06-0.49), and LS aBMD=0.41 (0.22-0.75). For boys in the highest quarter of sports practice (>240 min/week), subtotal and LS BMC were protective of fracture-OR=0.39 (0.16-0.98) and 0.51 (0.27-0.96), respectively.ConclusionIn prepubertal children, BMC and aBMD predicted fracture history only in the highest levels of physical activity.
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http://dx.doi.org/10.1038/pr.2017.113DOI Listing
September 2017

[Work and health in Portugal 2016: first report on occupational health in Portugal].

Arch Prev Riesgos Labor 2017 Jan to Mar;20(1):6-9

Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal.

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http://dx.doi.org/10.12961/aprl.2017.20.1.01DOI Listing
January 2017

Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures.

Acta Reumatol Port 2016 Oct-Dec;41(4):305-321

Objective: To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures.

Methods: A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions.

Results: 10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX® (FRAX®Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX® are highlighted and guidance for appropriate adjustment is provided, when possible.

Conclusions: Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.
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January 2018