Osvaldo Santos

Validation of the Portuguese self-administered computerised 24-hour dietary recall among second-, third- and fourth-grade children

BACKGROUND Current methods for assessing childrens dietary intake, such as interviewer-administered 24-h dietary recall (24-h DR), are time consuming and resource intensive. Self-administered instruments offer a low-cost diet assessment method for use with children. The present study assessed the validity of the Portuguese self-administered, computerised, 24-h DR (PAC24) against the observation of school lunch. METHODS Forty-one, 7-10-year-old children from two elementary schools, in Lisbon, were observed during school lunch followed by completion of the PAC24 the next day. Accuracy for reporting items was measured in terms of matches, intrusions and omissions; accuracy for reporting amounts was measured in terms of arithmetic and absolute differences for matches and amounts for omissions and intrusions; and accuracy for reporting items and amounts combined was measured in terms of total inaccuracy. The ratio of the estimated weight of food consumed with the actual weight consumed was calculated along with the limits of agreement using the method of Bland and Altman. RESULTS Comparison of PAC24 against observations at the food level resulted in values of 67.0% for matches, 11.5% for intrusions and 21.5% for omissions. The mean for total inaccuracy was 3.44 servings. For amounts, accuracy was high for matches (-0.17 and 0.23 servings for arithmetic and absolute differences, respectively) and lower for omissions (0.61 servings) and intrusions (0.55 servings). PAC24 was found to under-estimate the weight of food on average by 32% of actual intake. CONCLUSIONS PAC24 is a lower-burden procedure for both respondents and researchers and, with slight modification, comprises a promising method for assessing diet among children.

The impact of migration on body weight: a review

A obesidade pode ser uma das caracteristicas mais alteraveis no processo de migracao. Pretendeu-se resumir a informacao sobre o impacto da migracao no indice de massa corporal (IMC). Realizou-se uma revisao sistematica da literatura de acordo com as diretrizes PRISMA, por meio de pesquisa eletronica (ultima atualizacao em agosto de 2014). Foram incluidos e avaliados qualitativamente 39 artigos. A associacao entre migracao e evolucao de IMC varia de acordo com o grupo etnico e paises de origem/acolhimento. Imigrantes hispânicos, europeus e africanos apresentam relacao consistente e positiva entre IMC e tempo de migracao. Os imigrantes asiaticos apresentam associacao positiva em menos da metade dos estudos. No geral, a qualidade dos estudos e fraca e ha necessidade de melhorar conceitos e metodos. Parece existir um efeito deteriorativo da migracao no IMC. Alteracoes nutricionais, de atividade fisica, fatores psicossociais e suscetibilidade genetica podem ser motivos subjacentes a incluir como variaveis moderadoras em estudos futuros.Immigrants may be more vulnerable to obesity as a result of the immigration process. The aim of this article is to summarize current knowledge about the impact of immigration on body mass index (BMI). A systematic review was performed in accordance with PRISMA guidelines through a database search of scientific articles (last updated in August 2014). Thirty-nine articles were included and assessed. Results varied according to ethnic background, country of origin and host country. A consistent positive association between BMI and time since immigration was found among Hispanic, European and African immigrants. Less than half of the studies observed a positive association among Asian immigrants. The quality of the majority of the studies assessed was poor, reflecting a need to improve methodology and concept definition. Immigration appears to have a deteriorative effect on BMI. Underlying causes may include changes in nutrition and physical activity, psychological and social factors, and genetic susceptibility and these aspects should be included as moderator variables in future studies.

Cancer screening in Portugal: sex differences in prevalence, awareness of organized programmes and perception of benefits and adverse effects

Cancer screening has contributed to downward trends in cancer mortality, but is also associated with adverse effects, which highlights the importance of promoting the participation based on informed decisions.

Health-related knowledge of primary prevention of cancer in Portugal.

The increasing number of new cases of cancer highlights the relevance of primary prevention for cancer control, which is influenced, among other factors, by the population’s health-related knowledge. Therefore, we aimed to describe cancer-related knowledge in Portugal, including perception of risk, awareness of cancer causes and preventive behaviours. We evaluated 1624 Portuguese-speaking dwellers, aged between 16 and 79 years, through face-to-face interviews conducted using a structured questionnaire. We computed adjusted (sex, age, education) regression coefficients and prevalence ratios, using linear and Poisson regression, respectively, to quantify associations with cancer-specific knowledge. The proportions of nonresponse ranged from 13.4 to 63.5% for the most frequent cancer in Portugal and the leading cause of cancer, respectively. The mean of the estimated lifetime risk of cancer in the Portuguese population was 37.0%. A total of 47.5% of the respondents identified breast cancer as the most frequent in Portugal, 72.0% named lifestyles as the leading cause of cancer and 40.2% selected not smoking as the most important preventive behaviour. Lower levels of education were associated with higher proportions of nonresponse, but not consistently with inaccurate knowledge. Men provided lower estimates of the lifetime risk of cancer, indicated breast cancer less frequently and more often lung cancer as the most frequent, and were more likely to select not smoking as the most important preventive behaviour. The present study provides relevant data on knowledge of cancer prevention, which may be used for the planning and evaluation of awareness-raising and primary prevention interventions in Portugal.

On Sounder Ground: CAAT, a Viable Widget for Affective Reaction Assessment

The reliable assessment of affective reactions to stimuli is paramount in a variety of scientific fields, including HCI (Human-Computer Interaction). Variation of emotional states over time, however, warrants the need for quick measurements of emotions. To address it, new tools for quick assessments of affective states have been developed. In this work, we explore the CAAT (Circumplex Affective Assessment Tool), an instrument with a unique design in the scope of affect assessment -- a graphical control element -- that makes it amenable to seamless integration in user interfaces. We briefly describe the CAAT and present a multi-dimensional evaluation that evidences the tools viability. We have assessed its test-retest reliability, construct validity and quickness of use, by collecting data through an unsupervised, web-based user study. Results show high test-retest reliability, evidence the tools construct validity and confirm its quickness of use, making it a good fit for longitudinal studies and systems requiring quick assessments of emotional reactions.

Cross-cultural adaptation and validation of the health literacy assessment tool METER in the Portuguese adult population

OBJECTIVE We aimed to culturally adapt and validate METER in the Portuguese population, and to define cut-off values for adequate health literacy. METHODS We used the standard procedure for the adaptation of the words and surveyed health professionals to select the non-words. The instrument was administered to a total sample of 249 participants and retested in a sub-sample of 45 after three months. Cut-offs were defined using the modified Angoff procedure. Construct validity was assessed through association with educational attainment and health-related occupation. RESULTS Exploratory factor analysis revealed two dimensions of the instrument, one for words and another for non-words. METER showed a high degree of internal consistency, and acceptable test-retest reliability. Adequate health literacy was defined as scoring at least 35/40 in words and 18/30 in non-words. Physicians scored higher than any other group, followed by health researchers, researchers from other areas and by people with progressively lower levels of education (p<0.001). CONCLUSION We culturally adapted a brief and simple instrument for health literacy assessment, and showed it was valid and reliable. PRACTICE IMPLICATIONS The Portuguese version of METER can be used to assess health literacy in Portuguese adults and to explore associations with health outcomes.

Association between hedonic hunger and body-mass index versus obesity status

Obesity-associated differences in hedonic hunger, while consistently reported, have not been adequately quantified, with most studies failing to demonstrate strong correlations between Body Mass Index (BMI) and hedonic hunger indicators. Here, we quantified and assessed the nature of the relationship between hedonic hunger and BMI, in a cross-sectional study using the Portuguese version of the PFS (P-PFS) to measure hedonic hunger. Data were collected from 1266 participants belonging to non-clinical, clinical (candidates for weight-loss surgery) and population samples. Across samples, significant but weak positive associations were found between P-PFS scores and BMI, in adjusted linear regression models. However, in logistic regression models of data from the clinical and non-clinical samples, the P-PFS Food Available domain score was significantly and robustly associated with belonging to the clinical sample (OR = 1.8, 95%CI: 1.2–2.8; p = 0.008), while in the population sample it was associated to being obese (OR = 2.1, 95%CI: 1.6–2.7; p < 0.001). Thus, hedonic hunger levels are associated with obesity status with the odds of being obese approximately doubling for each unit increase in the P-PFS Food Available score.

Food Insecurity in Older Adults: Results From the Epidemiology of Chronic Diseases Cohort Study 3

Introduction: The public health problem of food insecurity also affects the elderly population. This study aimed to estimate the prevalence of household food insecurity and its associations with chronic disease and health-related quality of life characteristics in individuals ≥65 years of age living in the community in Portugal. Methods: The data were collected from the Epidemiology of Chronic Diseases Cohort Study 3 (EpiDoC3)—Promoting Food Security Study (2015–2016), which was the third evaluation wave of the EpiDoC and represented the Portuguese adult population. Food insecurity was assessed using a psychometric scale adapted from the Brazilian Food Insecurity Scale. The data on sociodemographic variables, chronic disease, and management of chronic disease were self-reported. Health-related quality of life were assessed using the European Quality of Life Survey (version validated for the Portuguese population). Logistic regression models were used to determine crude and adjusted odds ratios (for age group, gender, region, and education). The dependent variable was the perceived level of food security. Results: Among older adults, 23% were living in a food-insecure household. The odds of living in a food-insecure household were higher for individuals in the 70–74 years age group (odds ratio (OR) = 1.405, 95% confidence interval (CI) 1.392–1.417), females (OR = 1.545, 95% CI 1.534–1.556), those with less education (OR = 3.355, 95% CI 3.306–3.404), low income (OR = 4,150, 95% CI 4.091–4.210), and those reporting it was very difficult to live with the current income (OR = 16.665, 95% CI 16.482–16.851). The odds of having a chronic disease were also greater among individuals living in food-insecure households: diabetes mellitus (OR = 1.832, 95% CI 1.818–1.846), pulmonary diseases (OR = 1.628, 95% CI 1.606–1.651), cardiac disease (OR = 1.329, 95% CI 1.319–1.340), obesity (OR = 1.493, 95% CI 1.477–1.508), those who reduced their frequency of medical visits (OR = 4.381, 95% CI 4.334–4.428), and who stopped taking medication due to economic difficulties (OR = 5.477, 95% CI 5.422–5.532). Older adults in food-insecure households had lower health-related quality of life (OR = 0.212, 95% CI 0.210–0.214). Conclusions: Our findings indicated that food insecurity was significantly associated with economic factors, higher values for prevalence of chronic diseases, poor management of chronic diseases, and decreased health-related quality of life in older adults living in the community.

P2K07 Competencies on epidemiological research : methodological details of an ongoing national study about training and education needs

The IEA-EEF European Congress of Epidemiology 2012: Epidemiology for a Fair and Healthy Society ! Springer Science+Business Media B.V. 2012 Epidemiology for a fair and healthy society: Euroepi 2012

Defining a Brief Intervention for the Promotion of Psychological Well-being among Unemployed Individuals through Expert Consensus

Background Epidemiologic evidence highlights the harmful consequences of unemployment on health and well-being. This emphasizes the need to design low-cost interventions to prevent the adverse mental health effects of unemployment. The main aim of this study was to create expert-consensus regarding development and implementation of a brief, sustainable, and effective intervention program for promoting mental health among unemployed. Methods The Delphi technique entailed a selected panel of 75 experts from various relevant professional backgrounds. Panel members were asked to state their level of agreement (5-point Likert scale) regarding (a) required characteristics for an effective mental health intervention for unemployed people and (b) key variables for assessing the effectiveness of that intervention. Consensus was obtained throughout two rounds of data collection through e-mail contact, with structured questionnaires. Items of the questionnaire were based on literature reviews about community-based interventions for unemployed individuals. Results Overall, 46 experts collaborated with the Delphi process (final participation rate: 61.3%). Based on a review of the literature, 185 items were identified and grouped into two broad categories (set of characteristics of the intervention and set of variables for effectiveness assessment), aggregating a total of 11 dimensions. The two Delphi rounds resulted in the selection of 35 characteristic items for the intervention program and 54 variables for its effectiveness assessment. Brief group interventions were considered to be effective and sustainable for mental health promotion in unemployment conditions if targeting mental health literacy, training interpersonal skills, and job-search skills. Conclusion As agreed by the panel of experts, a brief, sustainable and effective intervention can be developed and implemented by accounting for unemployed capacity-building for mental health self-care and adequate job-searching attitudes and skills. These results should be further implemented in community and multisector-based standardized interventions, targeting mental health among unemployed people, ensuring adequate conditions for its effectiveness assessment.