Hospital de São José (Portuguese pronunciation: [ɔʃ.piˈtaɫ dɨ ˈsɐ̃w̃ ʒu.ˈzɛ], "Saint Joseph's Hospital") is a public Central Hospital serving the Greater Lisbon area as part of the Central Lisbon University Hospital Centre (CHULC), a state-owned enterprise.Saint Joseph's has operated as a hospital since 1775, following the destruction of its institutional predecessor as the main public hospital in the city of Lisbon, the 15th-century All Saints' Royal Hospital, in the 1755 Lisbon earthquake..
Micromobility includes lightweight vehicles, such as bicycles and electric scooters, with limited speed and weight, and is promoted as a sustainable alternative for urban transport. Its expansion has been accompanied by a significant rise in accidents, particularly among users without helmets or under the influence of alcohol. In Portugal, despite growing adherence, data on the clinical and economic impact of micromobility remain scarce. This study aims to characterise the morbidity, severity, and associated costs of these accidents in a Portuguese tertiary hospital between 2019 and 2022. A retrospective observational study was conducted at Unidade Local de Saúde de São José, including adult patients with trauma related to micromobility vehicles between January 2019 and December 2022. Data were retrieved from hospital clinical records. Drivers or occupants of motorcycles were excluded. Statistical analysis was performed using IBM SPSS® (IBM Corp., Armonk, NY), applying the Mann-Whitney test (p < 0.05). A total of 1,566 patients with micromobility-related trauma were included, mostly from single-vehicle incidents (n = 1,379; 88.1%) and involving electric scooters (n = 1,015; 64.8%). The mean age was 50 years, and 677 patients (43.2%) were Portuguese nationals. Helmet use was reported in only 21 of 302 cases with available data (7%). The most frequent injuries affected the limbs (n = 1,000; 63.8%) and the head (n = 718; 36.9%), with a mean Injury Severity Score (ISS) of 2.7. Sixteen cases (1.0%) were classified as severe (ISS ≥ 16). Alcohol consumption was significantly associated with greater severity (p = 0.009). A total of 271 patients (17.3%) were hospitalised, 18 of whom (1.1%) required intensive care. The estimated total cost of hospitalisation was €456,000. There were five in-hospital deaths (0.3%) and 34 cases (2.2%) of persistent neurological sequelae. Most micromobility accidents involved scooters and resulted from single-vehicle crashes, reflecting patterns similar to those reported internationally. Risk behaviours, such as low helmet use and alcohol consumption, were identified, the latter being associated with increased injury severity. Although minor injuries predominated, a subgroup sustained severe trauma with significant clinical, functional, and economic impact. These findings highlight the need for preventive strategies and standardised registries to support effective monitoring and the implementation of targeted public health measures. Although minor injuries were most frequent, a minority of cases involved severe trauma with relevant clinical and economic impact. The findings support the need for preventive measures and prospective data collection systems to inform effective public policies.
Background:Older adults represent an increasing proportion of intensive care unit admissions, but the relationship between country-level human development and outcomes after critical illness remains incompletely understood. Methods:We conducted a secondary analysis of three prospective multicentre registries, VIP1, VIP2, and COVIP, including acutely admitted older ICU patients with available Clinical Frailty Scale assessment, country-level Human Development Index (HDI), and 30-day vital status. VIP1 and VIP2 enrolled patients aged ≥80 years, whereas COVIP enrolled patients aged ≥70 years. The primary exposure was exceptionally high human development, defined as HDI ≥ 0.90 versus <0.90. The primary outcome was 30-day mortality. Associations were assessed using logistic regression with robust standard errors clustered by country, adjusting for age, sex, SOFA score, frailty, admission diagnosis, organ support modalities, and treatment-limitation decisions. Exploratory mediation analyses examined selected ICU management variables as potential pathways linking HDI to mortality. Results:Among 9920 patients included in the primary analysis, 8324 (83.9%) were treated in countries with HDI ≥ 0.90 and 1596 (16.1%) in countries with HDI < 0.90. Thirty-day mortality was lower in high-HDI countries than in lower-HDI countries (40.0% vs. 53.3%). In unadjusted analysis, HDI ≥ 0.90 was associated with lower 30-day mortality (OR 0.58; 95% CI 0.38-0.90; P = 0.016). This association persisted after multivariable adjustment (adjusted OR 0.49; 95% CI 0.31-0.80; P = 0.004) and was similar after additional adjustment for study cohort (aOR 0.49; 95% CI 0.31-0.77; P = 0.002) and ICU bed capacity (aOR 0.50; 95% CI 0.29-0.86; P = 0.013). When modelled continuously, higher HDI was associated with lower mortality after full adjustment (OR 0.33 per 0.10-unit increase; 95% CI 0.19-0.56; P < 0.001). Exploratory mediation analyses suggested that lower use of invasive mechanical ventilation in high-HDI countries may partially contribute to the observed association (NIE OR 0.86; 95% CI 0.83-0.89). Mediation analyses involving treatment-limitation decisions were more difficult to interpret because these decisions are closely linked to prognosis, clinical trajectory, and end-of-life practice. Conclusions:In this large European cohort of older critically ill patients, treatment in countries with exceptionally high human development was associated with lower 30-day mortality. The association persisted after adjustment for patient-level severity, frailty, treatment limitation, organ support, study cohort, and ICU bed capacity. These findings suggest that country-level development and ICU management patterns, particularly invasive ventilation practices, may contribute to outcome differences. Because this was an observational secondary analysis using country-level exposure data, causal interpretation should remain cautious.
Background/Aim Walking ability is key for independence in daily life in older adults following intertrochanteric fractures (ITF), yet gait impairments in this population remain poorly described. This study aimed to evaluate gait impairments in patients after ITF surgery and investigate the relationship between gait kinematics and hip-related disability. Methods Gait analysis was performed in 21 ITF patients at 3 and 6 months (M) post-surgery with intramedullary nails, and in 21 controls. Lower-limb kinematics and spatiotemporal gait parameters were computed. Hip disability was assessed through the Hip Disability and Osteoarthritis Outcome Score (HOOS). Differences in HOOS and gait parameters within and between groups were determined using t-tests; kinematic differences were examined with Hotelling’s tests and general linear models, using statistical parametric mapping (SPM). Linear regression tested associations between pelvic/hip kinematics profiles and HOOS, using SPM. Results Improvements in HOOS between post-surgery time-points were detected. Spatiotemporal and lower-limb kinematic parameters did not differ from 3 M to 6 M (e.g., speed: 3M=0.63 m/s; 6M=0.66m/s; p > 0.05). Spatiotemporal variables were different from the healthy group (e.g., speed=1.25 m/s; p < 0.05) at both time points. Increased pelvic obliquity upward of the fractured side during swing was associated with worse HOOS Activities Daily Living (ADL) (R2=0.39,%stride=85%) at 3 M, and reduced hip extension motion with lower HOOS at 6 M postoperatively (ADL: R2=0.62,%stride=56%; sports/recreational: R2=0.54,%stride=56%). Discussion Our findings suggest partial recovery of hip-related disability by 6 M post-surgery, yet persistent gait impairments compared to healthy individuals. Kinematic deficits around the hip and pelvis appear to hinder overall mobility and may serve as a mediator in self-perceived activities and participation.
BACKGROUND AND OBJECTIVES:Contrast-associated acute kidney injury (CA-AKI) is a potentially preventable complication after exposure to iodinated contrast media. In patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the incidence and clinical impact are poorly characterized, and no validated prediction tool is currently available. The aim of this study was to assess the incidence and prognostic significance of CA-AKI in EVT-treated patients with AIS and to develop and validate a predictive score. METHODS:A retrospective, multicenter cohort study was conducted involving EVT-treated patients across 73 centers in 16 countries (January-December 2023). Inclusion criteria were age ≥18 years, absence of dialysis, availability of preprocedural and 48-hour postprocedural creatinine levels, and available 90-day follow-up (modified Rankin Scale [mRS] score). The primary outcome was CA-AKI, defined by KDIGO (Kidney Disease: Improving Global Outcomes criteria;creatinine increase ≥0.3 mg/dL or ≥1.5 times baseline, within 48 hours). Secondary outcomes were (1) in-hospital mortality, (2) 90-day mRS score, and (3) 90-day severe disability or death (mRS score >3). Logistic models assessing associations with outcomes accounted for within-center clustering by applying robust standard errors. CA-AKI prediction models were developed across imputed data sets using univariable selection (p < 0.20), backward elimination (p < 0.05), and coefficient-based scoring after categorization of continuous predictors, with internal validation by bootstrap to obtain optimism-adjusted estimates. RESULTS:Among 6,638 patients (median age 74 years; 48.7% male), CA-AKI occurred in 326 (4.9%) and was independently associated with in-hospital mortality (adjusted odds ratio [aOR] 2.269; 95% CI 1.615-3.190), higher 90-day mRS scores (adjusted common odds ratio 1.584; 95% CI 1.110-2.258), and 90-day severe disability or death (aOR 1.530; 95% CI 1.057-2.216). A preprocedural risk model including 12 routine clinical variables-sex, ethnicity, arterial hypertension, dyslipidemia, chronic kidney disease, antiplatelet therapy, NIH Stroke Scale score at admission, serum glucose, estimated glomerular filtration rate, hemoglobin, mean arterial pressure, and IV thrombolysis-demonstrated acceptable discrimination (area under the receiver operating characteristic curve 0.710 [95% CI 0.682-0.738]; precision-recall area under the curve 0.13 [95% CI 0.10-0.16]), good calibration (slope 0.870 [95% CI 0.759-0.928]), good overall performance (Brier score 0.045 [95% CI 0.042-0.049]). A second model that included EVT-related variables (e.g., contrast volume) showed similar performances. DISCUSSION:In this large, international cohort, CA-AKI occurred in approximately 1 in 20 EVT-treated patients with AIS and was independently associated with poor outcomes. A simple preprocedural risk score enables early identification of high-risk individuals and may support preventive strategies.
