Healthcare systems face increasing pressure from aging populations, chronic diseases, and the demand for accessible, high-quality care. Yet many innovations fail to address the needs of vulnerable groups. This study examines Responsible Innovation (RI) in healthcare through the Patient Innovation (PI) multi-sided platform (MSP) case. Using a mixed-methods approach, it explores how patient-driven solutions can be integrated into mainstream healthcare and traditional innovation networks. The MSP model advances RI by building collaborative ecosystems, connecting patient innovators with mentors and stakeholders, and supporting the validation and scaling of solutions. These activities promote broader societal impacts by strengthening engagement across stakeholders and fostering industry-patient collaboration. However, systemic barriers-such as funding models, limited patient-centered metrics, and regulatory complexity-hinder full RI adoption. The study calls for reforms prioritizing quality of life and long-term public benefit. MSPs offer a promising pathway to make healthcare innovation more sustainable and responsive to patients' needs.

IntroductionThis study conducted a meta-analysis across three large European cohorts (UKBB, FinnGen, and REPAIR), including 12,660 rheumatoid arthritis (RA) cases, 2,446 radiographic axial spondyloarthritis (r-axSpA) cases, and over 530,000 shared controls.MethodsTen independent SNPs in CARMIL1, GRM4, ITPR3, PRSS16, ZNF322, HTT, IKZF1, MANEA, and MGAM2 were analyzed, and functional characterization was performed through cytokine and protein assessments as well as eQTL analyses.ResultsTen independent SNPs were significantly associated with both RA and r-axSpA. Risk alleles included HTTrs363075A, IKZF1rs12718261A, MANEArs72920280T, and MGAM2rs73158426G, while CARMIL1rs72831267C, GRM4rs2495964G, ITPR3rs77601296A, ITPR3rs9469540T, PRSS16rs72843633T, and ZNF322rs6901425G had protective effects. Functional analysis showed that GRM4rs2495964G was linked to decreased CCL25 levels (p = 0.00030), and ITPR3rs9469540T to reduced IL10 production after LPS stimulation (p = 1.3×10−4). The ZNF322rs6901425G allele was associated with reduced TNFB and increased TGM2 levels (p = 9.60×10−4 and p = 3.00×10−4), both involved in immune signaling and tissue remodeling. Disease-specific associations were found in BTN2A1, BTN3A2, and H2BC11. The BTN2A1rs1977199A allele was protective in RA (OR = 0.93) but increased r-axSpA risk (OR = 1.23), and was associated with reduced IL22 (p = 0.00016) and elevated HO-1 in obese individuals (p = 6.73×10−6). In contrast, BTN3A2rs9393716G and H2BC11rs66462181C increased RA risk but were protective in r-axSpA, linked to decreased HO-1 and IL6 (p = 2.43×10−5, 3.287times;10−4, 1.18×10−4). These SNPs also acted as eQTLs for immune-related genes such as BTN3A2, HMGN4, and TRIM38.DiscussionOur findings highlight novel shared and disease-specific variants and key immunoregulatory mediators—IL10, IL22, IL6, CCL25, and HO-1—offering insights for disease stratification and therapeutic targeting.

Timely referral in Rheumatoid Arthritis (RA) is critical for early diagnosis and initiation of treatment, which are crucial to improve patient outcomes and limit radiographic progression. Optimized referral criteria, whether applied by clinicians or healthcare artificial intelligence systems, can facilitate faster and more accurate decisions regarding patient assessment by a Rheumatologist. Despite this need, a validated and widely adopted referral tool for RA is still lacking. To compile and analyse all available RA referral criteria since January 2001 until October 2023. We searched PubMed, Scopus and Web of Science in the considered period, using a defined set of strings. Studies were only included if they provided RA referral criteria or Inflammatory/Early Arthritis criteria directed at RA diagnosis. We identified 19 publications. Most include symptoms in referral criteria, either arthralgia or stiffness (63

Background:Oral health behaviors play an essential role in maintaining oral health and preventing oral diseases, which are often neglected in older adults. This study aimed to investigate the prevalence of oral health behaviors and their associated factors in older adults. Methods:This cross-sectional study included participants aged 65 years or older who attended a university dental hospital in Portugal. Data were collected through a questionnaire on oral health behaviors, socioeconomic data, general health characteristics, self-perceived oral health and oral health-related quality of life. The oral clinical assessment included the Oral Hygiene Index-Simplified (OHI-S), the Decayed, Missing and Filled Teeth Index (DMFT), the Modified Community Periodontal Index, the presence of oral mucosal lesions, prosthetic presence, and prosthetic and treatment needs. Statistical analysis included descriptive and inferential methodologies. The association between potential risk indicators and oral health behaviors was assessed and modelled using logistic regression analysis. Results:A sample of 302 older adults participated in this study, and 56.0% were female. The mean age was 73.5 years (±5.8). Regarding oral health behaviors, 21.9% brushed less than twice a day, 52.1% did not use interdental devices and 49.3% last visited a dentist for treatment. Risk indicators for less frequent brushing were being male [OR = 3.00, 95% CI (1.65-5.47)], having a perceived prosthetic need [OR = 3.46, 95% CI (1.72-6.95)] and increased values of DMFT [OR = 1.15, 95% CI (1.08-1.22)]. Risk indicators for not using interdental devices were increased values of OHI-S [OR = 2.41, 95% CI (1.71-3.40)], being male [OR = 2.31, 95% CI (1.38-3.89)] and the presence of chronic diseases [OR = 1.87, 95% CI (1.03-3.39)]. Risk indicators for treatment being the reason for the last dental appointment were prosthetic presence [OR = 3.23, 95% CI (1.79-5.82)] and increased values of DMFT [OR = 1.06, 95% CI (1.01-1.11)]. Conclusion:Assessment of oral health behaviors and associated factors should be considered to guide future public health strategies to improve compliance with oral health care among older adults and to prevent oral diseases.

Superb Microvascular Imaging (SMI) uses an adaptive algorithm that improves the visualization of vessels with low-velocity blood flow. Power Doppler (PD) imaging is routinely used in clinical practice but includes a wall filter, resulting in signal loss from small blood vessels with low flow. A standardized EULAR-OMERACT scoring system exists for rheumatoid arthritis (RA), incorporating semi-quantitative grading for both synovitis on grey-scale (GS) and PD signals. To compare SMI and PD in the evaluation of synovitis in the hand and wrist joints of patients with RA. Consecutive patients with an RA diagnosis, fulfilling the EULAR-ACR classification criteria and showing ultrasonographic synovitis in at least one joint, were recruited. Ultrasonographic assessments were performed using high-end machines equipped with high-frequency linear transducers for all metacarpophalangeal (MCP), proximal interphalangeal (PIP), and wrist joints (22 joints per patient), including GS, PD, and SMI grading. The existing EULAR-OMERACT score, which combines GS and PD signal, was compared with a proposed new version: the adapted EULAR-OMERACT score, which combines GS and SMI. A blinded real-time interrater agreement exercise between two ultrasonographers was conducted beforehand for GS, PD, and SMI, showing substantial agreement (squared-weighted κ = 0.729). Fifty-eight RA patients were enrolled (74.1

BACKGROUND AND AIMS:Heart failure (HF) is a major global health burden, yet its true prevalence remains uncertain due to heterogeneous study designs and evolving diagnostic criteria. The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) aimed to estimate the prevalence and phenotypic distribution of HF in community-dwelling adults aged ≥50 years in mainland Portugal. METHODS:PORTHOS was a cross-sectional, population-based study with a two-stage design. Stage 1 randomly selected community-dwelling individuals aged ≥50 years via structured interviews and point-of-care N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing. Individuals with NT-proBNP ≥125 pg/mL and/or a self-reported HF diagnosis, plus a random 5% of screen-negatives, proceeded to stage 2. This confirmatory stage included clinical assessment, electrocardiogram, and echocardiography. HF diagnosis required the presence of symptoms, NT-proBNP ≥125 pg/mL, and echocardiographic criteria. HF was defined as per the 2021 ESC and HFA-PEFF guidelines. RESULTS:Of 6189 participants, 2249 screened positive and 1136 were diagnosed with HF. The estimated HF prevalence was 16.54%, increasing with age (from 4.01% in 50-59 years old to 30.68% in those ≥70) and higher in females than males (21.00% vs 10.47%). Notably, 93.4% had HF with preserved ejection fraction (HFpEF), and 90% were previously undiagnosed. HFpEF was independently associated with older age, female sex, type 2 diabetes, atrial fibrillation, and dyslipidaemia. CONCLUSIONS:HF affects approximately one in six Portuguese adults aged ≥50 years, with HFpEF accounting for over 90% of cases, most previously undiagnosed. These findings support NT-proBNP-based screening combined with echocardiographic evaluation to improve early HF detection in ageing populations.

Background Osteoporosis-related fractures significantly impact older adults, often leading to disability and even premature death. While pharmacological and nonpharmacological interventions are widely recommended for managing osteoporosis, adherence to these interventions remains low. To address this challenge, we developed the Healthy Bone digital platform (desktop, mobile app, and smart TV internet-based) for use in clinical settings to improve disease management and treatment adherence. It integrates a multimedia health-related behavioral change program with a patient monitoring and management system. Objective This study aimed to evaluate the usability and user experience of the desktop version of the Healthy Bone digital platform prototype from the patients’ perspective. The findings will provide valuable insights into optimizing the digital platform and enhancing its functionality. Methods A mixed-methods study was conducted. During usability testing, patients completed tasks simulating real-world use of the platform while using a Think-Aloud approach. After each task, participants filled out an After Scenario Questionnaire to assess task satisfaction. Subsequently, participants completed the System Usability Scale (SUS) and the eHealth Usability Benchmarking Instrument (HUBBI) to measure usability quantitatively. Following this, semistructured interviews were conducted to explore participants’ experiences with the platform in greater depth. Descriptive statistics were used for quantitative analysis. Qualitative data analysis involved a combined deductive and inductive approach, ensuring a comprehensive evaluation of the platform’s usability and user experience. Deductive content analysis was guided by an ontology of eHealth usability components, while thematic analysis adhered to Braun and Clarke’s method to identify emerging themes. Results Seven participants evaluated the digital platform, reporting high usability with a mean overall SUS score of 87.1 (SD 13.3). Similarly, good usability was reported across all categories of the HUBBI, except for the guidance and support category, which presented moderate levels of usability (mean 3.3, SD 1.1). Patients reported high levels of task satisfaction and identified 24 unique usability issues, predominantly related to the basic system performance, interface design, and navigation and structure categories of the eHealth usability ontology. Overall, patients had positive perceptions and acceptability of the digital platform, highlighting its simplicity, accessibility, utility, and potential to empower those with osteoporosis. Barriers to usage included limited skills, lack of suitable equipment, and time, while facilitators included motivation for behavior change, health benefits, and the decrease of potential inequalities. Conclusions This study provided valuable insights into the usability and user experience of the desktop version of the Healthy Bone digital platform prototype. These findings will play a key role in optimizing the platform to ensure it is effectively tailored to the needs of the target population. This platform adds an understanding of how various information and communication technology tools can support and benefit large numbers of osteoporosis patients in society.

AIMS/BACKGROUND:Prostate cancer is the most common malignancy in men and a leading cause of cancer-related death. Progression from non-metastatic castration-resistant prostate cancer (nmCRPC) to metastatic CRPC (mCRPC) significantly worsens health-related quality of life (HRQoL), increases mortality, and raises healthcare costs. This study assessed the impact of avoiding or delaying progression to mCRPC on HRQoL, mortality, and economic outcomes, incorporating patients' lived experiences and unmet needs. METHODS:Three complementary studies were conducted. Study 1 was a scoping review of HRQoL and functional outcomes across disease stages, analyzing 56 studies (27 RCTs, 29 observational). Study 2 used a pharmacoeconomic survival-partition model of apalutamide, calibrated for the Portuguese healthcare system, to estimate utility gains, mortality impacts, and healthcare costs associated with delaying progression (excluding drug costs). Study 3 comprised two virtual focus groups (n = 5) exploring patient experiences, including symptom burden, psychological impact, daily life disruption, coping strategies, and care-related unmet needs. RESULTS:High-risk nmCRPC patients had higher HRQoL and better function than mCRPC patients. Symptomatic mCRPC had the lowest HRQoL (EQ-5D 0.63-0.90 vs 0.85-0.86; FACT-P 93-123 vs 109-121). Delaying progression yielded an estimated utility gain of 0.192, reduced annual mortality (0.1% vs 19.1%), and 4.4-fold lower healthcare costs. Focus groups confirmed greater physical symptoms, emotional distress, and social disruption in mCRPC, while nmCRPC experiences centered on monitoring and uncertainty. Patients identified gaps in supportive care, including psychosocial, sexual, and functional needs. CONCLUSIONS:Delaying progression from nmCRPC to mCRPC confers substantial HRQoL, survival, and economic benefits. Patient perspectives highlight gaps in supportive care and the value of early targeted interventions. LIMITATIONS:Small qualitative sample, reliance on baseline HRQoL without longitudinal adjustment, heterogeneity across studies, and exclusion of nmCRPC treatment costs may limit generalizability and precision.

Depression, as a prevalent global mental health disorder, stands as one of the main causes of disability worldwide, imposing significant individual, societal, and economic burdens. While its heterogeneous nature is well recognized, growing evidence highlights the importance of understanding depression trajectories, which describe the long-term course and variability of depressive symptoms over time. These trajectories are shaped by a complex interplay of biological, psychological, and social factors. However, despite extensive research on depression’s prevalence and risk factors, a comprehensive synthesis of trajectory patterns, their determinants, and their long-term implications remains limited. This review systematically examines the existing literature on depression trajectories in adults, identifying key influences such as age, gender, socioeconomic status, early life experiences, social support, physical health, lifestyle factors, and external stressors, including pandemics. By integrating findings from longitudinal and epidemiological studies, this review provides novel insights into the bidirectional relationship between depression and chronic health conditions, underscoring the need for a holistic, trajectory-based approach to mental health care. The findings have important implications for clinical practice, public health, and future research. Recognizing distinct trajectory patterns may facilitate earlier identification of high-risk individuals, inform the development of personalized interventions, and optimize the allocation of mental health resources. Furthermore, by elucidating the complex interconnections between depression and broader health determinants, this review establishes a foundation for advancing targeted, evidence-based interventions aimed at reducing the long-term burden of depression, particularly among vulnerable populations. • Depression affects millions of adults around the world. • Adult depression trajectories and symptoms are multifaceted and diverse. • Depression trajectories are shaped by biological, psychological, and social factors. • Understanding depression's trajectories unveils critical insights into mitigating its impact. • Every individual's trajectory should require personalized mental health care approaches.

Psoriatic arthritis (PsA) is a very heterogeneous disease with significant impact on health-related quality-of-life (HRQoL). Our objective was to assess and identify predictors of HRQoL in a 3-year follow-up period among PsA patients. Patients with PsA included in the Rheumatic Diseases Portuguese Register (Reuma.pt), with HRQoL data measured by the EuroQoL five Dimensions (EQ-5D) with at least two evaluations throughout a 3-year period, were analysed. Statistics included t-tests, logit and linear mixed models and univariable and multivariable linear regression. PsA patients’ (n = 342) mean age 51.0 (12.2) years, 48.5% being female, mean disease duration 11.8 (9.3) years with a follow-up period of 3-years had a mean EQ-5D of 0.53 (0.28), 0.59 (0.29), and 0.58 (0.28) at baseline, 1-year and 3-year evaluations, respectively. During the follow-up period, EQ-5D score and EQ VAS, significantly improved at both time-point assessments, compared to baseline. Poorer HRQoL was significantly associated with older age (β=-0.004; p-value = 0.008), female sex (β=-0.092; p-value = 0.01), non-employment (β=-0.112; p-value = 0.018), higher disease activity (β=-0.005; p-value < 0.001), prior exposure of three or more biologics at baseline and switching of biologic therapy during the study follow-up [(β=-0.182; p-value = 0.04); (β=-0.150; p-value = 0.002), respectively]. Our study provides important insights into the long-term predictors of HRQoL in PsA patients, highlighting the influence of sociodemographic factors, disease activity and therapeutic approach (prior use and switch/cycle of biologic therapies) on HRQoL.

Dietary protein may prevent or modulate the progression of frailty, by slowing down the decline of muscle mass, strength, and physical function with ageing. We aimed to examine the association between higher protein intake and transitions between frailty states. The analytic sample included 27,128 participants aged 50 + from the UK Biobank cohort study. Physical frailty at baseline and follow-up was based on slow walking speed, unintentional weight loss, exhaustion, low physical activity, and weakness. Protein intake was assessed with web-based 24 h recalls on up to 5 occasions. The effect of protein intake on forward and backward transitions (and maintenance) between frailty states (non-frailty, pre-frailty, and frailty) and to death over a mean of 5 (max 16) years was examined with multi-state models. There were 5646 transitions from non-frail to pre-frail, 4187 from pre-frail to non-frail, 552 from pre-frail to frail, and 311 from frail to pre-frail. Middle-aged and older participants with higher protein intake (increments of 0.1 g/kg bodyweight/day and protein categories of < 0.8 (ref), 0.8 to < 1.0, 1.0 to < 1.2, ≥ 1.2 g/kg bodyweight/day) were less likely to progress from pre-frailty to frailty, and appeared to be more likely to recover from pre-frailty to non-frailty, with evidence of a dose-dependent relationship. E.g. For participants with protein intake of 0.8 to < 1.0, 1.0 to < 1.2 and ≥ 1.2, hazard ratios (95

The chapter examines the role of the "Patient Innovation" project as a multisided platform (MSP) in healthcare, aiming to transform how healthcare solutions are conceived, developed, and disseminated by directly involving patients in the innovation process. Using a case-study approach, it investigates how the platform functions as a community organizer, market matchmaker, and innovation manager. The study draws data from platform metrics, user testimonials, and interviews with innovators and healthcare professionals, alongside the analysis of the regulatory and safety review processes that innovations undergo before being shared. The findings indicate that the "Patient Innovation" platform has successfully engaged over 300,000 users from more than 100 countries, with thousands of solutions shared and validated, ranging from simple home adaptations to complex medical devices requiring regulatory approval. The platform has facilitated numerous connections between patient innovators and industry partners, leading to the commercialization of several patient-developed innovations. The "Patient Innovation" project effectively demonstrates how MSPs can leverage patient- led innovations to enhance healthcare outcomes. By providing a structured environment for sharing and developing innovations, the platform ensures that these solutions are safe, effective, and aligned with market needs, underscoring the potential of user-driven innovation in healthcare and its capacity to complement traditional R&D approaches. The significance of this study lies in its demonstration of the potential for MSPs to revolutionize healthcare innovation by involving patients and caregivers. This approach not only accelerates the adoption of innovative solutions tailored to real-world needs but also fosters a more inclusive and responsive healthcare system. The findings advocate for broader adoption of similar platforms across other sectors, suggesting a shift towards more user-centered innovation frameworks in healthcare and beyond.

Given the high prevalence of rheumatic diseases in Portugal, contributing to significant disability and impacts on work, the study aims to assess the impact of health literacy, training, and empowerment on chronic disease management among patients with rheumatic diseases. Data were collected from a cross-sectional study involving rheumatic patients, including 209 participants, all of whom had various chronic rheumatic diseases. Health literacy, training, and empowerment play a significant role in the effective management of these diseases. Low levels of health literacy observed in this study can negatively impact both individual and community health, leading to increased health inequalities and affecting disease management. The analysed variables show significant roles of empowerment and health literacy in influencing areas such as autonomy, therapeutic adherence, social support, and quality of life. Considering this, new public and private approaches are needed to enhance patients' behavior, to improve their literacy, training, and empowerment. Furthermore, it is crucial to provide health professionals with effective communication strategies that foster a more comprehensive and holistic approach during their interactions with patients. This study highlights the importance of promoting health literacy and empowerment for transdisciplinary and multisectoral interventions. It emphasizes the importance of implementing actions that support health promotion policies and behavioral sciences. Such actions should focus on engaging communities in adopting healthy lifestyles, thereby contributing to a more sustainable re for global health.

OBJECTIVE: To explore the effects of minimal intervention of patient education (MIPE) for reducing disability and pain intensity in patients with low back pain (LBP). DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials. LITERATURE SEARCH: We searched the MEDLINE, Embase, CENTRAL, CINAHL, and PsycINFO databases from inception to May 2023. STUDY SELECTION CRITERIA: Trials comparing MIPE, consisting of a single session of patient education, to no or other interventions in patients with LBP. DATA SYNTHESIS: Random effects meta-analysis was conducted where possible. A noninferiority margin of 5 points (0-100 scale) was considered for noninferiority hypotheses. We assessed risk of bias using the revised Cochrane risk-of-bias tool (RoB 2), and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. RESULTS: A total of 21 trials were included. There were no differences between MIPE and no intervention for effects on disability and pain intensity. There was low-certainty evidence that MIPE had inferior effects on short-term disability (mean difference = 3.62; 95% CI: 0.85, 6.38; 15 trials; n = 3066; I2 = 75%) and pain intensity (mean difference = 9.43; 95% CI: 1.31, 17.56; 10 trials; n = 1394; I2 = 90%) than other interventions. No differences were found for subsequent time points. CONCLUSION: As an intervention delivered in isolation, and without tailoring (ie, one-size-fits-all intervention), MIPE on average did not provide benefits for reducing disability and pain intensity over no or other interventions. We encourage clinicians to consider using additional/other or more tailored treatments when helping people manage LBP. J Orthop Sports Phys Ther 2024;54(2):1-13. Epub 16 November 2023. doi:10.2519/jospt.2023.11865.

Fragility fractures are a major problem in our aging society leading to early death and loss of independence for activities of daily living. Physical activity in a long-term follow-up of Portuguese women over 50 years with a fragility fracture was associated with better physical function and quality of life. To evaluate the long-term impact of physical activity on physical function and health-related quality of life (HRQoL) in women ≥ 50 years old who suffered a fragility fracture. We evaluated the association of physical activity with physical function and HRQoL in women ≥ 50 years old who self-reported at least one low-impact fracture ≥ 40 years old from the EpiDoC cohort, a population-based cohort. Self-reported data regarding sociodemographics, clinical, and lifestyle behaviors were collected through a semi-structured questionnaire at baseline during a face-to-face clinical interview. During a long-term follow-up, a phone interview was conducted to evaluate physical activity (using a non-validated scale developed for the EpiDoC study), physical function (Health Assessment Questionnaire), and HRQoL (European Quality of Life – 5 Dimension). Women were divided into three groups according to the frequency of physical activity (non-frequent = 0 times/week, frequent = 1–2 times/week, or very frequent = ≥ 3 times/week). The association of physical activity frequency (non-frequent, frequent, and very frequent) with physical function and HRQoL over time was assessed through linear mixed models considering varying intercepts for each woman. This study followed 323 post-fracture women, during a mean follow-up of 3.9 ± 3.5 years. Frequent (β = − 0.1419 [− 0.2783, − 0.0064]) and very frequent (β = − 0.1908 [− 0.2944, − 0.0881]) physical exercise were associated with improvements in physical function relative to non-frequent physical exercise adjusted for BMI, multimorbidity, hospitalizations, alcohol and smoking habits, and the number of fragility fractures at baseline. As for HRQoL, a positive association was found for exercise frequency, specifically frequent (β = 0.1305 [0.0646, 0.1958]) and very frequent (β = 0.1354 [0.0856, 0.1859]) suggesting improvements for HRQoL, in this follow-up period. These findings based on longitudinal data with long-term follow-up suggest that regular physical activity is associated with better function and HRQol among middle-aged and older post-fracture osteoporotic Portuguese women.

PURPOSE To determine the effects of stratified primary care for low back pain (SPLIT program) in decreasing back -related disability for patients with low back pain (LBP) in primary care. METHODS We conducted a before -and -after study. We compared health -related outcomes for 2 sequential, independent cohorts of patients with LBP recruited at 7 primary care units in Portugal. The first prospective cohort study characterized usual care (UC) and collected data from February to September 2018. The second was performed when the SPLIT program was implemented and collected data from November 2018 to October 2021. Between cohorts, physical therapists were trained in the implementation of the SPLIT program, which used the STarT Back Screening Tool to categorize patients for matched treatment. We compared back -related disability (Roland -Morris Disability Questionnaire, 0-24 points), pain (Numeric Pain Rating Scale, 0-10 points), perceived effect of treatment (Global Perceived Effect Scale, -5 to +5 points), and health -related quality of life (EuroQoL 5 dimensions 3 levels index, 0-1 points). RESULTS We enrolled a total of 447 patients: 115 in the UC cohort (mostly treated with pharmacologic treatment) and 332 in the SPLIT cohort (all referred for a physical therapy intervention program). Over the study period of 6 months, patients in the SPLIT program showed significantly greater improvements in back -related disability (ss, -2.94; 95% CI, -3.63 to -2.24; P <= .001), pain (ss, -0.88; 95% CI, -1.18 to -0.57; P <= .001), perceived effect of treatment (ss, 1.40; 95% CI, 0.97 to 1.82; P <= .001), and health -related quality of life (ss, 0.11; 95% CI, 0.08 to 0.14; P <= .001) compared with UC. CONCLUSIONS Patients in the SPLIT program for LBP showed greater benefits regarding health -related outcomes than those receiving UC.

Although the oral health status has improved in developed countries in recent years, oral diseases are still unequally distributed across socio-economic groups. Research on the impact of socio-economic factors on oral health care among older adults in Europe, including Portugal, remains limited. The main aim of this study was to investigate the association between socio-economic factors and oral health indicators in Portuguese older adults. This retrospective cross-sectional study analyzed data from 915 participants (aged 65 years and older) from the third wave (2015–2016) of the Epidemiology of Chronic Diseases Cohort Study (EpiDoC), a population-based study. Socio-economic and demographic information, general health-related characteristics and oral health data (prosthetic need, oral hygiene frequency, and last dental procedure) were collected by questionnaire. Multivariate logistic and multinomial regression models analyzed the associations between socio-economic factors and oral health indicators. Participants with lower education level, perceived lower income and a fewer number of private sector appointments were more likely to have poor oral health (need for prosthetic treatment, less frequent oral hygiene, and tooth extraction as last dental procedure). Other factors found to be associated with oral health were sex, age, geographical area, smoking habits, and body mass index. Socio-economic factors were associated with oral health in Portuguese older adults. These findings may contribute to future national public health strategies by expanding oral health services to ensure better access and coverage for at-risk groups.

BackgroundObesity has been extensively studied over the years, primarily focusing on the physiological aspects of the disease. However, the general burden of obesity mainly the financial implications and its influence on hospitalization and length of stay have only recently garnered attention in the literature, particularly in the case of Portugal.AimThis study aimed to investigate the association between obesity and hospitalizations in the Portuguese adult population and compare the average costs of hospitalization among participants with and without obesity.MethodsAt baseline, the analytic sample consisted of 10,102 participants aged ≥18 years from the Portuguese population-based Epidemiology of Chronic Diseases Cohort (EpiDoC). Participants were then followed for up to 10 years from 2011 to 2021 in three more waves of data collection. Body mass index was derived from self-reported weight and height, and instances of hospitalization were self-reported by the participants. The associated costs for each hospitalization episode were categorized according to national legislation and valued according to the pricing for Diagnosis Related Groups.ResultsObesity was associated with more hospitalizations (for example, Obesity class I vs. normal weight: OR = 1.33 [1.14–1.55]). However, when the presence of multimorbidity was considered, this association diminished. While longer hospital length of stay was observed in individuals with higher obesity categories, this difference did not reach statistical significance. On average, the total hospitalization costs per patient with obesity amounted to €200.4 per year.ConclusionObesity is as a risk factor for hospitalizations and potentially with higher length of stay hospitalizations, with this effect being partially mediated by the concurrent presence of multimorbidity. Consequently, obesity constitutes an additional burden on healthcare systems. This underscores the imperative of implementing cost-effective prevention programs aimed at addressing and managing this significant public health concern.

Background: Age-related conditions, such as being misinformed, having limited oral health literacy, and the loss of manual dexterity, autonomy, or visual acuity, may act as barriers to oral health. The aim of this study was to evaluate the effectiveness of two different oral hygiene instruction methods on oral hygiene and the self-perception of oral health in older adults. Methods: This randomized controlled trial included participants aged 65 and older who completed a questionnaire on socio-economic factors, self-perceived oral health, and oral hygiene behaviours. Oral hygiene status was assessed using the Oral Hygiene Index—Simplified (OHI-S). Participants were randomly allocated into two different groups, according to the method of oral hygiene instruction: a “General Approach” (GA) (n = 28) and a “Personalized Technique” (PT) (n = 26). After two months, a follow-up session was conducted. Data were analysed using descriptive and inferential methodologies. Results: The GA and PT methods were effective in promoting oral hygiene behaviours, with a significant increase in the use of interdental devices, but no significant differences were found between the two methods. Self-perceived oral health did not change significantly, neither after the instruction nor between methods. Significant improvements were achieved with both methods for the OHI-S, with significant differences between the two methods for the Calculus Index, where the PT achieved better results. Conclusions: Oral hygiene education leads to improvements in the adoption of oral hygiene behaviours and clinical indicators. Furthermore, a personalized approach promoted better results in clinical indicators.

BACKGROUND:Recurrences of low back pain (LBP) are frequent and associated with high levels of disability and medical costs. Regular exercise practice may be an effective strategy to prevent recurrences of LBP, however, the promotion of this behaviour by physiotherapists seems to be challenging. This study aims to explore physiotherapists' perceived barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice by patients at risk of recurrence of low back pain.METHODS:Two focus groups with primary healthcare physiotherapists were conducted, based on a semi-structured interview schedule informed by the Behaviour Change Wheel, including the Capability, Opportunity, Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). All focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis, using a coding matrix based on the COM-B and TDF, was performed by two independent researchers. A third researcher was approached to settle disagreements.RESULTS:In total, 14 physiotherapists participated in the focus groups. The analysis revealed a total of 13 barriers (4 COM-B components and 7 TDF domains) and 23 facilitators (5 COM-B and 13 TDF) to physiotherapists' implementation of a behaviour change-informed exercise intervention. The most common barriers were the lack of skills and confidence to implement the proposed intervention. These were explained by the fact that it differs from the usual practice of most participants and requires the learning of new skills applied to their contexts. However, for those who had already implemented other similar interventions or whose rationale is aligned with the new intervention, there seemed to exist more positive determinants, such as potential benefits for physiotherapists and the profession, improvement of quality of care and willingness to change clinical practice. For others who did not previously succeed in implementing these types of interventions, more context-related barriers were mentioned, such as lack of time to implement the intervention, schedule incompatibilities and lack of material and human resources.CONCLUSIONS:This study identified modifiable barriers and facilitators to physiotherapists' implementation of a behaviour change-informed exercise intervention for patients at risk of recurrence of LBP in primary healthcare. The findings of this study will allow the systematic and theory-based development of a behaviour change-informed training programme, aimed at physiotherapists and supporting the successful implementation of the exercise intervention.