MULTIPLE SCLEROSIS MSJ JOURNAL1258 journals.sagepub.com/home/msj BackgroundCognitive impairment (CI) is known to be present in all stages of multiple sclerosis (MS); however, the prevalence estimates vary considerably between studies, ranging from 40% to 65%. 1 The profile of CI in the overall MS population is now relatively well known, involving mainly complex attention, information processing speed, episodic memory, and executive functions. 1,2 Therefore, brief neuropsychological batteries for MS 3 and newly developed assessment tools 4 mainly focus on the assessment of these functions. However, few studies investigated the differences in the prevalence and profile of CI between the different MS disease subtypes, providing heterogeneous results. [5][6][7][8][9] Many of these studies included small clinical samples and focused mainly on relapsing remitting (RR) or progressive forms. Moreover, the association of CI with several clinical features, such as physical disability, sex, and disease duration, is not well established, since inconsistent results have been reported in the literature. [10][11][12][13] The heterogeneity of the published literature could be, at least in part, attributable to small sample size and dissimilarities in the clinical characteristics of the studies' samples. Exploring the independent effects of age, physical disability, disease duration, and disease subtype could prove central to provide a better understanding of the potential role and interaction of cognitive reserve, brain aging, and disease severity for determining CI in MS. The severity of impairment and the number of involved domains were significantly higher in SP and primary progressive multiple sclerosis (PPMS) than in CIS and RR. In multivariable logistic regression analysis, the presence of CI was significantly associated with higher Expanded Disability Status Scale (EDSS) and older age. Conclusion: CI is present in all MS subtypes since the clinical onset and its frequency is increased in the progressive forms, but these differences seem to be more associated with patient age and physical disability than to disease subtype per se.

Background: Evidence of the association between parental childfeeding practices and the child's body mass index (BMI) is controversial, and bidirectional effects have been poorly studied. Objective: We aimed to examine bidirectional associations between parental child-feeding practices and BMI at 4 and 7 y of age. Design: This study included 3708 singleton children from the Generation XXI birth cohort with data on parental child-feeding practices and BMI at 4 and 7 y old. Feeding practices were assessed through a self-administered questionnaire by combining the Child Feeding Questionnaire and the Overt/Covert Control scale and then adapting it to Portuguese preschool children. Weight and height were measured according to standardized procedures, and age-and sex-specific BMI z scores were computed based on the WHO Growth References. Linear regression models were used to estimate the bidirectional associations between each practice and BMI z score. Crosslagged analyses were performed to compare the directions of those associations (the mean score of each practice and BMI z score at both ages were standardized to enable effect size comparisons). Results: After adjustments, pressure to eat and overt control at 4 y of age were associated with a lower BMI z score 3 y later (b: 20.05; 95% CI: 20.08, 20.03 and b: 20.05; 95% CI: 20.09, 20.01, respectively). Regarding the opposite direction of association, a higher BMI z score at 4 y of age was significantly associated with higher levels of restriction and covert control at 7 y of age (b: 0.06; 95% CI: 0.03, 0.08 and b: 0.06; 95% CI: 0.04, 0.08, respectively) and with lower levels of pressure to eat (b: 20.17; 95% CI: 20.20, 20.15). The only bidirectional practice, pressure to eat, was more strongly influenced by the BMI z score than the reverse (b standardized : 20.17 compared with b standardized : 20.04; likelihood ratio test: P , 0.001). Conclusions: We found that parents both respond to and influence the child's weight; thus, this child-parent interaction should be considered in future research.Am J Clin Nutr 2016;103:861-7.

Background: The increasing diversity of population in European Countries poses new challenges to national health systems. There is a lack of data on accessibility and use of health care services by migrants, appropriateness of the care provided, client satisfaction and problems experienced when confronting the health care system. This limits knowledge about the multiple determinants of the utilization of health services. The aim of this study was to describe the access of migrants to health care and its determinants in Portugal.

The National Food, Nutrition and Physical Activity Survey of the Portuguese general population aimed to collect nationwide and regional data on dietary intake and physical activity, and their relation with health determinants, namely socioeconomic factors. Results from this project were obtained from a representative sample of the Portuguese population, aged between three months to 84 years of age, selected from the National Heath Registry, by multistage sampling (a sample size of 5068 individuals was estimated and 5811 participants with two dietary assessments were achieved). To accomplish the EFSA requirements, a minimum, of 260 individuals in each age group (130 by sex) was planned. Two face-to-face interviews were conducted at a health care centre or participant's home. Dietary intake was obtained by two non-consecutive days of food diaries for children (<10 years old) and two nonconsecutive 24-hours recalls for the older age groups, with a time interval between 8 and 15 days, complemented with a Food Propensity Questionnaire. An electronic platform based on a client-server architecture was used to manage the field work and to assist the data collection. The Electronic Assessment Tool for 24-hours recall (eAT24) allowed the collection of dietary data by an Automated Multiple-Pass Method for 24-hours. This interview-based dietary assessment instrument allowed obtaining a very detailed description and quantification of foods, recipes, and food supplements consumed in the course of the preceding day, and it had several adaptations, described in detail in this report. The survey outcomes support solid evidence-based information covering all age groups of the population, using harmonized methodologies at the European level, and will contribute to develop a national infrastructure for monitoring progress of specific targets supporting national and European policies and future interventions on diet, physical activity and food safety.

BackgroundThe assessment of food consumption data using harmonized methodologies at the European level is fundamental to support the development of public policies. Portugal is one of the countries with the most outdated information on individual food consumption.ObjectiveThe objective of this study was to describe the design and methodology of the National Food, Nutrition and Physical Activity Survey, 2015-2016, developed to collect national and regional data on dietary habits, physical activity (PA), and nutritional status, in a representative sample of the Portuguese general population (3 months-84 years).MethodsParticipants were selected by multistage sampling, using the National Heath Registry as the sampling frame. Data collection, during 12 months, was harmonized according to European guidelines (EU-MENU, European Food Safety Authority [EFSA]). Computer-assisted personal interviewing (CAPI) was performed on a specific electronic platform synchronized with nutritional composition data and considering the FoodEx2 classification system. Dietary assessment was performed using 24-hour recalls (two nonconsecutive, 8-15 days apart) or food diaries in the case of children aged <10 years, complemented with a food propensity questionnaire; PA data (International Physical Activity Questionnaire [IPAQ], the Activity Choice Index [ACI], and 4-days PA diaries); sociodemographic data, and other health-related data were also collected.ResultsA sample of 6553 individuals completed the first interview, and 5811 participants completed two dietary assessments. The participation rate among eligible individuals was 33.38% (6553/19,635), considering the first interview, and 29.60% (5811/19,635) for the participants with two completed interviews (about 40% in children and adolescents and 20% in elderly individuals). Results of the survey will be disseminated in national and international scientific journals during 2018-2019.ConclusionsThe survey will assist policy planning and management of national and European health programs on the improvement of nutritional status and risk assessment related to food hazards, and the enhancement of PA. The infrastructures and data driven from this Survey are a solid basis to the development of a future national surveillance system on diet, PA, and other health behaviors reproducible over time.

The prevalence of infection among adults is still very high in Portugal, suggesting that stomach cancer rates will remain high over the next few decades.

Objectives A discrepancy in crown-rump length (CRL) and/or nuchal translucency thickness (NT) between monochorionic twins has been found to be associated with an increased risk of twin-twin transfusion syndrome (TTTS TTTS of 11.86 (95% CI,

Research on the importance of serum uric acid (SUA) as a contributing metabolic factor to cardiovascular diseases has conducted to conflicting results, with most studies assuming a cross-sectional design. The aim of this study was to evaluate the association of SUA and metabolic syndrome (MetS) and its features. A representative sample of 2,485 individuals aged ≥18 years was randomly selected from the non-institutionalized resident population of Porto, Portugal. A total of 1,054 eligible subjects were included for the longitudinal analyses. Hyperuricemia was defined as SUA ≥70 mg/L in men and ≥60 mg/L in women. MetS was defined according the Joint Interim (2009) criteria. Associations were estimated using Poison regression and binomial models. In the cross-sectional analysis, subjects with hyperuricemia had a 2.10-fold increased risk of MetS as compared with normouricemic subjects (PR = 2.10, 95% CI: 1.68-2.63). Among MetS features, high triglycerides presented the strongest association with hyperuricemia (PR = 2.32, 95% CI: 1.84-2.91). The MetS crude incidence rate was 4.5/100 person-year (95% CI: 3.9-5.2) in normal uricemic and 13.0/100 person-year (95% CI: 8.5-20.0) in hyperuricemic participants. Using a multivariate longitudinal approach, hyperuricemia was positively associated with MetS incidence rate ratios (IRR = 1.73, 95% CI: 1.08-2.76). One standard deviation increase of SUA concentration was associated with a 1.22-fold increase in MetS risk (IRR = 1.22, 95% CI: 1.05-1.42). Elevated SUA presented the strongest association with high-triglycerides concentration (IRR = 1.44, 95%: 1.22-1.71) and waist circumference (IRR = 1.25, 95%: 1.05-1.49). The independent positive association between SUA and MetS suggested by this longitudinal study supports that SUA might be a risk factor for MetS.