Portuguese Adult Population Research Articles

Perspectives on Creating a Chronic Pain Support Line in Portugal: Results of a Focus Group Study among Patients and Healthcare Professionals.

Background: Chronic pain (CP) patients frequently feel misunderstood and experience a lack of support. This led to the creation of support telephone lines in some countries. However, there is no scientific data grounding their development or evaluating their performance. Almost 37% of the Portuguese adult population suffers from CP, with great costs for patients and the healthcare system. Methods: To determine the viability of a support line for CP in Portugal, a qualitative study was designed, and online focus group meetings, with patients and healthcare professionals, were conducted. Their perspectives, beliefs, and expectations were evaluated and described. Results: This study revealed that a CP support line is a feasible project from the participants' perspective if its interventions are limited to active listening, emotional support, and tailored suggestions. Conclusions: It has the potential to generate a positive impact on healthcare services, while also contributing to greater equity of access to support.

Malignant melanoma in Portuguese adult population: a scoping review of the real-world evidence.

Malignant melanoma is an aggressive cancer, and there is a notable dearth on epidemiology, clinical and treatment characterization within the Portuguese population. We performed a scoping review to identify real-world evidence studies focused in Portuguese adult patients with malignant melanoma. A comprehensive search was conducted. After screening, we described the studies by design, sample size, geographics, setting, population, and outcomes reported. The search yielded 54 studies, mainly retrospective (79.6%). The population assessed was heterogeneous varying from patients with melanoma in general to specific types of melanoma, or even more restricted to patients with specific conditions. The evidence found was mostly concerning clinical outcomes (n=46), patients' clinical profile (n=44) and demographic characterization (n=48). Treatment information was described in 30 studies whereas only 18 reported epidemiological parameters. Studies were mainly performed by the major oncology centers in Lisbon, Oporto and Coimbra, and only two evaluated the entire Portuguese population. To allow comparability, only studies including patients with cutaneous malignant melanoma were considered (13 of the 54) for outcomes evaluation analysis. Median OS varied from 18 to 36 months, assessed after melanoma treatment. Incidence was the most reported epidemiological parameter, confirming the increasing number of cutaneous malignant melanoma patients over the years. Only one study reported prevalence and four reported mortality rates. The evidence found confirms the lack of information about malignant melanoma in Portugal, highlighting the need of real-world studies to assess melanoma prevalence and incidence rates, current treatment approaches, and clinical characterization of these patients.

Hospitalization costs in Portugal among people with obesity: results from a nationwide population-based cohort 2011 to 2021.

Obesity 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. This 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. At 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. Obesity 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. Obesity 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.

Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study

Diabetes poses a substantial disease burden, prompting preventive interventions. Physical inactivity, a major risk factor for type 2 diabetes, can potentially be mitigated by enhancing area-level walkability. Despite this, limited population-based studies have investigated the link between walkability and objective diabetes measures. Our study aims to estimate the association between area-level walkability and individual glycated haemoglobin levels in the Portuguese adult population without the diagnosis of diabetes. Data from the 2011 census and an updated street map were obtained to construct a walkability index based on residential density, land-use mix, and street connectivity. Individual health data were sourced from The National Health Examination Survey (INSEF) 2015, a representative survey of the Portuguese adult population. Gamma regression was employed for estimation of the main associations, revealing that residing in moderately walkable areas significantly reduced average glycated haemoglobin levels (Exp(β) = 0.906; 95% CI: 0.821, 0.999) compared to the least walkable areas. The association was less pronounced and not statistically significant for the third tertile of walkability (Exp(β) = 0.919; 95% CI: 0.822, 1.028). Our findings highlight a nonlinear protective association between walkability and glycated haemoglobin, emphasizing the potential policy implications for urban planning, diabetes prevention, and health promotion.

Sudden death in young South European population: a cross-sectional study of postmortem cases

To describe the annual incidence and the leading causes of sudden non-cardiac and cardiac death (SCD) in children and young adult Portuguese population. We retrospectively reviewed autopsy of sudden unexpected deaths reports from the Portuguese National Institute of Legal Medicine and Forensic Sciences’ database, between 2012 and 2016, for the central region of Portugal, Azores and Madeira (ages 1–40: 26% of the total population). During a 5-year period, 159 SD were identified, corresponding to an annual incidence of 2,4 (95%confidence interval, 1,5–3,6) per 100.000 people-years. Victims had a mean age of 32 ± 7 years-old, and 72,3% were male. There were 70,4% cardiac, 16,4% respiratory and 7,5% neurologic causes of SD. The most frequent cardiac anatomopathological diagnosis was atherosclerotic coronary artery disease (CAD) (33,0%). There were 15,2% victims with left ventricular hypertrophy, with a diagnosis of hypertrophic cardiomyopathy only possible in 2,7%. The prevalence of cardiac pathological findings of uncertain significance was 30,4%. In conclusion, the annual incidence of SD was low. Atherosclerotic CAD was diagnosed in 33,0% victims, suggesting the need to intensify primary prevention measures in the young. The high prevalence of pathological findings of uncertain significance emphasizes the importance of molecular autopsy and screening of first-degree relatives.

The SHED Index: A Validation Study to Assess Sustainable HEalthy Diets in Portugal.

This study aims to adapt and validate the Sustainable HEalthy Diet (SHED) Index for the Portuguese adult population, which was developed to assess sustainable and healthy eating patterns. Data were collected using a web-based questionnaire administered through interviews with 347 individuals aged between 18 and 65 years old. The SHED Index evaluates 30 items, allowing for the assessment and scoring of sustainable and healthy eating patterns. The higher the SHED Index score, the more sustainable and healthier the diet. A semi-quantitative food frequency questionnaire was used to assess the participants' dietary intake. The criterion validity was examined by testing the relationship between the SHED Index score and adherence to the Mediterranean Diet. Reproducibility was assessed by determining agreement and reliability with test-retest. Construct validity was confirmed based on established criteria. A higher SHED Index score was associated with moderate to high adherence to the Mediterranean diet, while it was inversely related to the proportion of animal-sourced foods in the overall food intake (r = -0.281, p < 0.001). Good reliability and agreement were found for the SHED Index score. Our findings suggest that the SHED Index is a valid and reliable tool for assessing sustainable and healthy diets in the Portuguese adult population.

The impact of obesity on hospitalized patients with COVID-19 in southern Portugal

COVID-19 is the disease caused by SARS-CoV-2 coronavirus infection, with patients exhibiting asymptomatic or mild clinical manifestations to severe life-threatening respiratory disease. Obesity was early identified as one of the risk factors for the worsening COVID-19 related clinical manifestations. Considering that around a fifth of the Portuguese adult population has obesity, it is pivotal to explore the impact of obesity on COVID-19 clinical outcomes also in this population. To assess the association between obesity and the outcomes of patients hospitalized with COVID-19 in a University Hospital in southern Portugal (Algarve), clinical and biochemical data from a continuous sample of patients was collected and analyzed. Comparisons between patients with and without obesity were performed with appropriate statistical tests. From the 215 patients hospitalized with COVID-19, 24.7% were classified with obesity. Logistic regression showed that patients with obesity were more likely to need intensive care (OR = 2.66; p = 0.009) and higher oxygen requirement (OR = 5.04; p = 0.033), even after adjusting for hypertension (which was more prevalent in the obesity group). Obesity in patients with COVID-19 was not associated with increased mortality, as there were no differences in inflammation or sepsis biomarkers, or the use of corticosteroids/antibiotics, compared to patients without obesity. This work highlights the risk associated with obesity in COVID-19 patients in terms of the course of clinical outcomes. This is the first study analyzing the relationship between obesity and COVID-19 when it comes to clinical outcomes in a Portuguese population from the southern Portugal.

Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study

Abstract Diabetes is responsible for a high burden of disease, yet there is a great potential for prevention. Physical inactivity is one of the major risk factors for type 2 diabetes which can be tackled by increasing area-level walkability. That said, there are still few population-based studies exploring the association between area-level walkability and objective measures of diabetes. The aim of this study is therefore to estimate the association between area-level walkability and individual levels of glycated haemoglobin in the Portuguese adult population. Area-level data required to estimate walkability was obtained from the 2011 census and an updated street map. The walkability index was constructed using measure of residential density, land-use mix and street connectivity. Individual-level health data was obtained from The National Health Examination Survey (INSEF) 2015, a population-based survey representative of Portuguese adult population. We used gamma regression to estimate associations. The regression coefficients showed that living in medium walkable areas reduced the average glycated haemoglobin (Exp(β)=0.906; 95%CI: 0.821, 0.999) in a statistically significant way when compared with least walkable areas. The association was smaller, and not significant, for the third tercile of walkability (Exp(β)=0.919; 95%CI: 0.822, 1.028). Our findings suggest a non-linear protective association of walkability on glycated haemoglobin. These findings could have important policy implications for urban planning, with a goal of preventing diabetes and promoting health by increasing walkability.

The burden of cardiovascular disease associated with PM2.5 exposure in the Portuguese population

Abstract Background Exposure to air pollution has been associated with increased mortality, premature mortality, and morbidity. A causal relationship between fine particulate matter (PM2.5) exposure and cardiovascular morbidity and mortality was demonstrated by the American Heart Association. In 2020, exposure to PM2.5 concentrations above limits defined by World Health Organization was responsible for 238,000 and 2,600 premature deaths in the European Union and in Portugal, respectively. Aim To estimate the impact on cardiovascular diseases (CVD) attributable to exposure to PM2.5 between 2010 and 2020, expressed as years of life lost (YLL), in Portugal. Methods National Statistics databases were used to collect the number of cardiovascular mortality cases between 2010 and 2020. The atmospheric levels of PM2.5 were obtained from Online Database on Air Quality of the Portuguese Environment Agency. When PM2.5 data were absent, PM10 data were used to estimate the PM2.5 concentration through the ratio: PM2.5/PM10=0,65. The burden of disease was estimated as YLL. The YLLs due to PM2.5-associated stroke and IHD in the Portuguese adult population, older than 30 years, were determined using the population-attributable fraction (PAF). Results YLLs per year for stroke and IHD were estimated as 41,489.60 (95% CI: 34,610.68 - 48,368.52) YLL and 27,573.44 (95% CI: 24,939.94 - 30,206.93) YLL respectively. Between 2010 and 2020, the crude number of YLL in mainland Portugal due to PM2.5 exposure-associated stroke and IHD decreased. The YLLs for IHD and for stroke are higher for men than for women. However, for stroke, the YLLs do not demonstrate as significant a difference as for IHD. Conclusions These findings provide evidence of the impact of air pollution on human health, which are crucial for decision-making. Acknowledgments This work is funded by FCT/MCTES through national funds to PMCardImpact (EXPL/SAU-PUB/0944/2021). Key messages • Exposure to PM2.5 has a significant health impact concerning cardiovascular mortality. • Estimating burden of disease contributes for the decision making and environmental policies.

Health and well-being of the Portuguese citizens: impacts of the COVID-19

BackgroundCOVID-19 pandemic placed unprecedented pressure on societies and healthcare systems around the world. Over the last years, measures imposed in almost all countries dealing with the pandemic sent the entire world into an extensive crisis and thus into a deep global recession. Since the outbreak began, many European countries have faced three/four waves of pandemic. Portugal has mainly dealt with three waves (March/April’2020; October/November’2020; January/February’2021), the third being the deadliest one. The purpose of this article is to provide evidence on the impact of the COVID-19 on health-related quality of life (HRQol) and well-being (W-B) of Portuguese citizens. It aims to (i) characterize these outcomes during the COVID-19 pandemic; (ii) compare them to pre-COVID-19 Portuguese population; and (iii) identify the social determinants that may affect these outcomes during the COVID-19 pandemic.MethodsThis study used data from a survey that collected data on HRQoL, W-B, satisfaction with life, economic and labour impacts, access to healthcare, mental and physical health, amongst others. The survey was implemented by telephone to a representative random sample of 1,255 respondents from the general adult Portuguese population, stratified by sex, age group and region. Data was collected during the end of the second national lockdown. For comparison purposes, we have also used two other representative databases from the general Portuguese population: (i) data from before the pandemic (n = 1,006); and (ii) data from a survey conducted during the first lockdown, (n = 904).ResultsLooking at health and access to healthcare, 4% of citizens had their surgeries postponed or cancelled because of COVID-19, more than a quarter had medical appointments or complementary exams postponed or cancelled, with 7% over 65 years old with surgeries cancelled or postponed and 32% medical appointments. COVID-19 pandemic also impacted negatively on the HRQoL of citizens, especially in the first lockdown. Half of the respondents reported feeling nervous, anxious, or on edge, about 45% of citizens felt sad or depressed. Sleeping problems were reported for almost 39% of citizens, and loneliness is reported by 29% of citizens. For about 70–85% of citizens, these feelings were more so than before the pandemic. Citizens with fair/strong economic stability were the most economically affected by the pandemic.ConclusionsWe provided evidence on the impact of COVID-19 on health and W-B of Portuguese citizens. Their health was worse than before the pandemic and the access to healthcare was highly affected.

Methodological approaches for the assessment of bisphenol A exposure

Bisphenol A (BPA) is an endocrine disruptor used in food contact materials, by the application of polycarbonate plastics and epoxy resins. The main objective of this study is to compare the estimate of daily BPA exposure at 13 years of age and in the adult Portuguese population, using different methodological approaches, and assess the associations between this exposure and sociodemographic characteristics. MethodologyCross-sectional data of 13-years follow-up from a population-based birth cohort Generation XXI (GXXI) (n = 2804) and from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015–2016) (n = 3845, ≥18 years old) was used. Dietary information was collected through three food diaries for adolescents and two non-consecutive 24-hour-recalls for adults.To estimate the daily exposure to BPA, three methodological approaches were used. “Food groups attribution” merged the food consumption data with the concentration of BPA in food groups. “Regression tree model” and “random forest” combined food consumption information with urinary BPA, measured in a subsample of 24-hour urine (in adolescents n = 216, and in adults n = 82), both used to predict BPA exposure in the remaining sample. The fit-index of the methodologies was assessed through the root mean square error (RMSE), mean absolute error (MAE) and Spearman correlation coefficient (ρ). Associations between BPA exposure and sociodemographic variables were tested by linear regression models, adjusted for sex, age groups (in adults) and educational level. Tolerable Daily Intake (TDI) of 0.2 ng/kg body weight (bw), recently proposed by the European Food Safety Authority (EFSA), was used for the risk characterization of BPA exposure. ResultsThe “random forest” was found as the best methodology to estimate the daily BPA exposure (adolescents: RMSE = 0.989, MAE = 0.727, ρ = 0.168; adults: RMSE = 0.193, MAE = 0.147, ρ = 0.250). The median dietary BPA exposure, calculated by “food groups attribution”, was 79.1 and 46.1 ng/kg bw/day for adolescents and adults, respectively, while “random forest” estimated a BPA exposure of 26.7 and 38.0 ng/kg bw/day. 99.9% of the Portuguese population presented a daily exposure above TDI. Male adolescents, females and higher educated adults, were those more exposed to BPA. ConclusionsThe estimated daily BPA exposure strongly depends on the methodological approach. Food groups attribution may overestimate the exposure while the random forest appears to be a better methodological approach to estimate BPA exposure. Nevertheless, for all methods, the Portuguese population presented an unsafe BPA exposure by largely exceeding the safe levels proposed by EFSA.

The real relationship: the Portuguese version of the Real Relationship Inventory-Client form.

The Real Relationship is a relational construct that has influenced other constructs, like the working alliance, although empirically neglected. The development of the Real Relationship Inventory provides a reliable and valid way of measuring the Real Relationship in research and clinical applications. This study aimed to validate and explore the psychometric properties of the Real Relationship Inventory Client Form with a Portuguese adult sample in the context of psychotherapy. The sample includes 373 clients currently in psychotherapy or concluded recently. All clients completed the Real Relationship Inventory (RRI-C) and the Working Alliance Inventory. The confirmatory analysis revealed the same two factors in the RRI-C for the Portuguese adult population, Genuineness and Realism. The observation of the same factor structure suggests the cross-cultural value of the Real Relationship. The measure demonstrated good internal consistency and acceptable adjustment. A significant correlation was found between the RRI-C and the Working Alliance Inventory and significant correlations between the Bond and Genuineness and Realism subscales. The present study reflects on the RRI-C while also contributing to the importance of the Real Relationship in different cultures and clinical contexts.

Prevalence of Type 2 Diabetes, Impaired Fasting Glucose, and Diabetes Risk in an Adult and Older North-Eastern Portuguese Population.

The aims of this study were (1) to evaluate the prevalence of type 2 diabetes (T2D) in a middle-aged north-eastern Portuguese population, (2) to analyze the prevalence of impaired fasting glucose (IFG), and (3) to assess the risk of T2D in this community-based sample. An exploratory, retrospective, and cross-sectional study was conducted from a total of 6570 individuals aged 18-102 years, among which 3865 were women (57.4 ± 18.1 years) and 2705 were men (60.0 ± 16.8 years). T2D diagnosis, IFG, and the diabetes risk score (low to very high risk) were assessed. The prevalence of T2D in this adult and an older north-eastern Portuguese population was 17.4%. A higher prevalence of T2D was reported in men (22.2%) than in women (14.0%); however, this was without significant differences (p = 0.086). Otherwise, the prevalence of T2D was significantly different among the age groups and increased with age (p < 0.001). Regarding IFG, a higher percentage of cases was observed in men (14.1%) than in women (8.4%) (p < 0.001). The risk of developing T2D in the next 10 years showed an association with sex and age group (p < 0.001) with a small-to-moderate effect (V = 0.1-0.3). Men and the elderly had the highest percentage of cases in the moderate-to-very high-risk bands. The current research confirmed a higher prevalence of T2D, IFG, and diabetes risk than previous Portuguese epidemiological reports. The results also suggest potential prediabetes cases, which should be carefully monitored. The current research adds evidence to the worldwide trend of the increasing prevalence of T2D and intermediate hyperglycemia (i.e., prediabetes).

Have we been underestimating the burden of heart failure?

Have we been underestimating the burden of heart failure?

Reference Equation of a New Incremental Step Test to Assess Exercise Capacity in the Portuguese Adult Population

Step tests are important in community- and home-based rehabilitation programs to assess patients' exercise capacity. A new incremental step test was developed for this purpose, but its clinical interpretability is currently limited. This study aimed to establish a reference equation for this new incremental step test (IST) for the Portuguese adult population. A cross-sectional study was conducted on people without disabilities. Sociodemographic (age and sex), anthropometric (weight, height, and body mass index), smoking status, and physical activity (using the brief physical activity assessment tool) data were collected. Participants performed two repetitions of the IST and the best test was used to establish the reference equation with a forward stepwise multiple regression. An analysis comparing the results from the reference equation with the actual values was conducted with the Wilcoxon test. A total of 155 adult volunteers were recruited (60.6% female, 47.8 ± 19.7 years), and the reference equation was as follows: steps in IST = 475.52 - (4.68 × age years) + (30.5 × sex), where male = 1 and female = 0, and r2 = 60%. No significant differences were observed between the values performed and those obtained by the equation (p = 0.984). The established equation demonstrated that age and sex were the determinant variables for the variability of the results.

Índice de Massa Corporal, aporte energético e de macronutrientes e sua correlação com a saúde mental

Introduction: Studies have shown that diet and mental health may be related, sometimes in a bidirectional relationship. Objectives: Evaluate the Body Mass Index and the intake of Energy and Macronutrient in relation to symptoms of Anxiety, Depression and Stress in a sample of the Portuguese adult population. Materials and Methods: The study sample consisted of 144 individuals (24.6 ± 5.6 years), 56.4% female and 45.1% male. An online survey (n=144) was conducted on the Google Forms platform that included questions about sociodemographic data, the Anxiety, Depression and Stress Scale (EADS-21) and the Food Frequency Questionnaire (FFQ). Results: There was no statistically significant correlation between BMI and mental health. There were statistically significant correlations, in female gender, between sugar intake and symptoms of depression and stress, and in the male gender, correlations were found between complex carbohydrates intake and stress symptoms; total, polyunsaturated, and saturated fat intake with symptoms of depression and stress, as well as monounsaturated fat intake with depressive symptoms. Conclusion: The consumption of carbohydrates and fats appear to be correlated with mental health. A balanced diet is the basis to prevent a large part of the pathologies, including mental disorders.

Characterization of sudden death etiologies in a Portuguese population younger than 40 years-old

Abstract Background The incidence and pathogenesis of sudden death (SD) in the young adult population in Portugal remains to be clarified. Some of the causes are known to be hereditary and a better understanding of these can have implications on the development of a national screening program for relatives of SD victims. Purpose To describe the leading causes of sudden cardiac and non-cardiac death in a young adult Portuguese population (≤40 years-old). Methods The authors retrospectively reviewed cases from a national database regarding individuals who underwent an autopsy, between 2012 and 2016, at 6 districts of mainland Portugal plus the islands. All young adults (1–40 years-old) who had a sudden unexpected death were included and violent deaths were excluded. This study was approved by the Institute Ethics Committee. We reviewed the autopsy files and collected demographic, clinical, necropsic, anatomopathological and toxicological data from each case. We performed statistical analysis using Stata 13.0 software. Results During a 5-year period, out of an estimated total of 2101 deaths in ages 1 to 40, 175 SD were identified. SD victims had a mean age of 32±9 years-old, the majority being of male gender (69%,n=120). There were 115 (66%) cases of SD of confirmed cardiac origin (see Table 1). The remaining causes were respiratory (18%), cerebral (7%), digestive (6%), endocrinologic (2%), urinary (1%), infectious (1%). The most frequent cardiac cause being coronary atherosclerosis (n=40,35%), which included lesions with estimated luminal narrowing &amp;gt;75% and/or documented type 1 acute myocardial infarction. These patients were older (31±8 vs 35±4, p&amp;lt;0.020), had a minimum age of 26 years, and more frequently male (85% vs 61%, p=0.011). There were 17 (15%) victims who had cardiopathy with histopathological hypertrophy (5 of them with associated fibrosis), and the diagnosis of hypertrophic cardiomyopathy (HCM) was possible in only 3 (3%) victims. In addition, there were 15 (13%) who died from pulmonary embolism who were predominantly women (23% vs 80%, p&amp;lt;0.001). There were 8 (7%) victims with a final diagnosis of cardiopathy with histopathological dilation, 2 possibly corresponding to post-partum cardiomyopathy (CMP), 1 to ethanolic CMP and 1 to ventricular dilation and fibrosis due to previous myocarditis, who had associated hepatitis with signs of activity. Six cases of acute myocarditis were identified, who were significantly younger, comparing to patients dying from other cardiac causes (23±13 vs 33±7, p=0,011). There were 2 cases of HCM with genetic data, one of which was complemented during molecular autopsy. Conclusions During a 5-year period, the cumulative incidence of SD in a region of Portugal is very low (n=175), cardiac causes being present in 66% of the cases. The most frequent cardiac cause is coronary atherosclerosis (35%). Funding Acknowledgement Type of funding sources: None.

P22-27 Exposure assessment of total DON in urine of Portuguese adult population under the HBM4EU aligned studies

P22-27 Exposure assessment of total DON in urine of Portuguese adult population under the HBM4EU aligned studies

Patients and healthcare professionals perspectives on creating a chronic pain support line in Portugal: A qualitative study protocol

Chronic pain affects almost 38% of the Portuguese adult population, with high costs for both patients and society. Those who suffer with chronic pain frequently complain of feeling misunderstood and of lack of support. These complaints are the main reason why support telephone lines for chronic pain were created in some countries. However, there is no scientific data supporting their creation or evaluating their performance. This paper presents a qualitative study protocol to assess patients and healthcare professionals' perspectives on the creation of a telephone support line for chronic pain. It constitutes the first step to attain the main goal of developing and implementing a functioning support line for chronic pain in Portugal. The methodology to assess patients and healthcare professionals' perspectives and needs is presented. In order to gather information as close to reality as possible, focus groups interviews were chosen as data sources. Given the present context of the COVID-19 pandemic, meetings will take place online, using a digital platform. All interviews will be transcribed verbatim, coded and synthesised into categories and main themes. Thematic analysis will be conducted using NVivo® V12 software, employing an iterative and reflexive approach. Finally, comparative and relational analysis will be performed in order to identify topics where patients and professionals converge or greatly diverge. The findings will be useful for grounding the creation of a telephone support line for chronic pain patients. Results dissemination will be important for policy-makers to develop a new perspective towards chronic pain services available.

Low- and No-Calorie Sweetener (LNCS) Presence and Consumption among the Portuguese Adult Population

The use of low and no-calorie sweeteners (LNCS) in food and beverages has become increasingly common in the development and reformulation of products to reduce energy derived from added sugars. Our aim was to identify the presence and consumption of LNCS through food and beverages according to consumption patterns in a representative sample (n = 256) of the Portuguese adult population. The study had a descriptive cross-sectional observational design and was based on the application of a Food Frequency Questionnaire. Overall, it was found that 4.1% of the foods and 16.7% of the beverages consumed by the Portuguese adult population contained LNCS. Food groups mostly contributing to LNCS consumption were non-alcoholic beverages such as soft drinks and juices (34.2%); milk and dairy products (16.5%); appetizers such as chips (8.6%); sugars and sweets such as chocolates, candies, or chewing gums (6.1%); meat and derivative products (2.2%); cereals and derivatives (1.2%) and canned fruits (1.2%). Main LNCS consumed were acesulfame-K, sucralose, and aspartame, single or combined, although their prevalence of use differs greatly among foods, beverages, or tabletop sweeteners. In conclusion, LNCS were found across a wide variety of products available in the Portuguese market and their prevalence of inclusion in the diet of the population evidences the need to develop more studies on the evolution of LNCS intake and its impact on the full dietary model and health. Consequently, these food additives should be included in food composition databases and, periodically, updated to reflect the recurrent reformulation strategies adopted by the food industry in its efforts to reduce the energy contribution of added sugars.