Children In Portugal Research Articles

Haemophilus influenzae Carriage among Healthy Children in Portugal, 2015-2019.

Haemophilus influenzae is an important cause of mucosal and invasive infections and a common colonizer of the upper respiratory tract. As there are no recent data on H. influenzae carriage in Portugal, we aimed to characterize carriage samples and investigate possible parallelisms with disease isolates. Between 2016–2019, 1524 nasopharyngeal samples were obtained from children (0–6 years) attending day-care. H. influenzae were serotyped and screened for β-lactamase production. Strains producing β-lactamase and/or those that were encapsulated were further characterized by antibiotype; encapsulated strains were also investigated for MLST and the presence of antimicrobial resistance and virulence genes (extracted from whole genome sequencing). The overall carriage rate was 84.1%. Most isolates (96.7%) were nonencapsulated. Encapsulated strains were of serotypes f (1.8%), e (1.1%), a (0.3%), and b (0.1%). MLST showed clonality within serotypes. Although the lineages were the same as those that were described among disease isolates, colonization isolates had fewer virulence determinants. Overall, 7.5% of the isolates were β-lactamase positive; one isolate had blaTEM-82, which has not been previously described in H. influenzae. A single isolate, which was identified as H. parainfluenzae, had an incomplete f-like cap locus. In conclusion, circulation of serotype b is residual. The few encapsulated strains are genetically related to disease-causing isolates. Thus, surveillance of H. influenzae carriage should be maintained.

Nutritional adequacy of commercial food products targeted at 0-36-month-old children: a study in Brazil and Portugal.

In the context of the global childhood obesity, it is essential to monitor the nutrition value of commercial foods. A cross-sectional study (November 2018 to April 2019) aimed to evaluate the nutritional adequacy of processed/ultra-processed food products targeted at 0-36-month-old children in Portugal and in Brazil. The nutrient profiling model developed by the Pan American Health Organization was used. A total of food 171 products were assessed (123 in Portugal and forty eight in Brazil). From the fifteen available meat- or fish-based meals in Brazil, 60 % exceeded the amount of Na and 100 % exceeded the target for total fat. Given the lack of specification of sugars within carbohydrates in the label of the foods in Brazil, it was not possible to calculate free sugars. In Portugal, from the seventeen fruit and vegetable purees and the six juice/smoothie/tea/drinks available, 82 % and 67 %, respectively, surpassed the level of free sugar, while total and saturated fat was excessive in all yogurt and yogurt-related products (n 21), 40 % of biscuit/wafer/crisps (two out of five) and 13 % meat- or fish-based meals (two out of sixteen). These findings demonstrate the relevance of improving the nutritional profile of some food products targeted to young children.

COVID-19 in Portugal: a retrospective review of paediatric cases, hospital and PICU admissions in the first pandemic year

BackgroundCOVID-19 is considered by WHO a pandemic with public health emergency repercussions. Children often develop a mild disease with good prognosis and the recognition of children at risk is essential...

Becoming a Migrant Mother: An Intersectional Approach to the Narratives of Cape Verdean Women in Portugal

Becoming a mother in the context of migration configures itself as a dynamic process of identity constitution that raises questions about citizenship, belonging, and migration policies. Furthermore, it is a process that involves a new set of maternal positions and practices that are composed through possibly conflicting cultural values. Based on the occurrence of unplanned pregnancies, this study sought to analyze the dimensions crossed by this event through an intersectional perspective of the narratives of Cape Verdean immigrant women who had children in Portugal, focusing on gender, migration, race/ethnicity. In-depth interviews were conducted with nine women, born in Cape Verde and residing in Greater Lisbon, through the Biographic-Narrative Interpretative Method (BNIM), which enabled an approach to the different dimensions that intersect in life stories of becoming an immigrant mother. Thematic analysis was chosen as an analytical tool, and the framework provided by intersectionality allows us to see the multiple identities that shape the processes of becoming a migrant mother. The results brought to light themes and issues that overlap and make motherhood more complex in the context of migration, highlighting and reinforcing the conditions of inequality.

Economic stress among couples with emerging adult children in Portugal.

Macroeconomic crises occur cyclically, entailing devastating social consequences for individuals and families. Previous research addressing families' responses to socioeconomic upheavals has been mainly conducted with couples with young or adolescent children. Less research attention has been given to middle-aged couples with emerging adult children who might be struggling to support their offspring's transition to adulthood emotionally and financially. The present study examines the impact of economic stressors on family and individual functioning reported by couples with emerging adult children in Portugal. Using a sample of 317 heterosexual middle-aged couples, structural equation models were built to assess the links between economic hardship, economic pressure, and family functioning and psychological well-being. Following an actor-partner interdependence model (APIM) approach, both actor and partner effects were tested. The results showed that greater economic hardship was indirectly linked with (a) poor family functioning as reported by men and women, via the economic pressure felt by men, revealing an actor and a partner effect and (b) poor psychological well-being via each partner's own feeling of economic pressure, revealing only actor effects. Findings also indicated that economic stress processes may operate differently across socioeconomic status (SES) groups, with men from low/medium-low SES reporting a more pronounced association between economic pressure and family functioning. This study added support to previous literature on the adverse impact of economic stressors on family and individual functioning, extending family economic stress research to the Portuguese cultural setting and to an understudied stage of the family life cycle. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impact of private use of the 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal carriage among Portuguese children living in urban and rural regions

In Portugal, the 13-valent pneumococcal conjugate vaccine (PCV13) was commercially available between 2010 and 2015, following a decade of private use of PCV7. We evaluated changes on serotype distribution and antimicrobial susceptibility of pneumococci carried by children living in two regions of Portugal (one urban and one rural). Three epidemiological periods were defined: pre-PCV13 (2009–2010), early-PCV13 (2011–2012), and late-PCV13 (2015–2016). Nasopharyngeal samples (n = 4,232) were obtained from children 0–6 years old attending day-care centers. Private use of PCVs was very high in both regions (>75%). Pneumococcal carriage remained stable and high over time (62.1%, 62.4% and 61.6% (p = 0.909) in the urban region; and 59.8%, 62.8%, 59.5% (p = 0.543) in the rural region). Carriage of PCV7 serotypes remained low (5.3%, 7.8% and 4.3% in the urban region; and 2.5%, 3.7% and 4.8% in the rural region). Carriage of PCV13 serotypes not targeted by PCV7 decreased in both the urban (16.4%, 7.3%, and 1.6%; p < 0.001) and rural regions (13.2%, 7.8%, and 1.9%; p < 0.001). This decline was mostly attributable to serotype 19A (14.1%, 4.4% and 1.3% in the urban region; and 11.1%, 3.6% and 0.8% in the rural region, both p < 0.001). Serotype 3 declined over time in the urban region (10.1%, 4.4%, 0.8%; p < 0.001) and had no obvious trend in the rural region (4.2%, 6.7%, 2.4%; p = 0.505). Serotype 6C decreased in both regions while serotypes 11D, 15A/B/C, 16F, 21, 22F, 23A/B, 24F, 35F, and NT were the most prevalent in the late-PCV13 period. Intermediate resistance to penicillin and non-susceptibility to erythromycin decreased significantly in both regions (19.5%, 13.3%, and 9.3%; and 25.4%, 25.9%, and 13.4%; both p < 0.001, respectively in the urban region; and 12.4%, 11.1%, and 2.8% (p < 0.001); and 15.3%, 14.7%, and 9.2% (p = 0.037), respectively, in the rural region). In conclusion, private use of PCV13 led to significant changes on the pneumococcal population carried by children in Portugal.

Feelings in the Field

Despite the recent theoretical debate over the importance of addressing emotions in fieldwork, most European undergraduate programmes in anthropology still lack methodology courses that specifically focus on the emotional impact of doing research. In this article, I draw from my research with activist parents of autistic children in Portugal to explore the affective dimensions of fieldwork experience. In particular, I give an account of how I have dwelled on the emotional challenges that I faced, how these have resulted in vehicles of understanding and affected the analysis of my work as an anthropologist. While fieldwork experience always entails unexpected and surprising emotional challenges, I argue that as anthropologists we can surely benefit from more tailored support networks, safer spaces for discussion, and better pastoral care.

Effects of COVID-19 Confinement on the Household Routines Of Children in Portugal.

The severe acute respiratory syndrome coronavirus 2 disease (COVID-19) was first identified in December 2019 in Wuhan, China, and was declared a pandemic by the World Health Organization on 11 March, 2020. Since then, physical distancing measures such as confinement have been adopted by different governments to control human to human transmission. This study aimed to determine how confinement affects children’s routines, more specifically their physical activity (PA) and sedentary time. An online survey was launched to assess how Portuguese children under 13 years of age adjusted their daily routines to confinement. Parents reported the time each child was engaged in different activities throughout the day, which was used to calculate overall sedentary time and overall physical activity time. Based on the data of 2159 children, our study showed that during confinement: (i) there was a decrease in children’s physical activity time and an increase in screen time and family activities; (ii) boys engaged in more playful screen Time than girls (p < 0.05), and girls played more without PA than boys (p < 0.05); (iii) along the age groups, there was a trend for an increase of the overall sedentary time and an associated decrease of the overall physical activity time. In summary, PA of confined children showed low levels and a clear decreasing trend along childhood. Conjoint family and societal strategies to target specific age groups should be organized in the future.

Left behind parents: A qualitative study on the experience of parental abduction of a child in Portugal.

Parental abduction of a child occurs when the child is removed, by one parent, from the custody of the other parent or legally appointed guardians. The absence of the child has a profound impact on family members and significantly affects their lives. Also, parental abduction of a child is a relevant social problem which calls for further understanding. The aim of this research was to characterize the experiences of left behind parents in the context of parental abduction of a child. The data for this exploratory qualitative study were analyzed through thematic analysis of the semi-structured interviews carried out with eight male participants in Portugal. Participants' perceptions were organized around three main themes: the impact of this adverse event on different areas of their lives, recovery strategies, and perspectives regarding the future. Findings and their implications for professionals working with these families are discussed in light of the ambiguous loss and ambiguous boundaries frameworks.

Post-traumatic growth during the COVID-19 pandemic in carers of children in Portugal and the UK: cross-sectional online survey.

Although the negative effects of the COVID-19 pandemic on mental health have attracted interest, little attention has focused on its positive effects and possible post-traumatic growth. To assess anxiety, well-being and post-traumatic growth in carers of children aged 6-16 years in Portugal and the UK. A cross-sectional online survey of volunteers conducted at the peak of the first wave of COVID-19 during lockdown (1 May to 27 June 2020). A total of 385 caregivers (Portuguese, n = 185; UK, n = 200), predominantly mothers (n = 341, 88.6%), completed the survey. The majority were working exclusively from home (n = 271, 70.4%), almost half reported a reduction in income (n = 174, 45.2%), most children were home taught (n = 358, 93%), and 75 (19.5%) identified a family member with suspected or confirmed COVID-19 infection. In total, 341 caregivers (88.6%) identified positives arising from COVID-19, most commonly related to the post-traumatic growth domains of improved relationships, a greater appreciation of life, discovering and embracing new possibilities, and positive spiritual change. A comparison of those who did (n = 341) and did not (n = 34) report any positives found a significant difference in well-being scores (t373 = 2.24, P = 0.025) but not in anxiety scores (t373 = 0.75, P = 0.45). Despite experiencing considerable adversity, examples of post-traumatic growth during the lockdown were common. Although the voluntary online nature of our survey is a limitation, our findings suggest that further research exploring post-traumatic growth following pandemics is warranted.

Association of Use of a Meningococcus Group B Vaccine With Group B Invasive Meningococcal Disease Among Children in Portugal

A 4-component meningococcus group B vaccine (4CMenB) is the only vaccine in use to prevent group B invasive meningococcal disease in young children, but no matched controlled studies have evaluated it. To determine the association between receipt of 4CMenB and invasive group B meningococcal disease. Matched incidence density case-control study. Patients presenting from October 2014 to March 2019 were ascertained, with follow-up until death or discharge (last follow-up in June 2019) in 31 pediatric services in Portugal. Children and adolescent residents in Portugal with laboratory-confirmed invasive meningococcal disease were included. Controls, usually 2 per case, with unrelated conditions who were at the same hospital at the same time were matched for sex, age, and residence. Immunization with 4CMenB, ascertained from the national database (2-4 doses are recommended, depending on age). The primary outcome was group B invasive meningococcal disease in fully vaccinated cases compared with controls. The secondary outcomes were all serogroup invasive meningococcal disease in fully vaccinated cases compared with controls and group B and all serogroup invasive meningococcal disease in cases compared with controls who received at least 1 vaccine dose. Of 117 patients with invasive meningococcal disease, 98 were eligible for inclusion and 82 had group B invasive meningococcal disease; 69 were old enough to have been fully vaccinated and considered protected. Among these 69 cases, the median (interquartile range) age was 24 (4.5-196) months, 42 were male, and the median (interquartile range) duration of hospitalization was 8 (0-86) days. Five of 69 cases (7.2%) and 33 of 142 controls (23.1%) were fully vaccinated (difference, -16.0% [95% CI, -26.3% to -5.7%]; odds ratio [OR], 0.21 [95% CI, 0.08-0.55]). For all serogroup invasive meningococcal disease, 6 of 85 cases (7.1%) and 39 of 175 controls (22.3%) were fully vaccinated (difference, -15.2% [95% CI, -24.3% to -6.1%]; OR, 0.22 [95% CI, 0.09-0.53]). For group B disease, 8 of 82 cases (9.8%) and 50 of 168 controls (29.8%) received at least 1 vaccine dose (difference, -20.0% [95% CI, -30.3% to -9.7%]; OR, 0.18 [95% CI, 0.08-0.44]) and for all serogroup invasive meningococcal disease, 11 of 98 cases (11.2%) and 61 of 201 controls (30.3%) received at least 1 vaccine dose (difference, -19.1% [95% CI, -28.8% to -9.5%]; OR, 0.23 [95% CI, 0.11-0.49]). During the first 5 years of vaccine availability in Portugal, vaccination with 4CMenB was less likely among children who developed invasive meningococcal disease compared with matched controls without invasive meningococcal disease. These findings may help inform the use of the 4CMenB vaccine in clinical practice. ISRCTN Identifier: ISRCTN10901628.

Children’s performance on Raven’s Coloured progressive matrices in Portugal: The Flynn effect

The goal of this study was to examine how IQ changes (the Flynn effect) among school-aged children in Portugal behaved over a period of 25 years (1991, 2008 and 2016) that registered major economic transformations in the country. The country's initial move to prosperity was followed by a recent move into recession, which might affect IQ gains. Changes in IQ by level of intellectual ability were also inspected. Children's scores on Raven's Coloured Progressive Matrices in Portugal were compared between the years 1991, 2008 and 2016. Differences in IQs were calculated according to Flynn's (1987) procedures. In addition, percentile distributions of children's scores in the period of economic growth (between 1991 and 2008) were compared for inspection of IQ changes across levels of intellectual ability. Results showed an IQ gain of 2.6 points per decade from 1991 to 2008, followed by a smaller increase (of 1.7 points per decade) from 2008 to 2016, with negative gains observed for seven-, eight- and 10-year-old children. The gains in IQ from 1991 to 2008 have occurred mainly for lower levels of intellectual ability. IQ relative gains accompanied the country's economic fluctuations, and children in lower levels of intellectual ability seemed to have benefitted the most from the economic growth. The trends in the country are suggestive of the influence of economic fluctuations on family dynamics, which, although moderated by education, have consequences for children's cognitive development.

Anticipating Parenthood Among Lesbian, Gay, Bisexual, and Heterosexual Young Adults Without Children in Portugal: Predictors and Profiles.

Parenthood is a highly valued life goal, independent of one’s sexual orientation. However, the majority of studies exploring young adults’ parenthood plans have relied exclusively on samples of heterosexual individuals. This study aimed (i) to explore differences in parenthood intentions as a function of sexual orientation, (ii) to investigate to what extent sociodemographic and psychological characteristics predict parenthood intentions of lesbian, gay, bisexual (LGB), and heterosexual individuals, (iii) to test the mediating effect of stigma between sexual orientation and parenthood intentions, and (iv) to identify and characterize profiles of prospective parenthood (through cluster analysis). Data were gathered using an online survey from 375 self-identified LGB and heterosexual young adults without children in Portugal, with a mean age of 25.83 years old (SD = 4.49). Findings indicated that LGB individuals were less likely to intend to have children than heterosexual individuals; furthermore, among LGB individuals, lesbian women expressed stronger intentions to have children than did gay men. Similarities between heterosexual and LGB young adults were observed concerning the psychological determinants of parenthood intentions. Four distinctive profiles of prospective parenthood were identified: aspiring parents not anticipating stigma, aspiring parents anticipating stigma, childfree intent, and childfree ambivalent. Lesbian and bisexual women mostly populated the childfree ambivalent cluster; in contrast, the aspiring parents anticipating stigma cluster contained an overrepresentation of men, including sexual minority men. Professionals may want to attend to communalities and specificities of prospective parenthood as a function of sexual orientation, in order to provide unbiased and culturally competent support to sexual minority individuals.

Opening up ideological spaces for multilingual literacies at the margins of the Portuguese education system? Ethnographic insights from a Russian complementary school

AbstractEastern European migration to Portugal is a relatively recent yet significant phenomenon due to its impact on national legislation and discourses about language, citizenship and identity. Along with other migration movements to Portugal, it has also brought about changes in state policies. The monolingual order within the Portuguese education system has been reinforced through the adoption of the notion of ‘Portuguese as a non-native language’ and the creation of different categories of speakers of ‘other’ languages. While these discourses predominate within the national educational system, other discursive spaces (such as complementary schools and playgroups) are being constructed, on the margins of Portuguese society, where other languages and literacies are being learned and used, alongside Portuguese. This paper presents some insights from longitudinal ethnographic research (2004–2013) that was carried out in a complementary school for Russian-speaking children in Portugal run by their parents and grandparents. It looks into the complex ways in which literacy ideologies and practices were reproduced, contested and negotiated in this particular discursive space. It also shows how students drew on the language, literacy and semiotic resources within their communicative repertoires in different ways as they responded agentively to tasks set by the teacher. The paper concludes with reflections on the potential of the complementary school as a “safe space” for fostering flexible multilingual pedagogies.

Trends in cause and place of death for children in Portugal (a European country with no Paediatric palliative care) during 1987\u20132011: a population-based study

BackgroundChildren and adolescents dying from complex chronic conditions require paediatric palliative care. One aim of palliative care is to enable a home death if desired and well supported. However, there is little data to inform care, particularly from countries without paediatric palliative care, which constitute the majority worldwide.MethodsThis is an epidemiological study analysing death certificate data of decedents aged between 0 and 17 years in Portugal, a developed Western European country without recognised provision of paediatric palliative care, from 1987 to 2011. We analysed death certificate data on cause and place of death; the main outcome measure was home death. Complex chronic conditions included cancer, cardiovascular, neuromuscular, congenital/genetic, respiratory, metabolic, gastro-intestinal, renal, and haematology/immunodeficiency conditions. Multivariate analysis determined factors associated with home death in these conditions.ResultsAnnual deaths decreased from 3268 to 572. Of 38,870 deaths, 10,571 were caused by complex chronic conditions, their overall proportion increasing from 23.7% to 33.4% (22.4% to 45.4% above age 1-year). For these children, median age of death increased from 0.5 to 4.32-years; 19.4% of deaths occurred at home, declining from 35.6% to 11.5%; factors associated with home death were year of death (adjusted odds ratio 0.89, 95% confidence interval 0.89–0.90), age of death (6–10 year-olds 21.46, 16.42–28.04, reference neonates), semester of death (October–March 1.18, 1.05–1.32, reference April–September), and cause of death (neuromuscular diseases 1.59, 1.37–1.84, reference cancer), with wide regional variation.ConclusionsThis first trend analysis of paediatric deaths in Portugal (an European country without paediatric palliative care) shows that palliative care needs are increasing. Children are surviving longer and, in contrast with countries where paediatric palliative care is thriving, there is a long-term trend of dying in hospital instead of at home. Age, diagnosis, season and region are associated with home death, and should be considered when planning services to support families choosing this option. Priorities should address needs of the youngest children, those with cancer, neuromuscular and cardiovascular conditions, as well as inequities related to place of residence.

The Infant Jesus as Divine Love: a Dressed Sculpture from Évora’s Museum.

The «Infant Jesus as Divine Love» is a noteworthy example of the exuberance reached by dressed sculptures of the Holy Child in Portugal [1]. The provenance of this 18th century sculpture is unknown1. It may have belonged to a religious institution, before being integrated in the Public Library collection. Finally, in 1915, it was incorporated in Évora’s National Museum. It is a lead sculpture, painted with very realistic flesh tones, in consonance with an elegant shape proper of a classical and erudite workmanship. In this unusual representation the Infant is holding a silver bow, arrows and a quiver, personifying Divine Love. In the left hand he holds a flower bouquet made of silk and paper.

Cost-effectiveness of the 13-valent Pneumococcal Conjugate Vaccine in Children in Portugal.

Pneumococcal infections are the leading cause of vaccine-preventable death in children. In June 2015, the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the Portuguese Immunization Program. We evaluated the cost-effectiveness of children vaccinated with PCV13 versus no vaccination for preventing pneumococcal diseases. A cohort simulation model for 2014 Portuguese newborns was used, considering a lifetime horizon and existence of herd effect on adults. Model outcomes measured life years gained, direct and indirect healthcare costs and net benefits considering &OV0556;20,000 per life years gained. PCV13 clinical effectiveness rate by serotype covered was assumed similar to PCV7. Patients' resource use was based on 2014 diagnostic-related group database and experts' opinion, while national legislation and official drug cost database were the main sources for unitary costs. Univariate sensitivity analyses were conducted to assess results' effectiveness. In base case scenario, PCV13 was a dominant strategy, being associated with better health outcomes and lower costs. In a lifetime, a total of 6238 infections (excluding acute otitis media) and 130 deaths were averted, with a total saving of &OV0556;397,217 ($432,966). Net benefits were estimated above &OV0556;28 million ($30 million). Results were robust in all sensitivity analyses, with positive net benefits, except when herd effect was excluded. Vaccination of children with PCV13 starting in their first year of life is a cost-effective intervention with the potential to save costs to the Portuguese health system and to provide health gains by reducing the burden of pneumococcal disease in the vaccines and through the herd effect of this vaccine.

Assessment of iodine importance and needs for supplementation in school-aged children in Portugal

BackgroundMicronutrients are essential for child proper growth and development. Nutritional deficiencies of these elements have increasingly been a concern in Europe, as they are often related to the cognitive potential and physical lifelong consequences. However, being an essential trace element for thyroid function, iodine intake in the desired quantities becomes also very important for neurodevelopment, including for school-aged children. Therefore, the aim of this paper is to highlight the need for wider dissemination of the physiological importance of iodine among health professionals and the general population as well as the knowledge of iodine needs and possible supplementation within families with school-aged children.MethodsThe present study is an observational, descriptive, cross-sectional evaluation of knowledge and perceptions of iodine physiological importance. An evaluation survey has been carried out based on knowledge of iodine needs and possible supplementation within families with school-aged children. It has been target at mothers with school-age children under 18 years old with residence in Portugal. Data are represented as frequency and percentages and association between variables was measured.ResultsThe internet survey has been answered by around 691 mothers, corresponding to 811 children data validated; 47% (n = 381) girls and 53% (n = 430) boys. Mother’s knowledge about iodine and the importance for the improvement of learning capacity is not independent of having health study/work area (χ2 at the 0.05 level). Nevertheless, it can be observed a slight association between mothers who agree with iodine supplementation and those who effectively supplement their child (χ2 9.315; Φ 0.116). Although use of iodized kitchen salt certainly changes the balance from sub-optimal to adequate iodine nutrition, only 8.8% (n = 61) reported using iodized salt. However, 87.6% (n = 605) assumed salt iodization importance without information.ConclusionsWe believe that the findings of this survey have great public health importance for Portugal. While many countries have mandatory iodizes salt programmes, in Portugal iodine supplementation is not a current practice. Therefore, we suggest an urgent evaluation of iodine in Portugal, namely for school-aged children, where iodine deficiencies are critical, as well as a systematic information dissemination as a form of publicizing iodine supplementation needs.

Assessment of multiple mycotoxins in breakfast cereals available in the Portuguese market

Mycotoxins are secondary metabolites of fungi that cause toxic and carcinogenic effects. Human exposure to multiple mycotoxins constitutes an increasing health concern due to potential mycotoxins combined effects. The presence of mycotoxins mixtures in foodstuffs as cereals has been reported over the last years, but few studies are available concerning its occurrence in cereals primarily marketed for children, a particular vulnerable population group. The present study aims to assess the co-occurrence of twenty-one mycotoxins and metabolites present in breakfast cereals primarily marketed for children in Portugal. Results showed that 96% of the analysed breakfast cereal samples were contaminated with several mycotoxins. Twenty-two combinations were identified including two to seven different mycotoxins. Conclusions pointed out an urgent need to review legislative limits in food matrices consumed by children and to perform a more accurate risk assessment of children’s exposure to mycotoxins mixtures in food.

Twelve Years of Kawasaki Disease in Portugal: Epidemiology in Hospitalized Children.

Kawasaki disease (KD) is the leading cause of acquired heart disease in developed countries. Reported incidences vary worldwide but incidence of KD has not been established in Portugal. The aims of the study were to describe the epidemiologic characteristics and estimate incidence rates of KD among hospitalized children in Portugal. This study was a descriptive, population-based study, which used hospital discharge records of patients <20 years of age diagnosed with KD from the Hospital Register database for 2000-2011. Incidence rates were calculated using the number of KD patients and corresponding National census data. There were 533 hospitalizations of 470 patients with KD as the primary diagnosis in Portugal, 63 hospitalizations were transfers of patients between hospitals and there were no relapses. The mean age at admission was 2.8 years, with male predominance (male-to-female ratio: 1.6:1). Children <5 years and infants <1 year represented 83% and 23% of all the patients admitted, respectively. Mean annual incidence was 6.5 per 100,000 children <5 years, 4.5 per 100,000 infants <1 year and 7.8 per 100,000 infants 1-4 years. We found considerable differences between national territorial regions, with majority of cases in most dense regions. The mean length of hospital stay was 9 days, and the incidence peaked in spring (35%) and spring/winter (63%). Coronary aneurysms were reported in 8.5% of patients with a higher male-to-female ratio (3.4:1) and a lower mean age (1.93 years). Reported mortality was 0.4%. This is the first large-scale epidemiologic study of KD in Portugal. The highest incidences occurred among male children 1-4 years of age and in spring/winter.