Stomach cancer belongs to the most common malignant tumors in Portugal. Main causal factors are age, dietary habits, smoking, and Helicobacter pylori infections. As these factors do not only operate on different time dimensions, such as age, period, or birth cohort, but may also vary along space, it is of utmost interest to model temporal and spatial trends jointly. In this paper, we analyze incidence of stomach cancer in Southern Portugal between 1998 and 2006 for females and males jointly using a spatial multivariate age-period-cohort model. Thus, we avoid age aggregation and allow the exploration of heterogeneous time trends between males and females across age, period, birth cohort, and space. Model estimation is performed within a Bayesian setting assuming (gender specific) smoothing priors. Our results show that the posterior expected rate of stomach cancer is decreasing for all counties in Southern Portugal and that males around 70 have a two times higher risk of getting stomach cancer compared with their female counterparts. We further found that, except for some few counties, the spatial influence is almost constant over time and negligible in the southern counties of Southern Portugal.

Purpose The blue ocean strategy refers to how rebuilding the inputs that customers value in the designing of a new value curve fundamentally requires a four field of action structure: reduce, eliminate, create and raise. However, this does not propose a methodology to identify these fields of action. Hence, the purpose of this study is to present importance-performance analysis (IPA), as a support tool to identify these fields of action given their relevance and utility to managers. Design/methodology/approach The 101 ex-customers of health club answered a survey to determine the cut-off boundaries for IPA, and therefore, maximising the discriminatory power of the logistical regression model. This correspondingly incorporated the evaluation of both the area below the receiver operating characteristic curve (ROC) and the adoption of coefficients for concordance and correlation. Findings The research results demonstrate the need to concentrate efforts on the attributes of: price, responses to complaints, emergency procedures, innovative services, changing rooms, support for selecting the activities members choose to undertake and an appropriate number of members per activity. With low levels of performance and importance, are candidates for elimination, specifically, the availability of specialist appointments, member socialisation activities, maintaining memories of members, bar services and services for children. Originality/value The contribution: presenting an IPA methodology applicable to identify the fields of action recognised by the blue ocean strategy as the literature currently only covers concrete situations in which organisations achieve success through reducing, eliminating, creating and elevating and does not set out any methodology to identify those same fields of action; the definition of the cut-off points in IPA based on the ROC curve, which is a more rigorous and exact statistical method than that applied in other studies; the study population, the ex-customers, who not only represent a very important source of latent demand but also because ex-customers are likely to return more impartial.

Temporomandibular joint disorders (TMDs) are characterized by their multifactorial etiology and pathogenesis. A 3-year prospective study was conducted in a Portuguese TMDs department to study the prevalence of different TMDs signs and symptoms and their association with risk factors and comorbidities. Five hundred ninety-five patients were included using an online database: EUROTMJ. Most patients were female (80.50%), with a mean age of 38.20 ± 15.73 years. The main complaints were: (1) temporomandibular joint (TMJ) clicking (13.26%); (2) TMJ pain (12.49%); (3) masticatory muscle tension (12.15%). The main clinical findings were myalgia (74%), TMJ clicking (60–62%), and TMJ arthralgia (31–36%). Risk factors such as clenching (60%) and bruxism (30%) were positively associated with TMJ pain and myalgia. Orthodontic treatment (20%) and wisdom tooth removal (19%) were positively associated with TMJ clicking, while jaw trauma (6%), tracheal intubation (4%) and orthognathic surgery (1%) were positively associated with TMJ crepitus, limited mandibular range of motion, and TMJ pain, respectively. In total, 42.88% of TMDs patients had other associated chronic diseases, most of them were mental behavioral or neurodevelopmental disorders (33.76%), namely, anxiety (20%) and depression (13%). The authors also observed a positive association of mental disorders with the degree of TMJ pain and myalgia. The online database seems to be a relevant scientific instrument for healthcare providers who treat TMDs. The authors expect that the EUROTMJ database can serve as a milestone for other TMDs departments.