Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.This work was primarily supported by grant OPP1132415 from the Bill & Melinda Gates Foundatio

Residents' Dissatisfaction and All-Cause Mortality. Evidence from 74 European Cities

Background: About 2/3 of the Europeans reside in cities. Thus, we must expand our knowledge on how city characteristics affect health and well-being. Perceptions about cities' resources and functioning might be related with health, as they capture subjective experiences of the residents. We characterized the health status of 74 European cities, using all-cause mortality as indicator, and investigated the association of mortality with residents' dissatisfaction with key domains of urban living. Methods: We considered 74 European cities from 29 countries. Aggregated data on residents' dissatisfaction was obtained from the Flash Eurobarometer, Quality of life in European cities (2004–2015). For each city a global dissatisfaction score and a dissatisfaction score by domain (environment, social, economic, healthcare, and infrastructures/services) were calculated. Data on mortality and population was obtained from the Eurostat. Standardized Mortality Ratios, SMR, and 95% Confidence Intervals (95% CI) were calculated. The association between dissatisfaction scores and SMR was estimated using Generalized Linear Models. Results: SMR varied markedly (range: 73.2–146.5), being highest in Eastern Europe and lowest in the South and Western European cities. Residents' dissatisfaction levels also varied greatly. We found a significant association between city SMR and residents' dissatisfaction with healthcare (β = 0.334; IC 95% 0.030–0.639) and social environment (β = 0.239; IC 95% 0.015–0.464). No significant association was found with the dissatisfaction scores related with the physical and economic environment and the infrastructures/services. Conclusions: We found a significant association between city levels of mortality and residents' dissatisfaction with certain urban features, suggesting subjective assessments can be also used to comprehend urban health.This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology, and Higher Education) under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013); and the Postdoc grant SFRH/BPD/97015/2013 (SF), co-funded by the FCT and the POPH/FSE Program

Geoprivacy in Neighbourhoods and Health Research: A Mini-Review of the Challenges and Best Practices in Epidemiological Studies

Neighbourhood and health research often relies on personal location data (e.g., home address, daily itineraries), despite the risks of geoprivacy breaches. Thus, geoprivacy is an important emerging topic, contemplated in international regulations such as the General Data Protection Regulation. In this mini-review, we briefly assess the potential risks associated with the usage of personal location data and provide geoprivacy-preserving recommendations to be considered in epidemiological research. Risks include inference of personal information that the individual does not wish to disclose, reverse-identification and security breaches. Various measures should be implemented at different stages of a project (pre-data collection, data processing, data analysis/publication and data sharing) such as informed consent, pseudo-anonymization and geographical methods. Copyright © 2022 Ribeiro, Dias, Ribeiro, Silva and Barros.This study was funded by FEDER through the Operational Programme Competitiveness and Internationalisation and national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (UIDB/04750/2020), Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR) (LA/P/0064/2020) and the project “HUG: The health impacts of inner-city gentrification, displacement and housing insecurity: a quasi-experimental multi-cohort study” (PTDC/GES-OUT/1662/2020). AR was supported by National Funds through FCT, under the “Stimulus of Scientific Employment—Individual Support” programme within the contract CEECIND/02386/2018

Tell me where you went, I may tell who you infected

[No abstract available]Funding text 1: Internationalization’ and received national funding from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology, and Higher Education) under the Epidemiology Research Unit - Institute of Public Health of the University of Porto (EPIUnit) (UIDB/04750/2020) and the Laboratory for Integrative and Translational Research in Population Health (ITR) (LA/P/0064/2020). Ana Isabel Ribeiro was supported by National Funds through the FCT, under the ‘Stimulus of Scientific Employment – Individual Support’ program, within contract CEECIND/02386/2018.; Funding text 2: This study was funded by the ERDF through the Operational Program ‘Competitiveness an

Association between neighbourhood green space and biological markers in school-aged children. Findings from the Generation XXI birth cohort

Background There is considerable literature on the psychological and behavioural benefits of green space. However, less is known about its health-promoting effects, as expressed on biological markers. Additionally, incorporating biomarkers into pediatric research may help elucidate the links between exposures to environmental stressors and lifelong health. Objective To measure the association between geographical accessibility to green spaces and allostatic load (AL), a measure of biological multi-system dysregulation. Methods We used data from 3108 7-year old children enrolled in Generation XXI, a population-based birth cohort from the Porto Metropolitan Area (Portugal). We computed an AL index based on seven biomarkers representing four regulatory systems: immune/inflammatory system (high sensitivity C-reactive protein); metabolic system (high density lipoprotein; total cholesterol; glycated hemoglobin; waist-hip ratio) and cardiovascular system (systolic and diastolic blood pressure). Accessibility to green spaces was calculated using a Geographic Information System and crude and adjusted associations were estimated using mixed-effects regression models. Results Among the 3108 children (51.7% male; mean age 87.3 months), the mean AL index was 0.00 (standard deviation 2.94). Adjusted models showed that having a green space within 400 m and 800 m from the child's school was inversely associated with AL (400 m: beta −0.29 95% CI −0.54 to −0.02; 800 m: −0.29 95% CI −0.51 to −0.07). Also, there was a 12% (0%; 23%) increase in the AL index for every 1 km increase in distance to the nearest green space. No significant associations with AL were observed with residential accessibility to green space or with the presence of a garden at home. Conclusion We found a cross-sectional negative association between accessibility to green space near schools and AL in children, suggesting that the provision of green space may contribute to improvements in population health beginning early in life.The authors gratefully acknowledge the families enrolled in Generation XXI for their kindness, all members of the research team for their enthusiasm and perseverance and the participating hospitals and their staff for their help and support. This study was supported by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013). G21 was funded by Programa Operacional de Saúde – Saúde XXI, Quadro Comunitário de Apoio III and Administração Regional de Saúde Norte (Regional Department of Ministry of Health). It has support from the Portuguese Foundation for Science and Technology, through Fundo Europeu de Desenvolvimento Regional (FEDER) by the Programa Operacional Temático Factores de Competitividade (POFC) – COMPETE (FCOMP-01-0124-FEDER-011000) and through national funds (PTDC/SAU-ESA/103958/2008), and from the Calouste Gulbenkian Foundation. This study was also funded by the European Regional Development Fund (FEDER), through the Competitiveness and Internationalization Operational Programme, and by national funding from the Foundation for Science and Technology (FCT) under the scope of the project PTDC/GES-AMB/30193/2017 (POCI-01-0145-FEDER-030193, 02/SAICT/2017 - 30193)

Housing Insecurity and Older Adults’ Health and Well-Being in a Gentrifying City: Results from the EPIPorto Cohort Study

Using 2022 data from 600 adults (≥ 60 years) in Porto, Portugal, we explored the association between housing insecurity and various health outcomes. We examined housing conditions, affordability, and stability in relation to loneliness, quality of life, cognitive function, perception of healthy ageing, and sleep using regression models. Older adults without house heating (β = 2.293; 95%CI = 0.753, 3.833), with leaks/dampness/rot (β = 3.741; 1.818, 5.664), insufficient daylight (β = 2.787; 0.095, 5.479), living in neighborhoods with noise (β = 1.793, 0.280 to 3.305), pollution/grime (β = 2.580; 0.746, 4.414), and violence/crime/vandalism (β = 3.940; 1.723, 6.157), who faced housing cost overburden (β = 2.001; 0.426, 3.577), eviction (β = 12.651; 0.852, 24.450), and moved frequently (β = 4.129; 1.542, 6.716) exhibited higher levels of loneliness. Similarly, lack of house heating (β = − 1.942; − 3.438, − 0.445), leaks/dampness/rot (β = − 4.157; − 5.999, − 2.316), insufficient daylight (β = − 3.124; − 5.714, − 0.534), noise (β = − 2.143; − 3.600, − 0.686), pollution/grime (β = − 2.093; − 3.860, − 0.325), violence/crime/vandalism (β = − 2.819; − 4.948, − 0.691), and those with housing cost overburden (β = − 2.435; − 3.930, − 0.940) reported lower quality of life. Those with no toilet (β = − 1.891; − 3.760, − 0.021) or shower (β = − 1.891; − 3.760, − 0.021) and who faced forced displacement (β = − 2.179; − 3.516, − 0.842) presented lower cognitive function. Furthermore, those living in neighborhoods with pollution/grime (OR = 0.494; 0.322, 0.756) and violence/crime/vandalism (OR = 0.477; 0.284, 0.801), those in social housing (OR = 0.728; 0.575, 0.922), and those who moved frequently (OR = 0.475; 0.257, 0.879) reported lower levels of perceived healthy ageing. Insufficient sleep was more common among residents in social housing (OR = 2.155; 1.102, 4.213), while poor sleep quality was least likely both among those living in social housing (OR = 0.445; 0.220, 0.900) and affordable housing (OR = 0.381; 0.162, 0.896). Good quality, stable, and affordable housing seems crucial for healthy ageing. © The Author(s) 2024.Open access funding provided by FCT|FCCN (b-on). This work was supported by FCT—Fundação para a Ciência e Tecnologia, IP, through the projects with references UIDB/04750/2020 and LA/P/0064/2020 and DOI identifiers https://doi.org/10.54499/UIDB/04750/2020 and https://doi.org/10.54499/LA/P/0064/2020 and the project “HUG: The health impacts of inner-city gentrification, displacement and housing insecurity: a quasi-experimental multi-cohort study” [PTDC/GES-OUT/1662/2020] [https://doi.org/10.54499/PTDC/GES-OUT/1662/2020]. Ana Isabel Ribeiro [https://doi.org/10.54499/CEECIND/02386/2018/CP1538/CT0001] and Ana Henriques [https://doi.org/10.54499/CEECIND/01793/2017/CP1406/CT0002] were supported by National Funds through FCT, under the “Stimulus of Scientific Employment – Individual Support.” Cláudia Jardim Santos was supported by National Funds through FCT, under the Ph.D. fellowship [UI/BD/150782/2020] [https://doi.org/10.54499/UI/BD/150782/2020]

Why does it take so long? The reasons behind tuberculosis treatment delay in Portugal

Introduction Delayed diagnosis and treatment of tuberculosis contributes to the spread of the disease. In this study, we aimed to determine the patient and healthcare system delay among tuberculosis patients in Portugal and identify associated factors at individual and contextual level. Methods We analysed all TB cases notified in Portugal between 2010 and 2014 using data from the national surveillance system. Patient and healthcare system delay were computed, log-transformed, and used as outcomes. Adjusted generalized linear models were fitted to identify sociodemographic, contextual and clinical determinants. Results The study included 6838 patients. The median of patient and healthcare system were 33 and 17 days, respectively. Adjusted regression models revealed that higher patient delay occurred in foreign patients (exponentiated beta: 1.177, 95%CI 1.091–1.270) and those addicted to alcohol (1.169, 1.072–1.276) and drugs (1.153, 1.027–1.295). Higher healthcare system delay was observed among patients with extra-pulmonary TB (2.067, 1.885–2.268) and pulmonary comorbidities – lung cancer (2.391, 1.656–3.452), sarcoidosis (3.316, 1.370–8.022) and COPD (1.295, 1.059–1.584) – and in patients residing further from a healthcare service (1.040, 1.018–1.062). Conclusion We found that various individual and contextual factors affect the time delay in tuberculosis treatment. Our findings indicate that some strategies, such as facilitating the access to healthcare services among foreign patients and patients with addictions and increasing the awareness towards TB among healthcare professionals, may result in better TB control.This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education) under the EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013)

Tuberculosis and gender - Factors influencing the risk of tuberculosis among men and women by age group

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Community socioeconomic deprivation and SARS-CoV-2 infection risk: findings from Portugal

Background: Socioeconomic differences have been observed in the risk of acquiring infectious diseases, but evidence regarding SARS-CoV-2 remains sparse. Hence, this study aimed to investigate the association between SARS-CoV-2 infection risk and socioeconomic deprivation, exploring whether this association varied according to different phases of the national pandemic response. Methods: A cross-sectional study was conducted. Data routinely collected for patients with a laboratorial result recorded in SINAVE®, between 2 March and 14 June 2020, were analysed. Socioeconomic deprivation was assessed using quintiles of the European Deprivation Index (Q1-least deprived to Q5-most deprived). Response phases were defined as before, during and after the national State of Emergency. Associations were estimated using multilevel analyses. Results: The study included 223 333 individuals (14.7% were SARS-CoV-2 positive cases). SARS-CoV-2 infection prevalence ratio increased with deprivation [PR(Q1)=Ref; PR(Q2)=1.37 (95% CI 1.19-1.58), PR(Q3)=1.48 (95% CI 1.26-1.73), PR(Q4)=1.73 (95% CI 1.47-2.04), PR(Q5)=2.24 (95% CI 1.83-2.75)]. This was observed during the State of Emergency [PR(Q5)=2.09 (95% CI 1.67-2.62)] and more pronounced after the State of Emergency [PR(Q5)= 3.43 (95% CI 2.66-4.44)]. Conclusion: The effect of socioeconomic deprivation in the SARS-CoV-2 infection risk emerged after the implementation of the first State of Emergency in Portugal, and became more pronounced as social distancing policies eased. Decision-makers should consider these results when deliberating future mitigation measures. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association.A.I.R. was supported by National Funds through FCT (Foundation for Science and Technology, Portuguese Ministry of Science, Technology and Higher Education), under the programme of 'Stimulus of Scientific Employment-Individual Support' within the contract CEECIND/02386/2018