Lower airway flow influences peak nasal inspiratory flow in school-aged children*

Background: Rhinitis and asthma frequently coexist. Peak nasal inspiratory flow (PNIF) objectively evaluates nasal obstruction. Lower airway flow’s impact on PNIF has seldom been analysed in children. We aimed to study the associations between PNIF and: (1)forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) in children with allergic rhinitis and asthma and healthy controls; (2)allergic rhinitis and asthma control subjective evaluation. Methods: Sequential assessments of PNIF before and after nasal decongestion and spirometry with bronchodilation test were performed in 65 children (6-12 years) with allergic rhinitis and asthma, and 24 gender, age-matched healthy controls. The Control of Allergic Rhinitis and Asthma Test in children (CARATkids) was used for control assessment. Associations were investigated by multiple linear regression models. Results: Baseline and decongested PNIF correlated with baseline and post-bronchodilation FEV1 and PEF, observed independently of rhinitis and asthma diagnosis. The best model for PNIF included PEF, age and gender. No association was found between PNIF and CARATkids scores, except for nasal obstruction self-report. Conclusion: In school-aged children, besides age and gender, PEF values should ideally be known to interpret PNIF values. PNIF can be complementary to subjective control assessment in children with allergic rhinitis and asthma.publishersversionpublishe

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

Background COVID-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 to successfully manage paediatric COVID-19. Quality epidemiological surveillance data are required to characterise and assess the pandemic. Methods Data on all reported paediatric COVID-19 cases, in Portugal, were retrospectively assessed from a fully anonymised dataset provided by the Directorate General for Health (DGS). Paediatric hospital admission results were obtained from the DGS vaccine recommendations and paediatric intensive care unit (PICU) admission results from the EPICENTRE.PT group. Reported cases and PICU admissions from March 2020 to February 2021 and hospital admissions between March and December 2020 were analysed. Results 92 051 COVID-19 cases were studied, 50.5% males, average age of 10.1 years, corresponding to 5.4% of children in Portugal. The most common symptoms were cough and fever, whereas gastrointestinal symptoms were infrequent. The most common comorbidity was asthma. A high rate of missing surveillance data was noticed, on presentation of disease and comorbidity variables, which warrants a cautious interpretation of results. Hospital admission was required in 0.93% of cases and PICU on 3.48 per 10 000 cases. PICU admission for Multisystem Inflammatory Syndrome in Children (MIS-C) was more frequent in children with no comorbidities and males, severe COVID-19 was rarer and occurred mainly in females and infants. Case fatality rate and mortality rates were low, 1.8 per 100 000 cases and 1.2 per 1 000 000 cases, respectively. Conclusions The overall reported case incidence was 5.4 per 100 children and adolescents andinfo:eu-repo/semantics/publishedVersio

The role of health preconditions on COVID-19 deaths in Portugal: evidence from surveillance data of the first 20293 infection cases

Background: It is essential to study the effect of potential co-factors on the risk of death in patients infected by COVID-19. The identification of risk factors is important to allow more efficient public health and health services strategic interventions with a significant impact on deaths by COVID-19. This study aimed to identify factors associated with COVID-19 deaths in Portugal. Methods: A national dataset with the first 20,293 patients infected with COVID-19 between 1 January and 21 April 2020 was analyzed. The primary outcome measure was mortality by COVID-19, measured (registered and confirmed) by Medical Doctors serving as health delegates on the daily death registry. A logistic regression model using a generalized linear model was used for estimating Odds Ratio (OR) with 95% confidence intervals (95% CI) for each potential risk indicator. Results: A total of 502 infected patients died of COVID-19. The risk factors for increased odds of death by COVID-19 were: sex (male: OR = 1.47, ref = female), age ((56-60) years, OR = 6.01; (61-65) years, OR = 10.5; (66-70) years, OR = 20.4; (71-75) years, OR = 34; (76-80) years, OR = 50.9; (81-85) years, OR = 70.7; (86-90) years, OR = 83.2; (91-95) years, OR = 91.8; (96-104) years, OR = 140.2, ref = (0-55)), Cardiac disease (OR = 2.86), Kidney disorder (OR = 2.95), and Neuromuscular disorder (OR = 1.58), while condition (None (absence of precondition); OR = 0.49) was associated with a reduced chance of dying after adjusting for other variables of interest. Conclusions: Besides age and sex, preconditions justify the risk difference in mortality by COVID-19.info:eu-repo/semantics/publishedVersio

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Multimorbidity profile of COVID-19 deaths in Portugal during 2020

Background: COVID-19 is caused by SARS-CoV-2 infection and has reached pandemic proportions. Since then, several clinical characteristics have been associated with poor outcomes. This study aimed to describe the morbidity profile of COVID-19 deaths in Portugal. Methods: A study was performed including deaths certificated in Portugal with “COVID-19” (ICD-10: U07.1 or U07.2) coded as the underlying cause of death from the National e-Death Certificates Information System between 16 March and 31 December 2020. Comorbidities were derived from ICD-10 codes using the Charlson and Elixhauser indexes. The resident Portuguese population estimates for 2020 were used. Results: The study included 6701 deaths (death rate: 65.1 deaths/100,000 inhabitants), predominantly males (72.1). The male-to-female mortality ratio was 1.1. The male-to-female mortality rate ratio was 1.2; however, within age groups, it varied 5.0–11.4-fold. COVID-19 deaths in Portugal during 2020 occurred mainly in individuals aged 80 years or older, predominantly in public healthcare institutions. Uncomplicated hypertension, uncomplicated diabetes mellitus, congestive heart failure, renal failure, cardiac arrhythmias, dementia, and cerebrovascular disease were observed among COVID-19 deceased patients, with prevalences higher than 10%. A high prevalence of zero morbidities was registered using both the Elixhauser and Charlson comorbidities lists (above 40.2%). Nevertheless, high multimorbidity was also identified at the time of COVID-19 death (about 36.5%). Higher multimorbidity levels were observed in men, increasing with age up to 80 years old. Zero-morbidity prevalence and high multimorbidity prevalences varied throughout the year 2020, seemingly more elevated in the mortality waves’ peaks, suggesting variation according to the degree of disease incidence at a given period. Conclusions: This study provides detailed sociodemographic and clinical information on all certificated deaths from COVID-19 in Portugal during 2020, showing complex and extreme levels of morbidity (zero-morbidity vs. high multimorbidity) dynamics during the first year of the pandemic in Portugal.info:eu-repo/semantics/publishedVersio

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio

Mammals in Portugal: a data set of terrestrial, volant, and marine mammal occurrences in Portugal

Mammals are threatened worldwide, with ~26% of all species being included in the IUCN threatened categories. This overall pattern is primarily associated with habitat loss or degradation, and human persecution for terrestrial mammals, and pollution, open net fishing, climate change, and prey depletion for marine mammals. Mammals play a key role in maintaining ecosystems functionality and resilience, and therefore information on their distribution is crucial to delineate and support conservation actions. MAMMALS IN PORTUGAL is a publicly available data set compiling unpublished georeferenced occurrence records of 92 terrestrial, volant, and marine mammals in mainland Portugal and archipelagos of the Azores and Madeira that includes 105,026 data entries between 1873 and 2021 (72% of the data occurring in 2000 and 2021). The methods used to collect the data were: live observations/captures (43%), sign surveys (35%), camera trapping (16%), bioacoustics surveys (4%) and radiotracking, and inquiries that represent less than 1% of the records. The data set includes 13 types of records: (1) burrows | soil mounds | tunnel, (2) capture, (3) colony, (4) dead animal | hair | skulls | jaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8), observation in shelters, (9) photo trapping | video, (10) predators diet | pellets | pine cones/nuts, (11) scat | track | ditch, (12) telemetry and (13) vocalization | echolocation. The spatial uncertainty of most records ranges between 0 and 100 m (76%). Rodentia (n =31,573) has the highest number of records followed by Chiroptera (n = 18,857), Carnivora (n = 18,594), Lagomorpha (n = 17,496), Cetartiodactyla (n = 11,568) and Eulipotyphla (n = 7008). The data set includes records of species classified by the IUCN as threatened (e.g., Oryctolagus cuniculus [n = 12,159], Monachus monachus [n = 1,512], and Lynx pardinus [n = 197]). We believe that this data set may stimulate the publication of other European countries data sets that would certainly contribute to ecology and conservation-related research, and therefore assisting on the development of more accurate and tailored conservation management strategies for each species. There are no copyright restrictions; please cite this data paper when the data are used in publications

Prevalence and determinants of uncontrolled asthma in Portugal : a national population-based study

Tese de mestrado, Epidemiologia, Universidade de Lisboa, Faculdade de Medicina, 2019Background: Asthma is a chronic disease that affects people worldwide with potentially negative effect on quality of life and in healthcare systems. Asthma control represents a main goal for the management of asthma disease. Notwithstanding the provided recommendations, international studies revealed low levels of disease control. Moreover, modifiable and non-modifiable factors have been identified as related to poor asthma control level. Aim: In this study we assessed the level of asthma control by individual’s perspective, in Portugal, and the determinants associated with uncontrolled asthma. Methods: 557 active asthmatic patients were identified by random phone number in households and 400 individuals (327 adults and 73 children) completed a questionnaire during 2011 to 2012. Asthma control was assessed based on Global Initiative for Asthma (GINA) guidelines recommendations. In adults, besides the evaluation of GINA based symptom control, we additionally determined the self-perception of control and the level of control according to Asthma Control TestTM (ACT). Results: The fulfilment of the GINA criteria was accomplished only in 3.5% of the individuals. The presence of asthma symptoms in the previous four weeks was reported by 52.1%, and the occurrence of an acute episode in the past twelve months by 70% individuals. Life activity limitations caused by asthma disease was the main criteria reported as failure (78.8%). 93.9% of adults perceived asthma as being completely, well or somewhat controlled, which didn’t match the objective assessment of control. 35.2% had uncontrolled asthma, 64.8% partially controlled and none of the individuals had totally control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01-1.03), female sex (OR 1.87; 95% CI: 1.15-3.04), educational level (OR 0.5; 95% CI: 0.28-0.89 at high school level or more), occupation (OR 4.92; 95% CI: 2.12-11.42 if looking for a first job or being unemployed) (OR 2.51; 95% CI: 1.35-4.65 if being retired), income (OR 0.23; 95% CI: 0.07-0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03-1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56-7.58) and using inhaled corticosteroids (OR 0.44; 95 %CI: 0.24-0.82 if used in the past or never used). Looking for a first job or being unemployed, BMI and having rhinitis symptoms were the determinants remaining significant after multivariate adjustments. Conclusions: This study reveals that the state of asthma management in Portugal is far from the long-term goals as stipulated by GINA guidelines. Also, there is an overestimation of asthma control through patient perception. Uncontrolled asthma was associated with several determinants (age, sex, educational level, occupation, income, BMI, having rhinitis symptoms and the use of inhaled corticosteroids as part of treatment plan), from which their identification can contribute to improve the strategies of care on these patients.Introdução: A asma é uma doença crónica caracterizada pela ocorrência de sintomas respiratórios que afeta indivíduos de qualquer idade e etnia em todo o mundo. Esta patologia resulta num efeito potencialmente negativo, quer na qualidade de vida dos indivíduos, quer ao nível dos sistemas de saúde. O Global Initiative for Asthma (GINA) foi criado em 1993 com o objetivo de melhorar a qualidade na prestação de cuidados de saúde aos doentes asmáticos. Contudo, apesar da existência de recomendações, inúmeros indivíduos com asma permanecem subtratados, em risco de ocorrência de exacerbações e com baixos níveis de controlo da doença. O controlo da doença asmática constitui um dos principais pilares da terapêutica desta patologia. A nível mundial são perdidos mais de 23 milhões de anos de vida ajustados à incapacidade (DALYs) resultantes da doença asmática. O custo de um doente asmático não controlado poderá chegar aos 2281€ por ano, face aos 509€ de um doente asmático controlado. Estes valores resultam não só dos custos diretos associados (ex: tratamentos, hospitalizações) mas também dos custos indiretos implicados (ex: faltas ao trabalho). Os estudos do Asthma Insights and Reality (AIR) foram realizados em vários países ao longo dos últimos anos para avaliar o controlo da asma e o cumprimento das orientações do GINA. Fatores modificáveis e não modificáveis (idade, sexo, comorbidades, aspetos psicológicos e determinantes socioeconómicos) têm sido estudados e identificados como associados ao baixo nível de controlo da doença. Objetivos: Neste estudo avaliamos a adesão às orientações para a gestão da doença asmática e para o nível de controlo da doença, segundo a perspetiva do indivíduo, em Portugal. Foram investigados também, nos adultos, os determinantes associados ao não controlo da asma. Métodos: O Asthma Insights and Reality in Portugal (AIR-P) é um estudo transversal realizado a nível nacional (entre março de 2011 e março de 2012), com adaptação da metodologia utilizada no Asthma Insights and Reality in Europe (AIRE). Uma amostra probabilística de indivíduos com asma ‘’ativa’’ foi identificada através de contato telefónico com número aleatório fixo ou móvel. O questionário aplicado avaliou as seguintes dimensões gerais: características sociodemográficas; controlo da asma e limitações relacionadas com a doença; a utilização de cuidados de saúde relacionados com a asma; terapêuticas e adesão; e conhecimentos e crenças em relação à asma. A avaliação de controlo foi efetuada com base nas recomendações do Global Initiative for Asthma (GINA). Adicionalmente, nos adultos foi avaliado o controlo sintomatológico baseado no GINA, o controlo auto percecionado e o nível do controlo através do Asthma Control TestTM (ACT)

Determinants associated with uncontrolled asthma in Portugal: a national population-based study

© 2020 Published by Elsevier España, S.L.U. on behalf of Sociedade Portuguesa de Pneumologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Introduction and objectives: Asthma is a chronic and heterogeneous disease that affects people of all ages and has a high estimated increase in prevalence worldwide. Asthma control represents a main goal in the disease management. International studies revealed low levels of disease control resulting in a significant burden for healthcare systems, not only in terms of quality of life, but also in terms of health costs. Modifiable and non-modifiable factors have been identified as relating to poor asthma control level. In this study we evaluated the distribution of asthma control levels in Portuguese adult population and examine the determinants associated with uncontrolled asthma. Materials and methods: Using a similar methodology to the one employed in the Asthma Insights and Reality in Europe (AIRE) survey, 327 active asthmatic patients were identified by random phone number and completed a questionnaire during 2011 to 2012. Asthma control was assessed by the evaluation of GINA based symptom control, by Asthma Control Test.äó (ACT) and by self-perception of control. To examine the relationship between uncontrolled asthma and its determinants, univariate logistic regression analysis, sequential multivariable regression and population attributable risk percentage were determinate. Results: 35.2% active asthmatic patients had uncontrolled asthma, 64.8% partially controlled and none of the individuals had total control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01.Çô1.03), female sex (OR 1.87; 95% CI: 1.15.Çô3.04), educational level (OR 0.5; 95% CI: 0.28.Çô0.89 at high school level or over), occupation (OR 4.92; 95% CI: 2.12.Çô11.42 if looking for a first job or unemployed) (OR 2.51; 95% CI: 1.35.Çô4.65 if being retired), income (OR 0.23; 95% CI: 0.07.Çô0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03.Çô1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56.Çô7.58) and using inhaled corticosteroids (OR 0.44; 95%CI: 0.24.Çô0.82 if used in the past or never used). Looking for a first job or being unemployed, BMI and having rhinitis symptoms remained significant after multivariate adjustments. Conclusions: Uncontrolled asthma was associated with several determinants. Their identification can contribute to improve asthma care both from clinical and from public health perspectives.This study was supported by a grant from the General Directorate of Health (DGS) of the Portuguese Health Ministry and by a scientific grant from AstraZeneca Foundation.info:eu-repo/semantics/publishedVersio

Improving morbidity information in Portugal: evidence from data linkage of COVID-19 cases surveillance and mortality systems

© 2022 Elsevier B.V. All rights reserved.Background: COVID-19 rapidly spread around the world, putting health systems under unprecedented pressure and continuous adaptations. Well-established health information systems (HIS) are crucial in providing data to allow evidence-based policymaking and public health interventions in the pandemic response. This study aimed to compare morbidity information between two databases for COVID-19 management in Portugal and identify potential complementarities. Methods: This is an observational study using records from both COVID-19 cases surveillance (National Epidemiological Surveillance System; SINAVE) and related deaths (National e-Death Certificates Information System; SICO) systems, which were matched on sex, age, municipality of residence and date of death. After the linkage, morbidity reported in SINAVE and identified in SICO, through the application of Charlson and Elixhauser comorbidity indexes algorithms, were compared to evaluate agreement level. Results: Overall, 2285 matched cases were analyzed, including 53.9% males with a median age of 84 years. According to the method of data reporting assessment, the presence of any morbidity ranged between 26.3% and 62.5%. The reporting of ten morbidities could be compared between the information reported in SINAVE and SICO databases. The proportion of simultaneous reporting in both databases ranged between 5.7% for diabetes and 0.0% for human immunodeficiency virus infection or coagulopathy. Minimal or no agreement was found when assessing the similarity of the morbidity reporting in both databases, with neoplasms showing the highest level of agreement (0.352, 95% IC: 0.277-0.428; p < 0.001). Conclusion: Different information about reported morbidity could be found in two HIS used to monitor COVID-19 cases and related deaths, as data are independently collected. These results show that the interoperability of SICO and SINAVE databases would potentially improve available HIS and improve available information to decision-making and address COVID-19 pandemic management.info:eu-repo/semantics/publishedVersio