Diagnóstico de má nutrição no internamento hospitalar : associação com a efetividade e a eficiência dos cuidados

RESUMO - INTRODUÇÃO: A má nutrição (MN) em contexto hospitalar é referida como um problema de saúde pública de dimensão desconhecida, e associada a piores resultados de saúde, como a mortalidade e o aumento do consumo de recursos. A literatura relata valores de prevalência superiores a 20% nos hospitais, contudo, a prevalência de registo do diagnóstico de MN nas bases de dados administrativos da morbilidade nos episódios de internamento foi inferior a 5%. Assim, o principal objetivo deste trabalho é analisar o perfil de utentes com diagnóstico de MN no internamento em Portugal e a sua associação com os resultados de saúde, nomeadamente a mortalidade e a eficiência dos cuidados. METODOLOGIA: Utilizou-se a base de dados administrativos dos hospitais públicos, entre 2013 e 2015. Considerou-se como MN os códigos da Classificação Internacional de Doenças - 9ª Revisão - Modificações clínicas entre o “260” e o “263.9” e ainda o “799.4”. Utilizaram-se dados sociodemográficos verificados na freguesia de proveniência dos utentes nos Censos 2011. Realizou-se a estatística descritiva e análise bivariável da amostra e as probabilidades do diagnóstico de MN foram calculadas com recurso a um modelo de regressão logística múltiplo. Realizou-se uma seleção aleatória de 3 controlos para cada episódio com MN, respeitando a correspondência nas variáveis sexo, grupo etário, diagnóstico principal e número de diagnósticos, para a análise da associação entre o diagnóstico de MN e a mortalidade ou eficiência dos cuidados, recorrendo a modelos de regressão logística condicional. RESULTADOS: De 2.961.402 episódios analisados, 23.126 (0,8%) apresentou diagnóstico de MN. A caquexia foi a forma de MN mais prevalente (69%) e as pneumonias constituíram o Grupo de Diagnóstico Homogéneo (GDH) em que estes episódios mais vezes foram agrupados (14,8%), totalizando um consumo de recursos estimado de 108 milhões de euros. Os utentes com diagnóstico de MN são mais velhos, com admissão urgente e agrupados em GDH’s médicos, apresentam mais diagnósticos, são submetidos a procedimentos de alimentação entérica ou parentérica e apresentam severidade e risco de morte superiores. O diagnóstico de MN foi associado a maior probabilidade de morte (ORa=1,66; IC95%: 1,61-1,71) e de a duração do internamento ser superior ao esperado (ORa=1,04; IC95%: 1,00-1,08). CONCLUSÃO: A prevalência de diagnóstico de MN no internamento hospitalar de Portugal é inferior aos resultados de prevalência relatados com outras abordagens de diagnóstico, pelo que são necessárias futuras investigações para confirmar em que iv dimensão a MN está a ser devidamente codificada. O diagnóstico de MN está associado a um aumento da probabilidade de morte e de se verificar uma duração do internamento superior ao esperado, sendo necessários novos estudos para avaliar o seu efeito causal.ABSTRACT - INTRODUCTION: Hospital malnutrition (MN) is an unrecognized public health problem associated with worse health outcomes like mortality and increased costs of healthcare. Evidences showed prevalence results above 20% in hospitals, however notification of MN diagnosis in inpatient administrative data is less than 5%. Thus, main aim of this study is analyze characteristics of inpatients with MN diagnosis and its association with health outcomes, namely mortality and efficiency of healthcare. METHODS: We examined administrative database of public hospitals of years between 2013 and 2015. MN was identified if present any Classification of Diseases, 9th Revision Clinical Modification from 260 to 263.9 and 799.4. We considered sociodemographic data from local of residence at Censos 2011. Statistical inference and bivariate analysis was conducted and the odds of having MN diagnosis was calculated using a multiple logistic regression model. Then, we randomize selected three controls for each MN episode matching sex, age group, principal diagnosis and number of diagnoses to analyze association between MN diagnosis and mortality and efficiency of healthcare using conditional logistic regression models. RESULTS: 2.961.402 were analyzed and 23.126 (0,8%) had MN diagnosis. Cachexia was most prevalent MN type and pneumonia was most frequent Diagnosis-related Group (DRG) between patients with MN diagnosis (14,8%), totalizing estimated costs of 108 million €. Patients with MN diagnosis were older, urgency admitted and grouped in medical DRG, with higher diagnoses number, submitted to enteral or parenteral nutrition procedure and showed higher severity and risk of mortality. MN diagnosis was associated with higher odds of death (ORa=1,66; IC95%: 1,61-1,71) and length of stay longer than expected (ORa=1,04; IC95%: 1,00-1,08). CONCLUSIONS: Prevalence of MN diagnosis in Portugal hospital inpatients is lowest than results from studies with other diagnostic criteria. Further investigation are necessary to quantify under-diagnosed MN. MN diagnosis was associated with an increase off death and length of stay longer than expected. Further investigation are necessary to assess its causal effect

Public health data challenges of the COVID-19 pandemic: a sisyphean task!

Copyright © 2022 Farinha, Nogueira, Feteira-Santos and Costa. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.In December 2019, a cluster of pneumonia cases was reported in Wuhan, China. Eventually it was identified, and the genetic sequence was thereafter disseminated, confirming a novel coronavirus infecting humans. Within just a few weeks, its rapid spread took on pandemic proportions, affecting people’s lives and daily routines. As of May 2022, the COVID-19 pandemic is still raging on, posing challenges worldwide. From its beginning, this pandemic has brought unexpected changes to health care systems and new challenges for public health, health monitoring, and health surveillance, namely in terms of the necessary data for clinical decisions, resource management, and policymaking. Moreover, health care systems had to maintain their non-COVID-19 activity while simultaneously the unrelenting impact of this new disease. The scientific world, too, was taken by a hurricane, and witnessed an impressive number of COVID-19-related publications in record time. As of the end of April 2022, PubMed, one of the most well-known databases containing biomedical cientific literature, retrieved more than 255,000 citations with “COVID-19” as the search term. Of those, 72,587 records also included a reference to “data,” revealing a large body of literature that likely involved the use of data to study COVID-19. Projects like the Population Health Information Research Infrastructure are, we believe, currently conducting literature reviews to better understand the uses, the pathways, and the needs of population health data in these pandemic times. It will take years, or even decades, to understand exactly what happened and what lessons we must assimilate to prepare for similar health crises and take with us into our new day-to-day.info:eu-repo/semantics/publishedVersio

Developing healthy eating promotion mass media campaigns: a qualitative study

Copyright © 2022 Capitão, Martins, Feteira-Santos, Virgolino, Graça, Gregório and Santos. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Background: Involving consumers in the development and assessment of mass media campaigns has been advocated, though research is still lacking. This study aimed to explore opinions and attitudes of citizens, health professionals, communication professionals, and digital influencers regarding the development and implementation of healthy eating promotion mass media campaigns. Methods: We conducted five semi-structured focus groups, where participants were exposed to the first nationwide mass media campaign promoting healthy eating in Portugal. Through criteria-based purposive sampling, 19 citizens, five health professionals, two communication professionals, and four digital influencers were included. Transcripts were analyzed using Charmaz's line-to-line open coding process. Results: Main identified themes were: considerations about informative-centered campaigns, health/nutritional issues to address, campaign formulation, target audiences, dissemination channels, and influencers' involvement. Participants favored campaigns focused on practical, transformative, and useful information with simple, innovative, activating, and exciting messages instead of strictly informative campaigns. Health and communication professionals mentioned the importance of adapting the message and dissemination channels to the target audience, addressing the most vulnerable and hard-to-reach individuals, and highlighted the importance of short video format. Conclusions: Active involvement of the health promotion target audience is crucial for the development and effectiveness of health campaigns. Campaigns need to convey health messages on simple though exciting communication materials, targeted to the most vulnerable subgroups, including deprived, less educated, younger, and older generations.This work was supported by the Portuguese Directorate-General of Health. The Directorate-General of Health had no role in the design, the analysis of this work, and the decision to publish. Researchers affiliated with the Portuguese Directorate-General of Health reviewed and made valuable contributions to the manuscript. The writing of the manuscript was also supported by funds from Fundação para a Ciência e a Tecnologia to ISAMB (ref. UIDB/04295/2020 and UIDP/04295/2020).info:eu-repo/semantics/publishedVersio

Developing healthy eating promotion mass media campaigns: A qualitative study

BackgroundInvolving consumers in the development and assessment of mass media campaigns has been advocated, though research is still lacking. This study aimed to explore opinions and attitudes of citizens, health professionals, communication professionals, and digital influencers regarding the development and implementation of healthy eating promotion mass media campaigns.MethodsWe conducted five semi-structured focus groups, where participants were exposed to the first nationwide mass media campaign promoting healthy eating in Portugal. Through criteria-based purposive sampling, 19 citizens, five health professionals, two communication professionals, and four digital influencers were included. Transcripts were analyzed using Charmaz's line-to-line open coding process.ResultsMain identified themes were: considerations about informative-centered campaigns, health/nutritional issues to address, campaign formulation, target audiences, dissemination channels, and influencers' involvement. Participants favored campaigns focused on practical, transformative, and useful information with simple, innovative, activating, and exciting messages instead of strictly informative campaigns. Health and communication professionals mentioned the importance of adapting the message and dissemination channels to the target audience, addressing the most vulnerable and hard-to-reach individuals, and highlighted the importance of short video format.ConclusionsActive involvement of the health promotion target audience is crucial for the development and effectiveness of health campaigns. Campaigns need to convey health messages on simple though exciting communication materials, targeted to the most vulnerable subgroups, including deprived, less educated, younger, and older generations

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

Active aging awareness and well-being among older adults in Portugal

Funding Information: This study is part of the research program of the General Foundation of the University of Salamanca, through the International Centre on Aging (CENIE), within the framework of the Programme for a Longevity Society (0551_PSL_6_E), a project co-financed by the European Regional Development Fund (ERDF) through the Interreg VA Spain-Portugal Programme (POCTEP) 2014–2020. Publisher Copyright: Copyright © 2023 Costa, Henriques, Alarcão, Henriques, Madeira, Virgolino, Sousa, Feteira-Santos, Arriaga, Rocha and Nogueira.Objective: This study aims to assess the active aging awareness of older adults in mainland Portugal and their levels of overall well-being and to identify social and health-related factors. Methods: A cross-sectional study was conducted with a representative sample of 613 older adults, aged 65 or older, who participated in the PROKnos – Knowing Social Prescribing needs of the elderly study in Portugal. The questionnaire consisted of the Active Ageing Awareness Questionnaire and the World Health Organization – Five Well-Being Index, as well as sociodemographic, economic, and health status questions. Correlation coefficients, t-tests for independent samples, and one-way ANOVA were used to explore potential associations between variables. Results: The active aging awareness levels were significantly higher for women (p = 0.031), and those who were younger (p = 0.011), more educated (p < 0.001), had a better financial situation (p < 0.001), and had better health (p < 0.001). The same pattern was found for well-being, except in relation to gender, as men had higher levels (p = 0.016). These variables were found to be correlated. Discussion: Even though active aging is an important strategy to implement, it is indispensable to consider the perceptions and conditions that need to be in place before that. This study reveals that several social and health-related factors are associated with well-being and active aging awareness, as well as the differences between groups that exist in mainland Portugal in relation to that. This emphasizes how vital it is to address social inequalities in active aging efforts, which are not necessarily uncovered when only considering actual active aging measures.publishersversionpublishe

development and validation of a questionnaire

Funding Information: We thank Centro Hospitalar de Lisboa Central for helping to conduct the study, and the patients that participated in the study. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Ambulatory care sensitive conditions (ACSC) can be avoided through effective care in the ambulatory setting. Patients are the most qualified individuals to express the social and individual contexts of their own experience. Thus, understanding why potentially preventable hospitalizations occur is important to develop patient-centred policies or interventions that may reduce them. This study aims to develop and validate a questionnaire to capture the patients’ perspective on the causes of the hospitalizations for ACSC. The development of a new questionnaire involved four phases: a literature review, face validity, pre-test, and validation. We conducted a three-step face validity verification to confirm the relevance of the identified determinants and to collect determinants not previously identified by interviewing healthcare providers, representatives of patients’ associations, and patients. Determinants were identified through the literature review predominantly in the “Healthcare Access”, “Disease self-management”, and “Social Support” domains. The validated resulting questionnaire comprises 25 questions, distributed by two dimensions (individual/contextual) covering seven domains and 20 determinants of ACSC hospitalization. Currently, there are no validated instruments as comprehensive and easy to use as the one described in this paper. This questionnaire should provide a base for further language/context validations.publishersversionpublishe

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

Active aging awareness and well-being among older adults in Portugal

ObjectiveThis study aims to assess the active aging awareness of older adults in mainland Portugal and their levels of overall well-being and to identify social and health-related factors.MethodsA cross-sectional study was conducted with a representative sample of 613 older adults, aged 65 or older, who participated in the PROKnos – Knowing Social Prescribing needs of the elderly study in Portugal. The questionnaire consisted of the Active Ageing Awareness Questionnaire and the World Health Organization – Five Well-Being Index, as well as sociodemographic, economic, and health status questions. Correlation coefficients, t-tests for independent samples, and one-way ANOVA were used to explore potential associations between variables.ResultsThe active aging awareness levels were significantly higher for women (p = 0.031), and those who were younger (p = 0.011), more educated (p &lt; 0.001), had a better financial situation (p &lt; 0.001), and had better health (p &lt; 0.001). The same pattern was found for well-being, except in relation to gender, as men had higher levels (p = 0.016). These variables were found to be correlated.DiscussionEven though active aging is an important strategy to implement, it is indispensable to consider the perceptions and conditions that need to be in place before that. This study reveals that several social and health-related factors are associated with well-being and active aging awareness, as well as the differences between groups that exist in mainland Portugal in relation to that. This emphasizes how vital it is to address social inequalities in active aging efforts, which are not necessarily uncovered when only considering actual active aging measures

Waste incineration and cancer mortality: a longitudinal controlled population-based study

&lt;p&gt;Poster presented in the 16th European Public Health Conference in Dublin, Ireland, between 9 and 11 of November, 2023&lt;/p&gt;&lt;p&gt;&nbsp;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Abstract&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Waste incinerator emissions have been associated with the possibility of increased risk for some cancers. Indeed, emissions are usually composed of heavy metals, dioxins, and furans, including carcinogens. Although emissions levels of incineration activity are considered safe, evidence about the impact of long-term human exposure to low dosages is lacking. We performed a longitudinal population-based study to compare cancer mortality rates between a geographical area exposed to pollutant emissions due to waste incineration and combined local industry activity, a non-exposed control area, and a reference (larger) area.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Exposed area was defined according to pollutants dispersion models, considering predominant wind intensity and direction. The control area was defined as near-to-the-exposed parishes unaffected by the pollutants emitted at the location where the incinerator is situated. Another larger area ("Large Lisbon") was also considered as the reference area. Data about cancer mortality was provided by the Portuguese National Statistics Institute. Relative risks (RR) compared standardized (age and sex) specific mortality rates due to malignant neoplasms (ICD-9 and ICD-10) between the exposed area and (a) control are and (b) reference area.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the first five years of the waste incinerator activity (2000-2004), the RR for each cancer-related mortality was not statistically significant (considering either control or reference areas). Considering the average mortality rates between 2015 and 2019 for exposed versus control area, we found increased RR for hepatic and biliary tract (RR = 1.50; 95%CI:1.15-1.85), pancreatic (RR = 1.37; 95%CI:1.06-1.67), and respiratory tract cancer (RR = 1.24; 95%CI:1.07-1.41). No significant RR was found when comparing the exposed with the reference area.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Strengthening public health surveillance systems is pivotal to assess air pollution's impact on health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key messages&lt;/strong&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;Exposure to emissions from an industrial region including a waste incinerator plant was found to have increased risk for hepatic and biliary tract, pancreatic, and respiratory tract cancer mortality.&lt;/li&gt;&lt;li&gt;Surveillance systems are needed to continuously monitor how long-term exposure to low concentrations of carcinogenic substances from waste incinerator emissions impacts on population's health.&lt;/li&gt;&lt;/ul&gt