Bringing government sectors together to address noncommunicable diseases: Portugal’s interministerial healthy eating strategy

Background: Unhealthy eating habits are among the main risk factors associated with the loss of healthy life years in the Portuguese population. Excessive consumption of fat, sugar and salt is the main factor contributing to mortality. In fact, eight out of ten deaths in European countries are caused by noncommunicable diseases. Implementation: To tackle the complex challenges brought about by noncommunicable diseases, a Health in All Policies approach was implemented. The role of behavioural determinants in morbidity and premature mortality led the Portuguese Government to recognize the promotion of healthy eating as a priority by involving several ministries. Results: The Integrated Strategy for the Promotion of Healthy Eating (2017– 2020) devised by the Portuguese Government identifies a broad set of health promotion and disease prevention measures. Furthermore, it provides the framework for several other initiatives that have already been implemented or are being implemented at the moment. Conclusion: The current Portuguese Government has shown political commitment to implementing the Integrated Strategy for the Promotion of Healthy Eating and significant achievements are evident merely a few months into its implementation. However, if Portugal is to maintain the current speed of implementing this strategy, future governments must ensure continued commitment with equal clear-sighted long-term national policies. Unless future problems are anticipated and planned for, overwhelming health care challenges may threaten entire societies.info:eu-repo/semantics/publishedVersio

The Portuguese NHS 2024 reform: transformation through vertical integration

Vertical integration models aim for the integration of services from different levels of care (e.g., primary, and secondary care) with the objective of increasing coordination and continuity of care as well as improving efficiency, quality, and access outcomes. This paper provides a view of the Portuguese National Health Service (NHS) healthcare providers’ vertical integration, operationalized by the Portuguese NHS Executive Board during 2023 and 2024. This paper also aims to contribute to the discussion regarding the opportunities and constraints posed by public healthcare organizations vertical integration reforms. The Portuguese NHS operationalized the development and generalization of Local Health Units management model throughout the country. The same institutions are now responsible for both the primary care and the hospital care provided by public services in each geographic area, in an integrated manner. This 2024 reform also changed the NHS organic and organizational structures, opening paths to streamline the continuum of care. However, it will be important to ensure adequate monitoring and support, with the participation of healthcare services as well as community structures and other stakeholders, to promote an effective integration of care

Toolkit for tackling misinformation on noncommunicable disease : forum for tackling misinformation on health and NCDs

Published online: 21 October 2021Noncommunicable disease related, and health misinformation is a growing concern as more and more individuals obtain their health information from digital venues such as search engines or social media platforms. While increased access to information on health issues can be seen as generally positive, the spread of inaccurate medical information is of course problematic. It can lead to harmful lifestyle or dietary choices, self-medication, the abandonment of medical treatment and incorrect diagnoses. As such, three meetings were hosted to discuss the topic with representatives from Member States, the media and social media sectors, and civil society. The outcomes of these meetings are reflected in this Toolkit. This Toolkit was drafted following these meetings, and includes the concerns, challenges and conclusions shared during those conversations by all discussion partners. It is the product of an intense iterative process, of arguments between competing views and interests, and of the constant upgrades in available knowledge. It reflects, to the extent possible, the developments that occurred after the meetings, but it should be read with the knowledge that it does not presume to contain everything there is to know about this topic

Eight years of sugar-sweetened beverages consumption among Portuguese children aged 6 to 8 years old: COSI Portugal 2008 – 2016

A obesidade é uma das doenças mais prevalentes entre as crianças portuguesas e, neste contexto, o consumo de bebidas açucaradas é apontado como um dos fatores que pode contribuir para o ganho ponderal em crianças. Estudos sugerem que a disponibilidade destas bebidas está a aumentar e, em Portugal, 22% das crianças com idade inferior a 10 anos consome pelo menos uma bebida açucarada por dia. O presente trabalho pretendeu avaliar o consumo de bebidas açucaradas em crianças e a sua disponibilidade nas escolas do 1º Ciclo do Ensino Básico entre 2008 e 2016. Dados da primeira e quarta ronda (2008 e 2016) do estudo COSI Portugal, referentes à frequência de consumo alimentar e à disponibilidade de bebidas açucaradas no ambiente escolar, foram obtidos e comparados através da análise descritiva dos Questionários Família e Escola. Apesar da prevalência de excesso de peso infantil (incluindo obesidade) em Portugal ter diminuído significativamente de 37,9% em 2008 para 30,7% em 2016, os resultados obtidos revelaram um aumento do consumo de bebidas açucaradas em crianças de 66,4% em 2008 para 80,1% em 2016. Também a disponibilidade destas bebidas nos recintos escolares aumentou neste período. Deste modo, este trabalho reflete a necessidade de monitorização contínua, tanto do estado nutricional como do consumo alimentar infantil, de forma a adaptar e/ou criar estratégias que incentivem a adoção de hábitos alimentares saudáveis.Obesity is one of the most prevalent diseases among Por tuguese children and one of the factors that may lead to weight gain during childhood is the intake of sugar-sweetened beverages. Some studies suggest that the availability of this type of drinks is increasing. In addition, in Portugal, 22% of the children under 10 years old drink at least one sugarsweetened beverage per day. The present study aimed to assess the intake of sugar-sweetened beverages among children and their availability on Primar y Schools between 2008 and 2016. Data from the first and four th round (2008 and 2016) of the COSI Por tugal study concerning the food consumption frequency and the availability of sugar-sweetened beverages on school environment, was collected and compared through the analysis of the Family and School Questionnaires. The prevalence of overweight (including obesity) in Por tugal has significantly decreased from 37,9% in 2008 to 30,7% in 2016. Nonetheless, the results showed an increase of the consumption of sugar-sweetened beverages among children, from 66,4% in 2008 to 80,1% in 2016. The availability of these drinks also increased at school level during this period. In conclusion, the present study reflects the need of continuous monitoring, both of the children’s nutritional status and food consumption, in order to adapt or create strategies that promote the adoption of healthy eating habits.info:eu-repo/semantics/publishedVersio

Implementation of non-communicable disease policies: a geopolitical analysis of 151 countries.

BACKGROUND: Most countries have endorsed WHO non-communicable disease (NCD) best buy policies, but we know very little about global implementation patterns and about the geopolitical factors affecting implementation. We aimed to assess global implementation based on analysis of multiple geopolitical datasets. METHODS: We used the 2015 and 2017 WHO NCD progress monitor reports to calculate aggregate implementation scores for 151 countries, based on their implementation of 18 WHO-recommended NCD policies. We ranked all countries and used descriptive statistics to analyse global trends. We used linear regression to assess the associations between policy implementation and World Bank geographic region, risk of premature NCD mortality, percentage of all deaths caused by NCDs, World Bank income group, human capital index, democracy index, and tax burden. FINDINGS: In 2017, the mean NCD policy implementation score was 49·3% (SD 18·4%). Costa Rica and Iran had the joint-highest implementation scores (86·1% of all WHO-recommended policies). Scores were lowest in Haiti and South Sudan (5·5%). Between 2015 and 2017, aggregate implementation scores rose in 109 countries and regressed in 32 countries. Mean implementation rose for all of the 18 policies except for those targeting alcohol and physical activity. The most commonly implemented policies were clinical guidelines, graphic warnings on tobacco packaging, and NCD risk factor surveys. Our multiple linear regression model explained 61·1% of the variance in 2017 aggregate scores (p<0·0001), but we found evidence of a high degree of collinearity between the explanatory variables. INTERPRETATION: Implementation of WHO-recommended NCD policies is increasing over time. On average, countries implemented just under half of the NCD policies recommended by WHO in 2017. Nutrition-related policies saw gains, while those related to alcohol and physical activity were the most likely to have been dropped. Aggregate implementation scores tended to be highest in high-income countries that invest in health care and education. FUNDING: National Institute for Health Research, Imperial College London, University of Oxford

Nutri-Score: uma ferramenta de saúde pública para melhorar os hábitos alimentares da população portuguesa

This article intends to help filling the existing gap in guidance for the implementation of FOP labelling systems.4 As such, the following sections present the growing evidence on the impact of the Nutri-Score labelling scheme in promoting healthier eating behaviours and informs health professionals, as well as decision makers, on the way forward.info:eu-repo/semantics/publishedVersio

transformation through vertical integration

Funding Information: The author(s) declare financial support was received for the research, authorship, and/or publication of this article. After submission, Imperial College London kindly agreed to fund the open access fees for this paper. Publisher Copyright: Copyright © 2024 Goiana-da-Silva, Sá, Cabral, Guedes, Vasconcelos, Sarmento, Morais Nunes, Moreira, Miraldo, Ashrafian, Darzi and Araújo.Vertical integration models aim for the integration of services from different levels of care (e.g., primary, and secondary care) with the objective of increasing coordination and continuity of care as well as improving efficiency, quality, and access outcomes. This paper provides a view of the Portuguese National Health Service (NHS) healthcare providers’ vertical integration, operationalized by the Portuguese NHS Executive Board during 2023 and 2024. This paper also aims to contribute to the discussion regarding the opportunities and constraints posed by public healthcare organizations vertical integration reforms. The Portuguese NHS operationalized the development and generalization of Local Health Units management model throughout the country. The same institutions are now responsible for both the primary care and the hospital care provided by public services in each geographic area, in an integrated manner. This 2024 reform also changed the NHS organic and organizational structures, opening paths to streamline the continuum of care. However, it will be important to ensure adequate monitoring and support, with the participation of healthcare services as well as community structures and other stakeholders, to promote an effective integration of care.publishersversionpublishe

Birth rate and fertility: knowledge and expectations analysis of 3585 university students

Copyright © Ordem dos Médicos 2014Introduction: Nowadays, Portuguese birth rate is insufficient to ensure renewal of generations. Women high education levels and labor market integration and increased economic difficulties are some of multiple factors leading to a delay in average parenting age and an increase of infertility; also subject to others such as obesity, smoking and alcohol consumption. Material and Methods: Transversal epidemiological study, analytical, uncontrolled, from self-filled online questionnaires, promoted by students’ university unions. A sample of 3585 university students was considered and a global and by gender statistic analysis was done through SPSS, Excel was used to build graphics and tables and ArcMap to represent maps. Results: Mainly students from the Health Sciences (40.6%), Universidade de Lisboa (59.4%), female (76.9%), median age of 22; intention to marry/ union 71.0%, parenthood 85.7%. A total of 18.4% smoke, 22.3% consume alcohol and obesity 15.4%; employment (47.4%) and the partner’s will (39.9%) were important determinants for parenthood decision as well as having financial stability to provide a good education (33.6%) and healthcare (38.6%); A total of 53.6% have considered the hypothesis of infertility and highlight above 35 year old maternal age (18.7%), obesity (18%) and female smoking (19.0) as factors. Higher and more significant values for smoking (p = 0.001) and alcohol consumption (p = 0.000) in males were found. Discussion: The sample seems representative, well distributed among different areas of study, with more female respondents than the university portuguese ratio. There are more students with parenting projects than marriage/cohabitation, in accordance with Portuguese data. Nevertheless, the same students identify the family as a priority in comparison with employment and career. Parenting decisions are tied by social-economic situation but an important factor is the low fertility due to the maternal age delay of the first pregnancy. Conclusion: University student unions are an excellent instrument to access them; a high number of respondents consider having children but delay the decision; there is a lack of information about the consequences of delaying parenting age and about infertility factors. The negative trend of fertility must be seen as a necessity to develop specific policies.Introdução: Em Portugal, a taxa de natalidade não é suficiente para assegurar a renovação de gerações. A licenciatura e participação no mercado de trabalho das mulheres e a actual instabilidade económica são alguns determinantes e têm como consequência, o adiamento da parentalidade e infertilidade condicionada ainda pela obesidade, tabagismo e álcool. Material e Métodos: Estudo epidemiológico transversal, analítico, através de questionários auto-preenchidos, online, divulgados pelas Associações de estudantes das Universidades Portuguesas. A análise estatística da amostra de 3585 estudantes foi desen-volvida em SPSS, Excel nas representações gráficas e ArcMap, para os mapas. Resultados: Predomínio de estudantes de Ciências de Saúde (40,6%), da Universidade de Lisboa (59,4%) e sexo feminino (76,9%), mediana de idades de 22 anos; tabagismo 18,4%, consumo de álcool 22,3% e excesso de peso e obesidade 15,4%; intenção de casamento/união de facto 71,0%, projecto de parentalidade 85,7%; o emprego (47,4%) e a vontade do parceiro (39,9%) foram considerados determinantes na probabilidade de ter filhos assim como a segurança financeira para boa educação (33,6%) e cuidados de saúde (38,6%); 53,6% consideram a hipótese de infertilidade. Encontrámos valores mais elevados e significativos para o tabagismo(p = 0,001) e consumo de álcool (p = 0,000) no sexo masculino. Discussão: Consideramos a amostra representativa, bem distribuída pelas áreas de estudo, a maioria jovem, predomínio feminino superior aos rácios das faculdades. Há mais estudantes com projectos de parentalidade do que de casamento/união de facto, o que está de acordo com a evolução em Portugal. No entanto, os mesmos estudantes identificam a família como prioritária relativamente ao emprego e carreira. A decisão da parentalidade é condicionada pelas condições socioeconómicas mas um factor importante a considerar é uma baixa fertilidade biológica devida ao adiamento da idade da primeira gestação. Conclusão: As associações de estudantes universitários são um excelente instrumento de acesso; um número muito significativo pensa ter filhos mas adia essa decisão; há falta de informação relativamente às consequências de adiar a idade do primeiro filho e aos factores de infertilidade. A tendência negativa da fecundidade deve ser encarada como necessidade de desenvolver políticas específicas.info:eu-repo/semantics/publishedVersio

Modeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation study.

Background: Excessive salt consumption-associated with a range of adverse health outcomes-is very high in Portugal, and bread is the second largest source. Current Portuguese legislation sets a maximum limit of 1.4 g salt per 100 g bread, but imported and traditional breads are exempted. In 2017 the Ministry of Health proposed reducing the salt threshold to 1.0/100 g by 2022, however the legislation was vetoed by the European Commission on free-trade grounds. Aims: To estimate the health impact of subjecting imported and traditional breads to the current 1.4 g threshold, and to model the potential health impact of implementing the proposed 1.0 g threshold. Methods: We gathered bread sales, salt consumption, and epidemiological data from robust publicly available data sources. We used the open source WHO PRIME modeling tool to estimate the number of salt-related deaths that would have been averted in 2016 (the latest year for which all data were available) from; (1) Extending the 1.4 g threshold to all types of bread, and (2) Applying the 1.0 g threshold to all bread sold in Portugal. We used Monte Carlo simulations to generate confidence intervals. Results: Applying the current 1.4 g threshold to imported and traditional bread would have averted 107 deaths in 2016 (95% CI: 43-172). Lowering the current threshold from 1.4 to 1.0 g and applying it to all bread products would reduce daily salt consumption by 3.6 tons per day, saving an estimated 286 lives a year (95% CI: 123-454). Conclusions: Salt is an important risk factor in Portugal and bread is a major source. Lowering maximum permissible levels and removing exemptions would save lives. The European Commission should revisit its decision on the basis of this new evidence