Geografia da doença cardiovascular : enfarte agudo do miocárdio : padrões e sazonalidade

Dissertação de mestrado em Geografia Humana, Ordenamento do Território e Desenvolvimento, apresentada à Faculdade de Letras da Universidade de Coimbr

Evidence of social deprivation on the spatial patterns of excess winter mortality

Objectives: The aims of this study are to identify the patterns of excess winter mortality (due to diseases of the circulatory system) and to analyse the association between the excess winter deaths (EWD) and socio-economic deprivation in Portugal. Methods: The number of EWD in 2002–2011 was estimated by comparing the number of deaths in winter months with the average number in non-winter months. The EWD ratio of each municipality was calculated by following the indirect standardization method and then compared with two deprivation indexes (socio-material and housing deprivation index) through ecological regression models. Results: This study found that: (1) the EWD ratio showed considerable asymmetry in its geography; (2) there are significant positive associations between the EWD ratio and both deprivation indexes; and (3) at the higher level of deprivation, housing conditions have a stronger association with EWD than socio-material conditions. Conclusions: The significant association between two deprivation dimensions (socio-material and housing deprivation) and EWDs suggests that EWD geographical pattern is influenced by deprivation.info:eu-repo/semantics/publishedVersio

Vestígios de glaciação da serra da Cabreira: cartografia geomorfológica de pormenor com recurso a tecnologias de geoprocessamento

O estudo da glaciação plistocénica no Noroeste de Portugal tem interessado a comunidade científica desde os finais do século XIX. Das serras minhotas, apenas a Peneda e o Gerês são consideradas pela referida comunidade como áreas montanhosas afectadas pelas glaciações quaternárias. No entanto, na serra da Cabreira ter-se-ão identificado igualmente implicações do frio quaternário enquanto glaciação. A glaciação wurmiana na serra da Cabreira é um assunto até hoje pouco estudado. J.C. Alves Vieira em 1923, na sua monografia sobre o concelho de Vieira do Minho, falava dos “incontestáveis documentos da era glacial”. Mas, foi S. Daveau (1977) que, depois de avançar com a possibilidade dessa glaciação, apresentou em 1985 em colaboração com N. Devy-Vareta, um importante estudo.Mais recentemente, P. Pereira e A. Bento Gonçalves (2001) salientaram as condições excepcionais para a ocorrência do episódio de glaciação no maciço culminante da Serra da Cabreira, onde distinguiram dois tipos de paisagem aí presentes, derivados de uma intensa gelifracção (vertentes cobertas de crioclastos) e da morfogénese glaciar, tendo cartografado os diferentes fenómenos observados. O recurso generalizado a informação topográfica de base a escalas que impossibilitam uma localização precisa dos elementos a cartografar tem-se traduzido na construção de mapas geomorfológicos com défice de rigor. Neste contexto o aparecimento de ferramentas GPS (Global Positioning Systems) de alta precisão tem-se constituído como uma mais valia, possibilitando colmatar este problema. Com recurso ao GPS modelo GS20 PDM Professional Data Mapper da Leica Geosystems (o qual permite atingir precisões na ordem dos 10 mm usando o recurso à fase diferencial ou de 30 cm em modo de operação estático ou móvel com recurso a pósprocessamento e usando o código diferencial) procedeu-se ao levantamento de pormenor de formas e depósitos do pequeno glaciar dos Gaviões. Assim, fazendo uso das recentes tecnologias de geoprocessamento – GPS e SIG – procedemos à cartografia geomorfológica de pormenor, reunindo o presente trabalho os resultados preliminares dessa cartografia, que correspondem ao início de um estudo que se pretende mais alargado, com vista à cartografia geomorfológica de pormenor de todo o maciço culminante da Serra da Cabreira

Seasonal mortality patterns and regional contrasts in Portugal

The main aim of this study is to identify the geographical seasonal mortality patterns in Portugal and, for the first time, to assess the relationship between seasonal and overall mortality. Monthly data from the Portuguese mortality database (2000-2009) by major cause of death were analysed and standardized to 30 days with adjustments for leap years. The chi-square goodness-of-fit test was used to compare the observed monthly deaths with deaths that could be expected if mortality were randomly distributed throughout the year. The seasonal burden was measured using the excess winter deaths (EWD) rate and the seasonal impact of winter on mortality was assessed through the EWD Index. The regions were clustered according to the overall mortality rate and the seasonal impact: 1–low seasonality and high values of overall mortality; 2–high seasonality and high values of overall mortality; 3–low values of seasonality and low overall mortality; 4–high seasonality and low overall mortality. Significant seasonal mortality increases were found in all causes of death. There were 86,000 EWDs, mostly through circulatory and respiratory diseases. 73% of the population lives in regions with high winter vulnerability to respiratory mortality and 60% in regions with high winter vulnerability to circulatory mortality. This study reinforces the idea that vulnerability to cold weather may play an important role in the public health in Portugal. This knowledge may be used to construct a set of regulations or policies designed to implement better health planning procedures and more effective warning systems.info:eu-repo/semantics/publishedVersio

Seasonal mortality patterns due to diseases of the circulatory system in Portugal

Exposure to cold weather has negative consequences on human health. Studies have been showing that the seasonality of mortality has an evident peak during winter months in European countries. However, the highest increases in mortality are registered in countries with mild winters. According to several studies winter deaths seem to be associated with low socioeconomic conditions. The main aims of this study are to identify the trends of mortality due to diseases of the circulatory system and excess winter deaths in Portugal and to assess the geographical pattern of seasonal mortality. In the 20 years under analyses, mortality due to diseases of the circulatory system increased 38% during winter months when compared to the non-winter period. Important regional disparities were found, the Excess Winter Death index ranged from 21% to 48%, the central regions tend to have better results. Our results indicate that although circulatory mortality is significantly decreasing in Portugal, the vulnerability to seasonal cold weather remains as an important public health issue. These findings suggest that the exposure to cold weather is an important determinant of cardiovascular diseases that is still neglected in Portugal.info:eu-repo/semantics/publishedVersio

Time series analysis applied on exposure to cold and daily hospital admissions in Portugal

(Introduction) The impact of the exposure to cold weather on human health is very often underestimated. Excess winter mortality is commonly assumed as a natural pattern of seasonality and very rarely as a public health issue. As a consequence only few countries have designed health policies to reduce this environmental determinant for health, and very few studies try to quantify the effect of cold on mortality or morbidity.info:eu-repo/semantics/publishedVersio

Equitable perinatal healthcare for migrants, Portugal: comparative analysis of a self-assessment tool

Migration is seen as a common risk factor in obstetricmanagement. Migrants often have a higher risk of experience worse pregnancy outcomes, higher rates of operative delivery, and a higher likelihood to receive less adequate postpartum care when compared to native women. This study evaluates self-perceived assessment of migrant women and hospital directors on equitable migrant friendly perinatal healthcare quality and access during intrapartum and postpartum period at public maternity units across Portuguese mainland between 2017-2019. This cross-sectional study analyses perinatal health data from migrant women over 18 years giving birth in public maternity units from between April 2017 and March 2019 as part of the baMBINO project. Data on the assessments of maternity units’ directors on equitable migrant friendly healthcare was collected in a self-assessment tool. Two standards on healthcare access and on healthcare quality were developed by: 1) scoring 25 and 30 questions, respectively, from 0 (worst) to 5 (best); 2) calculating the average of each score. The OneSample Wilcoxon Test (non-parametric) was applied to compare the assessment of hospital directors with the migrant mothers and the Kruskal-Wallis one-way analysis of variance to test for regional differences. Significant differences between migrant woman and healthcare directors’ assessments on migrant friendly healthcare access and quality of care were found. Directors rated healthcare access with a median score of 2.4, twice as good as migrant women (1.3). Migrant women rated healthcare quality with a median score of 4.0 (directors: 3.2). Significant differences between the regions for quality of care and healthcare access were found. Statistically significant difference between migrants from Portuguese and non-Portuguese speaking countries was identified for healthcare access (p-value <0.001) and healthcare quality (p-value < 0.05).info:eu-repo/semantics/publishedVersio

Equitable migrant-friendly perinatal healthcare access and quality in public maternity units in Portugal

Migrant women are at higher risk to face access barriers to perinatal care services and to experience worse pregnancy outcomes compared to native. Assessing the perception of migrant women and health providers discloses a multifaceted view on migrant-friendly care, a multidimensional concept in itself. This study aims to compare self-perceived assessments of migrant women and directors of obstetrics and gynaecology (GYN/OBS) departments on equitable migrant-friendly perinatal healthcare quality and access during the intrapartum and postpartum period at public maternities in Portugal. Methods: In this cross-sectional study, two indicators on Healthcare access and Quality of care were developed to compare how adult migrant women who gave birth between April 2017 and March 2019 and GYN/OBS department directors assessed offered care. The one-sample Wilcoxon test was used to compare directors' with migrants' assessments and the Kruskal-Wallis one-way analysis of variance to test for country regional differences. A stratified analysis by sex, spoken language, and country of birth tested for potential effect modifiers. Results: Migrants rated Healthcare access significantly better (P<0.05), but perceived Quality of care worse (P<0.01) than GYN/OBS department directors. Migrants' and directors' perceptions differed significantly according to directors' gender (P<0.05). Migrants' and directors' assessments on Healthcare access (P<0.05) and Quality (P<0.01) changed significantly across regions. Conclusions: Migrants' and directors' self-perceived appraisal of Healthcare access and Quality of care significantly varied. Identifying these discordances allows to deliver insights into existing barriers in access and provision of care and raises awareness to improve quality assurance, essential to inform practice and policies.info:eu-repo/semantics/publishedVersio

Assessing the impact of poor housing conditions on human health in Portugal

Improvement on the quality housing is fundamental for reducing thermal discomfort and thus exposure to cold and a better health. Morbidity and mortality has obviously a multivariable cause and one of them is the thermal discomfort in our homes where, as a sedentary being, we spend most of our daily life. A continuous exposure to cold surely debilitates our health and will lead to cardiovascular and respiratory diseases. Most of the Portuguese dwellings show a poor building quality. There are several origins for these deficiencies and with consequences at different levels, in particular, in terms of human comfort. In fact, Portugal is one of the southern European countries that have higher mortality in winter. However, the number of studies relating cold weather and morbidity/mortality is still very rare. These occurrences are suspected to be associated with housing quality especially thermal insulation. In order to assess the relation between the incidence of coronary events and housing, a national survey on patients with acute coronary syndromes in several regions of Portugal was realized during the winter months and data on the housing conditions and behavior attitudes against cold exposure were asked. A better knowledge about the influence of weather and climate on such ailment may be applied to built up a guide for housing design (to new and restorations of old dwellings), inpolicies and strategies for protection and adaptation, health planning, as well as alert systems in order to reduce the number of deaths by cardiovascular failure.info:eu-repo/semantics/publishedVersio