Where you live matters how degree of urbanization influences healthcare utilization in Portugal

Abstract publicado em: Eur J Public Health. 2023 Oct; 33(Suppl 2): ckad160.244. https://doi.org/10.1093/eurpub/ckad160.244The degree of urbanization is a health determinant, causing inequalities in exposure to risk factors, influencing health services’ territorial organization and enabling healthcare utilization. Since Portugal’s proportion of population residing in urban areas is higher than the world average, we aimed to estimate the magnitude of the association between the place of residence’s degree of urbanization and healthcare utilization in the country.N/

Hip fracture in elderly in Portugal – incidence from 2004 to 2010

Abstrat publicado em: http://www.springerlink.com/content/45745132180p7215/fulltext.pdfBackground: Hip fractures related to osteoporosis and falls in elderly are an important cause of decreased health state. After Hip fracture older adults have a 5 to 8-fol increased risk of all-cause mortality, a 2.5-fold increase risk for the development of a new fracture and the majority of patients never regain previous level of independence. In Portugal, during 2006, Direcção Geral da Saúde (DGS) estimated that 52 million Euros were spending in hospitals direct costs related with Hip fractures, with a medium cost of 4.100 Euros per hospitalization. Objectives: Estimate the annual incidence of Hip fractures; describe the evolution between 2004 and 2010 Methods: Using Administração Central dos Sistemas de Saúde (ACSS) information from Hospitals Discharges (GHD) database, Hospitalization with code 8200 to 8201 (Classification of Diseases 9th Revision Clinical Modification – ICD-9-CM) as the main cause (DDX1) of hospitalization were considered as being due to hip fracture. Number of hospitalization by hip fracture were analyzed considering age (65-74 years, 75-84 years and ≥ 85 years) and sex of the patients. Incidence rates and respective confidence intervals for the hospitalization hip fracture were estimated for each age group and gender. For each age group and year official data (from Statistics Portugal) was considered as the number of people at risk of being hospitalized by a hip fracture. Results: For the group aged 65-74 years incidence rate varied between 0.49 by 1000 Persons-year of follow-up (PYFU) [95% confidence-interval (95%CI): 0.45; 0.54) in 2010 and 0.65 by 1000 PYFU (95%CI: 0.60; 0.70) in 2004. For the group aged 75-84 years incidence rate varied between 1.99 by 1000 PYFU (95%CI: 1.89; 2.10) in 2010 and 2.41 by 1000 PYFU (95%CI: 2.30; 2.54) in 2006 and 2007. Considering people aged 85 or more incidence were highest in 2009 [6.86/1000 PYFU (95%CI: 6.50; 7.24)] and lowest in 2010 [6.09/1000 PYFU (95%CI: 5.75; 6.44)]. As far as the difference between sexes are concerned risk of hospitalization by hip fracture is approximately twice in women of all ages above 65 years comparing with men of the same age. Conclusions: The incidence rate of hospitalization discharges by hip fracture has been constant in the analyzed years. Further analysis is needed in order to understand the reasons on this phenomenon. Being an important cause of fracture we highlight the importance of fall prevention in this population

Consumo de tabaco - o que está a mudar em Portugal e na Europa

Apresentação realizada no Congresso de Pneumologia relativa à evolução de consumo do tabaco em Portugal e na Europa. Enquadramento: i) O consumo de tabaco é um importante fator de risco para várias doenças (neoplasias, doenças do aparelho respiratório e doenças cardiovasculares); está associado a mortalidade prematura; pode contribuir para o agravamento de doenças transmissíveis; ii) Existem diferenças sociodemográficas no consumo de tabaco.N/

Consumo de tabaco na população portuguesa - análise de efeitos de idade-período-coorte

INTRODUÇÃO: O consumo de tabaco é um importante factor de risco para várias doenças. Em Portugal tem-se verificado uma diminuição da prevalência de consumo entre os homens e aumento entre as mulheres, tendo sido sugerido um efeito de coorte. O objectivo deste trabalho é avaliar a existência de efeitos de idade-período-coorte na prevalência de consumo de tabaco. MÉTODOS: Dados dos Inquéritos Nacionais de Saúde (INS) disponíveis foram analisados (1987, 1995/96, 1998, 2005/06). Foram calculadas coortes com base na idade reportada à data do inquérito. Analisaram-se prevalência por idade (com períodos e coortes conectados), por período e por coorte, estratificadas por sexo. RESULTADOS: Nos homens verifica-se sobreposição na distribuição de prevalências por idade (ligada por período), excepto no período de 25-34 anos em que ocorre diminuição ao longo dos vários INS [prevalências 25-29 anos: 53,7% (1987) a 39,6% (2005)]. O mesmo se verifica na análise por período, com distribuição constante em cada faixa etária (excepto 25-34 anos). A análise por idade ligada por coorte apresenta sobreposição de prevalências na maioria das idades, enquanto a análise por coorte mostra linhas paralelas mas com prevalências decrescentes nos grupos etários (máximo 54,3% - 25-29 anos, coorte 1956-1960; mínimo nos ≥65 anos - 12,6%-15,0%). Nas mulheres não se verifica sobreposição nas prevalências por idade (ligada por período), com prevalências crescentes para os diferentes inquéritos e um desvio para a direita da faixa etária com maior prevalência (em 1987, 20-24 – 18.9%; em 2005, 30-35 – 20,2%). O mesmo se verifica por período, com aumento das prevalências nas várias idades (maior aumento nos 40-44, 14,5%). A análise por idade (ligada por coorte) não apresenta sobreposição de prevalências, verificando-se maiores prevalências nas coortes de 1961-65 e 1966-70 (em particular nesta última 35-39 anos - 20,2%). A análise por coorte mostra aumento progressivo em cada faixa etária, crescimento que se verifica até à coorte 1961, altura em que se verifica uma estabilização. DISCUSSÃO/CONCLUSÕES: Verificam-se diferentes padrões nos homens e mulheres: a análise sugere um efeito de idade para os homens e efeito de coorte-período para as mulheres. Apesar de limitada pelos períodos irregulares entre os inquéritos a presente análise permite perceber a dinâmica de evolução do consumo de tabaco, contribuindo para estabelecimento de intervenções mais dirigidas

Socio-demographic factors associated with tobacco consumption and cessation in Portugal

Background: Smoking is a significant risk factor for several diseases. Social inequalities have been described for tobacco consumption and though to a lesser extend for tobacco cessation. Objectives: Describe sociodemographic factors associated with tobacco consumption and cessation. Methods: Data from the 2005/2006 Portuguese National Health Interview Survey was analysed. A multinomial log-linear model was fitted considering 3 groups: present smokers, former smokers and never smokers. Relative Risk Ratios (RRR) were obtained. Men and women were analysed separately. RRR adjusted for age and comparatively with reference categories (Centre for regions, married for marital status, student for professional situation and higher education for education) are presented. RRR of present smokers compare to never smokers and RRR of former smokers to present smokers. Results: Men from groups that have higher RRR of present smoking also have lower RRR of stopping. The lowest risk of cessation and higher of consumption was observed in Azores [RRR (95 % Confidence Interval (CI 95)) 0.53 (0.46, 0.61) and 1.89 (1.64, 2.18), respectively]. Divorcees, unemployed, and men with lower secondary education all had lower risk of cessation and higher of consumption, [respectively RRR (IC 95): 0.50 (0.41, 0.61) and 2.01 (1.64, 2.46); RRR (IC 95): 0.16 (0.13, 0.20) and 6.29 (5.00, 7.91); RRR (IC 95): 0.65 (0.56, 0.77) and 1.53 (1.30, 1.79)]. Similar results were observed in women (higher RRR of smoking and lower RRR of stop). Exceptions were found in the non-unemployed women and those with less that upper secondary. Taking region into consideration women in Madeira had a lower RRR of stop smoking and in Lisbon they had the higher risk of smoking [RRR (IC 95) 0.40 (0.27, 0.58) and 2.11 (1.74, 2.57), respectively]. The same was observed for divorced women [RRR (IC 95) 0.54 (0.41, 0.69) and 3.21 (2.69, 3.84), respectively]. Unemployed had the lower risk of quitting smoking and the highest of smoking [RRR (IC 95) 0.83 (0.51, 1.38) and 4.23 (3.20, 5.58), respectively], while the other groups had highest RRR of stop smoking and smoking, comparatively with reference group. Less educated women (lower secondary or less) had lower risk of cessation but also lower risk of smoking. Conclusions: Unfavourable sociodemographic characteristics are associated with higher risks of being a current smoker and lower risks of being an ex-smoker. Different/further cessation measures are needed in these less prone to quit group of individuals, namely men from Azores, divorced, unemployed and with lower secondary education and for divorced and unemployed women

Assessing recording delays in general practice records to inform near real-time vaccine safety surveillance using the Clinical Practice Research Datalink (CPRD).

PURPOSE: Near real-time vaccine safety surveillance (NRTVSS) is an option for post-licensure vaccine safety assessment. NRTVSS requires timely recording of outcomes in the database used. Our main objective was to examine recording delays in the Clinical Practice Research Datalink (CPRD) for outcomes of interest for vaccine safety to inform the feasibility of NRTVSS using these data. We also evaluated completeness of recording and further assessed reporting delays for hospitalized events in CPRD. METHODS: We selected Guillain-Barré syndrome (GBS), Bell's palsy (BP), optic neuritis (ON) and febrile seizures (FS), from January 2005 to June 2014. We assessed recording delays (e.g. due to feedback from specialist referral) in stand-alone CPRD by comparing the event and system dates and excluding delays >1 year. We used linked CPRD-hospitalization data to further evaluate delays and completeness of recording in CPRD. RESULTS: Among 51 220 patients for the stand-alone CPRD analysis (GBS: n = 830; BP: n = 12 602; ON: n = 1720; and FS: n = 36 236), most had a record entered within 1 month of the event date (GBS: 73.6%; BP: 93.4%; ON: 76.2%; and FS: 85.6%). A total of 13 482 patients, with a first record in hospital, were included for the analysis of linked data (GBS: n = 678; BP: n = 4060; ON: n = 485; and FS: n = 8321). Of these, <50% had a record in CPRD after 1 year (GBS: 41.3%; BP: 22.1%; ON: 22.4%; and FS: 41.8%). CONCLUSION: This work shows that most diagnoses in CPRD for the conditions examined were recorded with delays of ≤30 days, making NRTVSS possible. The pattern of delays was condition-specific and could be used to adjust for delays in the NRTVSS analysis. Despite low sensitivity of recording, implementing NRTVSS in CPRD is worthwhile and could be carried out, at least on a trial basis, for events of interest. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd

Programa Bolsa-família, federalismo e poder local : o índice de gestão descentralizada municipal e o fator condicionalidade educação no município de Vitória (ES)

O processo de implementação do Programa Bolsa Família sofre impacto tanto por seu desenho institucional, deliberado no plano federal, como pelas diferentes capacidades institucionais disponíveis no plano local, no que diz respeito a recursos humanos, gestão e articulação entre diversos serviços e infraestrutura disponível. Os gargalos encontrados nos níveis municipais para a realização de uma coordenação de qualidade do programa motivaram a produção desta pesquisa, realizada em Vitória (ES). Dado o contexto federativo do Estado brasileiro, o objetivo deste trabalho é analisar a eficácia do Programa Bolsa Família a partir do Índice de Gestão Descentralizada Municipal, com recorte na condicionalidade educação neste município. Utilizou-se de pesquisa documental, com metodologia qualitativa de natureza exploratória, no intuito de se compreender a lógica de controle desta condicionalidade. O trabalho conclui que os resultados obtidos indicam que os objetivos gerais da gestão do Programa Bolsa Família vêm, ao longo dos últimos anos, sendo alcançados de forma efetiva na capital capixaba, mediante interlocução contínua e ações administrativas articuladas entre atores envolvidos no processo.The implementation process of the Programa Bolsa Família suffers impact by its institutional design, decided at the federal level, as the different institutional capacities available at the local level, regarding the human resources, management and coordination among distinct services and available infrastructure. The bottlenecks found in the municipal levels, in general, related to the program quality coordination, were the motivation point of this research, held in Vitória (ES). Taking in consideration the Federal State scenery, the main goal of this study is to analyze the effectiveness of the Programa Bolsa Família from Decentralized Municipal Index (IGD-M), observing carefully the Education Conditionality, in this municipality. Qualitative methodology of exploratory nature was used at this documental research, in order to understand the control tools of this conditionality. The results indicate that the overall goals of the “Programa Bolsa Família” have been achieved, along the last years, in a positive and effective way at the Espírito Santo capital, through continuous dialogue and administrative actions, articulated among actors involved in the process.CAPE

Implementing near real-time vaccine safety surveillance using the Clinical Practice Research Datalink (CPRD).

INTRODUCTION: Near real-time vaccine safety surveillance (NRTVSS) using electronic health records is increasingly used to rapidly detect vaccine safety signals. NRTVSS has not been fully implemented in the UK. We assessed the feasibility of implementing this surveillance using the UK Clinical Practice Research Datalink (CPRD). METHODS: We selected seasonal influenza vaccine/Guillain-Barré Syndrome (GBS) as an example of a rare outcome and measles-mumps-rubella (MMR) vaccine/febrile seizures as a positive control. For influenza/GBS we implemented a system for the 2013/2014 and 2014/2015 influenza seasons; for MMR/seizures the surveillance period was July 2014-June 2015. We used the continuous Poisson-based maximized sequential probability ratio test (PMaxSPRT), comparing observed-to-expected events, for both pairs. We calculated an age-sex-adjusted rate using 5years of historic data and used this rate to calculate the expected number of events in pre-specified post-vaccination risk-window (GBS: 0-42days, seizures: 6-21days). For MMR/seizures we also implemented the system using the Binominal-based maximized sequential probability ratio test (BMaxSPRT). For this, we compared seizures in the risk-window (6-21days) to a control window (0-5 and 22-32days). Delays in recording outcomes influence the data available, so we adjusted the expected number of events using a historical distribution of delays in recording GBS/febrile seizures. Analyses were run using data up to each CPRD monthly release. We also performed power calculations for detecting increases in relative risk (RR) from 1.5 to 10. RESULTS: For influenza/GBS we implemented a system in both seasons with no signal. Power to detect a signal was >80% for RR≥4. For MMR/seizures we were able to identify a signal with PMaxSPRT but not with BMaxSPRT. Power≥80% for RR≥2.5 for both tests. CONCLUSION: CPRD is a potential data source to implement NRTVSS to exclude large increases in the risk of rare outcomes after seasonal influenza and lower increases in risk for more frequent outcomes

different delays, different risk factors

Funding Information: The study was supported by the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) under the National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal (PTDC/SAU-PUB/31346/2017). Publisher Copyright: © 2021, The Author(s).Background: Delay in Tuberculosis (TB) diagnosis affects foreign-born and nationals in different ways, especially in low-incidence countries. This study characterises total delay and its components amongst foreign-born individuals in Portugal. Additionally, we identify risk factors for each type of delay and compare their effects between foreign-born and nationals. Methods: We analysed data from the Portuguese TB surveillance system and included individuals with pulmonary TB (PTB), notified between 2008 and 2017. We described patient, healthcare, and total delays. Cox regression was used to identify factors associated with each type of delay. All analyses were stratified according to the origin country: nationals (those born in Portugal) and foreign-born. Results: Compared with nationals, foreign-born persons presented statistically significant and longer median total and patient delays (Total: 67 vs. 63; Patient: 44 vs. 36 days), and lower healthcare services delays (7 vs. 9 days). Risk factors for delayed diagnosis differed between foreign-born and nationals. Being unemployed, having drug addiction, and having comorbidities were identified as risk factors for delayed diagnosis in national individuals but not in foreigners. Alcohol addiction was the only factor identified for healthcare delay for both populations: foreign-born (Hazard Ratio 1.34 [95% confidence interval 1.17;1.53]); nationals (Hazard Ratio 1.20 [95% confidence interval 1.13;1.27]). Conclusions: Foreign-born individuals with PTB take longer to seek health care. While no specific risk factors were identified, more in-depth studies are required to identify barriers and support public health intervention to address PTB diagnosis delay in foreign-born individuals.publishersversionpublishe