Suchergebnisse

Pneumonia is an important cause of morbidity, mortality and expenditure of health resources. Since the introduction of conjugated pneumococcal vaccines (PCV) in infant immunization programs in 2000s, there is consistent evidence of pneumonia reduction in vaccinated children1. Limited data are available on indirect effect of infant immunization on pneumonia burden in unvaccinated population subgroups. This study aims to assess the indirect effect of the introduction of infant 7-valent (PCV7) and 13-valent (PCV13) pneumococcal conjugated vaccines on the pneumonia burden among adults aged 65 or more years in Portugal, comparing trends in Pneumococcal Pneumonia (PP) hospitalization rates before and after the introduction of the PCV7/PCV13. ; The IMOVE+ project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 634446 ; N/A

Background: In 2008, the Portuguese smoke-free law came into effect including partial bans in the leisure-hospitality (LH) sector. The objective of the study is to assess the prevalence of smoking control policies (total ban, smoking permission and designated smoking areas) adopted by the LH sector in Portugal. The levels of noncompliance with each policy are investigated as well as the main factors associated with smoking permission and noncompliance with the law. Methods: Cross-sectional study conducted between January 2010 and May 2011. A random sample of venues was selected from the Portuguese LH sector database, proportionally stratified according to type, size and geographical area. All venues were assessed in loco by an observer. The independent effects of venues' characteristics on smoking permission and the level of noncompliance with the law were explored using logistic regression. Results: Overall, 1.412 venues were included. Total ban policy was adopted by 75.9% of venues, while 8.4% had designated smoking areas. Smoking ban was more prevalent in restaurants (85.9%). Only 29.7% of discos/bars/pubs opted for complete ban. Full or partial smoking permission was higher in discos/bar/pubs (OR = 7.37; 95%CI 4.87 to 11.17). Noncompliance with the law was higher in venues allowing smoking and lower in places with complete ban (33.6% and 7.6% respectively, p<0.001). Discos/bars/pubs with full smoking permission had the highest level of noncompliance (OR = 3.31; 95%CI 1.40 to 7.83). Conclusions: Our findings show a high adherence to smoking ban policy by the Portuguese LH sector. Nonetheless, one quarter of the venues is fully or partially permissive towards smoking, with the discos/bars/pubs considerably contributing to this situation. Venues with smoking permission policies were less compliant with the legislation. The implementation of a comprehensive smoke-free law, without any exceptions, is essential to effectively protect people from the second hand smoke. ; The work is part of a large Epidemiological Study on the Portuguese Tobacco Control Policy, developed by the Instituto de Medicina Preventiva da Faculdade de Medicina de Lisboa and supported, in its preliminary part, by the Direção-Geral da Saúde (DGS) and, in the second part, by the national funding institution Fundação para a Ciência e Tecnologia (FCT). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Aims: Anemia is a global public health problemwith relevant adverse health, social and economic consequences. The objective of this study was to analyze the distribution of the prevalence of anemia in the Portuguese population. Methods: This is a cross-sectional population-based study, based on the first Portuguese National Health Examination Survey (INSEF), which included 4812 participants aged 25 to 74 years, with data on hemoglobin levels and self-reported diagnosis of anemia. The socioeconomic status of participants was assessed by education level, employment status and material deprivation. The association between socioeconomic factors and anemia was estimated by adjusted prevalence ratios. Results: The prevalence of anemia overall was 5.8%, 3.1% in men and 8.4% in women. The overall prevalence of moderate–severe anemia was 1.1%. Previously undiagnosed cases represented 92.5%. In men, anemia was associated with age, education, occupation and material deprivation, and in women, with age group and urban typology. Conclusion: Anemia represents a relevant public health issue in Portugal. In women, it is more prevalent among those of childbearing age and older, and in men among older individuals of low socioeconomic status. This information is relevant for developing targeted strategies aimed at the prevention, diagnosis and treatment of anemia. ; This work was supported by the Public Health Initiatives Program within the European Economic Area Financial Mechanism (EEA Grants) 2009-2014, and by the Portuguese Government. ; info:eu-repo/semantics/publishedVersion

CIEC – Research Centre on Child Studies, UM (FCT R&D 317) ; Background: In 2008, the Portuguese smoke-free law came into effect including partial bans in the leisure-hospitality (LH) sector. The objective of the study is to assess the prevalence of smoking control policies (total ban, smoking permission and designated smoking areas) adopted by the LH sector in Portugal. The levels of noncompliance with each policy are investigated as well as the main factors associated with smoking permission and noncompliance with the law. Methods: Cross-sectional study conducted between January 2010 and May 2011. A random sample of venues was selected from the Portuguese LH sector database, proportionally stratified according to type, size and geographical area. All venues were assessed in loco by an observer. The independent effects of venues' characteristics on smoking permission and the level of noncompliance with the law were explored using logistic regression. Results: Overall, 1.412 venues were included. Total ban policy was adopted by 75.9% of venues, while 8.4% had designated smoking areas. Smoking ban was more prevalent in restaurants (85.9%). Only 29.7% of discos/bars/pubs opted for complete ban. Full or partial smoking permission was higher in discos/bar/pubs (OR = 7.37; 95%CI 4.87 to 11.17). Noncompliance with the law was higher in venues allowing smoking and lower in places with complete ban (33.6% and 7.6% respectively, p, 0.001). Discos/bars/pubs with full smoking permission had the highest level of noncompliance (OR = 3.31; 95%CI 1.40 to 7.83). Conclusions: Our findings show a high adherence to smoking ban policy by the Portuguese LH sector. Nonetheless, one quarter of the venues is fully or partially permissive towards smoking, with the discos/bars/pubs considerably contributing to this situation. Venues with smoking permission policies were less compliant with the legislation. The implementation of a comprehensive smoke-free law, without any exceptions, is essential to effectively protect people from the ...

EVA Hospital Group: Irina Kislaya, Ana Paula Rodrigues, Liliana Dias, Paula Branquinho, Cláudia Mihon, Ana Rita Estriga, Ana Brito, Luís Vale, Helena Pacheco, André Almeida, Helena Amorim, Paula Lopes, Vitor Augusto, Rosa Ribeiro, Regina Viseu, Raquel Guiomar, Pedro Pechirra, Paula Cristovão, Patrícia Conde. ; Erratum in: Acta Med Port. 2021 Jan 4;34(1):70-73. doi:10.20344/amp.15515. Epub 2021 Jan 4. ; Introduction: The project 'Integrated Monitoring of Vaccines in Europe' aimed to measure seasonal influenza vaccine effectiveness against hospitalised adults, aged 65 years and over, with influenza. We describe the protocol implementation in Portugal. Material and Methods: We implemented a test-negative design, targeting community-dwelling patients aged 65 years old and over hospitalised with severe acute respiratory illness. Patients were reverse transverse-polymerase chain reaction tested for influenza. Cases were those positive for influenza while others were controls. Most variables were collected using hospital medical records. Selection bias was evaluated by comparison with the laboratory influenza test requests database according to demographic characteristics. Crude, season-adjusted influenza vaccine effectiveness was estimated as = 1 – odds ratio, and 95% confidence intervals were obtained by conditional logistical regression, matched with the disease onset month. Results: The recruitment rate was 37.8%. Most participants (n = 368) were female (55.8%) and aged 80 years old and over (55.8%). This was similar to values for potentially eligible severe acute respiratory illness patients (80 years old and over: 56.8%, female: 56.2%). The proportion of missing values was below 2.5% for 20 variables and above 5% (maximum 11.6%) for six variables. Influenza vaccine effectiveness estimates were 62.1% against AH1pdm09 (95% confidence intervals: -28.1 to 88.8), 14.9% against A(H3N2) (95% confidence intervals: -69.6 to 57.3), 43.6% against B/Yam (95% confidence intervals: -66.2 to 80.8). Discussion: Given the non-existence of a coded admission database in either participating hospital the selection of severe acute respiratory illness due to clinical features was the feasible one. These results are only valid for the older adult population residing in the catchment area of the two participating hospitals who were admitted to a public hospital with severe influenza or SARI symptoms. Conclusion: Despite the low participation rate, we observed comparable characteristics of participants and eligible severe acute respiratory illness patients. Data quality was high, and influenza vaccine effectiveness results were in accordance with the results of meta-analyses and European season-specific estimates. The final sample size was low, which inhibited obtaining estimates with good precision. ; Introdução: O projeto "Integrated Monitoring of Vaccines in Europe" pretende medir a efetividade da vacina antigripal nas hospitalizações por gripe nos adultos com mais de 65 anos. Este estudo pretende descrever a implementação do protocolo em Portugal. Material e Métodos: Implementou-se um estudo com desenho caso-controlo teste negativo. A população-alvo foram indivíduos com idade superior a 65 anos, hospitalizados com doença respiratória aguda grave. Os doentes foram testados para gripe por reverse transverse-polimerase chain reaction. Foram considerados casos aqueles com resultado positivo; os restantes foram controlos. Os dados foram obtidos através de registo clinicos. O potencial viés de seleção foi avaliado por comparação de características demográficas e enfermarias com dados das requisições laboratoriais. A efetividade da vacina, foi estimada em 1 – odds ratio por regressão logística condicional, emparelhada para o mês de início da doença. Resultados: A taxa de recrutamento foi de 37,8%. A maioria dos participantes (n = 368) era do sexo feminino (55,8%) e tinha idade superior a 80 anos (55,8%). Padrão similar foi verificado nos doentes elegíveis (idade superior a 80 anos: 56,8%; feminino: 56,2%). Os valores omissos foram inferiores a 2,5% em 20 variáveis e acima de 5% (máximo 11,6%) em seis variáveis. As estimativas da efetividade foram 62,1% contra AH1pdm09 (intervalo de confiança IC 95%: -28,1, 88,8); 14,9% contra A (H3) (intervalo de confiança 95%: -69,6; 57,3) e 43,6% contra B/yamagata (intervalo de confiança 95%: -66,2; 80,8). ; Abstract in English, Portuguese ; This work is part of I-MOVE+ (Integrated Monitoring of Vaccines in Europe) project that received funding from the European Union's Horizon 2020 research and innovation programme [grant agreement number 634446]. ; info:eu-repo/semantics/publishedVersion

This report was prepared as part of the Project "Monitoring Influenza vaccine effectiveness during influenza seasons and pandemics in the European Union" and describes the results obtained in Portugal under the Protocol Agreement celebrated between EpiConcept SARL, Paris and National Health Institute Dr. Ricardo Jorge, Lisbon. Data and activities related to the individuals 65 years and more were funded by European Union's Horizon 2020 research and innovation programme under grant agreement no 634446. ; The results to be presented are related to the 8th EuroEVA season (the Portuguese component of the multicentre I-MOVE study) and aimed the estimation of 2015/2016 end of season influenza vaccine effectiveness in i) all age groups and in <65 and 65 plus years ; ii) by risk group; iii) by influenza subtype and clade. Material and methods: The "Protocol for case-control studies to measure seasonal influenza vaccine effectiveness in the European Union and European Economic Area Member States- Portuguese site study version" was implemented entirely adding a new variable related to statin uptake. Also, a pilot study to incorporate genetic characterization of influenza virus from patients enrolled in vaccine effectiveness (VE) study was implemented. Within this pilot study, influenza A(H1)pdm09 positive cases were randomly selected to be genetically characterized. Selection was conducted in three phases of the epidemic: early, peak and late season. Results: In Portugal, a low intensity influenza epidemic occurred between week 53/2015 and week 8/2016. Influenza A(H1)pdm09 virus predominated during all season. Influenza B/Victoria lineage was detected in co-circulation in late season. From the 84 GP's that accepted to participate in the study, 51 GP's effectively participated in the study selecting patients (60.7% participation rate). A total of 336 ILI patients were enrolled and after excluding 26 ILI patients the final sample for analyses consisted on 310 ILI patients (147 cases and 102 controls). From the cases, 89.5% were positive for influenza A(H1)pdm09, 8.9% were positive for influenza B/Victoria and the remaining (1.6%) were positive for influenza A(H3). For genetic characterization of influenza virus, A(H1)pdm09 virus subtype was selected. The HA1 subunit of the hemaglutinin gene were successfully sequenced for 93 out of 126 cases with detected viruses. Phylogenetic analysis and clade assignment were performed. The majority of A(H1)pdm09 viruses belonged to the subgroup 6B.1 (87.1%) and the remaining viruses belonged to 6B clade. Comparing cases and controls, was confirmed that they were statistically different in relation to time between onset and swab collection, sex, seasonal vaccine uptake in 2014/2015, presence of at least one chronic disease and number of GP consultations in last 12 months. For 2015/2016 trivalent influenza vaccine, confounder- adjusted VE against A(H1)pdm09 was 54.0% (95% CI: -1.5; 79.2%) in all population and 63.9% (95% CI: (7.7%; 85.9%) in the target group for vaccination. Considering the population with less than 65 years, VE against AH1pdm09 was 56.2% (95% CI: -17.5%; 83.7%) and 74.9% (95% CI: -37.1; 95.4%) in the and more years of age. Conclusions: VE estimates during 2015/2016 season indicated that the seasonal flu vaccine conferred moderate protection against A(H1)pdm09 (varied between 54% to 64% considering all population and the target group for vaccination). The vaccine had a better performance in the elderly, where VE point estimates reached 75% (not significant nevertheless). The implementation of the genetic characterization pilot study was well succeeded, with a success rate of influenza virus characterization of 80.2%. For future seasons, the high sampling fraction in the first phase should continue in order to assist the definition of the virus subtype/clade target during the season. ; Os resultados apresentados correspondem à implementação da 8ª época do EuroEVA (a componente portuguesa do estudo multicêntrico I-MOVE) e pretende obter estimativas da efetividade da vacina (EV) sazonal 2015/2016 i) em todos os grupos etários e no grupo com idade inferior a 65 e com 65 e mais anos; ii) por grupo-alvo da vacinação e iii) por subtipo de vírus da gripe e por clade. Material e métodos: O "Protocol for case-control studies to measure seasonal influenza vaccine effectiveness in the European Union and European Economic Area Member States- Portuguese site study version" foi implementado na íntegra, acrescentando um nova variável relacionada com a toma de estatinas. De igual modo, foi implementando um estudo-piloto relacionado com a incorporação da caracterização genética dos participantes no estudo da efetividade. Dentro deste estudo-piloto, os casos positivos de A(H1)pdm09 foram aleatoriamente selecionados para caracterização genética, seleção esta que foi conduzida nas três fases do período epidémico: início, pico e fim. Resultados: Em Portugal o período epidémico ocorreu entre as semanas 53/2015 e 8/2016 tendo-se verificado uma atividade gripal de intensidade baixa. Predominou a circulação de vírus do subtipo Influenza A(H1)pdm09 e o vírus Influenza da linhagem B/Victoria co-circulou no final da época. De entre os 84 médicos de família (MF) que aceitaram participar no estudo, 51 reportaram doentes com síndroma gripal (SG), correspondendo a uma taxa de participação de 60,7%. No total foram selecionados 336 doentes com SG. Após exclusão de 26 doentes, a amostra final consistiu em 310 doentes com SG (147 casos e 102 controlos). De entre os casos, 89,5% eram do subtipo A(H1)pdm2009, 8,9% eram positivos para o vírus do subtipo B/Victoria e os restantes (1,6%) para o tipo A(H3). Para efeito de caracterização genética, o subptipo A(H1)pdm09 foi selecionado. A subunidade HA1 do gene da hemaglutinina foi sequenciada com sucesso para 93 dos 126 casos. A maioria dos casos de A(H1)pdm09 pertencia ao subgrupo 6B.1 (87,1%) e os restantes ao subgrupo 6B. Comparando casos e controlos verifica-se que os grupos eram estatisticamente diferentes no que diz respeito, ao tempo entre início de sintomas e colheita, ao sexo, a toma da vacina na época anterior, à presença de doença crónica relevante para vacinação da gripe e ao número de consultas com o MF nos últimos 12 meses. Para a vacina trivalente antigripal 2015/2016 a EV ajustada para confundimento contra o subtipo A(H1)pdm09 foi 54,0% (IC95%: -1,5; 79,2%) na população em geral e 63,9% (IC95%: (7,7%; 85,9%) no grupo alvo da vacinação contra a gripe. Considerando a população com menos de 65 anos, a EV contra o subtipo A(H1)pdm09 foi de 56,2 % (IC 95%: -17,5%; 83,7%), sendo que foi de 74,9% (IC 95%: -37,1; 95,4%) no grupo com 65 e mais anos de idade. Conclusões: As estimativas da EV da época 2015/2016 indicam que a vacina conferiu proteção moderada contra o subtipo A(H1)pdm09 (variou entre 54% e 64%, para a população em geral e para o grupo alvo da vacina, respetivamente). A vacina parece demonstrar uma melhor performance na população mais idosa, onde as estimativas da EV alcançam os 75% (apesar de não estatisticamente significativas). A implementação do estudo piloto foi bem conseguida, com uma taxa de sucesso de caracterização genética de 80,2%. Em épocas futuras, a amostragem na primeira fase deve manter elevada, de modo a assistir à definição do subtipo/clade do vírus a ser caracterizado.

O Departamento de Epidemiologia em conjunto com o Departamento de Doenças Infecciosas do INSA realizaram um estudo, na época de 2009-2010, que teve por objectivo estimar a efectividade da vacina sazonal (em indivíduos com 65 e mais anos) e pandémica (todas as idades). O estudo contou com a participação de: Portugal, Espanha, Irlanda, França, Itália, Hungria e Roménia. Este estudo surge enquadrado no projecto europeu multicêntrico - I-MOVE- Monitoring influenza vaccine efectiveness during influenza seasons and pandemics in the European Union, coordenado pela EpiConcept SARL e financiado pelo ECDC, que pretende estimar a efectividade da vacina sazonal e pandémica durante e após a época de gripe.

Bisphenols are among the chemicals with the highest production volume worldwide and are used to make polycarbonate plastic containers for food use, such as beverage containers and plastic dinnerware, and in the internal coatings of food and beverage cans among other products. According to the scientific literature, small amounts of these compounds migrate from packaging into food resulting in human exposure. Although numerous studies have been carried out in order to assess its effects on human health, there are still uncertainties concerning the possible toxic effects of these compounds. Nevertheless, the most commonly used bisphenol, bisphenol A (BPA), is considered an endocrine disrupting compound. As a consequence, current European legislation prohibits the use of BPA in baby bottles, infant sipping cups and in the coating of food containers for children up to 3 years old and significantly tightens the restrictions on the use of BPA in other food contact materials. This has led to the replacement of BPA by other bisphenols, such as BPS and BPF, whose health effects are still largely unknown. Considering the above and that there is no data on the exposure of the Portuguese population to these compounds, a new project named INSEF-ExpoQuim is currently being developed by the National Health Institute Doutor Ricardo Jorge, in cooperation with the five Regional Health Administrations and the Regional Health Secretariats of the Autonomous Regions of the Azores and Madeira, as part of the European Human Biomonitoring Initiative HBM4EU with the aim to assess exposure to bisphenols in the Portuguese population and contribute to the food risk assessment of bisphenols in Portugal. It is expect that project results will contribute to the reduction of the impact on the health of the Portuguese population that could result from the exposure to these chemicals, by producing high quality data on the actual exposure of the population, in order to support the development and implementation of policy measures aimed at minimizing exposure. ; HBM4EU has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 733032. ; N/A

Introduction: Exposure to hazardous chemicals may endanger human health and pollute the environment. To assess and minimize the risks associated with the use of chemicals it is essential to know whether and to what extent these substances are present in the human body. We report preliminary results of the recruitment phase in the study of Exposure of the Portuguese Population to Environmental Chemicals: a study nested in INSEF 2015 (INSEF-ExpoQuim). Methods: INSEF-ExpoQuim is an epidemiologic study nested in INSEF 2015 targeting 300 non-institutionalized individuals aged 28-39 years, living in Portugal for more than 12 months, able to follow an interview in Portuguese. Fieldwork started in June 2019 and is ongoing. Procedures are according to the guidelines of the HBM4EU project. Selected individuals receive an invitation letter and are later contacted by phone to schedule sample collection and the telephone interview. Urine samples for determination of heavy metals, bisphenols and Polycyclic Aromatic Hydrocarbons are collected, as well as data on socio-demographic characteristics, living conditions and residential history, habits/lifestyle, nutrition, health, occupation and substance specific information covering nearly all exposure pathways. Results: Up to date 384 of the 848 eligible individuals were successfully contacted (45,3%), of which 172 accepted to participate in INSEF-ExpoQuim corresponding to a participation rate of 20%. Conclusions: Results from INSEF-ExpoQuim will contribute to reduce the health impact that could result from the exposure of the population residing in Portugal to environmental chemicals, by producing high quality data on the actual exposure of the Portuguese population to hazardous chemicals, in order to support the development and implementation of policy measures aimed at minimizing exposure to those chemicals. ; HBM4EU has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 733032. ; N/A

Introduction: Health surveys constitute a relevant information source to access the population's health status. Given that survey errors can significantly influence estimates and invalidate study findings, it is crucial that the fieldwork progress is closely monitored to ensure data quality. The objective of this study was to describe the fieldwork monitoring conducted during the first Portuguese National Health Examination Survey (INSEF) regarding protocol deviations and key performance indicators (KPI). Methods: Data derived from interviewer observation and from the statistical quality control of selected KPI were used to monitor the four components of the INSEF survey (recruitment, physical examination, blood collection and health questionnaire). Survey KPI included response rate, average time distribution for procedures, distribution of the last digit in a specific measure, proportion of haemolysed blood samples and missing values. Results: Interviewer observation identified deviations from the established protocols, which were promptly corrected. During fieldwork monitoring through KPI, upon implementation of corrective measures, the participation rate increased 2.5-fold, and a 4.4-fold decrease in non-adherence to standardized survey procedures was observed in the average time distribution for blood pressure measurement. The proportion of measurements with the terminal digit of 0 or 5 decreased to 19.6 and 16.5%, respectively, after the pilot study. The proportion of haemolysed samples was at baseline level, below 2.5%. Missing data issues were minimized by promptly communicating them to the interviewer, who could recontact the participant and fill in the missing information. Discussion/Conclusion: Although the majority of the deviations from the established protocol occurred during the first weeks of the fieldwork, our results emphasize the importance of continuous monitoring of survey KPI to ensure data quality throughout the survey. ; Introdução: Os inquéritos de saúde constituem uma importante fonte de informação para conhecer o estado de saúde da população. Visto que os erros associados aos inquéritos podem afetar significativamente as estimativas, invalidando as suas conclusões, é crucial monitorizar o progresso do trabalho de campo. Este estudo teve como objetivo descrever a monitorização do trabalho de campo realizado durante o primeiro Inquérito Nacional de Saúde com Exame Físico (INSEF) referente a desvios ao protocolo e principais indicadores de desempenho (KPI). Métodos: Dados resultantes da observação dos entrevistadores e do controlo estatístico de qualidade de alguns dos KPI foram utilizados para monitorizar as quatro componentes do inquérito (recrutamento, exame físico; colheita de sangue e questionário de saúde), durante a implementação do trabalho de campo. Os KPI selecionados incluíram a taxa de resposta, distribuição do tempo médio de realização dos procedimentos, proporção do último dígito para medidas específicas, proporção de amostras de sangue hemolisadas e dos valores omissos. Resultados: A observação dos entrevistadores permitiu identificar e corrigir atempadamente desvios ao protocolo. Após a implementação de medidas corretivas, com base na monitorização dos KPI, a taxa de participação aumentou 2,5 vezes e foi observada uma redução de 4,4 vezes na não adesão aos procedimentos padronizados para a medição da pressão arterial. Após o estudo piloto, a proporção de medições com o dígito terminal de 0 ou 5 diminuiu para 19,6% e 16,5%, respectivamente. A proporção de amostras hemolisadas foi inferior a 2,5%. A proporção dos valores omissos foi minimizada comunicando-os imediatamente ao entrevistador, que poderia recontactar o participante e completar a informação. Discussão/Conclusão: Embora a maioria dos desvios ao protocolo tenha ocorrido durante as primeiras semanas do trabalho de campo, os resultados mostram a importância da sua monitorização continua nos inquéritos de saúde de forma a garantir a qualidade dos dados recolhidos. ; INSEF was developed as part of the predefined project of the Public Health Initiatives Program, "Improvement of Epidemiological Health Information to Support Public Health Decision and Management in Portugal. Towards Reduced Inequalities, Improved Health, and Bilateral Cooperation," that benefited from a EUR 1,500,000 grant from Iceland, Liechtenstein and Norway through the EEA Grants and the Portuguese government. ; info:eu-repo/semantics/publishedVersion

Background: The safety issues regarding foods derived from genetically modified (GM) plants are central to their acceptance into the food supply. The potential allergenicity of proteins newly introduced in GM foods is a major safety concern. Objective: We sought to monitor, in potentially sensitive human populations, the allergenicity effects of 5 GM materials obtained from sources with no allergenic potential and already under commercialization in the European Union. Methods: We have performed skin prick tests with protein extracts prepared from transgenic maize (MON810, Bt11, T25, Bt176) and soya (Roundup Ready) samples and from nontransgenic control samples in 2 sensitive groups: children with food and inhalant allergy and individuals with asthmarhinitis. We have also tested IgE immunoblot reactivity of sera from patients with food allergy to soya (Roundup Ready) and maize (MON810, Bt11, Bt176) samples, as well as to the pure transgenic proteins (CryIA[b] and CP4 5-enolpyruvylshikimate- 3-phosphate synthase). Results: None of the individuals undergoing tests reacted differentially to the transgenic and nontransgenic samples under study. None of the volunteers tested presented detectable IgE antibodies against pure transgenic proteins. Conclusion: The transgenic products under testing seem to be safe in terms of allergenic potential. We propose postmarket testing as an important screening strategy for putative allergic sensitization to proteins introduced in transgenic plants. ; Supported by Fundação Calouste Gulbenkian, research project SDH.SP.I.01.11 and by Comissão de Fomento da Investigação em Cuidados de Saúde, research project no. 186/01

<b><i>Background:</i></b> The genetic inter-individual variability of drug response can lead to therapeutic failure or adverse drug reactions (ADRs). The aims of this study were to assess the pharmacogenetic profile of a South Portuguese population according to established dosing guidelines for commonly prescribed drugs and to compare it with that of previously genotyped populations. <b><i>Methods:</i></b> A cross-sectional study was developed in the context of the Portuguese Component of the European Health Examination Survey (EHES). A total of 47 pharmacogenetically relevant variants in 23 different genes were genotyped in 208 participants. Allelic and genotypic frequencies were calculated, and the pharmacogenetic profile of the participants was defined. A comparative analysis was conducted through electronic database search. Pairwise<i> Fst</i> calculations were performed to assess the genetic distance between populations. <b><i>Results:</i></b> We found a significant small differentiation between the Portuguese regional populations regarding <i>CYP2C9 </i>rs1057910<i>, CYP2D6 </i>rs3892097<i>, MTHFR </i>rs1801133 and <i>F5 </i>rs6025. When consid-ering 4 HapMap populations, <i>ADH1B</i> rs2066702,<i> ADH1B</i> rs1229984,<i> NAT2</i> rs1799931 and <i>VKORC1</i> rs9923231 displayed a significant population differentiation. We found that 18.9% of the participants are intermediate or poor metabolizers for at least 3 drugs simultaneously and that 84.6% of the participants have at least one therapeutic failure or ADR risk allele for the considered drugs. <b><i>Conclusions:</i></b> There is a high prevalence of risk alleles associated with an altered drug metabolism regarding drugs largely used by the South Portuguese population. This knowledge contributes to the prediction of their clinical efficacy and/or toxicity, optimizing therapeutic response while improving cost-effectiveness.

In the fifth season of Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE), we undertook a multicentre case–control study (MCCS) in seven European Union (EU) Member States to measure 2012/13 influenza vaccine effectiveness against medically attended influenza-like illness (ILI) laboratory confirmed as influenza. The season was characterised by substantial co-circulation of influenza B, A(H1N1)pdm09 and A(H3N2) viruses. Practitioners systematically selected ILI patients to swab ≤7 days of symptom onset. We compared influenza-positive by type/subtype to influenza-negative patients among those who met the EU ILI case definition. We conducted a complete case analysis using logistic regression with study as fixed effect and calculated adjusted vaccine effectiveness (AVE), controlling for potential confounders (age, sex, symptom onset week and presence of chronic conditions). We calculated AVE by type/subtype. Study sites sent 7,954 ILI/acute respiratory infection records for analysis. After applying exclusion criteria, we included 4,627 ILI patients in the analysis of VE against influenza B (1,937 cases), 3,516 for A(H1N1)pdm09 (1,068 cases) and 3,340 for influenza A(H3N2) (730 cases). AVE was 49.3% (95% confidence interval (CI): 32.4 to 62.0) against influenza B, 50.4% (95% CI: 28.4 to 65.6) against A(H1N1)pdm09 and 42.2% (95% CI: 14.9 to 60.7) against A(H3N2). Our results suggest an overall low to moderate AVE against influenza B, A(H1N1)pdm09 and A(H3N2), between 42 and 50%. In this season with many co-circulating viruses, the high sample size enabled stratified AVE by type/subtype. The low estimates indicate seasonal influenza vaccines should be improved to achieve acceptable protection levels.

Within the Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE) project we conducted a multicentre case–control study in eight European Union (EU) Member States to estimate the 2011/12 influenza vaccine effectiveness against medically attended influenza-like illness (ILI) laboratory-confirmed as influenza A(H3) among the vaccination target groups. Practitioners systematically selected ILI / acute respiratory infection patients to swab within seven days of symptom onset. We restricted the study population to those meeting the EU ILI case definition and compared influenza A(H3) positive to influenza laboratory-negative patients. We used logistic regression with study site as fixed effect and calculated adjusted influenza vaccine effectiveness (IVE), controlling for potential confounders (age group, sex, month of symptom onset, chronic diseases and related hospitalisations, number of practitioner visits in the previous year). Adjusted IVE was 25% (95% confidence intervals (CI): -6 to 47) among all ages (n=1,014), 63% (95% CI: 26 to 82) in adults aged between 15 and 59 years and 15% (95% CI: -33 to 46) among those aged 60 years and above. Adjusted IVE was 38% (95%CI: -8 to 65) in the early influenza season (up to week 6 of 2012) and -1% (95% CI: -60 to 37) in the late phase. The results suggested a low adjusted IVE in 2011/12. The lower IVE in the late season could be due to virus changes through the season or waning immunity. Virological surveillance should be enhanced to quantify change over time and understand its relation with duration of immunological protection. Seasonal influenza vaccines should be improved to achieve acceptable levels of protection. ; ECDC

BACKGROUND: In the third season of I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe), we undertook a multicentre case-control study based on sentinel practitioner surveillance networks in eight European Union (EU) member states to estimate 2010/11 influenza vaccine effectiveness (VE) against medically-attended influenza-like illness (ILI) laboratory-confirmed as influenza. METHODS: Using systematic sampling, practitioners swabbed ILI/ARI patients within seven days of symptom onset. We compared influenza-positive to influenza laboratory-negative patients among those meeting the EU ILI case definition. A valid vaccination corresponded to > 14 days between receiving a dose of vaccine and symptom onset. We used multiple imputation with chained equations to estimate missing values. Using logistic regression with study as fixed effect we calculated influenza VE adjusting for potential confounders. We estimated influenza VE overall, by influenza type, age group and among the target group for vaccination. RESULTS: We included 2019 cases and 2391 controls in the analysis. Adjusted VE was 52% (95% CI 30-67) overall (N = 4410), 55% (95% CI 29-72) against A(H1N1) and 50% (95% CI 14-71) against influenza B. Adjusted VE against all influenza subtypes was 66% (95% CI 15-86), 41% (95% CI -3-66) and 60% (95% CI 17-81) among those aged 0-14, 15-59 and ≥60 respectively. Among target groups for vaccination (N = 1004), VE was 56% (95% CI 34-71) overall, 59% (95% CI 32-75) against A(H1N1) and 63% (95% CI 31-81) against influenza B. CONCLUSIONS: Results suggest moderate protection from 2010-11 trivalent influenza vaccines against medically-attended ILI laboratory-confirmed as influenza across Europe. Adjusted and stratified influenza VE estimates are possible with the large sample size of this multi-centre case-control. I-MOVE shows how a network can provide precise summary VE measures across Europe. ; The authors have no support or funding to report. ; Sí