Purpose – The purpose of this paper is to reflect on how qualitative approaches can improve a prevalence study on older adults' violence. The paper describes how qualitative data can help frame a complex and multidimensional problem, such as older adults' violence, within the culture where it happens and therefore prevent two risks present in prevalence studies: underestimation and overestimation.
Design/methodology/approach – To adequately measure violence and violent behaviours the authors first conducted four focus groups with the target population – older adults aged 60 and over – and 13 in-depth interviews with older adult victims of violence. Through content analysis of focus groups and in-depth interviews the authors sought to understand how violence is perceived, defined and limited by the general population and by victims.
Findings – By employing qualitative methods the authors were able to operationalise violence, decide upon and select specific behaviours to measure, rephrase questions and develop strategies to approach the general population through telephone interviews.
Research limitations/implications – The qualitative approaches helped reduce participants bias in the prevalence study and therefore to minimise the risks of underestimation and overestimation.
Originality/value – The study exemplifies how assessing quantitatively to a sensitive subject requires taking into account the perspective of the target population through a qualitative approach.
Introduction: The metabolic syndrome consists of a set of factors that, when associated, are associated with a higher risk of developing cardiovascular diseases and type 2 diabetes, and is thus an important public health problem. The objective of this study was to estimate the prevalence of this syndrome in the Portuguese population, and to evaluate possible associations with demographic and socioeconomic determinants. Material and Methods: Based on the 1st National Health Survey with Physical Examination of 2015, a cross-sectional epidemiological study was conducted on a representative sample of the Portuguese population (n = 4797) aged between 25 and 74 years old. The prevalence was estimated for the total population and each gender, stratified by age group, health region, type of urban area, marital status, education, professional status, and risk of poverty. The magnitude of the associations was measured with adjusted prevalence ratios. Results: In the Portuguese population the estimated prevalence was 33.4% [95% CI, 31.7 - 35.1] [35.6% in men (95% CI, 31.9 - 39.2) and 31.3% in women (95% CI, 28.5 - 34.2)]. In both genders, the highest prevalence was significantly associated with increasing age, widowed/married/de facto partners and those with lower levels of education. There was no association with gender, health region, type of urban area, professional status or risk of poverty. Discussion: This syndrome was present in a third of the Portuguese population. The knowledge of its epidemiology enables the identification of population groups with higher cardiovascular and metabolic risk. Conclusion: Metabolic syndrome was independently associated with specific groups. This knowledge reinforces the importance of a holistic assessment of the health determinants associated with the metabolic syndrome.
Purpose Psychological elder abuse (PEA) assessment is described with different thresholds. The purpose of this paper is to examine how the prevalence of PEA and the phenomenon's characterisation varied using two different thresholds.
Design/methodology/approach Participants from the cross-sectional population-based study, Aging and Violence (n=1,123), answered three questions regarding PEA. The less strict measure considered PEA as a positive response to any of the three evaluated behaviours. The stricter measure comprised the occurrence, for more than ten times, of one or more behaviours. A multinomial regression compared cases from the two measures with non-victims.
Findings Results show different prevalence rates and identified perpetrators. The two most prevalent behaviours (ignoring/refusing to speak and verbal aggression) occurred more frequently (>10 times). Prevalence nearly tripled for "threatening" from the stricter measure (>10 times) to the less strict (one to ten times). More similarities, rather than differences, were found between cases of the two measures. The cohabiting variable differentiated the PEA cases from the two measures; victims reporting abuse >10 times were more likely to be living with a spouse or with a spouse and children.
Research limitations/implications Development of a valid and reliable measure for PEA that includes different ranges is needed.
Originality/value The study exemplifies how operational definitions can impact empirical evidence and the need for researchers to analyse the effect of the definitional criteria on their outcomes, since dichotomization between victim and non-victim affects the phenomenon characterisation.
Letters to editor ; This study aimed to provide early 2017/2018 seasonal IVE using data from the Portuguese influenza surveillance system. This analysis included patients with influenza-like illness (ILI) from primary care and emergency departments swabbed for the detection of influenza using RT-PCR between weeks 38/2017 to 5/2018. We used the test-negative case–control study design, where influenza laboratory confirmed incident ILI patients (Cases) were compared to laboratory influenza negative ILI patients (Controls). IVE analysis was restricted to ILI patients with symptoms compatible with the European Union ILI definition, i.e., with sudden onset of at least one systemic and one respiratory symptom. Chi-square test was used to compare baseline characteristics between Cases and Controls. Crude IVE, design adjusted for calendar time, was estimated using 1-odds ratio (OR) of being vaccinated in Cases vs. Controls and was further adjusted for confounding by age group and presence of chronic condition.A total of 732 ILI patients were reported to the NISS and approximately 74% adhered to the ILI definition. In a season with B/Yamagata dominance and with vaccine lineage mismatch, the 2017/2018 trivalent seasonal influenza vaccine conferred moderate protection against medically attended influenza. The use of surveillance data constituted a useful tool to have early in the season IVE estimates. These results assist modifications to health interventions, such as using antiviral treatment in high-risk patients, reinforcement of social eviction and individual hygiene measures to reduce risk of influenza transmission, regardless of the vaccination status. ; info:eu-repo/semantics/publishedVersion
Background: Pneumonia is one of the leading causes of mortality and has a high burden in morbidity. In Portugal, 7-valent pneumococcal conjugated vaccine (PCV) was used since 2001 and PCV10/13 since 2009, being the last introduced into the National Immunization Program in 2015. Methods: We conducted an ecological study to evaluate the impact of PCV7 and PCV13 on pneumococcal pneumonia (PP) hospitalizations in adults aged 65 years or more in Portugal. National hospital discharge registry data from 1998/99 to 2015/16 were used, and PP hospitalization was defined as any hospitalization coded in primary diagnosis as 481 (ICD-9-CM) or J18 (ICD-10-CM). Poisson regression models adjusted for seasonality, influenza-like illness and allowing for overdispersion was used to estimate annual average change of PP hospitalization rate. To assess PP hospitalization trends before and after PCV7 and PCV13 introduction interrupted time series analysis was performed. Results: In 1998/99 PP hospitalization rate was 7.0 per 10,000 inhabitants, varying between 3.2 (females, 65-74 years) to 20.7 (males, +85 years), and annually increasing by 16% during the pre-PCV7 period. Statistically significant reduction of 14% per year in PP hospitalization rate was observed after PCV7 introduction. Between 2004/05 and 2009/10 PP hospitalization rate decreased annually by 4% and after PCV13 introduction by 11% per year. In 2015/16 we found an overall reduction of 2.9 (CI 95%: 2.7; 3.1) PP hospitalizations per 10,000 inhabitants (598 hospitalizations) attributable to PCV13, varying from 2.2 (CI 95%: 1.3; 3.1) (female, 65-74 years) to 5.6 (CI 95%: 3.8; 7.5) (female, +85 years). Conclusions: Our results suggest that introduction of both PCV7 and PCV13 vaccines resulted in the reduction of PP hospitalizations rates among older adults. ; The IMOVE+ project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 634446 ; info:eu-repo/semantics/publishedVersion
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
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
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
Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6807025/pdf/main.pdf ; Introduction: Influenza A(H3N2) viruses predominated in Europe in 2016–17. In 2017–18 A(H3N2) and A(H1N1)pdm09 viruses co-circulated. The A(H3N2) vaccine component was the same in both seasons; while the A(H1N1)pdm09 component changed in 2017–18. In both seasons, vaccine seed A(H3N2) viruses developed adaptations/alterations during propagation in eggs, impacting antigenicity. Methods: We used the test-negative design in a multicentre primary care case-control study in 12 European countries to measure 2016–17 and 2017–18 influenza vaccine effectiveness (VE) against laboratory-confirmed influenza A(H1N1)pdm09 and A(H3N2) overall and by age group. Results: During the 2017–18 season, the overall VE against influenza A(H1N1)pdm09 was 59% (95% CI: 47–69). Among those aged 0–14, 15–64 and ≥65 years, VE against A(H1N1)pdm09 was 64% (95% CI: 37–79), 50% (95% CI: 28–66) and 66% (95% CI: 42–80), respectively. Overall VE against influenza A(H3N2) was 28% (95% CI: 17–38) in 2016–17 and 13% (95% CI: -15 to 34) in 2017–18. Among 0–14-year-olds VE against A(H3N2) was 28% (95%CI: -10 to 53) and 29% (95% CI: -87 to 73), among 15–64-year-olds 34% (95% CI: 18–46) and 33% (95% CI: -3 to 56) and among those aged ≥65 years 15% (95% CI: -10 to 34) and -9% (95% CI: -74 to 32) in 2016–17 and 2017–18, respectively. Conclusions: Our study suggests the new A(H1N1)pdm09 vaccine component conferred good protection against circulating strains, while VE against A(H3N2) was <35% in 2016–17 and 2017–18. The egg propagation derived antigenic mismatch of the vaccine seed virus with circulating strains may have contributed to this low effectiveness. A(H3N2) seed viruses for vaccines in subsequent seasons may be subject to the same adaptations; in years with lower than expected VE, recommendations of preventive measures other than vaccination should be given in a timely manner. ; This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement no. 634446 to conduct the study in individuals aged 65 years or more. ECDC has contributed funds for the coordination and some study sites under the Framework contract no. ECDC/2014/026 for the individuals aged less than 65 years. The WHO Regional office for Europe has contributed funds for the Romanian study site ; info:eu-repo/semantics/publishedVersion
We measured COVID-19 vaccine effectiveness (VE) against symptomatic SARS-CoV-2 infection at primary care/outpatient level among adults ≥ 65 years old using a multicentre test-negative design in eight European countries. We included 592 SARS-CoV-2 cases and 4,372 test-negative controls in the main analysis. The VE was 62% (95% CI: 45-74) for one dose only and 89% (95% CI: 79-94) for complete vaccination. COVID-19 vaccines provide good protection against COVID-19 presentation at primary care/outpatient level, particularly among fully vaccinated individuals. ; This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 101003673. ; Sí
As the COVID-19 pandemic began in early 2020, primary care influenza sentinel surveillance networks within the Influenza - Monitoring Vaccine Effectiveness in Europe (I-MOVE) consortium rapidly adapted to COVID-19 surveillance. This study maps system adaptations and lessons learned about aligning influenza and COVID-19 surveillance following ECDC / WHO/Europe recommendations and preparing for other diseases possibly emerging in the future. Using a qualitative approach, we describe the adaptations of seven sentinel sites in five European Union countries and the United Kingdom during the first pandemic phase (March–September 2020). Adaptations to sentinel systems were substantial (2/7 sites), moderate (2/7) or minor (3/7 sites). Most adaptations encompassed patient referral and sample collection pathways, laboratory testing and data collection. Strengths included established networks of primary care providers, highly qualified testing laboratories and stakeholder commitments. One challenge was the decreasing number of samples due to altered patient pathways. Lessons learned included flexibility establishing new routines and new laboratory testing. To enable simultaneous sentinel surveillance of influenza and COVID-19, experiences of the sentinel sites and testing infrastructure should be considered. The contradicting aims of rapid case finding and contact tracing, which are needed for control during a pandemic and regular surveillance, should be carefully balanced.
