Background and Purpose: The association between smoking and CV has been proved; however smoking is still the first preventable cause of death in the EU. We aim to evaluate the potential impact of the smoke ban on the number of ACS events in the Portuguese population. In addition, we evaluate the longitudinal effects of the smoking ban several years after its implementation.Methods. We analyzed the admission rate for ACS before and after the ban using data from hospital admission. Monthly crude rate was computed, using the Portuguese population as the denominator. Data concerning the proportion of smokers among ACS patients were obtained from the NRACS. Interrupted time series were used to assess changes over time.Results. A decline of -5.8% was found for ACS crude rate after the smoking ban. The decreasing trend was observed even after years since the law. The effect of the ban was higher in men and for people over 65 years. The most significant reduction of ACS rate was found in Lisbon.Conclusions. Our results suggest that smoking ban is related to a decline in ACS admissions, supporting the importance of smoke legislation as a public health measure, contributing to the reduction of ACS rate. ; info:eu-repo/semantics/publishedVersion
This document reviews the current policy and legislation instruments and tools in place for delivering public health operations in the WHO European Region. It aims to underpin and complement the European Action Plan for Strengthening Public Health Capacities and Services (EAP). It provides initial findings on the wide spectrum of legal and policy frameworks at regional and global levels discovered by mapping the available public health instruments and tools across 10 essential public health operations (EPHOs). The main findings are that at the global level legally binding instruments and tools are mainly concentrated in EPHO 3 (health protection) with 306 tools, EPHO 4 (health promotion) with 31 and EPHO 6 (governance) with 41. This corresponds to more than 90% of the total number of public health tools. However, there were only 2 tools for EPHO 5 (disease prevention), 3 for EPHO 7 (workforce) and 1 for EPHO 8 (organizational structures and financing). No legally binding tools were found for EPHO 9 (communication) and EPHO 10 (research). For EPHO 1 (surveillance) and EPHO 2 (response to health hazards and emergencies), there is a more balanced use of both legally and nonlegally binding tools. More evidence is needed on the cost–effectiveness of such instruments and tools. In addition, there is a need for greater advocacy, with a balance of regulation and persuasion, on what already exists – such as "best buy" interventions for noncommunicable diseases (NCDs) and the WHO Framework Convention on Tobacco Control (FCTC) – as well as a need to strengthen approaches to intersectoral governance. ; World Health Organization; Instituto Nacional de Saúde Doutor Ricardo Jorge
SciELO: S0870-90252015000200013 ; The exit from active life and the ingress into a life stage in which labour activities and relations do not exist, or could be of a different nature, is a feature of retirement. Several studies have investigated the effects of changes in health upon retirement. Several others have investigated the effects of retirement on health. If retirement is responsible for affecting health, then the implementation of public health policies, aimed at improving older individual's health, should take this matter into account. Similarly, the implementation of political changes in retirement age such as those that we are witnessing in Portugal should be carefully planned. The aim of this work is to describe and discuss the international and national studies conducted to improve the understanding of the relationship between health and retirement,especially between chronic diseases (and self-perceived health) and retirement, and also to highlight the importance of studying this subject from a public health point of view in Portugal. Regarding the effects of health on retirement, self-perceived health seems to have a relevant effect on retirement, as well as chronic diseases, although there is less agreement in the latter case. Findings on the impact of retirement in health are not consensual and it is thought that the nature of the analysis (cross-sectional or longitudinal), the timing and the reason for retirement, the circumstances of an individual before and after retirement and the health measure under research could be primarily responsible for the lack of consistency among studies. Concerning the Portuguese population, the few studies found about health and retirement are focused in different health status indicators, making it difficult to reach a general conclusion. Thus the need remains for the establishment of more methodologically valid research studies in Portugal, mainly epidemiologic studies involving the quantification of association and impact measures. ; publishersversion ; published
BACKGROUND: The InfAct (Information for Action) is a Joint Action of the European Commission's 3rd Health Programme with the main goal to build an infrastructure of a health information system for a stronger European Union and to strengthen its core elements. The InfAct Joint Action was developed along 36 months and structured in 10 work packages. Portugal co-led the Work Package 6 (WP6) of this project, which included the development of the proposal of a flagship capacity building programme - the European Health Information Training Programme - and its evaluation. The evaluation objectives included: to evaluate the adequacy of the training programme to the health information needs in the European Member States; to identify possible changes regarding the participants selection process, the training activities and the pedagogical project; and to contribute to the understanding of the potential of the programme to add to available offers in learning on the topics of Public Health information, on the capacity building and behavioural changes in Public Health activities which can be attributed to the course, and of the potential of the programme to contribute to the alignment of health information criteria and procedures between the European Member States. METHODS: The evaluation process was developed using an observational descriptive study design using a mixed methodological approach with both document analysis and primary data collected by questionnaires and interviews analysis. Mixed quantitative and qualitative data collection methods and analysis were used. RESULTS: The proposal of the European Health Information Training Programme seemed adequate to the formative needs and capacities in line with the work performed by the InfAct project. In what concerns about its main thematic areas, it was also aligned with the areas identified in the previous formative needs and capacities mapping. The participants selection process proposed seemed, in general, adequate. The potential of the European Health Information ...
The InfAct (Information for Action) project is a Joint Action of the European Commission's 3rd Health Programme, which includes 28 EU Member States and Associated Countries. The main goal of InfAct is to build an infrastructure of a health information system for a stronger European Union and to strengthen its core elements. Its vision is to improve the use of health data and information for a healthier Europe. Portugal co-leads the Work Package 6 (WP6) of this project, through a team of professionals from the Directorate-General of Health (who coordinates), the Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon and the National Institute of Health Doctor Ricardo Jorge. WP6 includes, among other tasks, the development of a Flagship Capacity Building Programme and its evaluation. The proposal of the programme was presented through the document "InfAct - Sustainable Capacity Building Programme (European Health Information Training Programme - EHITP), Task 6.2 – February 2020". ; H2020 EU 801553 InfAct ; 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
Abstract publicado em: Dev Med Child Neurol. 2021 Oct;63(S3):104-105. https://onlinelibrary.wiley.com/toc/14698749/2021/63/S3 ; Background and Objective(s) People with conditions affecting their health and their ability to be autonomous and socially included are particularly sensitive to sudden, severe disturbances of the social environment, especially if they also affect formal and informal caregivers and their infrastructures of support. The voices of these individuals are seldom heard, their needs unattended. People living with cerebral palsy (CP) are paradigmatic of the potentially difficult situation presented by the SARS-CoV2 pandemic. Study Design: Project "Barómetro COVID-19 e Paralisia Cerebral" monitors how the SARS-CoV2 pandemic affects people living with CP, hearing their own voices, through a web-based self-applied, anonymous, mixed-responses survey of people with CP, their relatives, caregivers and cohabitants. It has a common core of questions with "Barómetro COVID-19 Opinião Social" (NOVA National School of Public Health). As a dynamic tool, questions can be added as indicated by the periodical, intermediate analyses. Study Participants & Setting: People living with CP were invited to participate by the Federation of Portuguese Associations for Cerebral Palsy and the Portuguese Surveillance of Cerebral Palsy. The survey is available and ongoing from April 6th 2020. Data from responders self-identified as having CP and data related to them, reported by relatives, cohabitants, caregivers and technicians were considered for this analysis. Data reported until December 26th 2020 were considered. The period includes different legal settings or social restrictions and ends with the beginning of vaccination for Covid-19 in the European Union. Materials/ Methods: Descriptive statistics were applied. Results: Data on the daily life of people having CP were retrieved from 765 surveys (112 filled by individuals with CP and 234 by relatives, caregivers and cohabitants of individuals with CP). Most of the ...
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
<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.
