Meta-Analysis ; Ambient air pollution (AAP) is recognized a cardiovascular risk factor and lipid profile dysregulation seems to be one of the potential mediators involved. However, results from epidemiologic research on the association between exposure to AAP and altered lipid profile have been inconsistent. This study aims to systematically review and meta-analyse epidemiologic evidence on the association between exposure to ambient air pollutants (particulate matter, nitrogen oxides, sulphur dioxide, ozone, carbon monoxide, back carbon) and lipid profile parameters (Total cholesterol; High-Density Lipoprotein Cholesterol; Low-Density Lipoprotein Cholesterol; TG-Triglycerides) or dyslipidaemia. Systematic electronic literature search was performed in PubMed, Web of Science and Scopus databases (last search on 24th May 2019) using keywords related to the exposure (ambient air pollutants) and to the outcomes (lipid profile parameters/dyslipidaemia). Qualitative and quantitative information of the studies were extracted and fixed or random-effects models were used to obtain a pooled effect estimate per each pollutant/outcome combination. 22 studies were qualitatively analysed and, from those, 3 studies were quantitatively analysed. Particulate matters were the most studied pollutants and a considerable heterogeneity in air pollution assessment methods and outcomes definitions was detected. Age, obesity related measures, tobacco consumption, sex and socioeconomic factors were the most frequent considered variables for confounding adjustment in the models. In a long-term exposure scenario, we found a 3.14% (1.36%-4.95%) increase in TG levels per 10 μg/m3 PM10 increment and a 4.24% (1.37%-7.19%) increase in TG levels per 10 μg/m3 NO2 increment. No significant associations were detected for the remaining pollutant/outcome combinations. Despite the few studies included in the meta-analysis, our study suggests some epidemiologic evidence supporting the association between PM10 and NO2 exposures and increased TG levels. Due to the very low level of evidence, more studies are needed to clarify the role of lipid profile dysregulation as a mediator on the AAP adverse cardiovascular effects. ; INSEF was developed as part of the Predefined project financed under 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", with a 1.500.000V Grant from Iceland, Liechtenstein and Norway from EEA Grants and the Portuguese Government. The present study was also funded by the Portuguese Foundation for Science and Technology (FCT) (PhD Scholarship Reference: SFRH/ BD/129426/2017). ; info:eu-repo/semantics/publishedVersion
Ambient air pollution (AAP) is recognized a cardiovascular risk factor and lipid profile dysregulation seems to be one of the potential mediators involved. However, results from epidemiologic research on the association between exposure to AAP and altered lipid profile have been inconsistent. This study aims to systematically review and meta-analyse epidemiologic evidence on the association between exposure to ambient air pollutants (particulate matter, nitrogen oxides, sulphur dioxide, ozone, carbon monoxide, back carbon) and lipid profile parameters (Total cholesterol; High-Density Lipoprotein Cholesterol; Low-Density Lipoprotein Cholesterol; TG-Triglycerides) or dyslipidaemia. Systematic electronic literature search was performed in PubMed, Web of Science and Scopus databases (last search on 24th May 2019) using keywords related to the exposure (ambient air pollutants) and to the outcomes (lipid profile parameters/dyslipidaemia). Qualitative and quantitative information of the studies were extracted and fixed or random-effects models were used to obtain a pooled effect estimate per each pollutant/outcome combination. 22 studies were qualitatively analysed and, from those, 3 studies were quantitatively analysed. Particulate matters were the most studied pollutants and a considerable heterogeneity in air pollution assessment methods and outcomes definitions was detected. Age, obesity related measures, tobacco consumption, sex and socioeconomic factors were the most frequent considered variables for confounding adjustment in the models. In a long-term exposure scenario, we found a 3.14% (1.36%-4.95%) increase in TG levels per 10 μg/m3 PM10 increment and a 4.24% (1.37%-7.19%) increase in TG levels per 10 μg/m3 NO2 increment. No significant associations were detected for the remaining pollutant/outcome combinations. Despite the few studies included in the meta-analysis, our study suggests some epidemiologic evidence supporting the association between PM10 and NO2 exposures and increased TG levels. Due to the very low level of evidence, more studies are needed to clarify the role of lipid profile dysregulation as a mediator on the AAP adverse cardiovascular effects. ; Highlights: Ambient air pollution (AAP) is recognized as a risk factor for cardiovascular diseases; First systematic review and meta-analysis on the association between ambient air pollutants exposure and lipid profile; Some epidemiologic evidence supporting the association between PM10 and NO2 exposures and increased Triglycerides levels; More studies are needed to clarify the association between ambient air pollutants exposure and lipid profile. ; The authors are grateful to all the professionals and participants involved in the INSEF. INSEF was developed as part of the Predefined project financed under 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", with a 1.500.000V Grant from Iceland, Liechtenstein and Norway from EEA Grants and the Portuguese Government. The present study was also funded by the Portuguese Foundation for Science and Technology (FCT) (PhD Scholarship Reference: SFRH/BD/129426/2017). ; info:eu-repo/semantics/publishedVersion
Between 2005 and 2007, important reinforcements of the tobacco legislation have been implemented in Portugal, which may have affected smoking patterns. The aim of this study was to measure the change in prevalence of first- and second-hand smoking (SHS) among adults, and its socio-demographic patterning in Portugal from 2005 to 2014. Data from the last two Portuguese National Health Interview Surveys (2005 and 2014) were used. The changes in daily smoking and SHS were measured using Poisson regressions, stratifying by sex and survey year. The inequalities were measured using relative inequality indexes (RII). From 2005 to 2014, there was a reduction in SHS (75%-54% among men, and 52%-38% among women), and a reduction in smoking among men (27%-26%), and an increase among women (9%-12%). SHS reduction was more marked among less privileged people. Among Portuguese men, inequalities in daily smoking have increased slightly, while among women the gap favoring low-educated reduced. Between 2005 and 2014, SHS decreased, but not daily smoking, particularly among women. Additionally, socioeconomic inequalities in smoking increased. Future policies should simultaneously tackle smoking and SHS prevalence, and their socioeconomic patterning. More comprehensive policies such as comprehensive national (non-partial) bans, combined with price increases could be more effective. ; This study is part of the project SILNE-R "Enhancing the e ectiveness of programs and strategies to prevent smoking by adolescents: a realist evaluation comparing seven European countries", which was funded by the European Union's Horizon 2020 research and innovation program under the SILNE-R Grant Agreement number 635056. ; info:eu-repo/semantics/publishedVersion
Between 2005 and 2007, important reinforcements of the tobacco legislation have been implemented in Portugal, which may have affected smoking patterns. The aim of this study was to measure the change in prevalence of first-and second-hand smoking (SHS) among adults, and its socio-demographic patterning in Portugal from 2005 to 2014. Data from the last two Portuguese National Health Interview Surveys (2005 and 2014) were used. The changes in daily smoking and SHS were measured using Poisson regressions, stratifying by sex and survey year. The inequalities were measured using relative inequality indexes (RII). From 2005 to 2014, there was a reduction in SHS (75%–54% among men, and 52%–38% among women), and a reduction in smoking among men (27%–26%), and an increase among women (9%–12%). SHS reduction was more marked among less privileged people. Among Portuguese men, inequalities in daily smoking have increased slightly, while among women the gap favoring low-educated reduced. Between 2005 and 2014, SHS decreased, but not daily smoking, particularly among women. Additionally, socioeconomic inequalities in smoking increased. Future policies should simultaneously tackle smoking and SHS prevalence, and their socioeconomic patterning. More comprehensive policies such as comprehensive national (non-partial) bans, combined with price increases could be more effective. ; publishersversion ; published
ABSTRACT - 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. ; RESUMO - A saída da vida ativa e a entrada numa fase da vida em as relações e atividades laborais não existem ou são de natureza diferente constituem uma característica da reforma. Alguns estudos têm investigado os efeitos das alterações do estado de saúde na reforma. Outros têm investigado os efeitos da reforma no estado de saúde. Se a reforma for responsável por afetar o estado de saúde, então a implementação de políticas públicas saudáveis, para melhoria da saúde dos adultos idosos, deveriam tê-lo em consideração. Da mesma forma, a implementação de alterações na idade da reforma, tais como aquelas que têm vindo a verificar-se em Portugal, também o deverão ponderar. Constituem objetivos deste trabalho descrever e discutir os estudos que têm sido desenvolvidos para melhoria do conhecimento da relação entre a saúde e a reforma, nomeadamente, entre as doenças crónicas (e saúde percebida) e a reforma, assim como sublinhar a importância da investigação deste tema em Portugal numa perspetiva de Saúde Pública. No que concerne aos efeitos da saúde na reforma, a saúde percebida e as doenças crónicas parecem ter um importante papel para a reforma, apesar de haver menos concordância relativamente às últimas. Por outro lado, as conclusões sobre os efeitos da reforma na saúde não são consensuais, facto que tem sido atribuído às diferenças na natureza de análise (transversal ou longitudinal), do momento de reforma, dos motivos de reforma, e do indicador de estado de saúde sob investigação em diferentes estudos. Relativamente à população Portuguesa, os poucos estudos preconizados focam diferentes indicadores de saúde, tornando difícil atingir uma conclusão comum. Permanece, na verdade, a necessidade de desenvolvimento de estudos sobre esta matéria em Portugal metodologicamente mais válidos, principalmente com a quantificação de medidas de associação e de impacte. ; info:eu-repo/semantics/publishedVersion
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.
This report was prepared as part of the Project "Monitoring Influenza vaccine effectiveness during influenza seasons and pandemics in the European Union", financed by the European Centre for Disease Prevention and Control, and describes the results obtained in Portugal under the Protocol Agreement celebrated between EpiConcept SARL, Paris and National Health Institute Doutor Ricardo Jorge, Lisbon, signed on December 2014. ; Relatório elaborado em julho de 2015. ; [eng] Background: The EuroEVA project is the Portuguese component of the multicentre I-MOVE study. The results to be presented are related to the 7th EuroEVA season and aimed the estimation of 2014-15 end of season influenza vaccine effectiveness in i) all age groups; ii) by risk group; iii) by influenza subtype and thus contribute to monitor VE estimates every year. 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 with no changes to be added. VE was estimated as one minus the odds ratio of being vaccinated in cases versus controls adjusted for confounders by logistic regression. Potential confounders were investigated and included if they changed crude OR estimate in at least 10% after adjustment by the Mantel-Haenszel method. Results: In Portugal, influenza epidemic occurred between week 1/2015 and week 8/2015 and had a medium- high intensity. Both B and A(H3) virus were circulating, but with dominance of the first one. A(H1)pdm09 was only detected sporadically. From the 50 GP's that accepted to participate in the study, 31 GP's effectively participated in the study by selecting patients (which corresponds to a 62% participation rate). A total of 268 ILI patients were enrolled, each GP recruited in average 8.6 patients. After excluding 19 ILI patients the final sample for analyses consisted on 249 ILI patients (147 cases and 102 controls). From the cases, 68% were positive for type B virus, Yamagata lineage, 31% were positive for influenza A (H3) and 1% for A(H1)pdm09. Antigenic and genetic analysis indicated that influenza A(H3) viruses were genetically and antigenically different from the 2014/2015 vaccine strain, most of them belonging to the new virus cluster 3C.2a. Detected influenza B viruses belong to the same lineage (Yamagata) of the strain represented in the 2014/2015 influenza vaccine. Comparing cases and controls, we verified that they were statistically different in relation to: - Age: controls were older than cases (median age in controls was 51 yrs vs. 44 yrs in cases); - Any chronic disease: the prevalence of at least one chronic condition relevant for influenza vaccination was higher in controls (44.1% vs 28.1%); - Seasonal vaccine in 2013-14: controls were more often vaccinated against influenza in the last season than cases (28.4% vs. 12.3%); - Help bathing: controls needed more help for bathing than cases (0% in cases vs 4.1% in controls). Overall results indicated that vaccine coverage (VC) in controls was statistically higher (p<0.001) than in cases (VC controls=30.7% and VC cases=11.0%). Similar results were obtained for the target group for vaccination by the National Health Authorities (VC cases=26.8% and VC controls=54.9%, p=0.003). Restricting the analysis to type B virus (Yamagata lineage), VC was statistically (p=0.001) higher in controls than in cases (30.7% vs 8.1% in all ILI cases and 53.9% vs 20.0% in the target group). After adjustment for age, chronic disease and month of illness onset, VE adjusted estimates in all population was 63.4% (95% CI: 16.2%; 84.0%). In the target group for vaccination, after adjustment, VE estimates was 65.0% (95% CI: 8.1%; 86.7%). Restricting to B Yamagata cases, similar VE estimates were obtained for all population and target group: VE all population = 78.5% (95% CI: 39.5; 92.4); VE target group = 79.6% (95CI: 34.7; 93.6). Although all crude and adjusted VE estimates were statistically significant, low precision was observed. Conclusions: The 2014-2015 season adjusted VE estimates against B/Yamagata was approximately 79% (statistically significant but low precision). No VE estimates against A(H3) were obtained due to small sample size. All influenza B belonged to genetic group 3, different from genetic group 2, represented by B/Massachusets/02/2012 vaccine strain but antigenically these strains are related. This fact is in line with a moderate/high VE for influenza B in 2014-15 season. ; [pt] O projeto EuroEVA (Efetividade da vacina antigripal na Europa) é a componente portuguesa do estudo europeu multicêntrico I-MOVE. Os resultados apresentados correspondem à implementação do estudo EuroEVA na época 2014-2015 e pretende obter estimativas da efetividade da vacina (EV) sazonal 2014-2015 i) na população geral; ii) no grupo alvo para o qual a vacina é recomendada; iii) por tipo/sub tipo de vírus e desta forma contribuir para a monitorização da EV antigripal todas as épocas. 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 implemetado na integra sem alterações a reportar. A efetividade da vacina (EV) foi estimada através de EV=1-OR sendo OR o odd ratio de estar vacinado nos casos vs controlos ajustado fatores de confundimento foram analisados e incluídos se alteraram o odds-ratio bruto em pelo menos 10% após ajustamento pelo método de Mantel Haenszel. Resultados: Em Portugal o período epidémico ocorreu entre as semanas 1/2015 e 8/2015 tendo-se verificado uma atividade gripal média-alta. Verificou-se a co circulação de vírus do tipo B e do sub-tipo A(H3), tendo o primeiro dominado durante a época. Verificou- se ainda a circulação esporádica de vírus do tipo A(H1)pdm09. De entre os 50 médicos de família (MF) que aceitaram participar no estudo, 31 reportaram doentes com síndroma gripal (SG), correspondendo a uma taxa de participação de 62%. No total foram selecionados 268 doentes com SG, em média cada médico recrutou 8,6 doentes. Após exclusão de 19, por não respeitarem a definição de caso de SG, a amostra final para análise consistia em 249 doentes com SG (147 casos positivos e 102 controlos negativos). De entre os casos, 68% eram do tipo B vírus, linhagem Yamagata, 31% eram positivos para o vírus do subtipo A (H3) e 1% para o tipo A(H1)pdm09. A análise genética e antigénica dos vírus influenza A(H3) revelou que na sua maioria pertencem ao novo grupo genético 3C.2a, que se distinguem da estirpe A(H3) contemplada na vacina da época 2014/2015. Os vírus influenza B detetados pertencem à linhagem Yamagata, à semelhança do vírus do tipo B contemplado na vacina da época 2014/2015. Comparando casos e controlos verifica-se que os grupos eram estatisticamente diferentes nas seguintes variáveis: - Idade: os controlos eram mais velhos que os casos (idade mediana nos controlos o era 51 anos vs 44 anos nos casos); - Doença crónica: a prevalência de pelo menos 1 doença crónica com relevância para a infeção por gripe era mais elevada do que controlos (44,1% vs 28,1%); - Toma da vacina na época anterior: os controlos tinham uma história passada de toma da vacina (época 2013/14) mais frequente (28,4% vs. 12,3%); - Incapacidade (Ajuda na toma de banho): os controlos manifestaram em maior percentagem necessidade de ajuda para tomar banho (0% nos casos vs 4,1% nos controlos) De uma forma geral, a cobertura da vacina (CV) sazonal antigripal 2014/15 foi mais elevada (e com significado estatístico, p<0.001) nos controlos (30,7%) do que nos casos (CV=11,0%). Restringindo a análise para o grupo alvo para a toma da vacina de acordo com as Autoridades de Saúde Nacionais, verificaram-se resultados semelhantes (CV casos=26,8% and CV controlos=54,9%, p=0,003). Relativamente à análise por tipo de vírus dominante (vírus do tipo B/ Yamagata), a CV era estatisticamente superior (p=0,001) nos controlos do que nos casos (30,7% vs 8,1% na população geral e 53,9% vs 20,0% no grupo alvo da vacina). Após ajustamento para idade, presença de doença crónica e mês de início de sintomas, a EV ajustada para a população em geral foi de 63,4% (IC95%: 16,2%-84,0%). No grupo alvo da vacina a estimativa ajustada situa a EV em 65,0% (IC95%: 8,1%-86,7%). Restringindo a análise aos casos B/ Yamagata, obtiveram-se valores similares na população em geral e no grupo alvo da vacina: EV população geral = 78,5% (IC95%: 39,5%-92,4%); EV grupo alvo = 79.6% (IC95%: 34,7%-93,6%). Embora ambas as estimativas tenham significado estatístico, a precisão é baixa. ; European Center for disease Prevention and Control
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
Introduction: Human Biomonitoring (HBM) and health studies are very similar in terms of the infrastructure and procedures necessary for their implementation, as in either type of studies data is collected through fieldwork, which constitutes one of the largest expenditures for such studies. Thus, combined studies could result in more cost-effective ways to conduct health and environmental monitoring. As such, within the HBM4EU project an inventory of the health studies available which could include an HBM component was performed. Methods: An online questionnaire was developed to collect information on recently conducted, ongoing and planned health studies, which could be linked to an HBM study. The link to the questionnaire was distributed with the help of the National Hub Contact Points of the HBM4EU project. Results: From the 58 different studies included in this inventory, half were longitudinal and presented the possibility of introducing an HBM component in the future. Most of the studies for which data was reported had public funding, either from the government or from public grants (national or European). The vast majority of the studies included the collection of biological samples and the most frequently stored samples were blood, plasma, serum or DNA. More than 50% of the studies reported that the measurement of chemicals was already performed or was planned to be performed. The most frequently measured chemicals were phthalates, bisphenols and cadmium. Conclusions: In vast majority of the studies included in the inventory biological samples are collected and stored, posing the opportunity to use them in HBM studies for the analyses of chemicals of interest. About 50% of these studies already had ethical approval to measure chemicals from collected samples. Funding: HBM4EU has received funding from the European Union's Horizon 2020 research and innovation programme (grant agreement 733032). ; HBM4EU has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 733032. ; N/A
Regarding the wide genetic and antigenic variability of influenza viruses, overall or subtype influenza vaccine effectiveness (IVE) estimates may not be sufficient to assess vaccine protection against circulating strains. This is particularly important when low VE against a specific clade is suspicious or a new drifted virus is emerging. Viral genetic characterization is routinely performed in influenza surveillance but viruses are selected according patient age, severity and vaccine status. For instance, last season genetic characterized cases were more vaccinated than those not selected. A protocol for virological data integration on IVE studies within I-MOVE network was performed. It intended to solve the following issues: 1. Selection of the clade of interest to provide IVE; 2. Determination of the number of cases needed for genetic characterization; 3. Selection of cases for genetic characterization independently of patient features. During the 2015/16 season, a closely contact between epidemiological and laboratorial teams allows to perform a random selection of influenza cases for genetic characterization independently of cases features. Influenza A(H1N1)pdm09 was the selected subtype given its predominance and the emergence of new subclades (6B.1 and 6B.2). 52.2% of A(H1)pdm09 cases were successfully characterized. No differences regarding age, sex and vaccine status were found between selected and unselected cases for genetic characterization. The large sample size needed to estimate IVE against a specific clade requires an important effort on genetic characterization behind virological surveillance. However, random selection of cases for genetic characterization along season seems to be feasible without interfering with virological surveillance and obtains a representative sample of cases of the clade of interest. Virological data from randomly selected cases will permit to estimate IVE against a specific clade during influenza season. An extra effort on influenza genetic characterization is needed to achieve the needed sample size. ; This project was financed by the European Center for Disease Prevention and Control for data and actvi;es related to the individuals with less then 65 years. Data and activities related to the individuals 65 years and more were funded by European Union's Horizon 2020 research and innova;on programme under grant agreement No 634446. ; N/A
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
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
