26
|
Leite A, Pereira S, Vaz D, Smet T, Portilheiro C, Calé E, Morgado P. Assessing the implementation of population based cervical cancer screening in Amadora, Portugal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Population-based cervical cancer screening (CCS) are deemed to be more cost-effective than opportunistic screening and to reduce inequalities. Implementation in Portugal has been heterogeneous, at the regional level. In Amadora healthcare cluster (Lisbon area), implementation started in April 2018 in a pilot unit and was scaled-up. We aimed to assess population-based CCS implementation in Amadora.
Methods
Population-based CCS targets women aged 30-65, and utilises liquid-based cytology with partial HPV genotyping (HPV16/18 and other high-risk HPV - hrHPV). Samples positive for other hrHPV undergo a cytology. HPV16/18+ and other hrHPV+ with ≥ASCUS (atypical squamous cells of undetermined significance) are referred to colposcopy. We assessed implementation according to key indicators extracted from our information system: geographic coverage, number of tests, positive results, positive predictive value of referral (number of cervical intraepithelial neoplasia-CIN/number colposcopies).
Results
As of 30 August 2019, CCS were in place in 4 of the 9 units, potentially covering 20904 women (48.4% of the target population). 1797 womem performed screening within the programme. Invitation for screening is currently implemented in 1 of the 4 units. Screening results were available for 1702 women, 11,1% were HPV+. From these, 26,5% were HPV 16/18+ and 86.2% positive for other hrHPV. Among the latter, 63.2% were negative for intraepithelial lesion and 36.8% were ≥ASCUS. Overall, of these 189 women, 51.3% (n = 97) were referred for colposcopy. Colposcopy results were available for 37 women, of which 13 had a CIN. PPV of referral was 35.1% (95%confidence interval: 20.7;52.6).
Conclusions
Despite being a population-based screening most tests are still opportunistic. There is still a limited number of colposcopies results but the current PPV of referral is low and requires further investigation. Implementation towards a full population-based screening in Amadora should continue.
Key messages
Implementation of a population-based cervical cancer screening in Amadora, Portugal is underway but most screening tests are still applied in an opportunistic manner. A limited number of results is avaliable to estimate positive predictive value of referral to colposcopy. Results available indicate a value of 35.1%, which requires further investigation.
Collapse
|
27
|
Costa M, Cara d'Anjo A, Cardo M, Leite A. Zoonotic bacteria in the food chain: antimicrobial resistance and associated factors in Portugal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Antimicrobial resistance (AMR) poses a threat to public health and animal food-production plays a crucial role in AMR spread. We thus aimed to characterize AMR profiles and associated factors in zoonotic bacterial isolates in Portugal.
Data from the Portuguese AMR surveillance program on animal populations and derived food, 2014-2018, was used. AMR frequency was described in E coli, Campylobacter and Salmonella isolates from poultry and pigs, according to antibiotic and samples tested. For Salmonella, AMR associated factors were studied: animal populations (broilers, laying hens, pigs) and derived meat, sampling stage (farm, slaughterhouse, processing plant), sample type (environmental, carcase, food), sampler (HACCP, industry, official, official and industry), sample context (control and eradication programmes, monitoring), year (2014-2018) and season. Logistic regression was applied to estimate crude (OR) and adjusted odds ratio (aOR) with 95% confidence intervals (95%CI). The final model was obtained using a backward stepwise method.
We assessed 2157 E Coli, 561 Campylobacter and 826 Salmonella isolates. AMR rates were higher to cefepime (91-98%) in E coli in all sample types; cefotaxime (100%) in E coli in broiler's meat; nalidixic acid (79-96%) in E coli and Campylobacter in poultry and derived meat; ciprofloxacin (50-98%) in all bacteria isolates from poultry and derived meat. For Salmonella, AMR was more likely in pig's meat (OR 3.66; 95%CI:1.19-2.82), slaughterhouses (OR 10.18; 95%CI:4.69-26.70), carcases (OR 5.90;95%CI:3.74-9.69). The final model indicated a lesser chance of AMR in laying hens (aOR .21; 95%CI:.11-.37), industry sampling (aOR .25; 95%CI:.07-.73), 2018 (aOR .24; 95%CI:.13-.42), and a higher chance in summer (aOR 2.39; 95%CI:1.34-4.28).
The findings support the need for control measures on the use of key antibiotics in veterinary medicine. AMR occurrence in Portugal seems to be related to summer, although less in laying hens and in 2018.
Key messages
AMR in bacterial isolates suggests the need for integrated actions to mitigate and control the use of 3rd and 4rd generation cephalosporins, fluoroquinolones and quinolones in animal production. AMR occurrence in Portugal seems to be further related to summer conditions, while comparing to other seasons.
Collapse
|
28
|
Kislaya I, Leite A, Machado A, Tolonen H, Torres A, Nunes B. Bias correction in self-reported high blood pressure prevalence based on objectively measured data. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Reliable and precise estimates of high blood pressure (HBP) prevalence are essential to inform decision-making and policies evaluation. Self-reported HBP may be underestimated by surveys due to misclassification of health status by participants. Misclassification may lead to inaccurate inference. We aimed to assess a feasibility of correcting misclassification bias in self-reported HBP in the Portuguese component of the European Health Interview Survey (INS2014) using data on objective blood pressure measurements from a smaller health examination survey (INSEF).
Methods
We assumed that “true” measured HBP status was missing at random for INS2014 participants (n = 13937). Using a multiple imputation method of logistic regression for monotone missing data patterns, HBP was imputed for INS2014 sample. Auxiliary data on measured HBP from INSEF (n = 4910) was used. Crude and corrected HBP prevalence rates stratified by sex and age group were calculated.
Results
HBP prevalence based on INS2014 increased significantly after multiple imputation correction, from 22.0% [CI95%:20.6-23.5%] to 38.8% [35.4-41.9%] for men and from 26.8% [25.3-28.3%] to 33.0% [30.5-35.4%] for women. Corrected estimates were similar to the objectively measured from INSEF, 39.6% for men and 32.7% for women. Corrected HBP prevalence in INS2014 increased from 4.1% [2.9-5.9%] to 7.9% [4.0-11.8%] in 25-34 years old (yo); from 9.3% [7.8-11.0%] to 17.6% [14.0-21.3%] in 35-44 yo; from 22.5% [20.3-24.8%] to 38.7% [34.2-43.2%] in 45-54 yo; from 39.8% [37.2-42.4%] to 53.8% [49.1-58.5%] in 55-64 yo and from 54.3% [51.5-57.1%] to 67.7% [63.1-72.3%] in 65-74 yo. Corrected rates were similar to the obtained by INSEF (5.7%, 17.0%, 35.8%, 54.8% and 71.3%, respectively).
Conclusions
Our results highlight the importance of bias analysis when using self-reported data on HBP. Multiple imputation is a feasible approach to adjust misclassification bias in health outcomes collected by population surveys.
Key messages
The magnitude and direction of misclassification bias in self-reported health outcomes should be investigated. Multiple imputation is a feasible approach to misclassification bias correction in self-reported survey data.
Collapse
|
29
|
Leite A, Soares P, Santos J, Nunes C. Delays in the diagnosis of pulmonary tuberculosis in critical and non-critical areas in Portugal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Delays in diagnosing tuberculosis lead to longer infectious periods, posing a challenge in tuberculosis control. This is particularly relevant in high incidence areas (critical). Thus, the objectives of this work were to characterize tuberculosis diagnosis delay and its components (patient delay and health delay) in incidence critical and non-critical areas in Portugal, as well as associated factors.
Methods
Notified cases of pulmonary tuberculosis diagnosed due to symptoms (passive screening) in the Portuguese Tuberculosis Surveillance System were analysed (2008-2017). Patient, health and overall delays were calculated. Factors associated with each delays' components were identified utilising Cox regression, while adjusting for sex, age and education level. Analyses were stratified by area type (critical and non-critical).
Results
Median (1st-3rd quartile - Q1-Q3) delays in patient, health and overall delay in critical areas were: 40 (Q1-Q3: 21-76), 8 (Q1-Q3:1-31), and 65 (Q1-Q3: 40-105) days, respectively; similar delays in non-critical areas were 32 (Q1-Q3:16-63); 9 (Q1-Q3: 1-34) and 58 (Q1-Q3: 35-98), respectively. More recent cases, adults younger than 65 years and alcoholic presented longer patient delays (both areas); healthcare professionals and patients with HIV infection presented shorter patient delays (only critical areas). Tuberculosis high-risk groups (males, alcohol dependency, homelessness, community residency) presented shorter health delays in both areas; drug use also presented shorter health delays but only in critical areas. Existing comorbidities was associated with longer health delays in both areas.
Conclusions
Patient delays increased between 2008 and 2017. Groups with longer/shorter delays differed between delay type and area type. Intervening in tuberculosis diagnosis delays requires different action for critical and non-critical areas, targeting health literacy from the general population and training of healthcare professionals.
Key messages
Delays in diagnosing in Portugal are mainly driven by delays in patient seeking care and are longer in areas of higher tuberculosis incidence. Intervening in tuberculosis diagnosis delays in Portugal requires different action in different areas, targeting health literacy in the general population and training of professionals.
Collapse
|
30
|
Pinto de Oliveiraa A, Gautier D, Nunes P, Correia V, Leite A, Taylor H, Pinto de Oliveira A, Curado A. First year of implementation of a drug consumption room in Lisbon: the client’s profile. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
Drug consumption rooms (DCR) are in place for more than three decades in Europe and have been proven to be effective as a public health response. However, their implementation remains slow and controversial in many countries. In Portugal, despite being legal since 2001, the first DCR only came into reality in 2019 by the initiative of the City Council of Lisbon.
Description of the Problem
These Programs are aimed at high risk users with a very fragile social and health situation and for that reason usually they adopt a integrate model of care, offering other services behind supervised consumption: basic healthcare, social support, rapid testing and referral to other services. In context of the first year of implementation of a mobile DCR in Lisbon, we intend to investigate if the program was able to reach those at higher risk. Service data collected between April and December 2019 was used to define the client's profile.
Results
The data collected by the program indicates that the vast majority of registered users are men, over 40 years old and homeless. Most users have already been tested for HIV and viral hepatitis in their lifetime, however, there are still barriers in accessing and utilizing specialized care. We also observed high risk practices: injecting in public spaces, groin injection and high rates of benzodiazepine injection.
Lessons
The mobile DCR in Lisbon was able to reach those users at greater risk, both by the pattern of consumption, and by the social and health situation in which they find themselves.
Key message
DCR combined with other harm reduction responses and health services can contribute to improve the health of a very marginalized group of users.
Collapse
|
31
|
Leite A, Santos AJ, Silva S, Nunes B, Mexia R, Rodrigues AP. Assessing the use and understanding of the Portuguese heat-health warning system (ÍCARO). J Public Health (Oxf) 2020; 42:395-402. [PMID: 32166309 DOI: 10.1093/pubmed/fdaa029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/29/2020] [Accepted: 02/05/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Heatwaves can lead to increased mortality. In the Portuguese heat-health warning system (HHWS), ÍCARO, a daily report with heat-related mortality prediction is sent to heat-health action plan (HHAP) practitioners. HHAP practitioners assess risk and implement measures to prevent heatwave-related impact, but ÍCARO's use and understanding are unknown. We assessed ÍCARO's use and understanding by key HHAP practitioners. METHODS We conducted semi-structured interviews with national/regional HHAP practitioners. Interviews were recorded, transcribed and analysed using thematic content analysis. To maximize credibility a validation process was implemented through researcher triangulation; a sample of 30 segments was recorded by independent researchers. RESULTS We conducted six interviews with nine professionals (mean time 52 min) from five regions. We identified four categories: report's content and presentation, report's reception and communication, ÍCARO and risk assessment and other issues. Practitioners use ÍCARO and perceived it as relevant; they raised issues on its interpretation and felt these were not fully addressed, given researchers' use of statistical/epidemiological terms. We identified the need for improved communication and report's clarity. CONCLUSIONS Our study stresses the need for collaboration between experts within HHWS/HHAP. Despite ÍCARO's understanding being challenging, practitioners consider it a relevant tool. Researchers should use less statistical language and clarify ÍCARO's interpretation. Practitioners' needs should be considered when developing/revising tools.
Collapse
|
32
|
Borges-Canha M, Neves JS, Mendonça F, Silva MM, Costa C, Cabral PM, Guerreiro V, Lourenço R, Meira P, Salazar D, Ferreira MJ, Pedro J, Leite A, Viana S, Sande A, Belo S, Lau E, Freitas P, Carvalho D. The Impact of Bariatric Surgery on Hepatic Function and Predictors of Liver Steatosis and Fibrosis. Obes Surg 2020; 30:2935-2941. [DOI: 10.1007/s11695-020-04622-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
33
|
Almeida V, Constante D, Leite A, Almeida IF, Rocha JC, Sá R, Teixeira M, Teixeira A. Influence of disease phase on embitterment and emotional dysregulation in psoriatic patients. PSYCHOL HEALTH MED 2020; 26:242-259. [PMID: 32216602 DOI: 10.1080/13548506.2020.1741655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study aimed to evaluate the psychosocial differences between patients with psoriasis in different phases of the disease. Seventy-one patients in exacerbation and 83 in remission were evaluated regarding sociodemographic, clinical and psychological variables, on the premise that the visibility of lesions (exacerbation phase) may impact the emotional regulation and embitterment. A regression analysis was performed to identify the variables that contribute to explain embitterment: a diagnosis of anxiety and/or depression and psoriasis severity are the identified ones. The results point to higher values of emotional dysregulation and embitterment, as well as more critical clinical variables in patients with active disease, namely, alcohol and coffee consumption, smoking and less satisfaction with current treatment, more diagnoses and more family history of anxiety and depression, more psychology/psychiatry consultations and more use of anxiolytics and antidepressants. However, only the results referring to alcohol consumption and embitterment are significantly higher in subjects in the exacerbation phase of the disease. Particular clinical attention should be provided to patients in exacerbation phase regarding psychotherapeutic approach.
Collapse
|
34
|
Borges-Canha M, Neves JS, Mendonça F, Silva MM, Costa C, Cabral PM, Guerreiro V, Lourenço R, Meira P, Salazar D, Ferreira MJ, Pedro J, Leite A, Von-Hafe M, Vale C, Viana S, Sande A, Belo S, Lau E, Freitas P, Carvalho D. Thyroid Function and the Risk of Non-Alcoholic Fatty Liver Disease in Morbid Obesity. Front Endocrinol (Lausanne) 2020; 11:572128. [PMID: 33193088 PMCID: PMC7655985 DOI: 10.3389/fendo.2020.572128] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/02/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An association between hypothyroidism and the risk of Non-alcoholic Fatty Liver Disease (NAFLD) has been suggested. This association remains to be elucidated in patients with morbid obesity. AIM To evaluate the association between thyroid function and parameters of liver function and hepatic scores in patients with morbid obesity. METHODS Patients with morbid obesity followed in our center between January 2010 and July 2018 were included. The ones without evaluation of liver and thyroid functions were excluded. Fatty Liver Index (FLI) and BARD scores were used as predictors of hepatic steatosis and fibrosis, respectively. RESULTS We observed a positive association between TSH and both BARD (OR 1.14; p = 0.035) and FLI (OR 1.19; p = 0.010) in the unadjusted analysis. We found a negative association between free triiodothyronine levels and BARD (OR 0.70; p<0.01) and a positive association between free triiodothyronine levels and FLI (OR 1.48; p = 0.022). Concerning liver function, we found a positive association between total bilirubin and free thyroxine levels (β = 0.18 [0.02 to 0.35]; p = 0.033) and a negative association between total bilirubin and free triiodothyronine levels (β = -0.07 [-0.14 to -0.002]; p = 0.042). CONCLUSION Higher levels of TSH and free triiodothyronine may be associated with a higher risk of NAFLD, particularly steatosis, in patients with morbid obesity.
Collapse
|
35
|
Freire Rodrigues E, Leite A, Cabral M, Duarte G, Marques AP, Cale E, Silva AC. Local Tuberculosis Georeference: a tool to define BCG vaccination in high-incidence area in Portugal. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
Tuberculosis (TB) incidence in Portugal is < 20/100000 people, with high-incidence municipalities in urban areas such as Amadora. In 2016, the national vaccination programme moved the BCG vaccine from universal to restricted risk groups. Amadora, due to the higher-incidence area, maintained a universal vaccination policy. Recently, it was hypothesized that vaccination could be applied to specific parishes even in high incidence counties.
Description
We aimed to identify specific geographic areas with higher risk of TB to help redefine the local BCG vaccination policy. We proposed to georeference active TB cases between 2015 and 2017, in Amadora, to then assess the incidence per parish and statistical section. We also aimed at identifying geo-clusters and density of cases.
Methods
(1) notified TB cases from 1 January of 2015 to 31 December 2017 were extracted from TB surveillance system; (2) cases of latent TB infection (LTBI), cases out of Amadora’s bounds and without national ID were excluded; (3) ArcGis®Online and associated maps were used to provide populational estimates; (4) cumulative incidence was calculated per year and averaged for the 3-year period; (5) Clusters were determined using distance and simple density of cases was calculated using Kernel algorithm.
Results
Considering the 6 parishes of Amadora, the 3-year cumulative incidence varied from 19.58 to 38.3 per 100000 hab. The highest incidence was found on the parish with the best socio-economic profile. 14 geo-clusters were mapped; 3 matched known deprived neighborhoods. Overall density was higher in these neighborhoods.
Lessons
With this approach we found that deprived neighborhoods had higher levels of case density, but 3-year cumulative incidence was higher on the parish considered to have low occurrence of TB. As such, and due to the intense population flows in Amadora, the local public health unit recommended the persistence of BCG vaccination to all residents of the municipality.
Key messages
Georeferecing supported our recommendation to mantain a universal BCG vaccination policy. Georeferencing associated to surveillance systems is highly useful to ensure evidence based public health practices, even at the local level.
Collapse
|
36
|
Leite A, Santos AJ, Silva S, Nunes B, Mexia R, Rodrigues AP. Assessing the use and understanding of the Portuguese Heat–Health Warning System (ÍCARO). Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heatwaves can lead to increased mortality. Portugal has a Heat-Health Warning System (HHWS) in place (ÍCARO system). Researchers at the Instituto Ricardo Jorge send a daily report with heat-related mortality forecasts to key stakeholders (e.g. Heat-Health Action Plans (HHAP) staff). HHAP practitioners issue warnings and implement measures to prevent heatwaves-related mortality. ICARO is amongst the recommended data sources to assess risk and issue warnings but its use and understanding is unknown. Therefore, we aimed to assess ÍCARO’s use and understanding by key HHAP practitioners.
Methods
We conducted semi-structured interviews with national and regional HHAP practitioners. Interviews were recorded, transcribed, and analysed using thematic content analysis. Intercoder reliability was applied to a sample of segments from 5 of 6 interviews.
Results
We conducted 6 interviews with 9 professionals (mean time 52 minutes). We identified 4 categories: Report’s content and presentation, Report’s reception and communication, ÍCARO and risk assessment, Other issues. Practitioners use ÍCARO and perceived it as very relevant tool. However, they mentioned several questions on its interpretation. Practitioners also felt their questions were not fully answered, given researchers’ use of statistical terms. Finally, practitioners referred the need to assess risk at the local level, information not currently provided. We also identified the need for improved communication and report’s clarity.
Conclusions
Our study stresses the need for an integrated collaboration between experts within HHWS and HHAP. Despite ICARO’s understanding being challenging, practitioners consider it a relevant tool. Researchers should use less statistical language and clarify ÍCARO interpretation. Practitioners’ needs should be considered when developing or revising tools. We are currently implementing some of these recommendations in an attempt to close the gap between researchers and practitioners.
Key messages
Portuguese Heat–Health Action Plans practitioners use heat-related mortality forecasts (ICARO) and perceived it as very relevant instrument. However there find ICARO’s interpretation challenging. Portuguese Heat/Health Action Plans Practitioners’ needs should be considered when revising or developing tools, and notes should be added to clarify statistical/technical concepts.
Collapse
|
37
|
Cabral M, Leite A, Freire Rodrigues E, Vaz D, Calé E, Silva A. Benefits from a tabletop exercise in a Heat-Health Action Plan in Amadora, Portugal. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Issue
National guidelines for Heat-Health Action Plans (HHAP) in Portugal exist since 2004. These guidelines are further developed and implemented at Local Public Health Units (LPHU) together with local partners. Tabletop exercises are a useful tool to improve preparedness. Despite the long experience with HHAP there has not been any tabletop exercise in Amadora.
Description
Amadora’s LPHU organized a tabletop exercise with local partners to improve HHAP preparedness (12th July 2018). It included: LPHU, city hall, civil protection services, local social services, primary healthcare services, local public hospital, and firefighters. The exercise hypothesized a scenario of an unprecedented increase of temperature for an extended period of time, activating the highest level of warning (red) and action in the HHAP.
Results
During the exercise several issues were identified. Some partners were not clear about the pathway established for red warnings and partners were not aware of relevant HHAP activities. Also, from the 8 sites listed as climate shelters, only 2 were deemed as adequate for using in this scenario, even though they have been listed for several HHAP. Due to the exercise, it was possible to conduct an inspection of said shelters, which hadn’t took place yet due to the lack of resources. It was possible to find out that only one shelter was fit for purpose. Additional private facilities were identified as desirable shelter locations during the exercise. A few weeks later, a red warning was issued and clarification arising from the tabletop exercise was useful to properly implement measures.
Lessons
Despite the perceived frequent and good communication among partners of the HHAP, several issues - mainly regarding the adequacy of shelters - were identified with a tabletop exercise. It also improved preparedness for the following HHAP warning. As such, tabletop exercises should be promoted within HHAP.
Key messages
Despite developing heat-health action plans for several years, with the involvement of community partners, unidentified constraints existed in Amadora, Portugal. Tabletop exercises should be used more frequently, as we were able to identify and solve constraints within our heat-health action plan using one.
Collapse
|
38
|
Leite A, Cabral M, Rodrigues E, Vaz D, Calé E, Silva AC. Evaluating implementation of an Heat-health action plan during 2018 heatwave in Amadora, Portugal. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Issue
Heatwave-health effects are preventable. Heat-health action plans (HHAPs) include preventive measures aimed at protecting population. In Portugal, HHAPs exist since 2004 and have been operationalized at local level. Heatwaves occur infrequently, thus experience with HHAPs is relevant to countries implementing their own HHAPs.
Description
In the summer of 2018, Amadora (Lisbon, Portugal) issued a warning from the 2nd-6th August (highest level:4th-6th). Before/during the warning we implemented: 1.climatized shelter opened available upon request;2.text messages with recommendations and information on the walk-in clinic services available;3.information to nursing homes regarding available services (walk-in services/shelter);4.contact with individuals receiving home support and identified as vulnerable. Nationwide media publicity of individual protection measures was also ongoing. We aimed at evaluating these HHAP measures. We compared demand of walk-in clinic (primary care) and emergency department with existing capacity, updated during the heatwave. Mortality was analysed using an observed-expected ratio (O/E) of week 32 (following the heatwave) and 95% confidence interval (95%CI) under a Poisson distribution. Expected deaths were the average deaths in week 32 of the previous 4 years (2014-17).
Results
In the primary care walk-in clinic the demand was ½ of capacity; hospital emergency services demand did not increase. We had no requests for the shelter unit. Regarding mortality, O/E was 1.57 (95%CI:1.12-2.14). These results are preliminary; we are producing more detailed analyses of mortality data.
Lessons
We have no counterfactual to assess the effect of our HHAP but our results indicate the possibility to reduce heatwaves-mortality further and thus the need for additional measures. We did not observed the expected surge in service demand; the adequacy of supply-based measures is currently under debate. More detailed mortality analysis will provide further insights.
Key messages
We implemented several measures during a heatwave in Amadora, Portugal with no increased demand in available health services in the area. We detected an increased mortality following the heatwave, suggesting the need to implement further measures.
Collapse
|
39
|
Alvarenga C, La Banca R, Leite A, Alvarenga W, Nascimento L, Carvalho E. P12 Concept analysis of health literacy: a nursing diagnosis proposal. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz095.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
40
|
Duarte G, Leite A, Paixão M, Freire Rodrigues E, Capelão H, Cale E, Vaz D, Silva AC. Costs of a School-based intervention in Amadora – are we applying our money wisely? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
41
|
Duarte G, Leite A, Pinho M, Freire Rodrigues E, Capelão H, Cale E, Vaz D, Silva AC. Evaluating interventions in schools - growing experience in Public Health Unit in Amadora, Portugal. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
42
|
Freire Rodrigues E, Leite A, Duarte G, Vaz D, Marques AP, Calé E, Silva AC. Tuberculosis surveillance systems in Portugal: an evaluation in a high incidence area (2016 to 2017). Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
43
|
Deli A, Amodeo V, Betts J, Bartesaghi S, Vouri M, Roshani R, Galavotti S, Zhang Y, Ellis M, Lau J, Oberndorfer S, Leite A, Dinsdale D, Jones C, Nicotera P, Michod D, Brandner S, Salomoni P. An epigenetically controlled PML/Slit axis at the root of cell migration in both normal and neoplastic cells in the CNS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/nox238.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
44
|
Ferreira S, Leite A, Moniz T, Andrade M, Amaral L, de Castro B, Rangel M. EPR and 51V NMR studies of prospective anti-diabetic bis(3-hydroxy-4-pyridinonato)oxidovanadium(iv) complexes in aqueous solution and liposome suspensions. NEW J CHEM 2018. [DOI: 10.1039/c7nj04678b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
EPR/51V-NMR parallel studies of [VO(3,4-HPO)2] complexes in MOPS buffer and POPC liposome suspensions provide information regarding solvents for oral administration.
Collapse
|
45
|
Moniz T, Leite A, Silva T, Gameiro P, Gomes M, de Castro B, Rangel M. The influence of functional groups on the permeation and distribution of antimycobacterial rhodamine chelators. J Inorg Biochem 2017; 175:138-147. [DOI: 10.1016/j.jinorgbio.2017.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/10/2017] [Accepted: 07/16/2017] [Indexed: 10/19/2022]
|
46
|
Leite A, Martins L, Ribeiro P, Silva B, Teles A. Instrument Separation during the Non Surgical Endodontic Treatment. Causes, prevention and clinical approach. J Clin Exp Dent 2017. [DOI: 10.4317/medoral.176438649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
47
|
Pinto S, Leite A, Machado A, Nunes B, Dias C. Trends of tobacco consumption and associated socioeconomic factors in the Portuguese population. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw164.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
48
|
Leite A, Rodrigues S, Pereira E, Paulos K, Oliveira AF, Lorenzo JM, Teixeira A. Physicochemical properties, fatty acid profile and sensory characteristics of sheep and goat meat sausages manufactured with different pork fat levels. Meat Sci 2015; 105:114-20. [DOI: 10.1016/j.meatsci.2015.03.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/14/2015] [Accepted: 03/17/2015] [Indexed: 11/28/2022]
|
49
|
Paulos K, Rodrigues S, Oliveira AF, Leite A, Pereira E, Teixeira A. Sensory Characterization and Consumer Preference Mapping of Fresh Sausages Manufactured with Goat and Sheep Meat. J Food Sci 2015; 80:S1568-73. [DOI: 10.1111/1750-3841.12927] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/05/2015] [Indexed: 11/29/2022]
|
50
|
Cardosoa M, Hernandes M, Moreira D, Pontes F, Simone C, Leite A. Structural Insights Into Bioactive Thiazolidin-4-one: Experimental and Theoretical Data. LETT ORG CHEM 2015. [DOI: 10.2174/1570178612666150203005612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|