The number of cancers attributable to tobacco by sex, in mainland Portugal, in 2008

Background

In Portugal, cancer incidence increases annually about 3%. In 2016, cancer was the first cause of premature death, corresponding to 5 296.8 DALYs/100,000 inhabitants. The aim of this study is to estimate the number of cancers attributable to tobacco in mainland's Portugal by sex.

Methods

An observational, ecological, analytic study was performed. Data was collected by sex: tobacco consumption (current or past) in mainland Portugal resident population older than 20 years, in 1998; incidence of 12 types of cancer, by location: Esophagus (C15), Stomach (C16), Colon (C18), Rectum (C20), Liver (C22), Pancreas (C25), Larynx (C32), Lung (C34), Kidney (C64) and Bladder (C67), according to the ICD-10 classification, in 2008. The population attributable fraction (PAF), for each type of cancer, was calculated with Levin's formula. The confidence intervals (CI) were estimated by Monte Carlo simulation.

Results

The prevalence of tobacco consumption in population between 20-79 years old was 33.41% (CI 95% 32.44-34.38) and 9.88% (CI 95% 9.29-10.54) for men and women, respectively. Higher values of PAF were estimated to lung cancer (76.32% in men, 46.99% in women) followed by larynx cancer (69.55% in men, 39.13% in women).The largest number of attributed cases was estimated for lung cancer (1211 in men, 368 in women) and bladder cancer (827 in men, 114 in women). Total cancers attributable to tobacco were superior in men (3776 vs. 677).

Conclusions

In 2008, 4453 of the total common cancers in both sexes could have been avoided if there was no tobacco consumption (current and past). More cancers would have been prevented in men because they smoked more, but also because in most cancers' RR is higher in men. Actually, tobacco consumption has been increasing in women, thus, it is expected that its number of avoided cancers will approximate the one in men. Campaigns with well-defined target populations are important to increase its health level.

Key messages

Tobacco is a modifiable risk factor which can be prevented; thus it is important to promote campaigns in order to prevent early consumption. Secondary data must be used to provide evidence that will help Public Health in taking better decisions regarding interventions.

Perceptions of primary care providers on TB care for migrants: a mixed methods study in Portugal

Background

Tuberculosis (TB) is one of the main causes of death worldwide. In 2017, the proportion of TB cases among foreign-born individuals in Portugal was of 19%, and this proportion has been increasing. TB control among migrant populations largely depends on the role of the healthcare providers and their close contact with the patients. We aimed to explore the perspectives of primary care providers on the provision of TB care for migrant patients in Portugal.

Methods

An online survey and semi-structured interviews were conducted with healthcare providers from primary care settings in Portugal. Overall, 120 participated in the survey, and 17 were interviewed. Data from the survey and interviews were analysed using descriptive statistics and thematic analysis, respectively.

Results

Many participants (36.9%) considered that migrants arrive at an advanced stage of TB disease, and the main reason referred was migrants’ unawareness of the disease and its symptoms. Moreover, half (50.0%) of the providers considered that migrants frequently interrupt treatment, mainly due to their mobility, which causes difficulties in follow-up, and their social isolation that hampers social support. Overall, three main barriers for migrants’ access and use of TB care were mentioned: migrants’ low socioeconomic status, great bureaucracy required to register at services, and obstacles to benefit from social protection. Providers also suggested more training to improve their cultural competence and updating training on TB care.

Conclusions

Our study have shown social and economic factors that must be addressed to improve migrants’ access and use of TB care. In addition, increased health literacy for migrants and more training initiatives for providers can also contribute to improve TB care for migrants.

Key messages

Perspectives from primary care providers in Portugal highlighted social, economic, and administrative obstacles hampering the provision of TB care for migrants. With this work we expected to contribute with evidence to improve TB care for migrant patients in Portugal.

Selection for longer lived sperm within ejaculate reduces reproductive ageing in offspring

Males produce numerous sperm in a single ejaculate that greatly outnumber their potential egg targets. Recent studies found that phenotypic and genotypic variation among sperm in a single ejaculate of a male affects the fitness and performance of the resulting offspring. Specifically, within-ejaculate sperm selection for sperm longevity increased the performance of the resulting offspring in several key life-history traits in early life. Because increased early-life reproductive performance often correlates with rapid ageing, it is possible that within-ejaculate sperm selection increases early-life fitness at the cost of accelerated senescence. Alternatively, within-ejaculate sperm selection could improve offspring quality throughout the life cycle, including reduced age-specific deterioration. We tested the two alternative hypotheses in an experimental setup using zebrafish Danio rerio. We found that within-ejaculate sperm selection for sperm longevity reduced age-specific deterioration of fecundity and offspring survival but had no effect on fertilization success in males. Remarkably, we found an opposing effect of within-ejaculate sperm selection on female fecundity, where selection for sperm longevity resulted in increased early-life performance followed by a slow decline, while females sired by unselected sperm started low but increased their fecundity with age. Intriguingly, within-ejaculate sperm selection also reduced the age-specific decline in fertilization success in females, suggesting that selection for sperm longevity improves at least some aspects of female reproductive ageing. These results demonstrate that within-ejaculate variation in sperm phenotype contributes to individual variation in animal life histories in the two sexes and may have important implications for assisted fertilization programs in livestock and humans.

Factors influencing food-buying practices of grocery shoppers in London, Ontario

We need to understand better the reasons why people choose to buy the foods that they do. The main objective of this study was to obtain information on some of the factors that influence food-buying practices of grocery shoppers in London, Ontario. For this study, a copy of Canada's Food Guide to Healthy Eating tearsheet and a self-administered seven-item postcard-style questionnaire were distributed to 2,000 grocery shoppers in ten London A&P supermarkets; 29% of receptive shoppers (572 of 2,000) completed the survey. Grocery shoppers indicated that price, freshness and health considerations were the top three factors considered important when buying food. Average food expenditure for a family of three was approximately $103 per week. A majority of respondents (55%) wanted more information on healthy food choices. The results may provide information for health educators to understand better the factors that influence grocery shoppers food-buying practices. Knowledge of these factors may also help health educators design nutrition information and health promotion interventions at point-of-purchase outlets that could be aimed at influencing more grocery shoppers to take steps toward healthier food-buying behaviours.

Perceptions and use of Canada's Food Guide to Healthy Eating by grocery shoppers in London, Ontario

Limited information exists on grocery shoppers' perceptions and use of Canada's Food Guide to Healthy Eating. The main objective of this study was to examine grocery shoppers' perceptions and use of the food guide in London, Ontario. The guide tearsheet and a self-administered questionnaire about food-buying practices were distributed to 2,000 food shoppers in ten London supermarkets. The response rate was 572 of 2,000 shoppers, or 29%; detailed results are reported in a separate paper. Four months later, a follow-up survey on the perceptions and use of the food guide was conducted through the use of a mailed questionnaire. (Both questionnaires had been pretested.) The response rate to the follow-up survey was 21% (118 of 572 participants). This survey revealed that 79% found the tearsheet useful or very useful. A majority indicated they would recommend its use to others. Over 75% reported awareness of the messages and almost two-thirds indicated that they had made some changes in their eating habits. About 40% provided helpful suggestions for revisions of the guide. The information obtained from this study will help health educators better understand shoppers' perceptions about the usefulness of Canada's Food Guide to Healthy Eating. The guide must be made more accessible, and shoppers' concerns about healthy food choices must be addressed.