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Sethi S, Kumar A, Dias S, Blackwell J, Brookes MJ, Segal JP. Editorial: proactive anti-TNF drug monitoring in IBD-Ready for the prime time? Authors' reply. Aliment Pharmacol Ther 2023; 57:1455-1456. [PMID: 37243471 DOI: 10.1111/apt.17339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Sonika Sethi
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, Birmingham, West Midlands, UK
| | - Aditi Kumar
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Shiluka Dias
- Department of Gastroenterology, Guys and St Thomas' NHS Trust, London, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, Croydon Healthcare NHS Trust, London, UK
| | - Matthew J Brookes
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Research Institute in Healthcare Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Jonathan P Segal
- Department of Gastroenterology, University of Melbourne, Melbourne, Australia
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Trindade A, Dias S, Morais A. A curious manifestation of mechanical tension theory in idiopathic pulmonary fibrosis. Pulmonology 2023; 29:170-172. [PMID: 35963830 DOI: 10.1016/j.pulmoe.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- A Trindade
- Pulmonology Department, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal.
| | - S Dias
- Pulmonology Department, Hospital Pedro Hispano, Porto, Portugal
| | - A Morais
- Pulmonology Department - Centro Hospitalar Universitário de São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
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Sethi S, Dias S, Kumar A, Blackwell J, Brookes MJ, Segal JP. Meta-analysis: The efficacy of therapeutic drug monitoring of anti-TNF-therapy in inflammatory bowel disease. Aliment Pharmacol Ther 2022; 57:1362-1374. [PMID: 36495020 DOI: 10.1111/apt.17313] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/21/2022] [Accepted: 11/07/2022] [Indexed: 04/20/2023]
Abstract
BACKGROUND AND AIMS This systematic review and meta-analysis aimed to determine whether the use of therapeutic drug monitoring (TDM) in inflammatory bowel disease (IBD) patients on anti-tumour necrosis factor (anti-TNF) therapy results in improved rates of clinical and endoscopic remission, surgery, corticosteroid-free remission and hospitalisation. METHODS MEDLINE, EMBASE, EMBASE classic, PubMed, Cochrane central databases register of controlled trials and Cochrane Specialised Trials Register were searched between 01 Janurary 1946 and 08 April 2022. Randomised controlled trials (RCTs) and prospective and retrospective observational studies were included, comparing TDM to standard of care (SOC) or reactive vs proactive TDM. Results were reported as pooled relative risks (RR) with 95% confidence intervals (95% CI). RESULTS Twenty-six studies, including 9 RCTs, were included. Compared to SOC, proactive TDM was associated with a significantly decreased risk of treatment failure (RR 0.64, 95% CI 0.48-0.85 p<0.01), and a non-significant decrease in need for surgery (RR 0.51, 95% CI 0.25-1.02) and hospitalisation (RR 0.64, 95% CI 0.40-1.00). Furthermore compared to SOC, Proactive TDM was associated with higher rates of endoscopic remission (RR 1.19, 95% CI 0.93-1.53) and clinical remission (RR 1.07, 95% CI 0.97-1.18). Compared to reactive TDM, proactive TDM was associated with significant decreased risk of treatment failure (RR 0.46, 95% CI 0.21 = 0.98, p = 0.04) and significant reduction in hospitalisation (RR 0.33, 95% CI 0.21-0.54, p < 0.01). CONCLUSIONS Compared to SOC, proactive TDM was associated with significant benefit in reducing treatment failure. Compared to reactive TDM, proactive TDM led to a significant reduction in hospitalisation and treatment failure. More studies with larger RCTs and standardised assays are needed to substantiate these results and validate the cost-effectiveness of TDM.
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Affiliation(s)
- Sonika Sethi
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Midlands, West Bromwich, UK
| | - Shiluka Dias
- Department of Gastroenterology, Guys and St Thomas' NHS Trust, London, UK
| | - Aditi Kumar
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, Croydon Healthcare NHS Trust, London, UK
| | - Matthew J Brookes
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Research Institute in Healthcare Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Jonathan P Segal
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Gastroenterology, Northern Hospital, Epping, Melbourne, Australia
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Freire M, Graça SR, Dias S, Mendes S. Oral health-related quality of life in portuguese pre-school children: a cross-sectional study. Eur Arch Paediatr Dent 2022; 23:945-952. [PMID: 35982276 DOI: 10.1007/s40368-022-00741-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/26/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE To study Oral Health related Quality of Life (OHRQoL) of pre-school children and its associated factors. METHODS Cross-sectional study with sample data collected through an on-line questionnaire to a non-probabilistic sample. The questionnaire included the Portuguese version of the Early Childhood Oral Health Impact Scale (ECOHIS) and questions about sociodemographic characteristics, oral health behaviours, and reported oral health of the child. Data analyses included descriptive statistics, Mann-Whitney and Kruskal-Wallis tests and Linear regression (α = 0.05). RESULTS The sample consisted of 1475 parents of pre-school children (3-5 years-old), residing in Portugal. The mean ECOHIS total score was 1.5 (sd = 3.4). In the bivariate analysis the child's age, starting toothbrushing after one year of age, frequent intake of sugary food and drinks, previous appointment with an oral health professional, all reported of oral health problems, and a negative perception of oral health were negatively associated with OHRQoL (p < 0,05). In the regression model the factors that most contributed to a worse quality of life were dental caries and abscess, contributing to an ECOHIS average increase of 2.56 and 3.34, respectively. CONCLUSIONS The studied population presented a good OHRQoL, with the item related to pain being the most relevant for the ECOHIS score. Worst OHRQoL was found in older children, whose parents negatively rated the children's oral health and with reported dental caries, trauma, and abscess.
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Affiliation(s)
- M Freire
- Faculdade de Medicina Dentária, Unidade de Investigação E Ciências Orais E Biomédicas (UICOB), Universidade de Lisboa, Lisbon, Portugal
| | - S R Graça
- Faculdade de Medicina Dentária, Unidade de Investigação E Ciências Orais E Biomédicas (UICOB), Universidade de Lisboa, Lisbon, Portugal
| | - S Dias
- Estatística, ciTechCare - Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
- School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal
| | - S Mendes
- Faculdade de Medicina Dentária, Unidade de Investigação E Ciências Orais E Biomédicas (UICOB), Universidade de Lisboa, Lisbon, Portugal.
- Faculdade de Medicina Dentária da Universidade de Lisboa, Rua Teresa Ambrósio, Cidade Universitária, 1600-277, Lisbon, Portugal.
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Marques MJ, Gama A, Cheng C, Osborne R, Dias S. Addressing health literacy to reduce inequalities among migrants: which profiles need our attention? Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Health literacy, the ability to access, understand, appraise, remember and use health information and services, has great potential to reduce inequalities in access to and outcomes of care. People may have different patterns of health literacy needs and strengths. Yet, the design of interventions is frequently not responsive to the specificities of different segments of the population, including migrant groups. We aimed to identify profiles of migrants to inform the co-design of interventions targeting people at risk of poor outcomes. A cross-sectional survey was conducted with 1126 adult migrants living in Portugal. Data were collected using the 9-dimension HLQ (Health Literacy Questionnaire), and a sociodemographic questionnaire. A cluster analysis of data was performed. Semi-structured interviews were conducted with 15 migrants, stratified by the clusters. The optimal cluster solution yielded 16 profiles revealing diversity in combinations of strengths and needs across the HLQ domains. While 29.8% of migrants scored moderate to high on all 9 domains (profiles 2, 6, 8, 16), 63.4% of participants struggled with 1 or several aspects of health literacy, namely ‘Feeling understood and supported by healthcare providers'. Notably, 36.8% (6 profiles) exhibited difficulty across most of health literacy domains. The interviews provided a tangible description of the health literacy needs and resources with five main themes (access, understand, appraise, retrieve and use). Regarding ‘access', migrants expressed different preferred learning styles and needed to access different sorts of information at distinct times. The ‘use’ of information was rarely a one-time decision but a decision that people needed to make repeatedly. Health literacy is a highly diverse concept where subgroups exhibited diverse patterns. The cluster analysis can be used to inform the co-design, prioritisation and implementation of locally designed, fit-for-purpose solutions to improve health literacy.
Key messages
• Health literacy profiles can inform interventions to mitigate health inequalities among vulnerable migrant groups.
• The identification of distinct profiles can contribute to minimise the disconnect between what people/communities need and what is developed to improve health and equity.
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Affiliation(s)
- MJ Marques
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - A Gama
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - C Cheng
- Centre of Global Health and Equity, School of Health Sciences, Swinburne University of Technology , Melbourne, Australia
| | - R Osborne
- Centre of Global Health and Equity, School of Health Sciences, Swinburne University of Technology , Melbourne, Australia
| | - S Dias
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
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Gama A, Marques MJ, Pedro AR, Hoffmeister LV, Rodrigues F, Ribeiro JS, Dias S. Which effects had the pandemic in migrants’ health and well-being? A mixed-methods approach. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic affected populations’ health, with a disproportionate impact on those most socially vulnerable such as migrants. The way these populations experienced the pandemic lockdowns and its effects on daily life are yet to be known. This study aimed to understand the effects of the pandemic on health and well-being of migrants in Portugal.
Methods
In a mixed-methods approach, a survey was conducted with a community-based sample of 1126 migrants in the Lisbon Metropolitan Area, assessing sociodemographics, migration-related characteristics and the perceived impact of the pandemic on health. In addition, n = 12 migrants purposively recruited were invited to participate in a photovoice study, sharing photographs about their daily life during the lockdowns. Following semi-structured interviews were conducted. Quantitative data were analysed using multivariable analysis and qualitative data were analysed through content analysis.
Results
A fifth of the participants perceived having worse health condition since the pandemic, which was more likely among women (OR = 1.58, CI95% 1.13-2.20), those >45 years old (OR = 1.78, CI95% 1.02-3.16), with lower education (Basic education: OR = 1.57, CI95% 1.01-2.47) and with lower monthly income (<EUR 650: OR = 1.69, CI95% 1.18-2.44). Two themes emerged from the photovoice: effects of the pandemic lockdowns on daily life (routines, social relations, work) and on health and well-being (eating habits, physical exercise, leisure). Strategies to cope with the adverse effects included social activation and changes in lifestyles.
Conclusions
The pandemic had disproportionate effects on some migrant groups, intensifying social and health inequalities, with consequences for their well-being. Participatory methods can contribute to further understand migrants’ experiences while involving and empowering them for health promotion.
Key messages
• The pandemic had adverse effects on migrants’ health and well-being, disproportionately affecting most socially vulnerable migrant groups.
• Participatory research methods as photovoice are valuable to gain access to individual experiences and perspectives, while involving and empowering participants.
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Affiliation(s)
- A Gama
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - MJ Marques
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - AR Pedro
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - LV Hoffmeister
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - F Rodrigues
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - JS Ribeiro
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - S Dias
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
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Marques MJ, Gama A, Pedro AR, Magano R, Tiessen C, Hollanders P, Dias S. Mental health of migrants during the COVID-19 pandemic: additional stressors, increased inequalities. Eur J Public Health 2022. [PMCID: PMC9594497 DOI: 10.1093/eurpub/ckac131.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has resulted in an unprecedent range of negative mental health outcomes across populations worldwide. Such effects are increasingly being documented, however an evidence gap persists on the consequences on most vulnerable groups, as certain subgroups of migrants. These populations already suffer from increased psychological burden, and the pandemic effects may potentially exacerbate adverse experiences and outcomes. This study aims to uncover the perceived impact of the COVID-19 pandemic on the mental health of migrants in Portugal and the associated sociodemographic aspects. A survey was conducted with a community-based sample of 1126 adult migrants in Portugal, assessing sociodemographics, migration-related characteristics and the perceived impact of the pandemic on mental health. Association between sociodemographics and mental health indicators was measured through bivariable analysis. In total, 1126 adult migrants were surveyed: 53.4% female, mean age of 35.8 years (range 18-77), 48.9% from African countries, 29.5% from Middle East/Asian countries, 21.6% from Brazil. Most participants (80%) reported feelings of agitation, anxiety or sadness during the pandemic period with 26.4% experiencing these feelings most days. The pandemic had a disproportionate impact on women (86.9% reported negative impact compared to 72.5% of men, p < 0.05), those undocumented (83.3% vs 75.4%, p < 0.05), those whose financial situation got worse since the pandemic (82.8% vs. 77.3%, p < 0.05) and those who had increased food shortages (84.4% vs 79%, p < 0.05). Migrants perceived an elevated deterioration of their mental health during the COVID-19 pandemic. In addition, particular groups such as women and those with a more insecure income or residence status are particularly susceptible to experiencing negative mental health outcomes. Key messages • There is a need to recognize the detrimental mental health impact of the COVID-19 pandemic on particular migrant groups and to develop interventions that target their unique needs. • Investigating sociodemographic and migration aspects could help identifying migrants at a higher risk of experiencing mental health distress.
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Affiliation(s)
- MJ Marques
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - A Gama
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - AR Pedro
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - R Magano
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - C Tiessen
- Universiteit Amsterdam Vrije , Amsterdam, Netherlands
| | | | - S Dias
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa , Lisbon, Portugal
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Dias S, Lewis TL, Alkhalfan Y, Ahluwalia R, Ray R. Current concepts in the surgical management of chronic ankle lateral ligament instability. J Orthop 2022; 33:87-94. [PMID: 35874042 PMCID: PMC9305620 DOI: 10.1016/j.jor.2022.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022] Open
Abstract
Background/aims Ankle sprains are common injuries which can lead to chronic lateral ankle ligament instability (CAI). Methods The aim of this review is to provide a comprehensive overview of the epidemiology, pathophysiology, investigation, surgical management and rehabilitation of CAI. Results Investigation of CAI is based on history, clinical examination, and imaging. Surgical management of CAI can be defined as anatomic reconstruction, anatomic and non anatomic repair of ATFL and/or CFL. Anatomic repair has been shown to have better functional outcomes and less secondary osteoarthritis when compared to non anatomic repair. Non-anatomic methods do not replicate the normal anatomical course of ATFL/CFL and may lead to stiffness. The most common surgical treatment for CAI is the open modified Broström repair augmented with the Gould modification. There are arthroscopic techniques being developed which have reported promising clinical results. However, there are considerable areas of further research which should be carried out to improve understanding and effectiveness of current treatment options. Standardised validated patient reported outcome measures and evidence-based protocols in the rehabilitation periods are crucial for positive and reproducible outcomes. Conclusion Surgical repair has proven to show excellent outcomes for patients suffering from CAI, however larger prospective studies should be carried out to evaluate the use of newer surgical techniques.
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Affiliation(s)
- Shiluka Dias
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Thomas L. Lewis
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Raju Ahluwalia
- King's College Hospital MTC, London; King's College Hospital Diabetic Foot Unit & King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
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de Noronha N, Moniz M, Gama A, Laires PA, Goes AR, Pedro AR, Dias S, Soares P, Nunes C. Non-adherence to COVID-19 lockdown: who are they? A cross-sectional study in Portugal. Public Health 2022; 211:5-13. [PMID: 35988506 PMCID: PMC9271418 DOI: 10.1016/j.puhe.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022]
Abstract
Objectives The SARS-CoV-2 virus has spread worldwide, leading governments to implement mitigation measures. Understanding the reluctance to adhere to non-pharmacological interventions might help promote adherence to these measures. This study aimed to identify factors associated with non-adherence to the first lockdown in Portugal. Study design Cross-sectional study. Methods This study used data from a Portuguese community-based survey entitled ‘COVID-19 Barometer: Social Opinion’. Data were collected on risk perception, health status and social experiences using a snowball sampling technique. The event of interest corresponded to participants who reported not staying home during the lockdown period, serving as a proxy for non-adherence to lockdown. Logistic regression was used to identify factors associated with non-adherence to the first lockdown. Results Responses from 133,601 individual questionnaires that were completed during the first week of the first lockdown in 2020 were analysed. A minority of participants (5.6%) reported non-adherence to lockdown (i.e. leaving home for reasons other than essential situations). Working in the workplace was the factor with the strongest association of non-adherence to the lockdown. Several other factors were also associated with non-adherence to the first lockdown; namely, being a man, being a student, having a low level of education, having a low income, living alone or with a high-infection-risk professional (e.g. doctor, nurse, pharmaceutical, health technician, firefighter, police officer, military, essential services worker), perceiving the risk of getting COVID-19 to be high, not having social support in case of infection, feeling agitated, sad or anxious every day, and considering the preventive measures to be unimportant or inadequate. Conclusions Non-adherence to lockdown was associated with socio-economic, trust and perception factors. Future research should investigate the mechanisms underlying these associations to help identify the population groups who are most at risk of non-adherence.
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Affiliation(s)
- N de Noronha
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal.
| | - M Moniz
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - A Gama
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - P A Laires
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - A R Goes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - A R Pedro
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - S Dias
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - P Soares
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - C Nunes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
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Lees JS, Hanlon P, Butterly E, Wild SH, Mair FS, Taylor RS, Guthrie B, Gillies K, Dias S, Welton N, McAllister DA. 963 THE IMPACT OF AGE, SEX AND MORBIDITY COUNT ON EARLY TERMINATION: A META-ANALYSIS OF INDIVIDUAL PATIENT DATA FROM CLINICAL TRIALS. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Multimorbidity is found in around half of people with any long-term condition but is substantially less common in randomised controlled trials (‘trials’). Multimorbidity may diminish a participant’s ability to complete a trial. However, empirical estimates of the association between individual patient characteristics and early termination are lacking.
Method
Individual patient-level data were obtained from Phase 3/4 trials contained within two clinical trial repositories. Eligible trials for inclusion were identified according to pre-specified criteria (PROSPERO CRD42018048202). Within each trial, the association between morbidity count and early termination (failure for any reason to complete the final trial visit) was estimated in logistic regression models, adjusting for age and sex. These estimates were meta-analysed in Bayesian linear models, with partial pooling across index conditions and drug classes. Using these estimates, the impact of morbidity count on early termination was modelled for a set of notional trials.
Results
In 92 trials across 20 index conditions and 17 drug classes, the mean morbidity count ranged from 0.3–2.7. Neither age nor sex was associated with early termination (OR 1.04, 95% CI 0.98–1.11; OR 1.00, 95% PI 0.95–1.07 respectively). Morbidity count was associated with early termination (OR per additional morbidity: 1.11, 95% CI: 1.07 to 1.14). There was no evidence of non-linearity in the association between morbidity count and early termination, and there was minimal variation across drug classes and index conditions. For a notional trial with high level of early termination in individuals without multimorbidity, doubling the mean morbidity count from 1 to 2 increases risk of early termination from 29% to 31%.
Conclusion
Multimorbidity, irrespective of age and sex, is associated with a relatively modest increased odds of early termination of trial participation. The benefit of increased generalisability of trials by including patients with multimorbidity appears likely to outweigh the disadvantages of lower retention.
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Hanlon P, Butterly E, Shah AV, Hannigan LJ, Wild SH, Guthrie B, Mair F, Dias S, Welton NJ, McAllister DA. 955 ANALYSIS OF RANDOMISED CONTROLLED TRIAL SERIOUS ADVERSE EVENT RATES AS A MARKER OF TRIAL REPRESENTATIVENESS. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The applicability of randomised controlled trials of pharmacological agents to older people with frailty/multimorbidity is often uncertain, due to concerns that trials are not representative. However, assessing trial representativeness is challenging and complex. We explore an approach assessing trial representativeness by comparing rates of trial Serious Adverse Events (SAEs: most of which reflect hospitalisations/deaths) to rates of hospitalisation/death in routine care (which, in a trial setting, would be SAEs be definition).
Method
We identified 483 trials (n = 636,267) from clinicaltrials.gov across 21 index conditions. A routine care comparison was identified from SAIL databank (n = 2.3 M). SAIL data were used to derive the expected rate of hospitalisations/deaths by age, sex and index condition. We then calculated the expected number of SAEs for each trial compared to the observed number of SAEs (observed/expected SAE ratio). We then re-calculated the observed/expected SAE ratio additionally accounting for comorbidity count in 125 trials for which we accessed individual participant data.
Results
For 12/21 index conditions the observed/expected SAE ratio was <1, indicating fewer SAEs in trials than expected given community rates of hospitalisations and deaths. A further 6/21 had point estimates <1 but the 95% CI included the null. The median observed/expected SAE ratio was 0.60 (95% CI 0.56–0.65; COPD) and the interquartile range was 0.44 (0.34–0.55; Parkinson’s disease) to 0.88 (0.59–1.33; IBD). Higher comorbidity count was associated with SAEs and hospitalisations/deaths across index conditions. For most trials, the observed/expected ratio was attenuated but remained <1 after additionally accounting for comorbidity count.
Conclusion
Trial participants experience fewer SAEs than expected based on age/sex/condition specific hospitalisation/death rates in routine care, confirming the predicted lack of representativeness. This difference is only partially explained by differences in multimorbidity. Assessing observed/expected SAE may help assess applicability of trial findings to older populations in whom multimorbidity and frailty are common.
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Affiliation(s)
- P Hanlon
- Institute for Health and Wellbeing, University of Glasgow
| | - E Butterly
- Institute for Health and Wellbeing, University of Glasgow
| | - A V Shah
- London School of Hygiene and Tropical Medicine
| | - L J Hannigan
- Nic Waals Institute, Lovisenberg Diaconal Hospital , Oslo, Norway
- Population Health Sciences , Bristol Medical School,
- University of Bristol , Bristol Medical School,
- Department of Mental Disorders, Norwegian Institute of Public Health
| | - S H Wild
- Usher Institute for Population Health Sciences, University of Edinburgh
| | - B Guthrie
- Usher Institute for Population Health Sciences, University of Edinburgh
| | - F Mair
- Institute for Health and Wellbeing, University of Glasgow
| | - S Dias
- Centre for Review and Dissemination, University of York
| | - N J Welton
- Population Health Sciences , Bristol Medical School,
- University of Bristol , Bristol Medical School,
| | - D A McAllister
- Institute for Health and Wellbeing, University of Glasgow
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12
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Goes AR, Soares P, Moniz M, Gama A, Pedro AR, Laires P, Dias S, Nunes C. Factors associated with motivation to avoid meeting family and friends during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574604 DOI: 10.1093/eurpub/ckab164.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The widespread adherence to behaviours that prevent the transmission of the SARS-CoV-2 virus depends on human will. There is a paucity of research on the factors that influence adherence to social distancing. Available research suggests that it varies with the specific behaviour and that reducing contact with family and friends is the hardest one. This study aims to identify factors associated with motivation to avoid meeting with family and friends during the second lockdown of the COVID-19 pandemic in Portugal. Methods We used data from a community-based survey, “COVID-19 Barometer: Social Opinion”, which includes sociodemographics, psychosocial variables, and subjective health and wellbeing indicators from 20th February to 19th March 2021. We included 1336 participants who answered the question “To what extent is it easy for you to avoid visiting family and friends?”. Logistic regression analysis was used to identify factors associated with difficulty to avoid visiting family and friends. Results Preliminary data shows that 38.4% (513) had difficulties avoiding meeting with family and friends. Those with greater difficulty were the ones who have less education, higher negative emotionality, do not work remotely, have more difficulties to stay home and practice physical distancing and consider the Government's measures inadequate. Contrarily, those who have less difficulty avoiding visiting friends and family are older and have low risk perception of COVID-19 infection. Conclusions This study suggests higher difficulty in avoiding visiting friends and family for those whose routines demand not staying at home, with low agreement with Government measures, and struggle with higher negative emotionality, confirming the personal costs of these behaviours and the importance of habits. Older people had less difficulty, suggesting that these measures may be closer to their usual routines. Interventions should consider the specificities of social interaction. Key messages Social distancing comes at an enormous cost to people's livelihoods and it also depends on people living circumstances. Interventions to improve adherence to social distancing should consider the specificity of social interaction and the potential dissonance created by the overall routines.
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Affiliation(s)
- AR Goes
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Soares
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - M Moniz
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A Gama
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - AR Pedro
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Laires
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - S Dias
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - C Nunes
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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Gama A, Marques MJ, Pedro AR, Mendonça J, Fernandes AC, Dias S. Perceived need of health care and barriers in access to health services among migrants in Portugal. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Health care has been pointed out as a key determinant of migrants' health and social integration, but there is evidence of disparities in its access across subgroups. A deeper understanding of the barriers in access to health care, particularly among vulnerable groups, is needed. Our study aims to examine perceived need of health care, access to health services and barriers among migrants in Portugal. A cross-sectional survey was conducted with 1126 adult migrants (53.4% females), originated from African, Middle East, Asian countries and Brazil, living in Portugal for no longer than 10 years. The collected data included sociodemographic characteristics, perceived need of health care, access to health services and difficulties experienced. Differences between groups were analysed through chi-square tests. Results showed that most of the participants (64.7%) have needed health care in the previous 12 months in Portugal. Of these, 87.8% accessed a health care service. However, even needing health care, 3.3% decided not to seek care and 8.8% were not able to access a health care service. Reporting no access to health care was more frequent among migrants with shorter length of stay in the country (<1 year: 19.4% vs. 1 to 5 years: 7.3% and 6 to 10 years: 4.6%; p = 0.001) and those with non-regular migration status (in regularisation process: 11.5% and undocumented: 9.5% vs. documented: 7.2%; p = 0.040). Most common barriers were lack of the National Health Service user card (38%), financial constraints (15%), undocumented status (11%) and language difficulties (7%). Although efforts have been made over the past decades in Portugal to adopt inclusive policies and promote migrants' access to health care, strategies are needed to improve information on migrants' health rights, especially of those undocumented and recently arrived. Economic and language difficulties should be further addressed in comprehensive interventions to promote equal access to health care.
Key messages
Migrants residing in the country for less than a year and those with non-regular migration status reported more frequently not being able to access health care. Despite the efforts to adopt inclusive policies and promote migrants’ access to health care, strategies are needed to improve information on migrants’ health rights and promote equal access to care.
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Affiliation(s)
- A Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - MJ Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - AR Pedro
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - J Mendonça
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - AC Fernandes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - S Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
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14
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Dias S, Figueiredo C, Hoffmeister L, Gama A. Developing evidence on social prescribing initiative in Lisbon: Challenges and insights for improving. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Social prescribing is recent in Portugal and evidence is needed on the potential of this complex intervention to improve health and wellbeing outcomes but also to inform the commissioning of these programmes. In a collaborative approach, an evaluation protocol of the social prescribing in two primary healthcare units in Lisbon was developed, aiming to assess its implementation and impact at three levels: patients, health system and health-social sector intersection, within a mixed-methods approach. Exploring the social prescribing contribution to enhance patients' quality of life, well-being and activation involves assessing these outcomes throughout a longitudinal perspective. In an exploratory, prospective study, baseline data collection and three follow-ups are included. Secondary data comprise health status indicators collected from patients' medical records as well as referral and social responses elaborated within the intervention. Patients' experiences on the social prescribing activities performed, perceived changes in lifestyle, and perspectives about positive and negative aspects are assessed in semi-structured interviews. The need for further understanding the impact at the health system' level calls for an attentive look at the processes of change in patients' patterns of healthcare services use (appointments in primary healthcare units, hospital admissions and emergency episodes), but also changes in the services' reorganization to better integrative health care. At a broader level, insights will be obtained on the effects on the intersection between the health and social sectors and the experiences of networking, through focus group discussions with all the stakeholders involved. The social prescribing implementation process, barriers, facilitators and suggestions for improvement will also be explored. In this presentation, challenges will be debated, as well as insights for reflection about opportunities for improving evidence development.
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Affiliation(s)
- S Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - C Figueiredo
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Central Lisbon Health Center Cluster, Lisbon, Portugal
| | - L Hoffmeister
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - A Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
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15
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Nogales Crespo K, Muniz Rocha J, Vázquez M, Ricoca Peixoto V, Dias S. The COVID-19 policy response in Spain and Portugal: a study of measures to slow down infection rate. Eur J Public Health 2021. [PMCID: PMC8574229 DOI: 10.1093/eurpub/ckab165.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 global pandemic triggered massive policy responses worldwide. Measures taken during the pandemic differed across countries and time. Governance systems may influence the capacity of countries to respond promptly and mobilize the necessary resources in time. Identifying measures and when they appeared are critical questions to assess emergency response strategies. The objective of this study was to analyze the policy response to slow down the infection rate of COVID-19 cases in Portugal and Spain according to timing (related to death rates) and stringency. Methods A descriptive comparative study of non-pharmaceutical interventions was conducted through a content analysis of policies and records review of official government sources. Portugal and Spain were selected considering the similarities between national health systems, but different government organization and epidemic impact. The Autonomous Community of Madrid was also included as example of subnational systems. Death rates were retrieved from daily statistics of open secondary sources. Results Results show that countries responded with a complex mix of measures across policy sectors, following dynamic patterns established by the epidemic evolution and governance systems. Policies aimed to reduce the spread of the virus, enable individuals and businesses to comply with restrictions, and reinforce National Health System's capacity. The declaration of state of emergency was a critical tool to organize actions under clear leadership, especially in devolved contexts. Conclusions Our findings suggest that, in early epidemic phases, a centralized command can be more effective at timely enacting nationwide stringent measures. Evidence from this study contributes to the argument that a fast, robust, and early response might have been more effective at containing spread at the initial stages of the pandemic. Key messages The policy response included measured to reduce spread of infection, enhance adherence and strengthen health systems capacity to deal with the pandemic. The declaration of state of emergency was essential to ensure an organized, coherent, timely, and robust response, especially in devolved contexts.
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Affiliation(s)
- K Nogales Crespo
- NOVA National School of Public Health, Nova University of Lisbon, Lisbon, Portugal
- Department of Culture and Society, Linköping University, Linköping, Sweden
| | - J Muniz Rocha
- NOVA National School of Public Health, Nova University of Lisbon, Lisbon, Portugal
- Department of Culture and Society, Linköping University, Linköping, Sweden
- Public Health Research Center, NOVA University of Lisbon, Lisbon, Portugal
| | - M Vázquez
- Health Policy Research Unit, Consortium for Health and Social Care of Catalonia, Barcelona, Spain
| | - V Ricoca Peixoto
- Public Health Research Center, NOVA University of Lisbon, Lisbon, Portugal
- European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - S Dias
- NOVA National School of Public Health, Nova University of Lisbon, Lisbon, Portugal
- Public Health Research Center, NOVA University of Lisbon, Lisbon, Portugal
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16
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Marques P, Gama A, Geraldes M, Silva J, Vaccari N, Dias S. Sociocultural factors of cervical cancer screening uptake among migrant women: a mixed methods study. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Cervical cancer has a high mortality in Europe despite being preventable by cervical cancer screening (CCS). Migrant women have a lower CCS attendance compared to non-migrants. This study aims to describe CCS uptake among migrant women in Portugal and explore sociocultural influences. Within a mixed-methods approach, an online survey and focus group discussions (FGs) were conducted. The survey included 655 migrant women and collected data on sociodemographics, attendance and attitudes toward CCS. Four FGs with 12 healthcare workers and a FG with 5 community workers were conducted exploring perceptions on CCS attendance and barriers among migrant women. Quantitative data was analyzed using descriptive analysis and Chi-Square test and qualitative data through content analysis. Survey data shows that 24.9% of women never had CCS or had it over 5 years ago, more Asian and African women (51.3% and 36.7%, respectively) (p < 0.001). Non-attenders reported significantly more often embarrassment towards CCS (21.7% vs. 18.8% of CCS attenders, p = 0.002) and being unaware of their risk of cancer and the relevance of CCS (28.8% vs. 12.5%, p < 0.001). Around 24% of non-attenders reported concern with having a consultation with a male doctor. For FGs participants, CCS is a taboo in some communities, particularly African, Asian and Muslim. Lack of information about CCS along with feelings of embarrassment and discomfort related to pap smear and with being seen by a male doctor were referred as reasons for avoidance of CCS. Participants also stated that some women have low autonomy and often their husbands have a key role in deciding whether they should attend CCS. Lack of a preventive mindset was also stated as reason for low CCS attendance. The sociocultural background can influence migrant women's attendance to CCS. A culturally grounded approach is needed to provide tailored information on CCS and to create opportunities to engage migrant communities on CCS and improve their uptake.
Key messages
Lack of information, embarrassment and low autonomy hinder some migrant women’s attendance to CCS. The sociocultural influences on CCS uptake call for a culturally grounded approach to provide tailored information and engage migrant communities on CCS.
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Affiliation(s)
- P Marques
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A Gama
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - M Geraldes
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - J Silva
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - N Vaccari
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - S Dias
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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17
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Lopes S, Soares P, Gama A, Pedro AR, Moniz M, Laires P, Goes AR, Nunes C, Dias S. Factors associated with avoidance of emergency department visits in Portugal during the pandemic. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Avoiding an emergency department (ED) visit risks irreversible negative consequences for patients' health. EDs are a frequent access point to the Portuguese health system. Previous studies have shown that patients may avoid visiting ED during the pandemic. This study aims to identify factors associated with avoidance of ED visits in Portugal during the COVID-19 pandemic.
Methods
We used data from a community-based survey, “COVID-19 Barometer: Social Opinion”, which includes healthcare utilisation, health status, and risk perception in Portugal from 11th April 2020 to 16th April 2021. We included respondents that reported having needed ED care. Data were collected on sociodemographics, health status (comorbidities, mental health), risk perception (COVID-19 and complications), level of trust in health services and self-assessment of the severity of the reason for ED visit. The outcome of interest was the decision to avoid ED care. We used logistic regression to identify factors associated with the decision to avoid ED.
Results
Preliminary data showed that 914 respondents reported needing ED care (74.8% female; mean age 43 years). From those, 224 (25%) decided to avoid ED care. ED visits avoidance was higher during lockdowns (28%). People reporting specific comorbidities (cardiac, autoimmune, respiratory) avoided ED more than those without them. Perception of no severe reason for ED visit, poor mental health, perception of higher risk of COVID-19 and complications, and low trust in health services response to the pandemic were associated with higher odds of ED visit avoidance.
Conclusions
People avoiding ED visits represented a considerable share. The decision to avoid ED visit was associated with clinical characteristics, but the perception of risk and assessment of the context and health system response also played a role in decision making.
Key messages
The effect of avoided ED visits on health should be a research and policy concern. People with certain comorbidities or perception of high risk of COVID-19 and complications may be closely monitored.
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Affiliation(s)
- S Lopes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Soares
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A Gama
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - AR Pedro
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - M Moniz
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Laires
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - AR Goes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - C Nunes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - S Dias
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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Dias S, Silva-Junior AL, Garcia NP, Cardoso EC, Tarragô AM, Fraiji NA, Paula EV, Costa AG, Malheiro A. CARACTERIZAÇÃO DE ANAFILOTOXINAS EM PACIENTES COM ANEMIA FALCIFORME EM CRISE VASO-OCLUSIVA. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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19
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Sherriff NS, Jones AM, Mirandola M, Gios L, Marcus U, Llewellyn C, Rosinska M, Folch C, Dias S, Toskin I, Alexiev I, Kühlmann-Berenzon S. Factors related to condomless anal intercourse between men who have sex with men: results from a European bio-behavioural survey. J Public Health (Oxf) 2021; 42:e174-e186. [PMID: 31090894 PMCID: PMC7251420 DOI: 10.1093/pubmed/fdz052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/17/2019] [Indexed: 12/11/2022] Open
Abstract
Background Relationship status is an important factor associated with condomless anal intercourse (CAI) amongst men who have sex with men (MSM). Methods A multi-centre bio-behavioural survey with MSM was conducted in 13 European cities (n = 4901) exploring factors associated with CAI via bivariate and multivariate multilevel logistic regression analyses. Results Likelihood of CAI with casual partners was associated with being ‘out’ to a majority (AOR = 1.19;95% CI 1,1.42); knowing their HIV status (AOR = 1.86; 95% CI 1.25,2.76); using substances (1–2 AOR = 1.39; 95% CI 1.16,1.63, 2+ AOR = 1.81; 95% CI 1.35,2.42); being older (AOR = 0.98; 95% CI 0.97,0.99); successful sero-communication (AOR = 0.79; 95% CI 0.67,0.94); and, not having a recent HIV test (AOR = 0.78; 95% CI 0.66,0.92). CAI with steady partners was associated with successful sero-communication (AOR = 2.72; 95% CI 2.72,3.66); not having a recent HIV test (AOR = 1.26; 95% CI 1.09,1.46), and; being older (AOR = 0.99; 95% CI 0.98,0.99). Conclusions Understandings of partner type and/or relationship status in relation to CAI amongst MSM can potentially play an important role in the development of culturally appropriate HIV/STI prevention and risk-reduction efforts targeting at-risk MSM. Our results speak to the need to consider segmented and tailored public health and health promotion initiatives for MSM with differing CAI behaviours and relationship profiles.
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Affiliation(s)
- N S Sherriff
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK.,Centre for Transforming Sexuality & Gender, University of Brighton, Brighton, Brighton, BN1 9PH, UK
| | - A M Jones
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom, BN13 3EP, UK
| | - M Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - L Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - U Marcus
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - C Llewellyn
- Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PH, UK
| | - M Rosinska
- National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - C Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya / CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - S Dias
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública & GHTM, Universidade NOVA de Lisboa, Portugal
| | - I Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - I Alexiev
- National Reference Laboratory of HIV, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - S Kühlmann-Berenzon
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
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20
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Rego de Figueiredo I, Branco Ferrão J, Dias S, Vieira Alves R, Drummond Borges D, Torres M, Guerreiro Castro S, Lourenço F, Antunes AM, Gruner H, Panarra A. Tuberculosis infection in HIV vs. non-HIV patients. HIV Med 2021; 22:775-779. [PMID: 34000080 DOI: 10.1111/hiv.13119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/11/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Tuberculosis (TB) is the most common opportunistic infection and cause of mortality among people living with HIV, and it is possible that it may also influence the evolution of the HIV infection. We assessed the differences between HIV-positive and -negative people infected with TB. METHODS The present study is a cross-sectional retrospective study by electronic record revision. We included patients admitted to a tertiary hospital with a diagnosis of TB between 2011 and 2016, comparing those with HIV coinfection with non-HIV patients, according to demographic and clinical characteristics. RESULTS This study included 591 patients, of whom 32% were HIV-coinfected. HIV-TB patients were younger, with a predominance of male gender. Considering TB risk factors, there was a higher prevalence of homelessness and intravenous drug use in the HIV group. In the non-HIV group, direct contact with other patients with TB and immunosuppression were more prevalent. Relative to TB characteristics, the HIV-coinfected group presents with a higher prevalence of disseminated disease and a higher occurrence of previous TB infection. Cancer was the most frequent cause of immunosuppression in the HIV group and the number testing positive for TB via microbiological culture was lower. Assessment of microbiological resistance and in-hospital mortality showed similar numbers in both groups. CONCLUSIONS There are few papers comparing clinical course of TB between HIV-infected and non-infected patients. Our study differs from others in the literature as we focused on a country with middling incidence of TB and further characterized the differences between HIV-infected and non-infected patients which can contribute to the management of these patients.
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Affiliation(s)
- I Rego de Figueiredo
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - J Branco Ferrão
- Medicina 2.3, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - S Dias
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - R Vieira Alves
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - D Drummond Borges
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - M Torres
- Serviço de Doenças Infecciosas, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - S Guerreiro Castro
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - F Lourenço
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - A M Antunes
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - H Gruner
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - A Panarra
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
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21
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Bulhões C, Ramos E, Severo M, Dias S, Barros H. Trajectories of depressive symptoms through adolescence and young adulthood: social and health outcomes. Eur Child Adolesc Psychiatry 2021; 30:65-74. [PMID: 32065326 DOI: 10.1007/s00787-020-01493-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
Depressive symptoms display heterogeneous trajectories across adolescence, which can lead to different consequences. This study aimed to identify trajectories of depressive symptoms from adolescence to young adulthood, assessing the association with social and health outcomes at young adulthood. Adolescents born in 1990, enrolled in schools of Porto, Portugal, in 2003-2004 (EPITeen study) completed the Beck Depression Inventory II (BDI-II) at 13, 17 and 21 years. Mixed models and model-based clustering were used to describe the trajectories in the BDI-II score (n = 2010). Outcomes were assessed at age 21 years with self-administered questionnaires and face-to-face interviews (n = 1594). Odds ratios or regression coefficients, with 95% confidence intervals, were estimated using logistic and linear regression. Three trajectory classes of depressive symptoms were identified, similar in shape in both sexes: High (8.4%), Moderate (31.3%) and Low (60.2%). Participants in High or Moderate classes were more likely to describe lower scores of community involvement, more medical appointments during the last year, higher levels of pain and had higher probability of self-rating health as "good" or "fair or poor". Females in the High and Moderate classes were more likely to be current smokers, to describe ever using drugs and to report more sexual partners, emergency room visits and the use of antidepressants. The risk of depressive symptoms in adulthood is likely to be early determined in adolescence. The trajectory classes with higher levels of symptoms were associated with worse social and health outcomes.
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Affiliation(s)
- C Bulhões
- EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal.
| | - E Ramos
- EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
| | - M Severo
- EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
| | - S Dias
- Escola Nacional de Saúde Pública, Centro de Investigação Em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - H Barros
- EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
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22
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Klingelhoefer L, Bostanjopoulou S, Trivedi D, Hadjidimitriou S, Hausbrand D, Katsarou Z, Charisis V, Stadtschnitzer M, Dias S, Ntakakis G, Grammalidis N, Kyritsis K, Jaeger H, Iakovakis D, Papadopoulos A, Ioakeimidis I, Karayiannis F, Diniz J, Delopoulos A, Hadjileontiadis L, Reichmann H, Chaudhuri KR. Medical follow up assessments of iPrognosis application users for early Parkinson's disease detection. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Pinho-Bandeira T, Ricoca Peixoto V, Dias S, Sá Machado R. Factors associated with coinfection and reinfection by chlamydia, gonorrhoea and syphilis in Portugal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
In Europe, cases of chlamydia (CT), gonorrhoea (NG) and syphilis (TP) are rising and coinfections and reinfections are common. As there are limited data on factors associated with these events in Portugal, this study may be valuable to inform prevention strategies. We conducted an analytical cross-sectional study with all probable and confirmed cases of CT (including lymphogranuloma venereum), NG and TP notified in Portugal in the national system of epidemiological surveillance (SINAVE®) between January 1st, 2015 and December 31st, 2018. Descriptive and multivariable analyses were conducted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated.
Among 6506 cases in SINAVE®, 858 (13.2%) were coinfections and 204 (3.1%) were reinfections. Coinfections were found in 14.0% of males and 10.2% of females, while reinfections were present in 3.8% of males and 0.8% of females. In multivariable analysis, coinfections were positively associated with being younger than 26 (aOR 2.45, 95% CI 1.81-3.30), living in Lisbon area (aOR 1.43, 95% CI 1.13-1.81), being symptomatic (aOR 1.82, 95% CI 1.53-2.18), being men who have sex with men (MSM) (aOR 1.63, 95% CI 1.28-2.07), HIV+ status (aOR 1.46, 95% CI 1.19-1.80) and being diagnosed in an NGO (aOR 1.68, 95% CI 1.29-2.19). Reinfections were positively associated with living in Lisbon area (aOR 2.53, 95% CI 1.43-4.47), being symptomatic (aOR 2.37, 95% CI 1.66-3.37), being MSM (aOR 3.69, 95% CI 2.17-6.30) and HIV+ status (aOR 1.68, 95% CI 1.18-2.39).
This study contributes to identifying risk profiles for coinfection and reinfection by these STIs in Portugal. Younger age, living in Lisbon area, being MSM, HIV+ status and being diagnosed in an NGO are some of the associated factors. Targeted interventions are needed to tackle specific settings and populations to be successful in lowering STI's incidence in Portugal.
Key messages
We identified factors associated with coinfection and reinfection by chlamydia, gonorrhoea and syphilis in Portugal, that can be used to target interventions. A study to identify the changes and problems in sexual attitudes and sexual behaviour may be useful to help us understand this paradigm.
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Affiliation(s)
- T Pinho-Bandeira
- Division of Epidemiology and Statistics, Directorate-General of Health, Lisbon, Portugal
- Public Health Unit, Baixo Vouga Primary Healthcare Cluster, ACES Baixo Vouga, Aveiro, Portugal
- Public Health Unit, Health Service of the Autonomous Region of Madeira, SESARAM, EPE, Funchal, Portugal
| | - V Ricoca Peixoto
- Public Health Unit, North Lisbon Primary Healthcare Cluster, Lisbon, Portugal
- Public Health Research Centre, National School of Public Health, Lisbon, Portugal
- European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Portugal
| | - S Dias
- Public Health Research Centre, National School of Public Health, Lisbon, Portugal
| | - R Sá Machado
- Division of Epidemiology and Statistics, Directorate-General of Health, Lisbon, Portugal
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Destri K, Alves J, Gregório MJ, Dias S, Canhão H, Rodrigues A. The impact of obesity on absenteeism among working adults in Portugal and its costs. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Obesity leeds to poor health and may afffect work productivity. We aim to investigate the association between obesity and absenteeism and its indirect costs.
Methods
Individuals employeed and actively working at baseline form the EpiDoC Cohort, a large portuguese population-based prospective study analized from 2011 to 2016. Body mass index was assessed during baseline appointment. Follow-up assessment was performed through a phone interview and self reported absenteeism defined by the question”did you have a sick leave in previous 12 months? yes/no”, followed by the number of days missed work due to sickness in the previous twelve months.(1) Negative Binomial Regression model estimated the association between obesity and absenteeism. Indirect costs were computed using the human-capital method.
Results
EpiDoC cohort had 4338 participants who were working adults at baseline. The prevalence of obesity among working adults was 15.2% and of absenteeism was 29.4%. Obesity was associated with an increase in absenteeism incidence rate ratio by 31% (p < 0.01). Obese individual miss 3.9 days per year (95% CI 3.1-4.5). This number is higher in women, 4.6 days per year (95% CI 3.6-5.6) and according to the professional categories women with white collar professions were 82% (p < 0.01) more likely to miss work than peers with their normal weight. Extrapolating for the entire working population, absenteeism due to obesity has an estimated cost of 236€ million per year.
Conclusions
Obesity is an independent risk factor for absenteeism among working adults wich leads to high societal burden in terms of costs. Food and nutrition policies are needed in order improve food patterns and reduce obesity levels among south european population.
Key messages
Obesity is an independent risk factor for absenteeism among working adults. Obesity increases absenteeism mainly in women and has a major impact on economies.
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Affiliation(s)
- K Destri
- Epidemiology of Chronic Diseases Cohort Unit, Nova Medical School/New University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, Nova Medical School/New University of Lisbon, Lisbon, Portugal
| | - J Alves
- Comprehensive Health Research Center, Nova Medical School/New University of Lisbon, Lisbon, Portugal
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
| | - M J Gregório
- Epidemiology of Chronic Diseases Cohort Unit, Nova Medical School/New University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, Nova Medical School/New University of Lisbon, Lisbon, Portugal
- Faculty of Nutrition and Food Science, University of Porto, Porto, Portugal
| | - S Dias
- Epidemiology of Chronic Diseases Cohort Unit, Nova Medical School/New University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, Nova Medical School/New University of Lisbon, Lisbon, Portugal
- Center for Innovative Care and Health Technology, Polytechnic Institut of Leiria., Leiria, Portugal
| | - H Canhão
- Epidemiology of Chronic Diseases Cohort Unit, Nova Medical School/New University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, Nova Medical School/New University of Lisbon, Lisbon, Portugal
| | - A Rodrigues
- Epidemiology of Chronic Diseases Cohort Unit, Nova Medical School/New University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, Nova Medical School/New University of Lisbon, Lisbon, Portugal
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Dias S, Gama A, Simões D, Carreiras E, Mora C, Ferreira AP. Correlates of HIV, STI and TB among sub-Saharan African migrants in Lisbon: a biobehavioral study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Sub-Saharan African migrants (SAMs) have been disproportionately affected by infectious diseases such as HIV, other sexually transmitted infections (STIs) and Tuberculosis infection (TB). Research on infectious diseases and related factors among migrant populations is critical to further understand these populations' health needs and inform prevention strategies. However, migrants are often underrepresented in national statistics and research. This study aimed to examine correlates of HIV, past STI and past TB among SAMs.
A venue-based sample of 790 SSAMs completed a cross-sectional biobehavioral survey on sexual practices, HIV testing and self-reported infectious diseases; an HIV rapid test was offered. Uni- and multivariable logistic regression analyses were performed to examine factors associated with HIV, past STI and past TB.
Overall, 5.4% of participants were HIV-positive and 16.7% reported a past STI. Odds of being HIV positive increased by age (OR 1.07, 95%CI 1.03-1.11) and were higher among those who experienced violence from a partner (OR 2.77, 95%CI 1.08-7.10). Increased odds of having a past STI were found among migrants with low income (OR 2.86, 95%CI 1.48-5.56), long-term migrants (>25 years residing in Portugal: OR 2.16, 95%CI 1.06-4.38) and those who reported sexual risk behaviors (≥3 sexual partners: OR 2.06, 95%CI 1.14-3.70; inconsistent condom use: OR 2.61, 95%CI 1.32-5.17). In total, 4.1% of participants had TB in the past; these were more likely male (OR 3.42, 95%CI 1.29-9.06) and HIV positive (OR 11.48, 95%CI 4.55-28.94). Half of the participants had never been tested for HIV before, including over a third of those who had STI or TB in the past.
Efforts are needed to reduce missed opportunities for HIV/STIs prevention and uptake of HIV testing among SSAMs through more integrated care, while addressing social determinants of infectious diseases.
Key messages
High levels of HIV, STI and TB infection among SAMs were found to be strongly associated with socioeconomic disadvantage and poor living conditions in the host country. Social inequalities are persistently a major factor affecting risk for HIV, STIs and TB, and thus addressing social determinants of infectious diseases must remain a public health priority.
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Affiliation(s)
- S Dias
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - A Gama
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - D Simões
- Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - E Carreiras
- Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde, Amadora, Portugal
| | - C Mora
- Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde, Amadora, Portugal
| | - A P Ferreira
- Ser + - Associação Portuguesa para a Prevenção e Desafio à Sida, Cascais, Portugal
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Dias S, Loos J, Gama A, Simões D, Nöstlinger C. Risk for HIV acquisition among sub-Saharan African migrant travelers in Belgium and Portugal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Migrants often travel back to the origin countries and to other European states after settling in the residence country. Mobility along with structural vulnerabilities may increase HIV acquisition risk. Knowledge on HIV risk exposure when traveling is limited, yet crucial to inform prevention. This study aims to explore risky sexual behaviors and assess HIV prevalence among sub-Saharan African migrants (SAMs) who travel, residing in two European cities.
Two cross-sectional biobehavioral surveys were conducted in Lisbon and Antwerp with a venue-based sample of 1508 SAMs. Descriptive and multivariable logistic regression analyses were performed to examine travel patterns and associated sexual risk behaviors.
Overall, 68.4% of participants had traveled to other countries after settling in the residence country; 41% had traveled back to Africa and within Europe, 25.2% only to Africa and 33.8% only to Europe. Among travelers who reported sexual encounters abroad (49.2%), condomless sex at last intercourse was high both abroad (62.5%) and in the host country (70.7%). Odds of condomless sex at the last sexual encounter in the host country were five times higher among those who also reported no condom use abroad [OR: 5.32; 95% CI: 2.98-9.25], controlling for gender, age, educational level, relationship status, survey country, partner type and origin, and number of sexual partners over the last year. Condomless sex was higher with a regular partner and with an African partner, both abroad (79.9% and 67.5%, respectively) and in the host country (81.3% and 74.6%, respectively). Among the 75 participants who tested HIV-positive (around 5%), more than half had travelled to other countries; of these, about half reported condomless sex with their last sexual partner abroad.
SAMs are a mobile population and are exposed to sexual HIV risk both while traveling and in host countries. Prevention interventions should address the complex interplay between migrants' mobility and HIV risk.
Key messages
Migrants often travel to their origin home countries and other destinations after having settled in host countries, and this mobility increases exposure to HIV risk. A transnational perspective on HIV prevention and sexual health promotion is needed for effectively reducing migrants’ HIV risk related to their mobility.
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Affiliation(s)
- S Dias
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - J Loos
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - A Gama
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - D Simões
- Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - C Nöstlinger
- Grupo de Ativistas em Tratamentos, Lisbon, Portugal
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Abstract
Abstract
Background
Migration has become one of the most politically pressing issues of the 21st century. Still, migrant health remains an under-researched area in global health. Participatory Health Research (PHR) can potentially contribute to a paradigm shift, from a pathogenic deficit model that sees migrants as passively affected by policies to their re-conceptualization as creative, inspiring, and actively engaged citizens in search of solutions. However, PHR is not a panacea and there are specific challenges in enacting meaningful and impactful projects in this field.
Methods
This literature review examines the opportunities and challenges posed by the use of this approach in migrant health research. We highlight critical issues for consideration and provide some examples of successful PHR with migrants.
Results
A number of successful initiatives illustrate the value of engaging migrants in the definition of the research agenda, the design and implementation of health interventions, the identification of health protective factors, and the operationalization and validation of indicators to monitor progress in this field. Still, within fragmented community landscapes that are not necessarily constructed along ethnicity traits, and real-world contexts that are far from the ideals of justice and equality, inadequate structures of representation and power dynamics can hamper a meaningful implementation of PHR with migrants.
Conclusions
For each particular research context it is essential to reflect on what is the “optimal” level and type of participation that is more likely to leverage migrants' empowerment so we can better advocate for our voices to be heard, and our rights to be addressed.
Key messages
Participatory Health research can potentially contribute to address migrant health challenges. The level and type of participation must be tailored to each research context.
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Affiliation(s)
- M Roura
- School of Public Health, University College Cork, Cork, Ireland
- International Collaboration for Participatory Health Research, Berlin, Germany
| | - S Dias
- Public Health Research Center, NOVA National School of Public Health, Universidade NOVA, Lisbon, Portugal
- International Collaboration for Participatory Health Research, Berlin, Germany
| | - J LeMaster
- Kansas University Medical School, The University of Kansas Medical Center, Kansas City, USA
- International Collaboration for Participatory Health Research, Berlin, Germany
| | - A MacFarlane
- GEMS, University of Limerick, Limerick, Ireland
- International Collaboration for Participatory Health Research, Berlin, Germany
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Villadsen S, Dias S. What methods and challenges for taking account of context when transferring complex interventions? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
For complex public health interventions to be effective their implementation needs to adapt to the situation of those implementing and those receiving the intervention. While context matter for intervention implementation and effect, we still insist on learning from cross-country comparison of implementation. Next methodological challenges include how to increase learning from implementation of complex public health interventions from various context. The interventions presented in this workshop all aims to improve quality of reproductive health care for immigrants, however with different focus: contraceptive care in Sweden, group based antenatal care in France, and management of pregnancy complications in Denmark. What does these interventions have in common and are there cross cutting themes that help us to identify the larger challenges of reproductive health care for immigrant women in Europe? Issues shared across the interventions relate to improved interactional dynamics between women and the health care system, and theory around a woman-centered approach and cultural competence of health care providers and systems might enlighten shared learnings across the different interventions and context. Could the mechanisms of change be understood using theoretical underpinnings that allow us to better generalize the finding across context? What adaption would for example be needed, if the Swedish contraceptive intervention should work in a different European setting? Should we distinguish between adaption of function and form, where the latter might be less important for intervention fidelity? These issues will shortly be introduced during this presentation using insights from the three intervention presentations and thereafter we will open up for discussion with the audience.
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Affiliation(s)
- S Villadsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - S Dias
- Escola Nacional de Saúde Pública, CISP, Universidade NOVA de Lisboa, Lisbon, Portugal
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Nogales Crespo KA, Abrantes A, Dias S. Building a comprehensive list of health-related SDG targets for the WHO European Region. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Within a sustainable development framework, health is envisioned to integrate across all Sustainable Development Goals (SDGs) as both a precondition and an outcome. Yet, to this day, there is no consensus over which SDG targets are relevant for health and wellbeing. While WHO identified health-related targets across all SDGs, inputs from the academic community are more conservative. Using policy documents (PDs), this study aims to build a comprehensive list of health-related SDG targets for the WHO European Region.
Methods
PDs endorsed during the 2015-2018 Sessions of the Regional Committee for Europe were selected. A supplementary list of PDs was built reviewing the content of progress reports. 32 PDs were selected following the inclusion criteria of validity and scope. With the collaboration of the Sustainable and Development Programme of WHO EURO, a working list of health-related targets was built. A content analysis of PDs was used to test this list and discover additional targets.
Results
Outside SDG 3, we identified 55 health-related targets distributed across all SDGs (22 additional to the working list). Emerging fields circumscribed to SDG 2, 4, 5, 10, 11, 12, 13, 16, and 17 - in subjects related to food safety and sustainable production, health and sustainable literacy, social welfare policies, adequate housing, sustainable and inclusive communities, climate change resilience, accountable and effective institutions, participatory decision making, knowledge sharing, operational sciences, and partnerships for sustainable development.
Conclusions
By performing an analysis beyond the semantics of the SDGs, we constructed a more comprehensive and accurate representation of how health and wellbeing are embodied in the 2030 Agenda. Previous studies have used the explicit content of the SDGs, hindering the possibility to find additional connections. PDs constitute a valuable resource to advance public health within a sustainable development framework.
Key messages
PDs cross-sectoral approach contribute to understand and acknowledge the connection between health and a variety of non-health topics. Health in the 2030 Agenda relates to targets across all SDGs.
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Affiliation(s)
- K A Nogales Crespo
- NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
- Department of Culture and Communication, Linköping University, Linköping, Sweden
- Institute for Advanced Studies and Research, University of Evora, Evora, Portugal
| | - A Abrantes
- Public Health Research Center, NOVA ENSP, NOVA University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University of Lisbon, Lisbon, Portugal
| | - S Dias
- Public Health Research Center, NOVA ENSP, NOVA University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University of Lisbon, Lisbon, Portugal
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Nordström C, Ingleby D, Dias S, Magnus J, Eikemo TA, Kumar B. Challenges and opportunities in promoting health equity for migrants. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
What has to be done to achieve health equity for migrants? International bodies have published many weighty declarations and recommendations to this end, but these need to be ordered and synthesised. A recurring theoretical problem is how to disentangle the health effects of socioeconomic position (SEP) and migrant status, in order to develop policies that effectively address both factors.
Description of the problem
As part of the Policy Framework for Analysis (PFA) for Work Package 7 of the Joint Action on Health Equity Europe (JAHEE), key policy documents between 2007 and 2018 were reviewed to form a ‘Road Map' from which a coherent synthesis was extracted. The PFA also developed a model for conceptualising the joint influence of SEP and migrant status. What is the relationship between these, and what policy approaches does it imply?
Results
The main recommendations of the ‘Road Map' were summarised in two categories: ‘upstream' measures (data collection and research, governance, and intersectoral action to tackle social determinants of health) and ‘downstream' ones (access to health services, responsiveness to migrants' needs, and attention for vulnerable groups). In the past, ‘upstream' measures have been unduly neglected. According to the proposed model, migrant status can have both direct effects on health and indirect ones that are mediated via SEP. Along the indirect pathways, migrants may suffer from increased exposure and/or increased vulnerability to health threats associated with low SEP.
Lessons
A high degree of consensus already exists about health inequities affecting migrants and the measures needed to tackle them. The urgent challenge at the moment is to put these conclusions into practice. To this end, there is little point in tackling socioeconomic inequities and those linked to migration and ethnicity as though they had nothing to do with each other.
Key messages
The recommendations of international bodies on migrant health from 2007-2018 can be summarized in three ‘upstream’ measures and three ‘downstream’ ones. Promoting health equity for migrants requires breaking down the silos in which work on migration and on SEP has hitherto been carried out.
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Affiliation(s)
- C Nordström
- Cluster for health service analysis and research, Norwegian Institute of Public Health, Oslo, Norway
| | - D Ingleby
- Cluster for health service analysis and research, Norwegian Institute of Public Health, Oslo, Norway
| | - S Dias
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - J Magnus
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T A Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Kumar
- Cluster for health service analysis and research, Norwegian Institute of Public Health, Oslo, Norway
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31
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Wade R, Sharif-Hurst S, Smith C, Dias S. Characteristics modifying response to biological treatments for psoriasis: considering subgroups in network meta-analysis. Br J Dermatol 2020; 184:358-359. [PMID: 32812647 DOI: 10.1111/bjd.19494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/24/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- R Wade
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - S Sharif-Hurst
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - C Smith
- St John's Institute of Dermatology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - S Dias
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
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Dowling NA, Merkouris SS, Dias S, Rodda SN, Manning V, Youssef GJ, Lubman DI, Volberg RA. The diagnostic accuracy of brief screening instruments for problem gambling: A systematic review and meta-analysis. Clin Psychol Rev 2019; 74:101784. [PMID: 31759246 DOI: 10.1016/j.cpr.2019.101784] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 10/22/2019] [Accepted: 10/26/2019] [Indexed: 02/06/2023]
Abstract
Non-gambling specialist services, such as primary care, alcohol and other drug use, and mental health services, are well placed to enhance the identification of people with gambling problems and offer appropriate generalist first level interventions or referral. Given time and resource demands, many of these clinical services may only have the capacity to administer very short screening instruments. This systematic review was conducted to provide a resource for health service providers and researchers in identifying the most accurate brief (1-5 item) screening instruments to identify problem and at-risk gambling for their specific purposes and populations. A systematic search of peer-reviewed and grey literature from 1990 to 2019 identified 25 articles for inclusion. Meta-analysis revealed five of the 20 available instruments met criteria for satisfactory diagnostic accuracy in detecting both problem and at-risk gambling: Brief Problem Gambling Screen (BPGS-2), NODS-CLiP, Problem Gambling Severity Index-Short Form (PGSI-SF), NODS-PERC, and NODS-CLiP2. Of these, the NODS-CLiP and NODS-PERC have the largest volume of diagnostic data. The Lie/Bet Questionnaire and One-Item Screen are also promising shorter options. Because these conclusions are drawn from a relatively limited evidence base, future studies evaluating the diagnostic accuracy of existing brief instruments across settings, age groups, and timeframes are needed.
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Affiliation(s)
- N A Dowling
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia; Melbourne Graduate School of Education, University of Melbourne, Kwong Lee Dow Building, 234 Queensberry Street, Parkville, VIC 3053, Australia.
| | - S S Merkouris
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - S Dias
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - S N Rodda
- School of Population Health, Faculty of Medical and Health Sciences, 216 Morrin Road, Auckland 1142, New Zealand.
| | - V Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Level 2, 5 Arnold Street, Box Hil, 3128 Melbourne, Victoria, Australia; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia
| | - G J Youssef
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville 3052, Victoria, Australia
| | - D I Lubman
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Level 2, 5 Arnold Street, Box Hil, 3128 Melbourne, Victoria, Australia; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia
| | - R A Volberg
- School of Public Health and Health Sciences, University of Massachusetts, 715 N. Pleasant Street, Amherst, MA 01003, USA.
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Nordström C, Ingleby D, Dias S, Magnus J, Kumar B. Country Assessments: Identifying gaps in policy and practice to address equity in health for migrants. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue
The Joint Action on Health Equity in Europe (JAHEE) aims to address inequities in health across all groups. Work Package 7 Migration and Health (WP7) includes 13 partner countries and focuses on health inequities affecting the migrant population. The project started out by developing Policy Framework for Action (PFA), intended to form the basis for exploring opportunities for appropriate actions in the three-year implementation period of the action. The PFA formulated a ’road map’ encompassing six priorities identified in 22 ’soft policy’ documents that have been published by international /governmental organisations since 2007. It also discussed the state of the art in research on the causes of particular inequities undermining migrant health, as well as the measures that can be taken to tackle them.
Description of the problem
The main objective of the Country Assessments (CAs) is to identify the best opportunities (entry points) for developing country-specific actions. From this list, actions will be selected and implemented that are feasible within the constraints of JAHEE. The CAs will provide the information partners need in order to make informed choices. The assessments will indicate where the most serious inequities lie, what causes them, and what can be done about them. The CA Template was based on the PFA, reviewed by the Expert Group and then piloted in two countries (Norway and Italy) in March 2019. The 13 partners participating in WP7 are currently carrying out their assessments, which will be completed by July 2019.
Results
An overview of the main results of the CAs will be presented at the conference.
Lessons
Developing and piloting the Country Assessment Template has been participatory, with necessary revisions on the basis of experience. Completing these assessments for each participant is in itself is the first step towards action. Participants create an overview of available data, experiences and gaps in their countries.
Key messages
The Country Assessment Template is a tool that enables partners to take stock of the situation in their country. Analysis of data from the assessments will enable countries to make an appropriate choice of actions.
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Affiliation(s)
- C Nordström
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - D Ingleby
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - S Dias
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - J Magnus
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - B Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
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Tavares AM, Garcia AC, Gama A, Abecasis AB, Viveiros M, Dias S. Perceptions of primary care providers on TB care for migrants: a mixed methods study in Portugal. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
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.
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Affiliation(s)
- A M Tavares
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A C Garcia
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
- Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, I.P., Lisbon, Portugal
| | - A Gama
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A B Abecasis
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - M Viveiros
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - S Dias
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
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Dias S, Figueiredo C, Coelho A, Hoffmeister L, Gama A. Implementation process of social prescribing to improve primary care patients’ health and well-being. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Social prescribing (SP) is an innovative approach to tackle social determinants of health. It enables general practitioners (GPs) to address non-medical causes of ill-health by linking primary care patients with non-medical community sources of support. Despite convincing results from punctual evaluations, comprehensive evaluation of SP is needed to provide guidance on what works and evidence on its impact.
A SP pilot-project started in 2018 in a primary care service in Lisbon. Its implementation process and outcomes are being evaluated through a longitudinal mixed-method evaluation study assessing patients’ wellbeing, quality of life, anxiety and depression in key stages of the intervention and stakeholders’ perspectives on facilitators/barriers to the intervention implementation.
GPs refer patients to a social worker of the service, who defines with the patient the individual intervention plan using community resources. Initially, GPs and social workers were trained on SP, a network of community partners was built, SP information was distributed to patients, a referral online platform was created and a baseline study is being conducted. In the 1st semester, 130 patients were referred: 39.2% were ≥65 years old, 70.8% were female, 45.4% had foreign nationality. Over two thirds were referred for multiple reasons mostly social isolation, immigration/social integration, mental health, sedentary lifestyle, access to social benefits and employment/skills training.
The project has enabling to support patients with multiple complex psychosocial needs. Regular meetings between GPs and partners have improving collaboration and patients’ supervision. The participatory approach and training emerged as facilitators of the intervention. Yet, the increased burden on social workers due to growing referral profile and some stakeholders’ scepticism toward SP need to be addressed. The triangulation of sources, methods and data provide evidence on the intervention impact and scalability.
Key messages
The social prescribing intervention has been effective in tackling multiple social determinants of health. Intervention evaluation is being key to identify facilitators and opportunities for scale up.
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Affiliation(s)
- S Dias
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - C Figueiredo
- Unidade de Saúde Familiar da Baixa, ACES Lisboa Central, Lisbon, Portugal
| | - A Coelho
- Unidade de Saúde Familiar da Baixa, ACES Lisboa Central, Lisbon, Portugal
| | - L Hoffmeister
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A Gama
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
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Figueiredo Augusto G, Aldir I, Bettencourt J, Dias S, Abrantes A, Oliveira Martins M. The Portuguese HIV/AIDS Programme under austerity. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The HIV/AIDS Programme has been a core health programme in Portugal leading the country’s response to the HIV epidemics since the 1980s. In 2011, the severe financial and economical context forced the government to reorganize central services, including the Ministry of Health, aiming to improve efficiency and reduce costs. All vertical programmes were reformed, including the HIV/AIDS Programme.
Methods
For the period 2009-2018, we analyse the outcomes of core HIV prevention programmes managed by the National Programme for HIV/AIDS Infection: the syringe exchange programme, HIV testing, the distribution of preventive materials, and financial support to private non-for-profit organisations.
Results
This paper describes the main features of that reform and analyses selected outcomes, as well as how those financial constraints affected the response to HIV/AIDS. Despite some transitory cuts in spending, the National Programme for HIV/AIDS Infection was able to successfully expand testing and prevention interventions. Strategic partnerships with non-governmental and community-based organisations were crucial to continue delivering adequate HIV testing services and reaching most-at-risk groups.
Conclusions
The main goals of the National Programme for HIV/AIDS Infection for the term 2012-2016 were reached, including the decrease of new HIV infections, new AIDS cases and AIDS-related deaths, and the country is in a good position to meet UNAIDS’s 90-90-90 targets by 2020. Scaling-up access to pre-exposure prophylaxis, improving access and adherence to antiretroviral therapy, and continuously promoting access to HIV testing services and HIV self-testing stand as the main challenges of the National Programme for HIV/AIDS Infection in the near future.
Key messages
Prioritise spending under financial constrains can be cost-effective. Besides transitory cuts, HIV programme was able to meet its goals.
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Affiliation(s)
- G Figueiredo Augusto
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon, Lisbon, Portugal
| | - I Aldir
- National Programme for HIV/AIDS Infection, Directorate General of Health, Lisbon, Portugal
| | - J Bettencourt
- National Programme for HIV/AIDS Infection, Directorate General of Health, Lisbon, Portugal
| | - S Dias
- Health Promotion, National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal
| | - A Abrantes
- Health Policy and Administration, National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal
| | - M Oliveira Martins
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon, Lisbon, Portugal
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Slade E, Daly C, Mavranezouli I, Dias S, Kearney R, Hasler E, Carter P, Mahoney C, Macbeth F, Delgado Nunes V. Primary surgical management of anterior pelvic organ prolapse: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG 2019; 127:18-26. [PMID: 31538709 DOI: 10.1111/1471-0528.15959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anterior compartment prolapse is the most common pelvic organ prolapse (POP) with a range of surgical treatment options available. OBJECTIVES To compare the clinical effectiveness and cost-effectiveness of surgical treatments for the repair of anterior POP. METHODS We conducted a systematic review of randomised controlled trials comparing surgical treatments for women with POP. Network meta-analysis was possible for anterior POP, same-site recurrence outcome. A Markov model was used to compare the cost-utility of surgical treatments for the primary repair of anterior POP from a UK National Health Service perspective. MAIN RESULTS We identified 27 eligible trials for the network meta-analysis involving eight surgical treatments tested on 3194 women. Synthetic mesh was the most effective in preventing recurrence at the same site. There was no evidence to suggest a difference between synthetic non-absorbable mesh, synthetic partially absorbable mesh, and biological mesh. The cost-utility analysis, which incorporated effectiveness, complications and cost data, found non-mesh repair to have the highest probability of being cost-effective. The conclusions were robust to model inputs including effectiveness, costs and utility values. CONCLUSIONS Anterior colporrhaphy augmented with mesh appeared to be cost-ineffective in women requiring primary repair of anterior POP. There is a need for further research on long-term effectiveness and the safety of mesh products to establish their relative cost-effectiveness with a greater certainty. TWEETABLE ABSTRACT New study finds mesh cost-ineffective in women with anterior pelvic organ prolapse.
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Affiliation(s)
- E Slade
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - C Daly
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - I Mavranezouli
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - S Dias
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Centre for Reviews and Dissemination, University of York, York, UK
| | - R Kearney
- The Warrell Unit, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Medical Human Sciences, University Institute of Human Development, University of Manchester, Manchester, UK
| | - E Hasler
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - P Carter
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - C Mahoney
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - F Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - V Delgado Nunes
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
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Bulhões C, Ramos E, Dias S, Barros H. Depressive symptoms at 13 years as predictors of depression in older adolescents: a prospective 4-year follow-up study in a nonclinical population. Eur Child Adolesc Psychiatry 2019; 28:595-599. [PMID: 29974214 DOI: 10.1007/s00787-018-1194-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/02/2018] [Indexed: 11/28/2022]
Abstract
Depression is the most important source of disability in adolescents, partially due to its recurrence. There is a lack of studies on population-based samples investigating the continuity of depressive symptoms during adolescence. This study evaluates depressive symptoms at early adolescence as predictors of depressive symptoms later in adolescence. Urban adolescents born in 1990 and enrolled in schools of Porto, Portugal, in 2003-2004 (EPITeen study) were evaluated at 13 and 17 years (n = 1106, 55.9% females), and completed a questionnaire comprising health behaviors and Beck Depression Inventory II (BDI-II) to assess depressive symptoms. A questionnaire on socio-demographic and clinical characteristics was self-reported. Regression coefficients (β) and 95% confidence intervals (CI) were estimated using simple linear regression. The prevalence of adolescents with depressive symptoms above the cut-off (BDI-II > 13) was 11.9% at 13 years (girls: 17.1%; boys: 5.3%) and 10.8% at 17 years (girls: 14.7%; boys: 5.7%). Almost 6% of girls and 2% of boys had BDI-II > 13 at both assessments, and 35% of girls and boys with BDI-II > 13 at baseline also had BDI-II > 13 at follow-up. For both genders, depressive symptoms at age 13 were independently associated with depressive symptoms at age 17 (girls: β = 0.35, 95% CI 0.28-0.42; boys: β = 0.37, 95% CI 0.30-0.44). Depressive symptoms at age 13 were an independent predictive factor for adolescents' depressive symptoms at age 17. The prevalence of adolescents with BDI-II > 13 was higher in females, but the strength of this association was similar in both genders, highlighting the heavy burden of depressive symptoms already at an early age, among girls and boys.
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Affiliation(s)
- Cláudia Bulhões
- EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal.
| | - E Ramos
- EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - S Dias
- International Public Health and Biostatistics Unit and GHTM, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - H Barros
- EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Reis C, Rodrigues A, Dias S, Sousa R, Branco J, Canhão H, Paiva T. Lifestyles associated to sleep duration. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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40
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Dias S, Gama A, Roxo L, Simões J, Pita Barros P, Fronteira I. 7.5-O3Migrants' access to primary health care in Portugal: the impact of the financial crisis. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Dias
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - A Gama
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - L Roxo
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - J Simões
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - P Pita Barros
- School of Business and Economics, Universidade Nova de Lisboa, Portugal
| | - I Fronteira
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
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Tavares A, Garcia A, Abecasis A, Viveiros M, Dias S. 4.10-P12Perspectives of health care providers in Portugal on the provision of care to migrant patients with TB or HIV-TB co-infection. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Tavares
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | - A Garcia
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
- Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), Portugal
| | - A Abecasis
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | - M Viveiros
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | - S Dias
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
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Dias S, Gama A, Abrantes P, Akpogheneta O, Reigado V, Ferreira A, Carreiras E, Mora C, Simões D, Martins M. 5.5-O3Examining sexual risk, HIV infection and health services use: a cluster analysis with sub-Saharan African migrants. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Dias
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - A Gama
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - P Abrantes
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - O Akpogheneta
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - V Reigado
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - A Ferreira
- Ser + - Associação Portuguesa para a Prevenção e Desafio à Sida, Cascais, Portugal
| | - E Carreiras
- AJPAS - Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde, Portugal
| | - C Mora
- AJPAS - Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde, Portugal
| | - D Simões
- GAT - Grupo de Ativistas em Tratamentos, Portugal
| | - M Martins
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
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Dias S, Loos J, Roxo L, Gama A, Simões D, Noestlinger C. 5.5-O2Understanding the links between mobility, risky sexual behaviors and HIV among sub-Saharan African migrants (SAMs): a study in two European cities. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Dias
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - J Loos
- Institute of Tropical Medicine, Department of Public Health, Antwerp, Belgium
| | - L Roxo
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - A Gama
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - D Simões
- GAT - Grupo de Ativistas em Tratamentos, Portugal
| | - C Noestlinger
- Institute of Tropical Medicine, Department of Public Health, Antwerp, Belgium
- University of Vienna, Faculty of Psychology, Austria
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Oliveira C, Dias S, Oliveira Martins M, Keygnaert I. 5.1-O6A baseline for primary prevention of sexual and gender-based violence in European asylum reception facilities. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Oliveira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal
| | - S Dias
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal
| | - M Oliveira Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal
| | - I Keygnaert
- International Centre for Reproductive Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium
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45
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Curtarelli R, Pinto N, Sumar G, Dias S, Sordi M, Magini R, Cruz A. Characterization and cytotoxicity analysis of encapsulating simvastatin in PLGA microspheres. Dent Mater 2018. [DOI: 10.1016/j.dental.2018.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sarri G, Pedder H, Dias S, Guo Y, Lumsden MA. Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause. BJOG 2017; 124:1514-1523. [DOI: 10.1111/1471-0528.14619] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 01/25/2023]
Affiliation(s)
- G Sarri
- National Guideline Alliance; Royal College of Obstetricians and Gynaecologists; London UK
| | - H Pedder
- National Guideline Alliance; Royal College of Obstetricians and Gynaecologists; London UK
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - S Dias
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Y Guo
- National Guideline Alliance; Royal College of Obstetricians and Gynaecologists; London UK
| | - MA Lumsden
- Chair of the Guideline Development Group; University of Glasgow; Glasgow UK
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Rosano A, Buttigieg S, Dauvrin M, Dias S, Ronda E, Tafforeau J. Access to preventive health services of migrants in five EU countries. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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48
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Mawdsley D, Bennetts M, Dias S, Boucher M, Welton NJ. Model-Based Network Meta-Analysis: A Framework for Evidence Synthesis of Clinical Trial Data. CPT Pharmacometrics Syst Pharmacol 2016; 5:393-401. [PMID: 27479782 PMCID: PMC4999602 DOI: 10.1002/psp4.12091] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/30/2016] [Accepted: 06/06/2016] [Indexed: 12/13/2022]
Abstract
Model-based meta-analysis (MBMA) is increasingly used in drug development to inform decision-making and future trial designs, through the use of complex dose and/or time course models. Network meta-analysis (NMA) is increasingly being used by reimbursement agencies to estimate a set of coherent relative treatment effects for multiple treatments that respect the randomization within the trials. However, NMAs typically either consider different doses completely independently or lump them together, with few examples of models for dose. We propose a framework, model-based network meta-analysis (MBNMA), that combines both approaches, that respects randomization, and allows estimation and prediction for multiple agents and a range of doses, using plausible physiological dose-response models. We illustrate our approach with an example comparing the efficacies of triptans for migraine relief. This uses a binary endpoint, although we note that the model can be easily modified for other outcome types.
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Affiliation(s)
- D Mawdsley
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - M Bennetts
- Pharmacometrics Group, Pfizer Ltd, Sandwich, Kent, United Kingdom
| | - S Dias
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - M Boucher
- Pharmacometrics Group, Pfizer Ltd, Sandwich, Kent, United Kingdom
| | - N J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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49
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Hernández MA, Campos F, Santamaría T, Rojo MA, Dias S. Is isolation by distance the cause of the genetic structure of the Iberian white‐throated dipper populations? J Zool (1987) 2016. [DOI: 10.1111/jzo.12315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M. A. Hernández
- Department of Environmental Biology School of Sciences University of Navarra Pamplona Spain
| | - F. Campos
- European University Miguel de Cervantes Valladolid Spain
| | | | - M. A. Rojo
- European University Miguel de Cervantes Valladolid Spain
| | - S. Dias
- Centre for Applied Ecology Prof. Baeta Neves/InBIO Associate Laboratory (CEABN/InBIO) School of Agriculture University of Lisbon Lisbon Portugal
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Alfirevic Z, Keeney E, Dowswell T, Welton NJ, Medley N, Dias S, Jones LV, Caldwell DM. Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG 2016; 123:1462-70. [PMID: 27001034 PMCID: PMC5021158 DOI: 10.1111/1471-0528.13981] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 11/26/2022]
Abstract
Objectives To compare the clinical effectiveness and cost‐effectiveness of labour induction methods. Methods We conducted a systematic review of randomised trials comparing interventions for third‐trimester labour induction (search date: March 2014). Network meta‐analysis was possible for six of nine prespecified key outcomes: vaginal delivery within 24 hours (VD24), caesarean section, uterine hyperstimulation, neonatal intensive care unit (NICU) admissions, instrumental delivery and infant Apgar scores. We developed a decision‐tree model from a UK NHS perspective and calculated incremental cost‐effectiveness ratios, expected costs, utilities and net benefit, and cost‐effectiveness acceptability curves. Main results In all, 611 studies comparing 31 active interventions were included. Intravenous oxytocin with amniotomy and vaginal misoprostol (≥50 μg) were most likely to achieve VD24. Titrated low‐dose oral misoprostol achieved the lowest odds of caesarean section, but there was considerable uncertainty in ranking estimates. Vaginal (≥50 μg) and buccal/sublingual misoprostol were most likely to increase uterine hyperstimulation with high uncertainty in ranking estimates. Compared with placebo, extra‐amniotic prostaglandin E2 reduced NICU admissions. There were insufficient data to conduct analyses for maternal and neonatal mortality and serious morbidity or maternal satisfaction. Conclusions were robust after exclusion of studies at high risk of bias. Due to poor reporting of VD24, the cost‐effectiveness analysis compared a subset of 20 interventions. There was considerable uncertainty in estimates, but buccal/sublingual and titrated (low‐dose) misoprostol showed the highest probability of being most cost‐effective. Conclusions Future trials should be designed and powered to detect a method that is more cost‐effective than low‐dose titrated oral misoprostol. Tweetable abstract New study ranks methods to induce labour in pregnant women on effectiveness and cost. New study ranks methods to induce labour in pregnant women on effectiveness and cost.
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Affiliation(s)
- Z Alfirevic
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK
| | - E Keeney
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - T Dowswell
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK
| | - N J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - N Medley
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK
| | - S Dias
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - L V Jones
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK
| | - D M Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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