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Muñoz Laguna J, Puhan MA, Rodríguez Artalejo F, De Pauw R, Wyper GMA, Devleesschauwer B, Santos JV, Hincapié CA. Certainty of the Global Burden of Disease 2019 Modelled Prevalence Estimates for Musculoskeletal Conditions: A Meta-Epidemiological Study. Int J Public Health 2023; 68:1605763. [PMID: 37325175 PMCID: PMC10266422 DOI: 10.3389/ijph.2023.1605763] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/27/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives: To describe and assess the risk of bias of the primary input studies that underpinned the Global Burden of Disease Study (GBD) 2019 modelled prevalence estimates of low back pain (LBP), neck pain (NP), and knee osteoarthritis (OA), from Australia, Brazil, Canada, Spain, and Switzerland. To evaluate the certainty of the GBD modelled prevalence evidence. Methods: Primary studies were identified using the GBD Data Input Sources Tool and their risk of bias was assessed using a validated tool. We rated the certainty of modelled prevalence estimates based on the GRADE Guidelines 30-the GRADE approach for modelled evidence. Results: Seventy-two primary studies (LBP: 67, NP: 2, knee OA: 3) underpinned the GBD estimates. Most studies had limited representativeness of their study populations, used suboptimal case definitions and applied assessment instruments with unknown psychometric properties. The certainty of modelled prevalence estimates was low, mainly due to risk of bias and indirectness. Conclusion: Beyond the risk of bias of primary input studies for LBP, NP, and knee OA in GBD 2019, the certainty of country-specific modelled prevalence estimates still have room for improvement.
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Affiliation(s)
- Javier Muñoz Laguna
- Department of Preventive Medicine, Public Health and Microbiology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Fernando Rodríguez Artalejo
- Department of Preventive Medicine, Public Health and Microbiology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Grant M. A. Wyper
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, United Kingdom
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - João V. Santos
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS—Centre for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, ACES Grande Porto V – Porto Ocidental, ARS Norte, Porto, Portugal
| | - Cesar A. Hincapié
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
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2
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Wyper GM, Assuncao R, Fletcher E, Gourley M, Grant I, Haagsma JA, Hilderink H, Idavain J, Lesnik T, von der Lippe E, Majdan M, Mccartney G, Santric-Milicevic M, Pallari E, Pires SM, Plass D, Porst M, Santos JV, de Haro Moro MT, Stockton DL, Devleesschauwer B. The increasing significance of disease severity in a burden of disease framework. Scand J Public Health 2023; 51:296-300. [PMID: 34213383 PMCID: PMC9969303 DOI: 10.1177/14034948211024478] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent estimates have reiterated that non-fatal causes of disease, such as low back pain, headaches and depressive disorders, are amongst the leading causes of disability-adjusted life years (DALYs). For these causes, the contribution of years lived with disability (YLD) - put simply, ill-health - is what drives DALYs, not mortality. Being able to monitor trends in YLD closely is particularly relevant for countries that sit high on the socio-demographic spectrum of development, as it contributes more than half of all DALYs. There is a paucity of data on how the population-level occurrence of disease is distributed according to severity, and as such, the majority of global and national efforts in monitoring YLD lack the ability to differentiate changes in severity across time and location. This raises uncertainties in interpreting these findings without triangulation with other relevant data sources. Our commentary aims to bring this issue to the forefront for users of burden of disease estimates, as its impact is often easily overlooked as part of the fundamental process of generating DALY estimates. Moreover, the wider health harms of the COVID-19 pandemic have underlined the likelihood of latent and delayed demand in accessing vital health and care services that will ultimately lead to exacerbated disease severity and health outcomes. This places increased importance on attempts to be able to differentiate by both the occurrence and severity of disease.
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Affiliation(s)
- Grant M.A. Wyper
- Place and Wellbeing Directorate, Public
Health Scotland, UK,Grant MA Wyper, Public Health Scotland,
Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK.
| | | | - Eilidh Fletcher
- Data Driven Innovation Directorate,
Public Health Scotland, UK
| | - Michelle Gourley
- Burden of Disease and Mortality Unit,
Australian Institute of Health and Welfare, Australia
| | - Ian Grant
- Data Driven Innovation Directorate,
Public Health Scotland, UK
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus
MC, University Medical Centre Rotterdam, The Netherlands
| | - Henk Hilderink
- National Institute for Public Health
and the Environment (RIVM), The Netherlands
| | - Jane Idavain
- National Institute for Health
Development, Estonia
| | - Tina Lesnik
- National Institute of Public Health,
Slovenia
| | - Elena von der Lippe
- Department of Epidemiology and Health
Monitoring, Robert Koch Institute, Germany
| | - Marek Majdan
- Faculty of Health Sciences and Social
Work, Trnava University, Slovakia
| | | | - Milena Santric-Milicevic
- Institute of Social Medicine, Centre
School of Public Health and Health Management, Faculty of Medicine University of
Belgrade, Serbia
| | - Elena Pallari
- MRC Clinical Trials and Methodology
Unit, University College London, UK
| | - Sara M. Pires
- National Food Institute, Technical
University of Denmark, Denmark
| | - Dietrich Plass
- Section Exposure Assessment and
Environmental Health Indicators, German Environment Agency, Germany
| | - Michael Porst
- Department of Epidemiology and Health
Monitoring, Robert Koch Institute, Germany
| | - João V. Santos
- MEDCIDS, Department of Community
Medicine, Information and Health Decision Sciences, Faculty of Medicine, University
of Porto, Portugal,CINTESIS, Centre for Health
Technology and Services Research, Portugal,Public Health Unit, ACES Grande Porto
VIII – Espinho/Gaia, ARS Norte, Portugal
| | | | - Diane L. Stockton
- Clinical and Protecting Health
Directorate, Public Health Scotland, UK
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public
Health, Sciensano, Belgium,Department of Veterinary Public
Health and Food Safety, Faculty of Veterinary Medicine, Ghent University,
Belgium
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Santos JV, Viana J, Devleesschauwer B, Haagsma JA, Costa Santos C, Ricciardi W, Freitas A. Measuring health expectancy in the European Union. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.067] [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
Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods. In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on self-perceived health (SPH-HLE) and the Institute for Health Metrics and Evaluation's HLE based on disability weight (DW-HLE), by sex, and comparing these results with LE and proportion of life spent in good health (%GH).
Methods
We performed a retrospective study in the EU28 countries, between 2010 and 2017. The HLE methods differ in definition, measurement and valuation of health states. While SPH-HLE relies directly on one question, DW-HLE relies on epidemiological data adjusted for DW. Spearman's r, intraclass correlation coefficient, information-based measure of disagreement and Bland-Altman plots were used to assess reliability, correlation and disagreement in HLE resulting from both methods and in LE or %GH measured by both institutions.
Results
Correlation and reliability between SPH-HLE and DW-HLE were good (better for males), with low disagreement, and were even better for LE between both institutions. The HLE Bland-Altman plots suggest a variability range of approximately 6 years for both sexes, higher for females. There was also an increasing HLE difference between methods with higher average HLE for both sexes.
Conclusions
We showed wide variations between both methods with a clear and different high impact on female and male HLE, showing a tendency for countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.
Acknowledgements: This presentation was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020)
Key messages
• Different methods for evaluating health expectancy lead to significantly different results.
• There is a systematic tendency with countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.
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Affiliation(s)
- JV Santos
- Public Health Unit, ACES Espinho/Gaia, ARS Norte , Porto, Portugal
- MEDCIDS, Faculty of Medicine, University of Porto , Porto, Portugal
- CINTESIS, Centre for Health Technology and Services Research , Porto, Portugal
| | - J Viana
- MEDCIDS, Faculty of Medicine, University of Porto , Porto, Portugal
- CINTESIS, Centre for Health Technology and Services Research , Porto, Portugal
| | - B Devleesschauwer
- Department of Epidemiology and Public Health , Sciensano, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Ghent University , Merelbeke, Belgium
| | - JA Haagsma
- Erasmus MC, University Medical Center , Rotterdam, Netherlands
| | - C Costa Santos
- MEDCIDS, Faculty of Medicine, University of Porto , Porto, Portugal
- CINTESIS, Centre for Health Technology and Services Research , Porto, Portugal
| | - W Ricciardi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
| | - A Freitas
- MEDCIDS, Faculty of Medicine, University of Porto , Porto, Portugal
- CINTESIS, Centre for Health Technology and Services Research , Porto, Portugal
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Santos JV, Fernandes Silva D, Santos Martins F. New proposed measures to evaluate contact tracing effectiveness. Eur J Public Health 2022. [PMCID: PMC9593525 DOI: 10.1093/eurpub/ckac131.215] [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: 11/15/2022] Open
Abstract
Issue/problem Contact tracing is an important and widely used method to control transmission of communicable diseases. The COVID-19 pandemic presented a new and big challenge with a high number of confirmed cases and contacts and subsequent high burden on contact tracing activities. Naturally, the effectiveness of such interventions needs to be assessed, and appropriate measures are still rather underdeveloped. Description of the problem We propose two new measures for assessing contact tracing effectiveness: “number needed to quarantine” (NNQ), which is the number of quarantined person-days needed to prevent one infectious person-day, and the proportion of infectious days prevented by the quarantined (PPID). We have applied these measures to assess COVID-19 contact tracing effectiveness in COVID-19 confirmed cases diagnosed between July and mid-September 2020 in a local Public Health Unity in the Northern region of Portugal (Espinho/Gaia). For robustness checks and accounting for the uncertainty of the infectiousness period, we used three different scenarios. Results Depending on the infectiousness period considered, we have found a NNQ between 19.8 and 41.8 and a PPID between 19.7% and 38.2%. Contact tracing effectiveness was higher for some specific groups such as cohabitants and symptomatic contacts. Effectiveness also decreased with the increasing time from diagnosis or symptom onset to contact isolation Lessons NNQ and PPID are straightforward and easy to use measures to evaluate contact tracing effectiveness in communicable diseases. Although this example focuses in the COVID-19 pandemic at a local setting, these measures can also be used for different communicable diseases and at different levels. This assessment step can be important for priority setting of transmission control activities but also on a health management perspective. Key messages • New measures to evaluate contact tracing effectiveness are proposed: “number needed to quarantine” and “proportion of prevented infectious days”. • These measures allow the identification of priority groups that must be quarantined, as well as time periods of intervention, for better transmission control.
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Affiliation(s)
- JV Santos
- Public Health Unit, ACES Espinho/Gaia, ARS Norte , Porto, Portugal
- MEDCIDS, Faculty of Medicine, University of Porto , Porto, Portugal
- CINTESIS, Centre for Health Technology and Services Research , Porto, Portugal
| | | | - F Santos Martins
- Public Health Unit, ACES Espinho/Gaia, ARS Norte , Porto, Portugal
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Santos JV, Cylus J. What does it mean to age in good health? An analysis of Time Use Survey data. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.560] [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
While there is intrinsic value of ageing in good health, there is little evidence of how the daily lives of older people differ depending on their health status.
Methods
We use Time Use Survey data from the United Kingdom to assess how people at different ages spend their time, conditional on their self-reported health.
Results
While results are preliminary, we find stark differences between people's time use dependent on their health. For example, older people who report good health are more likely than comparable older people to engage in paid work, volunteer, and participate in leisure activities.
Conclusions
There are many benefits to supporting healthy ageing. By considering how time spent differs between those in good and poor health and attributing value to that time, one can take a more holistic perspective when conducting cost-benefit analysis of policy interventions.
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Affiliation(s)
- JV Santos
- London Hub, European Observatory on Health Systems and Policies, London, UK
| | - J Cylus
- London Hub, European Observatory on Health Systems and Policies, London, UK
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Pinto A, Santos JV, Lobo M, Viana J, Souza J, Ramalho A, Pereira A, Freitas A. Primary care organizational model mix and avoidable hospitalization: an ecological study in Portugal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.460] [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
In Portugal, there are different organizational models in primary health care (PHC), mainly regarding the payment scheme. USF-B is the only type with financial incentives to the professional (pay-for-performance). Our goal was to assess the relationship between groups of primary healthcare centres (ACES) with higher proportion of patients within USF-B model and the rate of avoidable hospitalizations, as proxy of primary care quality.
Methods
We conducted a cross-sectional study considering the 55 ACES from mainland Portugal, in 2017. We used data from public hospitalizations to calculate the prevention quality indicator (avoidable hospitalizations) adjusted for age and sex, using direct standardization. The main independent variable was the proportion of patients in one ACES registered in the USF-B model. Unemployment rate, proportion of patients with family doctor and presence of Local Health Unit (different organization model) within ACES were also considered. The association was assessed by means of a linear regression model.
Results
Age-sex adjusted PQI value varied between 490 and 1715 hospitalizations per 100,000 inhabitants across ACES. We observed a significant effect of the proportion of patients within USF-B in the crude PQI rate (p = 0.001). However, using the age-sex adjusted PQI, there was not a statistical significant association (p = 0.504). This last model was also adjusted for confounding variables and the association remains non-significant (p = 0.865).
Conclusions
Our findings suggest that, when adjusting for age and sex, there is no evidence that ACES with more patients enrolled in a pay-for-performance model is associated with higher quality of PHC (using avoidable hospitalizations as proxy). Further studies addressing individual data should be performed.
This work was financed by FEDER funds through the COMPETE 2020 - POCI, and by Portuguese funds through FCT in the framework of the project POCI-01-0145-FEDER-030766 “1st.IndiQare”.
Key messages
Adjusting PQI to sex and age seems to influence its value more than the type of organizational model of primary health care. Groups of primary healthcare centres with more units under the pay-for-performance scheme was not associated with different rate of avoidable hospitalizations.
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Affiliation(s)
- A Pinto
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - J V Santos
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Vila Nova de Gaia, Portugal
| | - M Lobo
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - J Viana
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - J Souza
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - A Ramalho
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - A Pereira
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
- Family Health Unit Prelada, ACES Porto Ocidental, ARS Norte, Porto, Portugal
- PHC - Contractualization Department, Northern Regional Administration of Health, ARS Norte, Porto, Portugal
| | - A Freitas
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
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Santos JV, Souza J, Pinto A, Ramalho A, Pereira A, Pestana JP, Camanho A, Freitas A. Efficiency of groups of primary healthcare centres: a frontier analysis of primary care in Portugal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.459] [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
Primary health care (PHC) is the cornerstone of several health systems. The Portuguese PHC is organized in five mainland regions (ARS), that oversee 55 local groups of primary healthcare centres (ACES). We assessed the efficiency of all 55 ACES in mainland Portugal, as well as organizational and socioeconomic determinants of the efficiency.
Methods
A cross-sectional non-parametric frontier analysis was performed for 2017. The first model included two inputs (i.e. number of physicians and number of nurses) and a single output (i.e. number of PHC visits), while the second model included an additional output, i.e. Prevention Quality Indicator (PQI) overall composite (avoidable hospitalizations) adjusted for age and sex - as undesirable output. In a second stage, a (multivariate) Tobit regression was used to assess organizational and socioeconomic determinants of efficiency.
Results
In the first model, only 8 ACES (14.5%) were on the efficiency frontier, while 25 ACES should readjust their human resource balance. In the second model, 9 ACES (16.4%) were considered efficient. When considering quality, one ACES previously considered inefficient moved to the frontier and two ACES lost their benchmark position. The second-stage analysis indicates that groups with a higher proportion of PHC units with pay-for-performance incentives were associated with higher efficiency.
Conclusions
Most ACES have the potential to improve their production levels., A better management of human resources can contribute to improve overall efficiency. ACES with a higher proportion of units with pay-for-performance schemes seem to be more efficient. These findings contribute to the evaluation of policies to integrate and scale up PHC services locally, such as the recent primary care networks in the NHS UK.
This work was financed by FEDER funds through the COMPETE 2020 - POCI, and by Portuguese funds through FCT in the framework of the project POCI-01-0145-FEDER-030766 “1st.IndiQare”.
Key messages
Most Portuguese ACES have the potential to improve their outputs given their current level of human resources. Local groups that aggregate more PHC units with pay-for-performance schemes are associated with high efficiency.
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Affiliation(s)
- J V Santos
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, ACES Grande Porto VIII – Espinho/Gaia, ARS Norte, Vila Nova de Gaia, Portugal
| | - J Souza
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - A Pinto
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - A Ramalho
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - A Pereira
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
- Family Health Unit Prelada, ACES Porto Ocidental, ARS Norte, Porto, Portugal
- PHC Contractualization Department, Northern Regional Administration of Health, ARS Norte, Porto, Portugal
| | - J P Pestana
- NOVA School of Business & Economics, NOVA University of Lisbon, Lisbon, Portugal
| | - A Camanho
- Faculty of Engineering, University of Porto, Porto, Portugal
| | - A Freitas
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
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Wyper GMA, Assunção R, Cuschieri S, Devleesschauwer B, Fletcher E, Haagsma JA, Hilderink HBM, Idavain J, Lesnik T, Von der Lippe E, Majdan M, Milicevic MS, Pallari E, Peñalvo JL, Pires SM, Plaß D, Santos JV, Stockton DL, Thomsen ST, Grant I. Correction to: Population vulnerability to COVID-19 in Europe: a burden of disease analysis. ACTA ACUST UNITED AC 2020; 78:57. [PMID: 32566224 PMCID: PMC7299839 DOI: 10.1186/s13690-020-00437-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Grant M A Wyper
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, Scotland, UK
| | - Ricardo Assunção
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Sarah Cuschieri
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, ida, Malta
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Eilidh Fletcher
- Data Driven Innovation Directorate, Public Health Scotland, Edinburgh, Scotland, UK
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Henk B M Hilderink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jane Idavain
- National Institute for Health Development, Tallinn, Estonia
| | - Tina Lesnik
- National Institute of Public Health, Ljubljana, Slovenia
| | - Elena Von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Marek Majdan
- Department of Public Health, Institute for Global Health and Epidemiology, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | | | - Elena Pallari
- MRC Clinical Trials and Methodology Unit, University College London, London, UK
| | - José L Peñalvo
- Unit of Noncommunicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sara M Pires
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Dietrich Plaß
- Exposure Assessment and Environmental Health Indicators, German Environment Agency, Berlin, Germany
| | - João V Santos
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS, Centre for Health Technology and Services Research, Porto, Portugal.,Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Porto, Portugal
| | - Diane L Stockton
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, Scotland, UK
| | | | - Ian Grant
- Data Driven Innovation Directorate, Public Health Scotland, Edinburgh, Scotland, UK
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9
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Wyper GMA, Assunção R, Cuschieri S, Devleeschauwer B, Fletcher E, Haagsma JA, Hilderink HBM, Idavain J, Lesnik T, Von der Lippe E, Majdan M, Milicevic MS, Pallari E, Peñalvo JL, Pires SM, Plaß D, Santos JV, Stockton DL, Thomsen ST, Grant I. Population vulnerability to COVID-19 in Europe: a burden of disease analysis. Arch Public Health 2020; 78:47. [PMID: 32501409 PMCID: PMC7256342 DOI: 10.1186/s13690-020-00433-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 05/04/2020] [Accepted: 05/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. METHODS Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. RESULTS Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. CONCLUSION Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19.
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Affiliation(s)
- Grant M. A. Wyper
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, Scotland, UK
| | - Ricardo Assunção
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Sarah Cuschieri
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Brecht Devleeschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Eilidh Fletcher
- Data Driven Innovation Directorate, Public Health Scotland, Edinburgh, Scotland, UK
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Henk B. M. Hilderink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jane Idavain
- National Institute for Health Development, Tallinn, Estonia
| | - Tina Lesnik
- National Institute of Public Health, Ljubljana, Slovenia
| | - Elena Von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Marek Majdan
- Department of Public Health, Institute for Global Health and Epidemiology, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | | | - Elena Pallari
- MRC Clinical Trials and Methodology Unit, University College London, London, UK
| | - José L. Peñalvo
- Unit of Noncommunicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sara M. Pires
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Dietrich Plaß
- Exposure Assessment and Environmental Health Indicators, German Environment Agency, Berlin, Germany
| | - João V. Santos
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Porto, Portugal
| | - Diane L. Stockton
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, Scotland, UK
| | | | - Ian Grant
- Data Driven Innovation Directorate, Public Health Scotland, Edinburgh, Scotland, UK
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Abstract
SETTING: In Portugal, as in other countries, tuberculosis (TB) is considered a disease that should be managed on an ambulatory basis. However, hospitalisation remains important to manage some at-risk groups and complications.OBJECTIVE: To identify the possible risk factors associated with hospitalisations in TB patients in Portugal.DESIGN: Data extraction through two national databases (one for registration of TB cases and the other with hospitalisation information in public health facilities) between 2007 and 2013. Univariate and multivariate analysis of demographic and clinical variables was performed.RESULTS: We identified 4421 hospitalisations. Chronic diseases, cancer, substance abuse, a higher social/economic risk, extra-pulmonary TB, lung cavitary disease and previous uncompleted treatment were more frequent among hospitalised patients. Human immunodeficiency virus coinfection, cancer, alcohol abuse, extra-pulmonary TB and uncompleted previous TB treatment were the most important predictors of hospitalisation with TB. The hospitalisation rate among TB patients in Portugal was lower when compared with other countries with lower and higher incidences.CONCLUSION: Immune dysfunctions and progression of chronic diseases are associated with more severe forms of TB and frequent adverse effects which can be sufficiently severe to necessitate hospital admission. Despite having an intermediate TB incidence, the hospitalisation rate in Portugal is not higher than that of other countries.
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Affiliation(s)
- M A Galego
- Serviço de Pneumologia, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos Entidade Pública Empresarial, Matosinhos
| | - J V Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto, Porto, Unidade de Saúde Pública, Agrupamento de Centros de Saúde de Espinho/Gaia
| | - J Viana
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto, Porto
| | - A Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto, Porto
| | - R Duarte
- Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, EPIUnit, Instituto De Saúde Pública Da Universidade Do Porto, Faculty of Medicine of the University of Porto, Porto, Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine of the University of Porto, Porto, Portugal
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Santos JV, Viana J, Souza J, Lobo M, Ramalho A, Gonçalves-Pinho M, Freitas A. Time trends of primary care quality across Portuguese regions: using prevention quality indicators. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.383] [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: 11/14/2022] Open
Abstract
Abstract
Background
Primary care quality is one of the main dimensions of primary care performance and can be evaluated by several methods, e.g. studying hospitalizations for conditions that could be treated, or less severe, if appropriately managed in primary care. Accordingly, the Agency for Healthcare Research and Quality (AHRQ) developed prevention quality indicators (PQIs). In this study, we aimed to compare PQIs and their time trends across Portuguese regions.
Methods
We performed a retrospective study, using all adult public hospital discharges in mainland Portugal, between 2011 and 2015. PQI rates for the overall (PQI 90) and composite indicators (i.e. 91 - acute, 92 - chronic, 93 - diabetes) were computed using AHRQ specifications. These rates were compared between the 5 Portuguese NUTS 2 regions of residence.
Results
From the total of 407,792 hospital discharges in mainland Portugal (2011-2015) 11.9% comprised the selected PQIs, the majority related the acute composite PQI, followed by the chronic composite PQI. The hospitalization rate of the overall PQI increased from 999.5 hospitalizations (2011) to 1231,0 hospitalizations/100,000 inhabitants (2015), with an increase in all NUTS 2 regions. In 2015, while Algarve and North had the lowest PQI rates, Centro and Alentejo showed the highest ones.
Conclusions
Between 2011 and 2015, there was an increasing trend of overall and composite PQI rates. Also, important differences between Portuguese regions were found that must be further studied.
The authors thank the support given by the Project ’POCI-01-0145-FEDER-030766’ (1st.IndiQare - Quality indicators in primary health care: validation and implementation of quality indicators as an assessment and comparison tool), funded by Fundação para a Ciência e a Tecnologia (FCT) and co-funded by Fundo de Desenvolvimento Regional (FEDER) through Operacional Competitividade e Internacionalização (COMPETE 2020).
Key messages
Between 2011 and 2015, overall prevention quality indicator rate increased in Portugal. There are great differences between Portuguese NUTS 2 regions regarding prevention quality indicators.
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Affiliation(s)
- J V Santos
- MEDCIDS – Department of Community Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS – Center for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, ACES Grande Porto VIII Espinho-Gaia, Vila Nova de Gaia, Portugal
| | - J Viana
- MEDCIDS – Department of Community Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS – Center for Health Technology and Services Research, Porto, Portugal
| | - J Souza
- MEDCIDS – Department of Community Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS – Center for Health Technology and Services Research, Porto, Portugal
| | - M Lobo
- MEDCIDS – Department of Community Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS – Center for Health Technology and Services Research, Porto, Portugal
| | - A Ramalho
- MEDCIDS – Department of Community Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS – Center for Health Technology and Services Research, Porto, Portugal
| | - M Gonçalves-Pinho
- MEDCIDS – Department of Community Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS – Center for Health Technology and Services Research, Porto, Portugal
| | - A Freitas
- MEDCIDS – Department of Community Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS – Center for Health Technology and Services Research, Porto, Portugal
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Duarte R, Santos JV, Santos Silva A, Sotgiu G. Epidemiology and socioeconomic determinants of tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10020717] [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: 11/05/2022]
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Santos JV, Ricciardi W, Freitas A. Inequalities in the sustainable development goal 3 in the European Union from 2000 to 2016. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.474] [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)
- JV Santos
- Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - A Freitas
- Faculty of Medicine, University of Porto, Porto, Portugal
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Santos JV, Lisboa C, Lanna C, Costa-Pereira A, Freitas A. Is the prevalence of hidradenitis suppurativa being overestimated in Europe? Or is the disease underdiagnosed? Evidence from a nationwide study across Portuguese public hospitals. Int J Dermatol 2017; 56:1491-1492. [PMID: 28762478 DOI: 10.1111/ijd.13703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/27/2017] [Accepted: 06/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- João V Santos
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Carmen Lisboa
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Dermatovenereology, Centro Hospitalar S. João, Porto, Portugal
| | - Caterina Lanna
- Faculty of Medicine, University of Rome "Tor Vergata", Porto, Portugal
| | - Altamiro Costa-Pereira
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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Santos JV, Oliveira A, Costa-Pereira A, Amarante J, Freitas A. Corrigendum to "Burden of burns in Portugal, 2000-2013: A clinical and economic analysis of 26,447 hospitalisations" [Burns 42 (4) (2016) 891-900]. Burns 2016; 42:1886. [PMID: 27789046 DOI: 10.1016/j.burns.2016.09.032] [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: 11/29/2022]
Affiliation(s)
- João V Santos
- CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Portugal.
| | - Andreia Oliveira
- CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal
| | - Altamiro Costa-Pereira
- CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Portugal
| | - José Amarante
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital São João, Faculty of Medicine, University of Porto, Portugal
| | - Alberto Freitas
- CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Portugal
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Costa-Martins S, Santos JV, Bernardes J. Laparoscopic surgery during pregnancy. A survey among European Obstetricians and Gynecologists. Eur J Obstet Gynecol Reprod Biol 2016; 206:247-248. [PMID: 27720300 DOI: 10.1016/j.ejogrb.2016.07.511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/08/2016] [Accepted: 07/26/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Sara Costa-Martins
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal.
| | - João V Santos
- CIDES - Department of Health Information and Decisions Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Research in Health Technologies and Information Systems, Portugal
| | - João Bernardes
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Research in Health Technologies and Information Systems, Portugal; Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
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Santos JV, Viana J, Amarante J, Freitas A. Paediatric burn unit in Portugal: Beds needed using a bed-day approach. Burns 2016; 43:403-410. [PMID: 27644139 DOI: 10.1016/j.burns.2016.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 05/19/2016] [Revised: 08/01/2016] [Accepted: 08/17/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite the high burden of children with burns, there is not a paediatric burn unit (PBU) in Portugal. We aimed to estimate the Portuguese health care providing needs on paediatric burns. METHODS We performed a nation-wide retrospective study, between 2009 and 2013, among less than 16 years-old inpatients with burns that met the transfer criteria to a burn unit in Portugal. A bed-day approach was used, targeting an occupancy rate of 70-75%, and possible locations were studied. The primary outcome was the number of beds needed, and secondary outcomes were the overload and revenue for each possible number of beds in a PBU. RESULTS A total of 1155 children met the transfer criteria to a burn unit, representing a total of 17,371 bed-days. Occupancy rates of 11-bed, 12-bed, 13-bed and 14-bed PBU were, respectively, 79.7%, 75.3%, 71.0% and 66.8%. The 13-bed PBU scenario would represent an overload of 523 bed-days, revenue of more than 5 million Euros and a ratio of 1 PBU bed per 123,409 children. CONCLUSIONS Using a groundbreaking approach, the optimal number of PBU beds needed in Portugal is 13. However, as half of the patients who met burn transfer criteria are not transferred, this bed number might be overestimated if this pattern maintains, despite the underestimation with our method approach. If a PBU is to be created the preferable location is Porto. Cost-effectiveness studies should be performed.
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Affiliation(s)
- João V Santos
- CIDES-Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS-Centre for Health Technology and Services Research, Portugal.
| | - João Viana
- CIDES-Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS-Centre for Health Technology and Services Research, Portugal
| | - José Amarante
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital São João and Faculty of Medicine, University of Porto, Portugal
| | - Alberto Freitas
- CIDES-Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS-Centre for Health Technology and Services Research, Portugal
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Santos JV, Oliveira A, Costa-Pereira A, Amarante J, Freitas A. Burden of burns in Portugal, 2000–2013: A clinical and economic analysis of 26,447 hospitalisations. Burns 2016; 42:891-900. [DOI: 10.1016/j.burns.2016.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/09/2016] [Accepted: 01/13/2016] [Indexed: 11/15/2022]
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Gonçalves-Pinho M, Santos JV, Costa A, Costa-Pereira A, Freitas A. The impact of a liberalisation law on legally induced abortion hospitalisations. Eur J Obstet Gynecol Reprod Biol 2016; 203:142-6. [PMID: 27285305 DOI: 10.1016/j.ejogrb.2016.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/18/2016] [Revised: 04/22/2016] [Accepted: 05/21/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Legal abortion based purely in maternal option without fetal/maternal pathology was liberalised in Portugal in 2007 and since then abortion rates have increased substantially. The aim of this paper was to study the impact of the liberalisation of abortion by maternal request on total legal abortion related hospitalisation trends. STUDY DESIGN We considered hospitalisations of legal abortion (ICD-9-CM codes 635.x) with discharges from 2000 to 2014. Data was obtained from a Portuguese administrative database, which contains all registered public hospitalisations in mainland Portugal. Performed legal abortions during the same period were obtained from INE (National Statistics Institute). Hospitalisations per abortion were calculated by dividing the number of legal abortions hospitalisations per the number of legal abortions, mean ages, number of hospitalisations per age group, complications, admission type and length of stay were also analysed, throughout the study period. RESULTS Hospitalisations rose during the study period, (from 618 episodes in 2000 to 1,259 in 2014, with a peak of 1,603 in 2010). Since the liberalisation law was passed there was a significant decrease in the number of hospitalisations per abortion: from 1.07 in 2000 to 0.11 in 2014 (p<0.001). Furthermore, the mean age maintained stable since liberalisation (30.8 years before 2007 and 31.0 after). Abortion related hospitalisations are more frequent in women aged 25-39. A significant decrease from the emergent to the scheduled type of admission occurred from 2000 to 2014 (from 83.5% to 56.7% of emergent admissions) (p<0.001). Complications remained stable between 2000 and 2014 and delayed or excessive haemorrhage was the most frequent (4.6%). CONCLUSIONS Since the liberalisation, hospitalisations per abortion have decreased, reflecting the major impact that the liberalisation of legal abortion by maternal request had on abortion trends nationwide. Before the liberalisation, each abortion led to approximately one hospitalisation while after the liberalisation this trend shifted to approximately 10% of the number of abortions. Legal abortion related hospitalisations are more frequent in women aged between 25 and 39 years old, an older age group when compared to the one registered in all cases of legal abortions, reflecting the differences between those hospitalised and those who are not. Our study shows the impact that legal abortion by maternal request liberalisation law can bring to abortion and to hospitalisation trends.
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Affiliation(s)
- Manuel Gonçalves-Pinho
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal.
| | - João V Santos
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Antónia Costa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, s/n, 4200-450 Porto, Portugal; Obstetrics and Gynecology Department, Hospital São João, Alameda Hernâni Monteiro, s/n, 4200-450 Porto, Portugal
| | - Altamiro Costa-Pereira
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Alberto Freitas
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
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Martins S, Carvalho I, Santos JV, Duarte R. Tuberculosis in undiagnosed children: what are the criteria to start treatment in Portugal? Rev Port Pneumol (2006) 2015; 21:223-4. [PMID: 25926241 DOI: 10.1016/j.rppnen.2015.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/12/2015] [Accepted: 03/22/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- S Martins
- Medical School, Porto University, Portugal.
| | - I Carvalho
- Hospital Centre of Vila Nova de Gaia/Espinho, Portugal
| | - J V Santos
- Department of Health Information and Decision Science, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Portugal
| | - R Duarte
- Medical School, Porto University, Portugal; Hospital Centre of Vila Nova de Gaia/Espinho, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, Medical School, Porto University, Portugal; EPIUnit Institute of Public Health, Porto University, Portugal
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Santos JV, Correia C, Cabral F, Bernardes J, Freitas A, Costa-Pereira A. How can we achieve consensual indicators to be better accepted and more widely used? Eur J Obstet Gynecol Reprod Biol 2014; 173:123-4; discussion 124. [DOI: 10.1016/j.ejogrb.2013.11.013] [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] [Received: 11/14/2013] [Accepted: 11/18/2013] [Indexed: 10/26/2022]
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Santos JV, Correia C, Cabral F, Bernardes J, Costa-Pereira A, Freitas A. Should European perinatal indicators be revisited? Eur J Obstet Gynecol Reprod Biol 2013; 170:85-9. [PMID: 23809998 DOI: 10.1016/j.ejogrb.2013.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/17/2012] [Revised: 04/11/2013] [Accepted: 05/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Our study presents the results of a survey of physicians and/or researchers working in 21 European countries, on their opinion about the relevance of perinatal indicators, in order to compare it with the EURO-PERISTAT recommendations. STUDY DESIGN In this cross-sectional study, we selected 21 out of the initial set of 34 indicators of the national data supply on the European Perinatal Health Report, and added four other indicators based on expert opinion. The relative relevance of these 25 perinatal indicators was then rated by 134 respondents--expert physicians and/or researchers who have published in perinatal medicine--through a web-based survey. We summarized our data using descriptive statistics. RESULTS The top five perinatal indicators, according to the respondents' rating were: neonatal mortality rate by gestational age, birth weight and plurality; percentage of highly preterm babies delivered in units without a NICU; prevalence of severe maternal morbidity; severe neonatal morbidity among babies at high risk and prevalence of hypoxic-ischemic encephalopathy. Of these top five indicators, however, only neonatal mortality rate by gestational age, birth weight and plurality was considered a core indicator, in 2003. Moreover, severe neonatal morbidity among babies at high risk and prevalence of hypoxic-ischemic encephalopathy, that were considered in 2003 as requiring further development, were now considered by the respondents as highly relevant. CONCLUSIONS Current views of European physicians and/or researchers working in the perinatal field may not be in agreement with the EURO-PERISTAT recommendations. A revision of the set of perinatal indicators is, therefore, mandatory if a more comprehensive view of health care systems performance across Europe is to be achieved.
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Affiliation(s)
- João V Santos
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Research in Health Technologies and Information Systems, Portugal.
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Coutinho P, Barros J, Zemmouri R, Guimarães J, Alves C, Chorão R, Lourenço E, Ribeiro P, Loureiro JL, Santos JV, Hamri A, Paternotte C, Hazan J, Silva MC, Prud'homme JF, Grid D. Clinical heterogeneity of autosomal recessive spastic paraplegias: analysis of 106 patients in 46 families. Arch Neurol 1999; 56:943-9. [PMID: 10448799 DOI: 10.1001/archneur.56.8.943] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Hereditary spastic paraplegias (HSPs) are a heterogeneous group of neurodegenerative disorders characterized by progressive and predominant spasticity of the lower limbs, in which dominant, recessive, and X-linked forms have been described. While autosomal dominant HSP has been extensively studied, autosomal recessive HSP is less well known and is considered a rare condition. OBJECTIVE To analyze the clinical presentation in a large group of patients with autosomal recessive HSP from Portugal and Algeria to define homogeneous groups that could serve as a guide for future molecular studies. RESULTS Clinical features in 106 patients belonging to 46 Portuguese and Algerian families with autosomal recessive HSP are presented, as well as the results of molecular studies in 23 of these families. Five phenotypes are defined: (1) pure early-onset families, (2) pure lateonset families, (3) complex families with mental retardation, (4) complex families with mental retardation and peripheral neuropathy, and (5) complex families with cerebellar ataxia. Six additional families have specific complex presentations, each of which is unique in the present series. Pyramidal signs in the upper limbs and pes cavus are frequent findings, while pseudobulbar signs, including dysarthria, dysphagia, and brisk jaw jerks, are more frequent in the complex forms. The complex forms have a poorer prognosis, while pure forms, particularly those with early onset, are more benign. One Algerian pure early-onset kindred was linked to the locus on chromosome 8, previously reported in 4 Tunisian families. Two of the Portuguese kindreds with complex forms (one with mental retardation and the other associated with hypoplasia of the corpus callosum) showed linkage to the locus recently identified on chromosome 16. CONCLUSIONS Although autosomal recessive HSP represents a heterogeneous group of diseases, some phenotypes can be defined by analyzing a large group of patients. The fact that only one Algerian family was linked to chromosome 8 suggests that this is a rare localization even in kindreds with the same ethnic background. Linkage to chromosome 16 was found in 2 clinically diverse Portuguese kindreds, illustrating that this locus is also rare and may correspond to different phenotypes.
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Affiliation(s)
- P Coutinho
- Department of Medicine, Hospital S. Sebastião, Santa Maria de Feira, Portugal
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Abstract
We report the case of a female patient who was exhibiting slowly progressive, severe, generalized freezing of voluntary movement and disequilibrium. Brain magnetic resonance imaging showed a very low signal intensity in both pallidal nuclei, with a high signal intensity in the central portion, the so called 'eye-of-the-tiger' sign. Despite the unusual clinical features, we believe that this is a case of Hallervorden-Spatz syndrome, although without neuropathological examination we were unable to confirm the diagnosis with certainty. This case further demonstrates the complex role of the pallidum in voluntary movement.
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Affiliation(s)
- J Guimarães
- Servico de Neurologia, Hospital de Egas Moniz - Rua da Junqueira, 126-1300, Lisboa, Portugal
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Santos JV, Baudet JA, Casellas FJ, Guarner LA, Vilaseca JM, Malagelada JR. Intravenous cyclosporine for steroid-refractory attacks of Crohn's disease. Short- and long-term results. J Clin Gastroenterol 1995; 20:207-10. [PMID: 7797828 DOI: 10.1097/00004836-199504000-00009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A prospective, open trial was conducted to test whether i.v. cyclosporine was effective in the treatment of refractory Crohn's disease. Eight patients with acute steroid-refractory attacks were included. Intravenous cyclosporine, 5 mg/kg/day, was added to ongoing drug therapy. Patients who responded were then switched to oral cyclosporine for a mean 2.6-month period, and steroids were discontinued when possible. Six patients improved, with a mean latency time to onset of improvement of 9 days. Two did not improve, and both underwent urgent operation. On oral cyclosporine, five patients maintained remission and discontinued steroids, whereas one relapsed and underwent surgery. After discontinuation of oral cyclosporine, the five remaining patients relapsed, and two underwent surgery. One reversible episode of hepatobiliary toxicity and one of gastrointestinal intolerance were recorded. We conclude that i.v. cyclosporine effectively and rapidly induces improvement of acute steroid-refractory flare-ups of Crohn's disease, but after discontinuation relapse is to be expected.
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Affiliation(s)
- J V Santos
- Digestive System Research Unit, Hospital General Vall d'Hebron, Barcelona, Spain
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Plassart E, Elbaz A, Santos JV, Reboul J, Lapie P, Chauveau D, Jurkat-Rott K, Guimaraes J, Saudubray JM, Weissenbach J. Genetic heterogeneity in hypokalemic periodic paralysis (hypoPP). Hum Genet 1994; 94:551-6. [PMID: 7959693 DOI: 10.1007/bf00211025] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Hypokalemic periodic paralysis (hypoPP) is an autosomal dominant disorder belonging to a group of muscle diseases known to involve an abnormal function of ion channels. The latter includes hypokalemic and hyperkalemic periodic paralyses, and non-dystrophic myotonias. We recently showed genetic linkage of hypoPP to loci on chromosome 1q31-32, co-localized with the DHP-sensitive calcium channel CACNL1A3. We propose to term this locus hypoPP-1. Using extended haplotypes with new markers located on chromosome 1q31-32, we now report the detailed mapping of hypoPP-1 within a 7 cM interval. Two recombinants between hypoPP-1 and the flanking markers D1S413 and D1S510 should help to reduce further the hypoPP-1 interval. We used this new information to demonstrate that a large family of French origin displaying hypoPP is not genetically linked to hypoPP-1. We excluded genetic linkage over the entire hypoPP-1 interval showing for the first time genetic heterogeneity in hypoPP.
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Affiliation(s)
- E Plassart
- INSERM U134, Hôpital de la Salpêtrière, Paris, France
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Haddock RL, Santos JV. Are the endemic motor neuron diseases of Guam really disappearing? Southeast Asian J Trop Med Public Health 1992; 23:278-81. [PMID: 1439982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Death certificates were reviewed to observe trends in the number of persons on Guam reported to have chronic degenerative motor neuron diseases (amyotrophic lateral sclerosis, parkinsonism-dementia or Parkinson's disease) at the time of death. Additional data, including age and race of the deceased and the name of the certifying physician were also collected. The number of persons having been diagnosed with amyotrophic lateral sclerosis is apparently decreasing while their mean age is increasing suggesting that the etiologic agents or factors causing this disease are less prevalent on Guam today than they have been in the past. Trends with regard to parkinsonism-dementia and Parkinson's disease are less clear.
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Affiliation(s)
- R L Haddock
- Department of Public Health and Social Services, Agana, Guam
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