Informal caregivers’ profile needs: where do we stand?

Background

Non-communicable diseases’ increase and demographic ageing require a solution to manage long-term care (1), where informal caregivers are key actors (2). Optimization in policies designed to support their caregiving role is needed. Portugal is an aged country with high prevalence of family that take care of dependent relatives. ‘Informal caregivers’ profile in Lisbon County: a health community approach’ is a nurse-led research project designed to meet these challenges with the main aim: to develop a profile on informal caregivers in Lisbon county.

Methods

Reporting the descriptive phase, a survey containing health/social questions was submitted to a non-probabilistic representative sample of careers, aged 18 years old or above in about 300 caregiver’s caring dependent persons resident in Lisbon, in 2021. Univariate descriptive analysis was performed.

Results

Married and retired women’ caring for a parent were the most typical informal caregiver profile (n = 13, 4%). The majority do not have support from social services (n = 209, 61%). Two thirds live with the cared-for person (n = 219, 64%). Almost half (n = 150, 44%) have a university degree and only few planned the transition to a caregiver role (n = 13, 4%). No more than 10% had access to support programs (n = 71, 20%).

Conclusions

Caregivers’ unmet needs can complexify societal mechanisms relying on their work. Addressing these needs will be key to develop a strategy focused on supporting informal caregivers’ priorities.

References

1. Zigante, V. (2018). Informal care in Europe: exploring formalisation, availability and quality. Publications Office of the European Union. https://doi.org/10.2767/78836.

2. Crisp, N. (Coord.) (2014). Um futuro para a saúde - todos temos um papel a desempenhar. Fundação Calouste Gulbenkian. https://www.gulbenkian.pt

Key messages

• Caregivers profile needs will be key support a strategy on informal caregivers’ priorities.

• No more than 10% of informal caregivers in a relevant European County had access to support programs.

Developing a social prescribing local system in a European Mediterranean country: a feasibility study to promote active and healthy aging

BACKGROUND

Social Prescribing (SP) is an innovative strategy to respond to the non-clinical health needs of the population. A Social Prescribing Local System (SPLS) can be defined as a set of joined community, health, and social organizations to foster SP-oriented activities. This study aimed to develop and assess the feasibility of an SPLS implemented in a Mediterranean country, to promote health and wellbeing and contribute to active and healthy aging.

METHODS

A mixed-methods approach was followed, including three sequential components: 1) Cross-sectional online survey targeting health professionals (HP) working in a primary health care cluster, Portugal's southern region; 2) Pilot study implementing an on-the-job training program for HP, designed to meet identified training needs in the survey; 3) Focus group (FG) with the HP who participated in the pilot study, two individual interviews, with an elderly patient and a community provider for assessing the satisfaction with the pilot test.

RESULTS

Sixty-five HP completed the survey; of these, 13 completed the theoretical part of the on-the-job training program; and six (out of these 13) completed the full program. Five HP participated in the FG, one patient and one community provider were interviewed. The surveyed HP perceived as facilitators to implement SP: an automatic system of notifications to prompt the use of SP, contribute to patient satisfaction, human and community resources' stability. The survey also highlighted barriers to SP implementation: length of appointments, shortage of human resources, data records confidentiality, low patient adherence rates, bureaucratic issues, time constraints, and financial costs. Participants were satisfied with the training. Identified SPLS implementation benefits were grouped into four dimensions (from the qualitative approach): gains for patients' health and wellbeing, support for the health services, sustainability of the community resources, and HP' professional satisfaction.

CONCLUSIONS

Our study took the first steps towards the implementation of an SPLS. Findings reinforce that training HP in SP and on-the-job training seems feasible. This approach was well received and appears to represent a suitable and sustainable strategy. It can promote professional satisfaction, support health services, contribute to the stability of community resources, improve health and promote active and healthy aging.

Epidemiology of infective endocarditis in Portugal, a populational study

Introduction

Infective endocarditis (IE) diagnosis and management continues to be a challenge.

Purpose

Describe temporal trends on the incidence of infective endocarditis, its clinical and outcome results, in Portugal.

Methods

A nationwide retrospective temporal trend study on the incidence and clinical characterization of patients hospitalized with infective endocarditis – 2010 to 2018, in Portugal.

Results

7574 hospitalized patients with infective endocarditis from 2010 to 2018 in Portuguese public hospitals. Predominantly men (56.9%), and 47.1% were between 60 and 79 years old. The most frequent infectious agents involved were Staphylococcus (16.4%) and Streptococcus (13.6%). During hospitalization, 12.4% of patients underwent heart valve surgery and 20% of the total cohort died. The annual incidence of infective endocarditis was 8.31 per 100,000 habitants, being higher in men and increased with age. In-hospital mortality rate significantly increased, the strongest independent predictors being ischemic or hemorrhagic stroke, sepsis, acute renal failure and older age.

Conclusions

In Portugal, between 2010 and 2018, the incidence of infective endocarditis presented a general growth trend with a deceleration in the most recent years. A significant rate of in-hospital complications, a mildly lower than expected stable surgical rate and a still high and growing mortality rate were noted.

Funding Acknowledgement

Type of funding sources: None.

Person-specific calibration of a partial body counter used for individualised Am241skull measurements

Incorporation of bone seeking alpha-emitting radionuclides such as²⁴¹Am are of special concern, due to the potential of alpha particles to damage the extremely radiation-sensitive bone marrow. In the case of an internal contamination with²⁴¹Am, directin vivomeasurements using Gamma-detectors are typically used to quantify the incorporated activity. Such detectors need to be calibrated with an anatomical phantom, for example of the skull, of known²⁴¹Am activity that reproduces the anatomy of the measured individual as closely as possible. Any difference in anatomy and material composition between phantom and individual will bias the estimation of the incorporated activity. Consequently, in this work the impact of the most important anatomical parameters on detection efficiency of one of the germanium detectors of the Helmholtz Center Munich (HMGU) partial body counter were systematically studied. For that a detailed model of the germanium detector was implemented in the Monte Carlo codes GEANT4 and MCNPX. To simulate the detector efficiency, various skull voxel phantoms were used. By changing the phantom dimensions and geometry the impact of parameters such as shape and size of the skull, thickness of tissue covering the skull bone, distribution of²⁴¹Am across the scull and within the skull bone matrix, on the detector efficiency was studied. Approaches to correct for these parameters were specifically developed for three physical skull phantoms for which Voxel phantoms were available: Case 102 USTUR phantom, Max-06 phantom, BfS phantom. Based on the impact of each parameter, correction factors for an 'individual-specific' calibration were calculated and applied to a real²⁴¹Am contamination case reported in 2014. It was found that the incorporated²⁴¹Am activity measured with the HMGU partial body counter was about twice as large as that estimated when using the BfS skull phantom without applying any correction factor for person-specific parameters. It is concluded that the approach developed in the present study should in the future be applied routinely for skull phantom measurements, because it allows for a considerably improved reconstruction of incorporated²⁴¹Am using partial body counters.

Pneumococcal and meningococcal vaccines - A significant reduction of pediatric admissions and deaths

Background

Mortality rates associated with paediatric inpatient stays in mainland Portuguese Hospitals have decreased approximately 50%, between 2000 and 2016, despite the majority of deaths occurring in hospitals. During this timeframe meningococcal and pneumococcal vaccines were introduced in the National Vaccination Programme (NVP). In this study, the authors analyzed admission and mortality rates associated with vaccine preventable diseases such as pneumococcal and meningococcal disease.

Methods

A sequential cross-sectional retrospective study was performed, from 2000 and 2016, to assess the hospitalizations for meningitis, sepsis and pneumonia of children and adolescents at the SNS (National Health Service) hospitals in mainland Portugal. An administrative Portuguese database that contains all the public hospital admissions to mainland Portugal hospitals was utilized and diagnoses were coded per ICD9. National Institute Of Statistics (INE) data was accessed as reference. All admissions of individuals 17 years old and younger were analysed.

Results

A 10-fold reduction of admissions and deaths for pneumococcal pneumonia and a 3-fold reduction of meningococcal sepsis were observed after the introduction of the antipneumococcal and antimeningococcal vaccine in the NVP, respectively.

Conclusions

These results highlight the importance of vaccination to prevent illness, hospital admissions and deaths in children and can provide evidence to educate the public towards vaccination.

Key messages

The results highlight the importance of vaccination to prevent illness, hospital admissions and deaths in children. The results show a 10x reduction in pneumococcal pneumonia hospital admission and deaths and a 3x in meningococcal meningitis.

Educational requirements for Health Information Systems: A scope review of the literature

Background

Sound and reliable information is fundamental to decision-making across all health system. New information technologies can contribute to a more accurate and efficient public health action, requiring new and more sophisticated skills to support this change. Considering the European context, where public health professionals vary by country and cover different areas, and the need for a skilled workforce, the objective of this study is to identify the basic educational components required for a public health information specialist. This study is part of the ongoing research under INFACT Joint Action.

Methods

A scope review (Pubmed/Ebsco, free access texts, no time restrictions) was carried out in order to answer the following question: Considering the set of activities of public health, what are the main topics and trends of the literature on both Human Resources and Health Information Systems (HIS) training? Abstracts were read by two reviewers and the select texts analyzed using HOT-FIT framework for HIS.

Results

Among the 53 records, it was possible to identify different study designs and elements related to different contexts and HIS. There is a trend for new publications, with a significant increase since 2014. The content analysis showed more frequent themes in three main categories - Human, Organization and Technology, allowing identifying a wide range of public health professionals and their educational needs.

Conclusions

Results reinforce the link between information systems and public health, showing the importance of regular HIS as data source for monitoring population health, specific events and determinants, management and research activities and during the stages of the planning cycle of public health activities. The proper workforce capacitation emerges as a success factor for HIS implementation, as well as several professional profiles that carry out public health activities and the areas where it is necessary to strengthen their training.

Key messages

There’s growing interest in the use of technologies for the development of public health information systems. Workforce needs to develop specific skills for the technological challenges in Public Health.

Developing a health information (HI) training programme: strengthening the public health workforce

Background

New developments and technologies require skilled professionals to manage and use public health information in most efficient ways. However, currently training in specific fields is lacking and large inequalities exist in Europe in terms of the availability and training of qualified professionals.

Methods

In order to set up a sustainable EU HI training program for HI professionals, core modules need to be selected to provide adequate training across Europe. This study a scoping review and is doing a survey on current existing HI programmes and aimes to identify the main educational components needed to train HI professionals. The databases of Pubmed and Ebsco were searched for the scoping review. The survey is being circulated to representatives of InfAct in 28 countries. Based on the results a baseline HI training programme for practicing public health professionals will be proposed.

Results

Initial search identified 249 papers. After the exclusion of duplicates and unavailable documents, 53 papers were selected for review. Only 5 papers were found related to the European context. However the results from other papers could be extrapolated. The results were organised in 3 domains: organisation, people and technology dimensions. The development of HI capacities is often done through multiple and sequential interventions, which are adapted to the needs, conditions and resources available within each HIS. Thus, the importance of aligning training with working processes and usability in professional practice is key. This can be challenging, as HI functions are diverse across Europe. The results of the survey will be presented when processed by the time of the workshop.

Conclusions

There is a need for qualified skilled professionals in HI taking into account a changing global environment. Most of HI capacity building programmes are yet to reach maturity, and this review and survey identify a set of important areas for further development of the HI training programme.

Monte Carlo simulation of dose coefficients for a fish eye lens model exposed to monoenergetic electrons

Vision is an important sense for the majority of the wildlife species, affecting their ability to find food and escape predation. Currently, no study on radiation induced cataract frequency on the fish eyes lens has been done. However, any thorough future study of this subject will require more accurate dose estimates for the fish eye lens than those currently available. For this purpose, the eye lens absorbed dose per unit fluence conversion coefficients for electron irradiation were calculated using the MCNPX Monte Carlo radiation transport code package. All results were validated against three different fish voxel models. The discrepancies between model results mainly originate from the different fish eye dimensions used in the different studies and in two of the cases the lack of a defined eye lens region. The dose conversion coefficients calculated in this work can be used to estimate the dose to the fish eye lens based on the activity concentration of the surrounding water. The model developed in this work has also demonstrated that the mathematical models still have several advantages over the voxel models.

Equity-focused health impact assessment of Portuguese tobacco control legislation

The World Health Organization recommend the Equity-Focused Health Impact Assessment (HIA) as a means to assess the impact of social and economic policies on the health of populations, and acknowledges their contribution to health inequality. We describe the application of the Equity-focused Impact Assessment methodology on the Portuguese law on Smoking Prevention and Tobacco Control (Law No. 37/2007). A rapid assessment was carried out to issue recommendations which could be incorporated into the law during a revision in 2014. Quantitative (consumption and health status indicators; equity analysis) and qualitative (Focus Group) approaches were taken to evaluate the impact of the law and formulate recommendations. Young people, men and women of low socioeconomic status, and pregnant women were identified as requiring specific and appropriate interventions to prevent smoking and support smoking cessation.

Capacity to report on mortality attributable to chronic hepatitis B and C infections by Member States: An exercise to monitor progress towards viral hepatitis elimination

Viral hepatitis is globally leading causes of death, and 96% of these are due to hepatitis B and C (HBV/HCV) late outcomes. The first Global Health Sector Strategy (GHSS) aims to reduce by 65% the mortality associated with HBV/HCV, and an indicator (C10) is proposed to monitor progress. Data on viral hepatitis and liver-related mortality are required, and different methods of estimation can be used, depending on availability and quality of sources. We aimed to understand the current situation and practicality of calculating C10, accessing available sources to estimate initial figure for Europe. We listed and compiled regional and national data sources reporting deaths from HCC, cirrhosis and chronic liver disease (CLD) and available estimates of attributable fraction. We critically appraised quality of data, highlighting gaps in current data and estimated mortality attributable to HBV and HCV, for 31 EU/EEA countries from 2010 to 2015. Mortality data are available for 30/31 countries. Quality varies but 60% of national sources report with specificity as required by WHO indicator. Attributable fraction is only available through the literature search. We estimated C10 for 87.6% country-years. Deaths attributable to HBV/HCV for this period and region were 292 600, while HCV deaths were three times higher. Incomplete data for 2015 prevented calculation of time trends. Regional sources are outdated for monitoring C10, but national sources are capable of reporting mortality data. Sources for attributable fraction are sparse, outdated and much needed. We recommend improvement of death registration allowing measuring this indicator. Studies measuring attributable fraction on national and subnational levels are crucial.

Caries prevalence and treatment needs in young people in Portugal: the third national study

OBJECTIVE

To evaluate caries prevalence and dental treatment needs in Portuguese children and teenagers, as well as fluorosis prevalence in 12-year-old children, in order to address public oral health program strategies.

PARTICIPANTS

A representative stratified random cluster sample of 3,710 participants of 6, 12, and 18 years old was selected. A questionnaire was applied to determine sociodemographic data and some oral health determinants. The clinical examination was based on the ICDAS criteria, then adapted to DMFS index, and Dean's index for fluorosis.

RESULTS

Caries prevalence at 6, 12, and 18 years old was 45.2%, 47.0%, and 67.6%, respectively. D₅MFT scores were 1.18 (SD 0.06) and 2.51 (SD 0.10), respectively. Treatment needs at 12 and 18 years old were associated with 0.37 (SD 0.03) and 0.75 (SD 0.06) values in the "decayed" (D₅) variable. SiC index at 12 years old was 2.68 (SD 1.68). Sealants were identified in 55% of 12-year-old children and the mean of sealants per individual was 3.61; also, moderate (2.2%) and severe (0.2%) levels of fluorosis were detected.

CONCLUSIONS

The oral health situation in Portugal is favorable for young people, resulting in low treatment needs. The National Oral Health Promotion Program should be extended to include 18-year-olds.

EFFICIENCY STUDY OF A LEGe DETECTOR SYSTEM FOR THE ASSESSMENT OF 241Am IN SKULL AT CIEMAT WHOLE BODY COUNTER

(241)Am incorporation due to an incident or chronic exposure causes an internal dose, which can be evaluated from the total activity of this isotope in the skeleton several months after the intake. For this purpose, it is necessary to perform in vivo measurements of this bone-seeker radionuclide in appropriate counting bone geometries with very low attenuation of surrounded tissue and to extrapolate to total activity in the skeleton (ICRP 89, Basic anatomical and physiological data for use in radiological protection: reference values. 2001. 265). The work here presented refers to direct measurements of americium in the Cohen skull phantom at the CIEMAT Whole Body Counter (WBC) using low-energy germanium (LEGe) detectors inside a shielding room. The main goal was to determinate the most adequate head counting geometry for the in vivo detection of americium in the bone. The calibration of the in vivo LEGe system was performed with four detectors with 2 cm of distance to Cohen phantom. Two geometries were measured, on junction of frontal to parietal bones and frontal bone. The efficiencies are very similar in both geometries, the preferred counting geometry is the most comfortable for the person, with the LEGe detectors in the highest part of the frontal bone, near the junction with the parietal bone, CIEMAT WBC participated in a skull intercomparison exercise organised by WG7 of EURADOS (European Radiation Dosimetry Group e.V.). Efficiencies using three different skull phantoms were obtained. Measurements were performed for different head counting positions, four of them in the plane of symmetry and others over the temporal bone. The detector was placed in parallel with the calibration phantom at a distance of 1 cm. The main gamma emission of (241)Am, 59.5 keV (36 %), was used for comparing efficiency values. The lower efficiency was obtained over the frontal and occipital bones. Measurement with one LEGe detector over the parietal bone is the most efficient. The activity of each skull phantom was calculated using CIEMAT head calibration. Results of the EURADOS intercomparison are presented here for discussion.

Seroprevalence to cytomegalovirus in the Portuguese population, 2002-2003

The prevalence of cytomegalovirus (CMV) infections ranges between 50% and 85% in adults in the United States, and its epidemiology varies in different regions of the world and between socioeconomic and age groups. In Portugal, no study has been carried out to date to determine the prevalence of CMV in the general population. Under the second National Serological Survey conducted in continental Portugal in 2001–2002, we estimated the prevalence of individuals with antibodies to CMV using indirect immunofluorescence to detect virus-specific IgG. The population sample included 2,143 individuals of both sexes and different ages from all 18 districts in Portugal. The national seroprevalence of CMV was determined as 77%. We analysed the proportion of CMV IgG by sex, age group and district of residence. This was the first nationally representative study of seroprevalence of CMV in Portugal. The results of the study indicate that CMV infection is highly prevalent in the population and occurs mainly in the first years of life.

Seroprevalence to cytomegalovirus in the Portuguese population, 2002-2003

Binary file ES_Abstracts_Final_ECDC.txt matches

Normalization strategies for real-time expression data in Chlamydia trachomatis

Chlamydia trachomatis is a widespread obligate intracellular pathogen genetically non-tractable for which transcriptomics is a fundamental tool to better understand its biology. However, the suitability of endogenous controls for normalization of transcriptomic data in this bacterium still needs validation. We aimed to assess the stability of 10 genes for their potential use as endogenous controls in real-time quantitative PCR assays at both normal and stress (D-cycloserine treatment) growth conditions throughout the developmental cycle of three C. trachomatis strains with different tissue tropism. Normalization was performed by real-time absolute quantification of the bacterial genomes. We also tested the applicability of two widely used softwares (geNorm and Normfinder) to our data. For all strains, we found that 16SrRNA was the most stably expressed gene throughout the chlamydial normal developmental cycle, which indicates its potential use as endogenous control in relative expression assays. However, it was highly unstable under D-cycloserine treatment (where oppA_2 was top-ranked), suggesting prudence when using ribosomal genes in expression experiments involving stress conditions. The geNorm and Normfinder algorithms revealed contrasting results and seem inappropriate for the selected pool of genes. Considering the multiplicity of experimental conditions, there should be an in loco validation of endogenous controls, where 16SrRNA appears to be in the front line. Alternatively, normalization of expression data against genomic DNA, which is less influenced by experimental constraints that are especially relevant for intracellular organisms, likely constitutes a good option. Moreover, the number of genomes also seems to be less subject to variation than expression of endogenous controls when working under stress conditions. The present study constitutes the first evaluation of putative endogenous controls for real-time expression assays in C. trachomatis.

Monte Carlo simulation of the full energy peak efficiency of a WBC

A whole body counting system is in operation at the Nuclear and Technological Institute, in Portugal. Computational methods were used to determine the detection efficiency; a well-known source of bias in modelling the behaviour of a HPGe detector is the insufficient knowledge regarding the thickness of the lithium dead layer. In order to accurately simulate the detection system and to achieve agreement between the Monte Carlo results and the performed measurements, the value for the dead layer thickness was optimized.

Cystic fibrosis F508del patients have apically localized CFTR in a reduced number of airway cells

Present state of knowledge, mostly based on heterologous expression studies, indicates that the cystic fibrosis transmembrane conductance regulator (CFTR) protein bearing the F508del mutation is misprocessed and mislocalized in the cytoplasm, unable to reach the cell surface. Recently, however, it was described that protein levels and localization are similar between F508del and wild-type CFTR in airway and intestinal tissues, but not in the sweat glands. In this study, we used immunocytochemistry with three different anti-CFTR antibodies to investigate endogenous CFTR expression and localization in nasal epithelial cells from F508del homozygous patients, F508del carriers, and non-CF individuals. On average, 300 cells were observed per individual. No significant differences were observed for cell type distributions among CF, carrier, and non-CF samples; epithelial cells made up approximately 80% to 95% of all cells present. CFTR was detected mostly in the apical region (AR) of the tall columnar epithelial (TCE) cells, ciliated or nonciliated. By confocal microscopy analysis, we show that the CFTR apical region-staining does not overlap with either anti-calnexin (endoplasmic reticulum), anti-p58 (Golgi), or anti-tubulin (cilia) stainings. The median from results with three antibodies indicate that the apical localization of CFTR happens in 22% of TCE cells from F508del homozygous patients with CF (n = 12), in 42% of cells from F508del carriers (n = 20), and in 56% of cells from healthy individuals (n = 12). Statistical analysis indicates that differences are significant among all groups studied and for the three antibodies (p < 0.05). These results confirm the presence of CFTR in the apical region of airway cells from F508del homozygous patients; however, they also reveal that the number of cells in which this occurs is significantly lower than in F508del carriers and much lower than in healthy individuals. These findings may have an impact on the design of novel pharmacological strategies aimed at circumventing the CF defect caused by the F508del mutation.

[Total cholesterol and high-density lipoprotein cholesterol in patients with non-insulin-dependent diabetes mellitus]

Non-insulin-dependent diabetics often have quantitative changes in plasma lipid profiles characterised by higher triglycerides and lower HDL-cholesterol than the average population. This paper summarises the cross-sectional data (reported by the general practitioners participating in Medicos-Sentinela) concerning total and HDL-cholesterol in a cohort of non-insulin-dependent diabetics treated at primary care settings in Portugal. Total cholesterol and High Density Lipoprotein (HDL) associated cholesterol were significantly higher in women. Total cholesterol increased significantly with age (in women), regular alcohol intake, body mass index, systolic blood pressure and diastolic blood pressure (in males). HDL-cholesterol showed significant increase with age (both sexes and males only), gender, and alcohol intake in males. The increase in total cholesterol found in patients with regular alcohol intake is an infrequently reported finding.

[Salvage coronary angioplasty in a young patient with Takayasu arteritis and myocardial infarction]

A 16 year old boy with Takayasu's disease was admitted with myocardial infarction. Thrombolytic therapy with intravenous streptokinase showed no signs of reperfusion. Rescue angioplasty of the left descending coronary artery was performed with success.