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Sá R, Roquette R, Rebecchi A, Matias J, Rocha J, Buffoli M, Capolongo S, Ribeiro AI, Nunes B, Dias C, Sousa Uva M. Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study. BMC Public Health 2024; 24:1116. [PMID: 38654178 PMCID: PMC11036776 DOI: 10.1186/s12889-024-18627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
Diabetes poses a substantial disease burden, prompting preventive interventions. Physical inactivity, a major risk factor for type 2 diabetes, can potentially be mitigated by enhancing area-level walkability. Despite this, limited population-based studies have investigated the link between walkability and objective diabetes measures. Our study aims to estimate the association between area-level walkability and individual glycated haemoglobin levels in the Portuguese adult population without the diagnosis of diabetes. Data from the 2011 census and an updated street map were obtained to construct a walkability index based on residential density, land-use mix, and street connectivity. Individual health data were sourced from The National Health Examination Survey (INSEF) 2015, a representative survey of the Portuguese adult population. Gamma regression was employed for estimation of the main associations, revealing that residing in moderately walkable areas significantly reduced average glycated haemoglobin levels (Exp(β) = 0.906; 95% CI: 0.821, 0.999) compared to the least walkable areas. The association was less pronounced and not statistically significant for the third tertile of walkability (Exp(β) = 0.919; 95% CI: 0.822, 1.028). Our findings highlight a nonlinear protective association between walkability and glycated haemoglobin, emphasizing the potential policy implications for urban planning, diabetes prevention, and health promotion.
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Affiliation(s)
- Regina Sá
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde (ACES) do Baixo Vouga, Aveiro, Portugal.
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde (ACES) Algarve I, Faro, Portugal.
| | - Rita Roquette
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
| | - Andrea Rebecchi
- Design & Health Lab, Department of Architecture, Built environment and Construction Engineering, Politecnico di Milano, Milan, Italy
| | - Judite Matias
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde (ACES) do Baixo Vouga, Aveiro, Portugal
| | - Jorge Rocha
- Instituto de Geografia e Ordenamento do Território (IGOT), Universidade de Lisboa e Laboratório Associado TERRA, Lisbon, Portugal
| | - Maddalena Buffoli
- Design & Health Lab, Department of Architecture, Built environment and Construction Engineering, Politecnico di Milano, Milan, Italy
| | - Stefano Capolongo
- Design & Health Lab, Department of Architecture, Built environment and Construction Engineering, Politecnico di Milano, Milan, Italy
| | - Ana Isabel Ribeiro
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP-NOVA), Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Carlos Dias
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP-NOVA), Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Mafalda Sousa Uva
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP-NOVA), Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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Gaio V, Roquette R, Monteiro A, Ferreira J, Matias Dias C, Nunes B. Investigating the association between ambient particulate matter (PM 10) exposure and blood pressure values: Results from the link between the Portuguese Health Examination Survey and air quality data. Rev Port Cardiol 2023; 42:251-258. [PMID: 36634759 DOI: 10.1016/j.repc.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/19/2022] [Accepted: 02/03/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES High blood pressure (BP) remains a major modifiable cardiovascular (CV) risk factor. Several epidemiologic studies have been performed to assess the association between air pollution exposure and this CV risk factor but results remain inconsistent. This study aims to estimate the effect of short-term PM10 exposure (average previous three-day concentration) on diastolic (DBP) and systolic (SBP) blood pressure values of the resident mainland Portuguese population. METHODS Our study was based on available DBP and SBP data from 2272 participants from the first Portuguese Health Examination Survey (INSEF, 2015) living within a 30 km radius of at least one air quality monitoring station, with available measurements of particulate matter with an aerodynamic equivalent diameter ≤10 μm (PM10). We used data from the air quality monitoring network of the Portuguese Environment Agency to obtain the individual allocated PM10 concentrations. Generalized linear models were used to assess the effect of PM10 exposure on DBP and SBP values. RESULTS No statistically significant association was found between PM10 exposure and both DBP and SBP values (0.42% DBP change per 10 μg/m3 of PM10 increment (95% confidence interval (CI): -0.85; 1.70) and 0.47% SBP change per 10 μg/m3 of PM10 increment (95% CI: -0.86; 1.79)). Results remain unchanged after restricting the analysis to hypertensive or obese participants or changing the PM10 assessment methodology. CONCLUSIONS In view of the PM10 levels observed in 2015, our results suggests that exposure to PM10 concentrations have a small or no effect on the blood pressure values. Other air pollutants and mixtures of pollutants that were not included in our study should considered in future studies.
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Affiliation(s)
- Vânia Gaio
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal.
| | - Rita Roquette
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal; Nova IMS Information Management School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Alexandra Monteiro
- CESAM & Department of Environment and Planning, Universidade de Aveiro, Aveiro, Portugal
| | - Joana Ferreira
- CESAM & Department of Environment and Planning, Universidade de Aveiro, Aveiro, Portugal
| | - Carlos Matias Dias
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
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Gómez V, Sousa-Uva M, Roquette R, Garcia AC, Matias Dias C. Evaluation of the European Health Information Training Programme (EHITP): results from InfAct Joint Action. Arch Public Health 2022; 80:133. [PMID: 35524318 PMCID: PMC9076499 DOI: 10.1186/s13690-022-00895-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background The InfAct (Information for Action) is a Joint Action of the European Commission’s 3rd Health Programme with the main goal to build an infrastructure of a health information system for a stronger European Union and to strengthen its core elements. The InfAct Joint Action was developed along 36 months and structured in 10 work packages. Portugal co-led the Work Package 6 (WP6) of this project, which included the development of the proposal of a flagship capacity building programme - the European Health Information Training Programme - and its evaluation. The evaluation objectives included: to evaluate the adequacy of the training programme to the health information needs in the European Member States; to identify possible changes regarding the participants selection process, the training activities and the pedagogical project; and to contribute to the understanding of the potential of the programme to add to available offers in learning on the topics of Public Health information, on the capacity building and behavioural changes in Public Health activities which can be attributed to the course, and of the potential of the programme to contribute to the alignment of health information criteria and procedures between the European Member States. Methods The evaluation process was developed using an observational descriptive study design using a mixed methodological approach with both document analysis and primary data collected by questionnaires and interviews analysis. Mixed quantitative and qualitative data collection methods and analysis were used. Results The proposal of the European Health Information Training Programme seemed adequate to the formative needs and capacities in line with the work performed by the InfAct project. In what concerns about its main thematic areas, it was also aligned with the areas identified in the previous formative needs and capacities mapping. The participants selection process proposed seemed, in general, adequate. The potential of the European Health Information Training Programme proposal to learning, capacity building and behavioral changes at work attributable to the course was considered positive, as well as the potential to the alignment of health information criteria and procedures between European Union Member States. Discussion In general, we found high consistency between the results obtained from data collected by the techniques used. However, different suggestions for improvement were outlined by the evaluation study population. Conclusions The proposed European Health Information Training Programme was a dynamic, flexible, sustainable formative programme in health information and focused on reducing inequalities. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00895-2.
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Affiliation(s)
- Verónica Gómez
- Epidemiology Department - National Institute of Health Doctor Ricardo Jorge, Lisbon, Portugal.
| | - Mafalda Sousa-Uva
- Epidemiology Department - National Institute of Health Doctor Ricardo Jorge, Lisbon, Portugal.,CHRC - Comprehensive Health Research Center, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Rita Roquette
- Epidemiology Department - National Institute of Health Doctor Ricardo Jorge, Lisbon, Portugal
| | - Ana Cristina Garcia
- Epidemiology Department - National Institute of Health Doctor Ricardo Jorge, Lisbon, Portugal
| | - Carlos Matias Dias
- Epidemiology Department - National Institute of Health Doctor Ricardo Jorge, Lisbon, Portugal.,CHRC - Comprehensive Health Research Center, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
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Kislaya I, Gonçalves P, Gómez V, Gaio V, Roquette R, Barreto M, Sousa-Uva M, Torres AR, Santos J, Matos R, Manita C, Almeida Santos J, Soeiro S, de Sousa R, Costa I, Verdasca N, Guiomar R, Rodrigues AP. SARS-CoV-2 seroprevalence in Portugal following the third epidemic wave: results of the second National Serological Survey (ISN2COVID-19). Infect Dis (Lond) 2022; 54:418-424. [PMID: 35023439 DOI: 10.1080/23744235.2021.2025421] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Integrated approaches to surveillance of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection are important for public health actions. The 2nd National Serological Survey (ISN2COVID-19) aimed to characterize the extent of SARS-CoV-2 infection and vaccine-induced response in the Portuguese population following the third epidemic wave and the launch of the vaccination campaign. METHODS A cross-sectional study was performed using data on 8463 Portuguese 1-79 years of age, collected in February and March, 2021. SARS-CoV-2 IgM and IgG (anti-nucleoprotein and anti-spike) antibodies were determined in serum samples using Abbott Architect chemiluminescent microparticle assays. Post-infection and vaccine-induced seroprevalence with 95% confidence intervals (95%CI) were estimated in the overall sample and stratified by population characteristics. RESULTS The estimated seroprevalence was 15.5% (95%CI:14.6-16.5%), of which 13.5% (95%CI: 12.6-14.4%) was attributable to natural infection and 2.0% (95%CI:1.7-2.4%) to vaccination. The lowest seroprevelence was observed in persons aged 70-79 years (8.9% 95%CI:6.8-11.6), while seroprevalence in children (14.3%; 95%CI:11.5-17.6%) and adolescents (12.9%; 95%CI:10.5-15.7%) was similar to that of persons aged between 20 and 69 years. Of seropositive individuals, 22.6% (95%CI:19.7-25.9%) did not report any symptoms in 6 months prior to interview. Of persons with completed vaccination (2-doses), 98.6% (95%CI: 93.0-99.7%) had specific IgG (anti-S) antibodies. CONCLUSIONS After the third epidemic wave, the post-infection SARS-CoV-2 seroprevalence was 1.7 times higher than the cumulative incidence based on PCR-testing, but was higher (2.7 times) in children may be due to the high proportion of asymptomatic and mild infections.
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Affiliation(s)
- Irina Kislaya
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Paulo Gonçalves
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Verónica Gómez
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Vânia Gaio
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Rita Roquette
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Marta Barreto
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Mafalda Sousa-Uva
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Ana Rita Torres
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Joana Santos
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Rita Matos
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Carla Manita
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - João Almeida Santos
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Sofia Soeiro
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Rita de Sousa
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Inês Costa
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Nuno Verdasca
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Raquel Guiomar
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Ana Paula Rodrigues
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
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Gaio V, Roquette R, Monteiro A, Ferreira J, Lopes D, Dias CM, Nunes B. PM10 exposure interacts with abdominal obesity to increase blood triglycerides: a cross-sectional linkage study. Eur J Public Health 2021; 32:281-288. [PMID: 34788428 PMCID: PMC9090274 DOI: 10.1093/eurpub/ckab190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Blood lipids and glucose levels dysregulation represent potential mechanisms intermediating the adverse cardiovascular effects of ambient particulate matter (PM) exposure. This study aims to estimate the effect of long-term PM10 exposure on blood lipids and glucose levels and to assess the potential mediation and/or modification action of abdominal obesity (AO) (waist-to-height ratio). Methods Our study was based on 2,390 participants of the first Portuguese Health Examination Survey (INSEF, 2015) with available data on blood lipids and glucose parameters and living within a 30-km radius of an air quality monitoring station with available PM10 measurements. PM10 concentrations were acquired from the air quality monitoring network of the Portuguese Environment Agency. Generalized linear models were used to assess the effect of 1-year PM10 exposure on blood lipids and glucose levels. An interaction term was introduced in the models to test the modification action of AO. Results We found an association between PM10 and non-fasting blood triglycerides (TG) after adjustment for age, sex, education, occupation, lifestyles-related variables and temperature but only in participants with AO. Per each 1 µg/m3 PM10 increment, there was a 1.84% (95% confidence interval: 0.02–3.69) increase in TG. For the remaining blood lipid and glucose parameters, no associations were found. Conclusions Our study demonstrates that even at low levels of exposure, long-term PM10 exposure interacts with AO to increase blood TG. Our findings suggest that reducing both AO prevalence and PM10 below current standards would result in additional health benefits for the population.
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Affiliation(s)
- Vânia Gaio
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Rita Roquette
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal.,Nova IMS Information Management School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Alexandra Monteiro
- CESAM and Department of Environment and Planning, Universidade de Aveiro, Aveiro, Portugal
| | - Joana Ferreira
- CESAM and Department of Environment and Planning, Universidade de Aveiro, Aveiro, Portugal
| | - Diogo Lopes
- CESAM and Department of Environment and Planning, Universidade de Aveiro, Aveiro, Portugal
| | - Carlos Matias Dias
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
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Gaio V, Roquette R, Matias Dias C, Nunes B. Ambient particulate matter exposure interacts with abdominal obesity to increase blood triglycerides. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Blood lipids levels dysregulation represent potential mechanism intermediating the adverse cardiovascular effects of ambient particulate matter (PM) exposure. The present study aims to estimate the effect of particulate matter (PM10) exposure on blood lipid levels (TC, Total Cholesterol; HDL-C, High-Density Lipoprotein Cholesterol; LDL-C, Low-Density Lipoprotein Cholesterol; TG, Triglycerides) in the adult Portuguese mainland population and to assess the potential mediation and/or modification action of abdominal obesity on this effect.
Methods
We used data from 2390 participants of the 1st Portuguese Health Examination Survey (INSEF, 2015) with available data on blood lipids parameters and living within a 30km radius of an air quality monitoring station with available PM10 measurements. PM10 concentrations were acquired from the air quality monitoring network of the Portuguese Environment Agency. Generalized linear models were used to assess the effect of 1-year PM10 exposure on blood lipids values. An interaction term was introduced in the models to test the modification action of abdominal obesity.
Results
We found an association between long-term exposure to PM10 and non-fasting blood TG levels after adjustment for age, sex, education, occupation, lifestyles related variables and temperature but only in participants with abdominal obesity (1.84% TG increase per each 1 µg/m3 PM10 increment, 95% CI: 0.02%; 3.69%) which is well supported by the sensitivity analysis.
Conclusions
Our study demonstrate that even at low levels of exposure, long-term PM10 exposure interacts with abdominal obesity to increase blood TG levels. To the best of our knowledge, this is the first study showing the modification action of abdominal obesity regarding the PM10 effect on a blood lipid parameter. Our findings suggest that reducing both abdominal obesity prevalence and PM10 below current standards would result in additional health benefits for the population.
Key messages
Long-term PM10 exposure interacts with abdominal obesity to increase non-fasting blood triglycerides levels by about 2% per each 1 µg/m3 PM10 increase. Reducing both abdominal obesity prevalence and PM10 below current standards would result in additional health benefits for the population.
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Affiliation(s)
- V Gaio
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge IP, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - R Roquette
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge IP, Lisbon, Portugal
- NOVA IMS Information Management School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - C Matias Dias
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge IP, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - B Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge IP, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
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Sousa-Uva M, Barreto M, Roquette R, Matias-Dias C, Ribeiro R, Manuel Boavida J, Nunes B. Association between area- and individual-level socio-economic factors with glycated haemoglobin-Evidence from a Portuguese population-based study. Diabet Med 2021; 38:e14542. [PMID: 33580515 DOI: 10.1111/dme.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Abstract
AIMS This study aims to estimate the associations between area-level deprivation and individual-level socio-economic factors, as well as their interaction, with glycated haemoglobin (HbA1c ) levels. METHODS We conducted a gamma multilevel regression analysis using individual-level data from the Portuguese National Health Examination Survey and a deprivation index built through factor analysis, at municipality level, with census variables. RESULTS Living in a municipality with high material deprivation and having a low level of education were independently associated with an increase of 2.3% (95% confidence interval [CI] 0.6, 4.0) and of 1.6% (95% CI 0.6, 2.7) in the mean levels of HbA1c , respectively. The interaction between area material deprivation and individual-level education was not associated with the levels of HbA1c (0.5%, 95% CI -1.3, 2.3). CONCLUSIONS Our findings support the collective resources model that argues that people in less deprived areas have better health because there are more collective resources. The results suggest that to reduce socio-economic inequalities associated with the levels of HbA1c and, consequently, with diabetes, will require attention to the area material deprivation and individual-level education. Upstream social determinants of health are thus highlighted.
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Affiliation(s)
- Mafalda Sousa-Uva
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
- CISP - Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Marta Barreto
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
- CISP - Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Rita Roquette
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Carlos Matias-Dias
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
- CISP - Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Rogério Ribeiro
- APDP Diabetes Portugal, Education and Research Center (APDP-ERC), Lisbon, Portugal
- iBiMED, Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - José Manuel Boavida
- APDP Diabetes Portugal, Education and Research Center (APDP-ERC), Lisbon, Portugal
- iBiMED, Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Baltazar Nunes
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
- CISP - Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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Osório HC, Rocha J, Roquette R, Guerreiro NM, Zé-Zé L, Amaro F, Silva M, Alves MJ. Seasonal Dynamics and Spatial Distribution of Aedes albopictus (Diptera: Culicidae) in a Temperate Region in Europe, Southern Portugal. Int J Environ Res Public Health 2020; 17:E7083. [PMID: 32992664 PMCID: PMC7579007 DOI: 10.3390/ijerph17197083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022]
Abstract
Aedes albopictus is an invasive mosquito that has colonized several European countries as well as Portugal, where it was detected for the first time in 2017. To increase the knowledge of Ae. albopictus population dynamics, a survey was carried out in the municipality of Loulé, Algarve, a Southern temperate region of Portugal, throughout 2019, with Biogents Sentinel traps (BGS traps) and ovitraps. More than 19,000 eggs and 400 adults were identified from May 9 (week 19) and December 16 (week 50). A positive correlation between the number of females captured in the BGS traps and the number of eggs collected in ovitraps was found. The start of activity of A. albopictus in May corresponded to an average minimum temperature above 13.0 °C and an average maximum temperature of 26.2 °C. The abundance peak of this A. albopictus population was identified from September to November. The positive effect of temperature on the seasonal activity of the adult population observed highlight the importance of climate change in affecting the occurrence, abundance, and distribution patterns of this species. The continuously monitoring activities currently ongoing point to an established population of A. albopictus in Loulé, Algarve, in a dispersion process to other regions of Portugal and raises concern for future outbreaks of mosquito-borne diseases associated with this invasive mosquito species.
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Affiliation(s)
- Hugo C. Osório
- Centre for Vectors and Infectious Diseases Research/National Institute of Health Doutor Ricardo Jorge, Avenida da Liberdade 5, 2965-575 Águas de Moura, Portugal; (L.Z.-Z.); (F.A.); (M.S.); (M.J.A.)
- Instituto de Saúde Ambiental, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso0, Ala C, 1649-028 Lisboa, Portugal
| | - Jorge Rocha
- Institute of Geography and Spatial Planning, University of Lisbon, Rua Branca Edmée Marques, 1600-276 Lisboa, Portugal;
| | - Rita Roquette
- Department of Epidemiology/National Institute of Health Doutor Ricardo Jorge, Avenida Padre Cruz, 1649-019 Lisboa, Portugal;
- NOVA Information Management School, Campus de Campolide, 1070-312 Lisboa, Portugal
| | - Nélia M. Guerreiro
- Department of Public Health and Planning, Algarve Regional Health Administration, IP, Rua Brites de Almeida, n° 6, 3rd Dt° 8000-234 Faro, Portugal;
| | - Líbia Zé-Zé
- Centre for Vectors and Infectious Diseases Research/National Institute of Health Doutor Ricardo Jorge, Avenida da Liberdade 5, 2965-575 Águas de Moura, Portugal; (L.Z.-Z.); (F.A.); (M.S.); (M.J.A.)
- BioISI—Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal
| | - Fátima Amaro
- Centre for Vectors and Infectious Diseases Research/National Institute of Health Doutor Ricardo Jorge, Avenida da Liberdade 5, 2965-575 Águas de Moura, Portugal; (L.Z.-Z.); (F.A.); (M.S.); (M.J.A.)
- Instituto de Saúde Ambiental, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso0, Ala C, 1649-028 Lisboa, Portugal
| | - Manuel Silva
- Centre for Vectors and Infectious Diseases Research/National Institute of Health Doutor Ricardo Jorge, Avenida da Liberdade 5, 2965-575 Águas de Moura, Portugal; (L.Z.-Z.); (F.A.); (M.S.); (M.J.A.)
| | - Maria João Alves
- Centre for Vectors and Infectious Diseases Research/National Institute of Health Doutor Ricardo Jorge, Avenida da Liberdade 5, 2965-575 Águas de Moura, Portugal; (L.Z.-Z.); (F.A.); (M.S.); (M.J.A.)
- Instituto de Saúde Ambiental, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso0, Ala C, 1649-028 Lisboa, Portugal
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Nunes B, Barreto M, Gil AP, Kislaya I, Namorado S, Antunes L, Gaio V, Santos AJ, Rodrigues AP, Santos J, Roquette R, Alves-Alves C, Castilho E, Cordeiro E, Dinis A, Prokopenko T, Silva AC, Vargas P, Lyshol H, Dias CM. The first Portuguese National Health Examination Survey (2015): design, planning and implementation. J Public Health (Oxf) 2020; 41:511-517. [PMID: 30239797 DOI: 10.1093/pubmed/fdy150] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/10/2018] [Revised: 07/09/2018] [Accepted: 08/03/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In Health Examination Surveys interview information is complemented with objective information, providing more accurate indicators than self-reported data. We report the study design, planning and implementation of the first Portuguese Health Examination Survey (INSEF). METHODS INSEF was a cross-sectional population-based study representative at regional and national level. Individuals aged between 25 and 74 years old, residing in Portugal were selected from the national health users' registry through multi-stage stratified probabilistic sampling. Sample size was set at 4200 individuals. Data was collected in primary care units and included blood pressure, height, weight, hip and waist measurements, blood collection for lipid profile, HbA1c and blood count and a general health questionnaire. European HES procedures were followed. RESULTS A total of 4911 individuals agreed to participate (43.9% participation rate). Participation rate varied by region, sex and age group, being lower in Lisbon and Tagus Valley (32.8%), for men (41.8%) and for those aged 25-34 years old (36%). CONCLUSIONS INSEF has set up an experienced national and regional structure for HES implementation. Nationally representative quality epidemiological data is now available for public health monitoring, planning and research.
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Affiliation(s)
- Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Marta Barreto
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana P Gil
- CICS.NOVA - Centro Interdisciplinar de Ciências Sociais, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Irina Kislaya
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Sónia Namorado
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Liliana Antunes
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal
| | - Vânia Gaio
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana J Santos
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal
| | - Ana P Rodrigues
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal
| | - Joana Santos
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal
| | - Rita Roquette
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal
| | - Clara Alves-Alves
- Department of Public Health, Norte Regional Health Administration, Porto, Portugal
| | - Emília Castilho
- Department of Public Health, Algarve Regional Health Administration, Faro, Portugal
| | - Eugénio Cordeiro
- Department of Public Health, Centro Regional Health Administration, Coimbra, Portugal
| | - Ana Dinis
- Department of Public Health, Lisbon and Tagus Valley Regional Health Administration, Lisboa, Portugal
| | - Tamara Prokopenko
- Department of Public Health, Alentejo Regional Health Administration, Évora, Portugal
| | - Ana C Silva
- Autonomous Region of Madeira, Regional Government, Vice.Presidency, Funchal, Portugal
| | - Patrícia Vargas
- Regional Directorate for Health, Regional Secretariat for Health, Autonomous Region of Azores, Angra do Heroísmo, Portugal
| | - Heidi Lyshol
- Department of Health and Inequality, Norwegian Institute of Public Health, Oslo, Norway
| | - Carlos M Dias
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
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10
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Melo IS, Braz P, Roquette R, Sousa P, Nunes C, Dias C. [Congenital Heart Disease Prevalence in Portugal in 2015: Data from the National Register of Congenital Anomalies]. ACTA MEDICA PORT 2020; 33:491-499. [PMID: 32669188 DOI: 10.20344/amp.12111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 11/13/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The prevalence at birth of congenital heart disease in Portugal is 8.3/1000 births; undetected critical congenital heart disease may result in adverse outcomes for the fetus/newborn infant. This study describes the reported cases of congenital heart disease in Portugal in 2015 regarding antenatal diagnosis, cardiac defect, and presence of other congenital anomalies/chromosomal abnormalities. These indicators are compared in live births and medical pregnancy terminations. Additionally, postnatal deaths were characterized. MATERIAL AND METHODS Congenital heart disease data derived from the 2015 Portuguese National Registry of Congenital Birth Defects were analyzed. The prevalence rates per 1000 births were assessed by the chi-square test of independence. RESULTS The prevalence of congenital heart disease in this study was 5/1000 live-births (339 live-births, 20% with critical defects). The most common defects were ventricular septal defect (38%), atrial septal defect (15%), aortic coarctation (7%), tetralogy of Fallot (7%) and pulmonary stenosis (5%). One third of the live births had antenatal diagnosis of congenital heart disease. In the live-births with critical congenital heart disease, 54% had antenatal diagnosis and 14% were diagnosed at birth. There were records of 84 pregnancy terminations; 49% had critical defects, 75% had non-cardiac congenital anomalies and 40% had chromosomal abnormalities. There were 15 postnatal deaths recorded (3.4% mortality rate), associated with prematurity/low birthweight, critical congenital heart disease, other non-cardiac congenital anomalies and chromosomal abnormalities. DISCUSSION The data analysis revealed a prevalence of congenital heart disease in this study of 5/1000 births (inferior to other international studies), with a distribution per type of anomaly similar to that reported in previously published work. There were significant regional differences that need further studying. CONCLUSION These results are paramount to characterize the Portuguese scenario and improve Healthcare planning. It is important to improve reporting in the Portuguese National Registry of Congenital Birth Defects.
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Affiliation(s)
- Isabel Saraiva Melo
- Pediatria. Clínica CUF Almada. Almada; Centro de Investigação em Saúde Pública. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Paula Braz
- Departamento de Epidemiologia. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisboa. Portugal
| | - Rita Roquette
- Departamento de Epidemiologia. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisboa. Portugal
| | - Paulo Sousa
- Centro de Investigação em Saúde Pública. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Carla Nunes
- Centro de Investigação em Saúde Pública. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Carlos Dias
- Centro de Investigação em Saúde Pública. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Departamento de Epidemiologia. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisboa. Portugal
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11
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Gaio V, Roquette R, Dias CM, Nunes B. Ambient air pollution and lipid profile: Systematic review and meta-analysis. Environ Pollut 2019; 254:113036. [PMID: 31465899 DOI: 10.1016/j.envpol.2019.113036] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/08/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
Ambient air pollution (AAP) is recognized a cardiovascular risk factor and lipid profile dysregulation seems to be one of the potential mediators involved. However, results from epidemiologic research on the association between exposure to AAP and altered lipid profile have been inconsistent. This study aims to systematically review and meta-analyse epidemiologic evidence on the association between exposure to ambient air pollutants (particulate matter, nitrogen oxides, sulphur dioxide, ozone, carbon monoxide, back carbon) and lipid profile parameters (Total cholesterol; High-Density Lipoprotein Cholesterol; Low-Density Lipoprotein Cholesterol; TG-Triglycerides) or dyslipidaemia. Systematic electronic literature search was performed in PubMed, Web of Science and Scopus databases (last search on 24th May 2019) using keywords related to the exposure (ambient air pollutants) and to the outcomes (lipid profile parameters/dyslipidaemia). Qualitative and quantitative information of the studies were extracted and fixed or random-effects models were used to obtain a pooled effect estimate per each pollutant/outcome combination. 22 studies were qualitatively analysed and, from those, 3 studies were quantitatively analysed. Particulate matters were the most studied pollutants and a considerable heterogeneity in air pollution assessment methods and outcomes definitions was detected. Age, obesity related measures, tobacco consumption, sex and socioeconomic factors were the most frequent considered variables for confounding adjustment in the models. In a long-term exposure scenario, we found a 3.14% (1.36%-4.95%) increase in TG levels per 10 μg/m3 PM10 increment and a 4.24% (1.37%-7.19%) increase in TG levels per 10 μg/m3 NO2 increment. No significant associations were detected for the remaining pollutant/outcome combinations. Despite the few studies included in the meta-analysis, our study suggests some epidemiologic evidence supporting the association between PM10 and NO2 exposures and increased TG levels. Due to the very low level of evidence, more studies are needed to clarify the role of lipid profile dysregulation as a mediator on the AAP adverse cardiovascular effects.
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Affiliation(s)
- Vânia Gaio
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.
| | - Rita Roquette
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal; NOVA IMS Information Management School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Carlos Matias Dias
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge IP (INSA, IP), Lisboa, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
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12
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Roquette R, Painho M, Nunes B. Geographical patterns of the incidence and mortality of colorectal cancer in mainland Portugal municipalities (2007-2011). BMC Cancer 2019; 19:512. [PMID: 31142284 PMCID: PMC6542026 DOI: 10.1186/s12885-019-5719-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 05/15/2019] [Indexed: 12/02/2022] Open
Abstract
Background Cancer is a leading cause of morbidity and mortality in the world. In Portugal, colorectal cancer is one of the most incident cancers; thus, it is crucial to act to fight it. Knowledge of the geographical distribution of the incidence and mortality of colorectal cancer can facilitate the execution of these actions and make them more effective. Methods Our paper aims to describe and discuss the geographical patterns of colorectal cancer incidence and mortality in mainland Portugal municipalities (2007–2011). We used the Besag, York and Mollié (BYM) model to compute the relative risk (RR) and posterior probability (PP). We performed a cluster analysis with Global Moran’s Index and Local Moran’s Index (LISA). We ran a geographically weighted regression (GWR) to compare incidence and mortality patterns. Results Incidence and mortality have different distributions of RR values. The interval of RR concerning incidence was higher than the interval of RR concerning mortality. PP values reinforce the finding of higher heterogeneity of the incidence of colorectal cancer. The comparison of the cluster maps for incidence and mortality shows a few municipalities classified with the same cluster type in both maps. Additionally, the GWR results show that the percentage of RR mortality explained by RR incidence differs throughout mainland Portugal. From the comparison of our results with the prevalence of risk factors (at NUTS II level), the need to be aware of smoking habits, alcohol consumption and the unhealthy diet of the Portuguese population stands out. Conclusions There are differences in the geographical distribution of the RR incidence and RR mortality of colorectal cancer in mainland Portugal municipalities. Likewise, it is relevant to highlight the cluster of two municipalities with high RR values concerning colorectal cancer’s incidence and mortality. Future research is necessary to explain the geographical differences in the distribution of colorectal cancer in mainland Portugal municipalities. Based on our findings, it may be interesting to examine the influence of smoking, alcohol consumption, diet and screening on colorectal cancer in greater detail. Additionally, it may be relevant to develop an analysis focused on municipalities where the incidence values explain the mortality values poorly (or well). Electronic supplementary material The online version of this article (10.1186/s12885-019-5719-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Roquette
- NOVA IMS Information Management School, Universidade Nova de Lisboa, Campus de Campolide, 1099-085, Lisbon, Portugal. .,Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal.
| | - M Painho
- NOVA IMS Information Management School, Universidade Nova de Lisboa, Campus de Campolide, 1099-085, Lisbon, Portugal
| | - B Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Av. Padre Cruz, Lisbon, 1600-560, Portugal
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13
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Cardoso D, Painho M, Roquette R. A geographically weighted regression approach to investigate air pollution effect on lung cancer: A case study in Portugal. Geospat Health 2019; 14. [PMID: 31099513 DOI: 10.4081/gh.2019.701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 10/25/2018] [Indexed: 06/09/2023]
Abstract
The risk of developing lung cancer might to a certain extent be attributed to tobacco. Nevertheless, the role of air pollution, both form urban and industrial sources, needs to be addressed. Numerous studies have concluded that long-term exposure to air pollution is an important environmental risk factor for lung cancer mortality. Still, there are only a few studies on air pollution and lung cancer in Portugal and none addressing its spatial dimension. The goal was to determine the influence of air pollution and urbanization rate on lung cancer mortality. A geographically weighted regression (GWR) model was performed to evaluate the relation between particle matter10 (PM10) emissions and lung cancer mortality relative risk (RR) for males and females in Portugal between 2007 and 2011. RR was computed with the BYM model. For a more in-depth analysis, the urbanization rate and the percentage of industrial area in each municipality were added. GWR efforts led to identifying three variables that were statistically significant in explaining lung cancer relative risk mortality, PM10 emissions, urbanization rate and the percentage of industrial area with an adjusted R2 of 0,63 for men and 0,59 for women. A small set of 8 municipalities with high correlation values was also identified (local R2 above 0,70). Stronger relationships were found in the north-western part of mainland Portugal. The local R2 tends to be higher when the emissions of PM10 are joined by urbanization and industrial areas. However, when assessing the industrial areas alone, it was noted that its impact was lower overall. As one of the first communications on this subject in Portugal, we have identified municipalities where possible impacts of air pollution on lung cancer mortality RR are higher thereby highlighting the role of geography and spatial analysis in explaining the associations between a disease and its determinants.
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14
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Nunes B, Silva S, Rodrigues A, Roquette R, Batista I, Rebelo-de-Andrade H. The 1918-1919 Influenza Pandemic in Portugal: A Regional Analysis of Death Impact. Am J Epidemiol 2018; 187:2541-2549. [PMID: 30099487 PMCID: PMC7314274 DOI: 10.1093/aje/kwy164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/30/2018] [Indexed: 02/07/2023] Open
Abstract
Although the impact of deaths occurring during the 1918–1919 influenza pandemic has been assessed in many archeo-epidemiologic studies, detailed estimates are not available for Portugal. We applied negative binomial models to monthly data on respiratory-related and all-cause deaths at the national and district levels from Portugal for 1916–1922. Influenza-related excess mortality was computed as the difference between observed and expected deaths. Poisson regression was used to estimate the association of geographic and sociodemographic factors with excess mortality. Two waves of pandemic influenza—July 1918 to January 1919 and April to May 1919—were identified, for which the excess all-cause death rate was 195.7 per 10,000 persons. All districts of Portugal were affected. The pandemic hit earlier in southeastern districts and the main cities, but excess mortality was highest in the northeast, in line with the high death burden experienced by northern Spanish provinces. During the period of intense excess mortality (fall/winter 1918–1919), population density was negatively associated with pandemic impact. This pattern changed during the March 1919 to June 1920 wave, when excess mortality increased with population density and in northern and western directions. Portuguese islands were less and later affected. Given the geographic heterogeneity evidenced in our study, subnational sociodemographic characteristics and connectivity should be integrated in pandemic preparedness plans.
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Affiliation(s)
- Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Susana Silva
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - Ana Rodrigues
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - Rita Roquette
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - Inês Batista
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - Helena Rebelo-de-Andrade
- Department of Infectious Diseases, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
- Host-Pathogen Interaction Unit, Research Institute for Medicines
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15
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Roquette R, Nunes B, Painho M. The relevance of spatial aggregation level and of applied methods in the analysis of geographical distribution of cancer mortality in mainland Portugal (2009-2013). Popul Health Metr 2018; 16:6. [PMID: 29587794 PMCID: PMC5870502 DOI: 10.1186/s12963-018-0164-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 03/15/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Knowledge regarding the geographical distribution of diseases is essential in public health in order to define strategies to improve the health of populations and quality of life. The present study aims to establish a methodology to choose a suitable geographic aggregation level of data and an appropriated method which allow us to analyze disease spatial patterns in mainland Portugal, avoiding the "small numbers problem." Malignant cancer mortality data for 2009-2013 was used as a case study. METHODS To achieve our aims, we used official data regarding the mortality by all malignant cancer, between 2009 and 2013, and the mainland Portuguese resident population in 2011. Three different spatial aggregation levels were applied: Nomenclature of Territorial Units for Statistics, level III (28 areas), municipalities (278 areas), and parishes (4050 areas). Standardized Mortality Ratio (SMR) and relative risk (RR) were computed with Besag, York and Mollié model (BYM) for the evaluation of geographic patterns of mortality data. We also estimated Global Moran's I, Local Moran's I, and posterior probability (PP) for the spatial cluster analysis. RESULTS Our results show that the occurrence of lower and higher extreme values of the standardized mortality ratio tend to increase with the decrease of data spatial aggregation. In addition, the number of local clusters is higher at small spatial aggregation levels, although the area of each cluster is generally smaller. Regarding global clustering, data forms clusters at all considered levels. Relative risk (RR) computed by Besag, York and Mollié model, in turn, also shows different results at the municipalities and parishes levels. However, the difference is smaller than the difference obtained by SMR computation. This statement is supported by the coefficient variation values. CONCLUSIONS Our findings show that the choice of spatial data aggregation level has high importance in the research results, as different aggregation levels can lead to distinct results. In terms of the case study, we conclude that for the period of 2009-2013, cancer mortality in mainland Portugal formed clusters. The most suitable applicable spatial scale and method seemed to be at the municipalities level and Besag, York and Mollié model, respectively. However, further studies should be conducted in order to provide greater support to these results.
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Affiliation(s)
- Rita Roquette
- Nova IMS Information Management School, Lisbon, Portugal.
- National Health Institute Doutor Ricardo Jorge, Avenida Padre Cruz, 1649-016, Lisbon, Portugal.
| | - Baltazar Nunes
- National Health Institute Doutor Ricardo Jorge, Avenida Padre Cruz, 1649-016, Lisbon, Portugal
- Escola Nacional de Saúde Pública, Lisbon, Portugal
| | - Marco Painho
- Nova IMS Information Management School, Lisbon, Portugal
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Roquette R, Painho M, Nunes B. Spatial epidemiology of cancer: a review of data sources, methods and risk factors. Geospat Health 2017; 12:504. [PMID: 28555468 DOI: 10.4081/gh.2017.504] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/25/2016] [Accepted: 11/27/2016] [Indexed: 06/07/2023]
Abstract
Cancer is a major concern among chronic diseases today. Spatial epidemiology plays a relevant role in this matter and we present here a review of this subject, including a discussion of the literature in terms of the level of geographic data aggregation, risk factors and methods used to analyse the spatial distribution of patterns and spatial clusters. For this purpose, we performed a websearch in the Pubmed and Web of Science databases including studies published between 1979 and 2015. We found 180 papers from 63 journals and noted that spatial epidemiology of cancer has been addressed with more emphasis during the last decade with research based on data mostly extracted from cancer registries and official mortality statistics. In general, the research questions present in the reviewed papers can be classified into three different sets: i) analysis of spatial distribution of cancer and/or its temporal evolution; ii) risk factors; iii) development of data analysis methods and/or evaluation of results obtained from application of existing methods. This review is expected to help promote research in this area through the identification of relevant knowledge gaps. Cancer's spatial epidemiology represents an important concern, mainly for public health policies design aimed to minimise the impact of chronic disease in specific populations.
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Affiliation(s)
- Rita Roquette
- Nova IMS Information Management School, Lisbon; National Health Institute Doutor Ricardo Jorge, Lisbon.
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Cortes-Martins H, Matos R, Moura S, Almeida L, Ferreira S, Manita C, Santos J, Pinto S, Nunes B, Roquette R, Cardoso C, Brum L, Palminha P. Anti-HAV IgG seroprevalence in Lisbon region residents: Preliminary results from the National Serological Survey 2015–2016. J Clin Virol 2016. [DOI: 10.1016/j.jcv.2016.08.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Palminha P, Ferreira S, Moura S, Almeida L, Lourenço T, Pinto S, Roquette R, Nunes B, Cardoso C, Brum L. National serological survey – Portugal 2015–2016: Rubella seroprevalence in a population-based sample of childbearing age women resident in the North, Lisbon and Algarve. J Clin Virol 2016. [DOI: 10.1016/j.jcv.2016.08.221] [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: 11/26/2022]
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Palminha P, Padua E, Cortes-Martins H, Borrego M, Matos R, Moura S, Nunes B, Roquette R, Cardoso C, Brum L. National serological survey – Portugal 2015–2016: Study design. J Clin Virol 2016. [DOI: 10.1016/j.jcv.2016.08.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sousa Uva M, Victorino P, Roquette R, Machado A, Matias Dias C. Epidemiological research on the incidence and prevalence of arterial hypertension in the Portuguese population: a scoping review. Rev Port Cardiol 2014; 33:451-63. [PMID: 25123417 DOI: 10.1016/j.repc.2014.02.012] [Citation(s) in RCA: 4] [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: 12/20/2013] [Accepted: 02/02/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The Portuguese population is reported to have among the highest levels of mean blood pressure. The aim of the present study is to conduct a structured literature review describing the scope (quantity, focus and nature) of published epidemiological research on the prevalence and incidence of hypertension in the Portuguese population. METHODS The scoping review was conducted during June 2013, using two information sources, B-on and PubMed, to search for published studies on the prevalence and incidence of hypertension with data collected between 2005-2013 and 1995-2013, respectively. RESULTS We identified 527 publications: 14 on the prevalence and two on the incidence of hypertension. The results show more studies on populations in the North region of Portugal; an apparent lack of published studies specifically targeting the Alentejo and Algarve populations; long delays between data collection and publication of results (up to nine years); considerable variability in measurement methods; and infrequent data stratification by gender and age. CONCLUSIONS Differences in blood pressure measurement methods, not specified in most studies, the infrequency of stratification of results by gender and age, and the geographic asymmetry in coverage of the Portuguese population, hinder monitoring of the incidence and prevalence of hypertension in Portugal.
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Affiliation(s)
- Mafalda Sousa Uva
- Departamento de Epidemiologia, Instituto Nacional Doutor Ricardo Jorge, Lisboa, Portugal.
| | - Paulo Victorino
- Departamento de Epidemiologia, Instituto Nacional Doutor Ricardo Jorge, Lisboa, Portugal
| | - Rita Roquette
- Departamento de Epidemiologia, Instituto Nacional Doutor Ricardo Jorge, Lisboa, Portugal
| | - Ausenda Machado
- Departamento de Epidemiologia, Instituto Nacional Doutor Ricardo Jorge, Lisboa, Portugal
| | - Carlos Matias Dias
- Departamento de Epidemiologia, Instituto Nacional Doutor Ricardo Jorge, Lisboa, Portugal
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Uva MS, Victorino P, Roquette R, Machado A, Dias CM. Epidemiological research on the incidence and prevalence of hypertension in the Portuguese population: A scoping review. Revista Portuguesa de Cardiologia (English Edition) 2014. [DOI: 10.1016/j.repce.2014.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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