Portuguese Journal of Public Health最新文献

Dementia poses major public health challenges, and high-quality epidemiological data are needed for service planning. Published estimates of numbers of people with dementia in Portugal have been based, in most cases, on prevalence rates derived from international studies or expert consensus. As in many other countries, Portuguese community prevalence studies' results are nongeneralizable to a country level. Moreover, their prevalence estimates differ (not surprisingly, owing to different methodologies, e.g., design, sampling, and diagnostic criteria). Regardless, the Portuguese 10/66 Dementia Research Group (10/66 DRG) population-based survey fulfilled 10 out of 11 Alzheimer's Disease International quality criteria for prevalence studies. It relied on cross-culturally validated methods, fostering a wide comparability of results. Therefore, we can provide rough estimates of 217,549 community dwellers with dementia in Portugal according to the 10/66 DRG criteria (that would be only 85,162 according to DSM-IV criteria). This refers to people aged 65 years or older who are not institutionalized. Although broadly consistent with international projections, these estimates must be cautiously interpreted. Particularly in the context of scarce funding, which will probably last for years, we need more efficient, evidence-based dementia policies. Concerning further epidemiological studies, high-quality methods are needed but also their comparability potential should be improved at national and international levels. Most of all, fund allocation in Portugal should now privilege routine dementia information systems in both health and social services.

Introduction: Health technology assessment (HTA) aims to provide decision makers with relevant data to make informed choices. Recent changes in the Portuguese HTA framework have altered substantially the assessment methodology with regard to economic evaluation, with potential impacts on access and process efficiency. The HTA Reshaping Project had as its main objective informing the debate on HTA in Portugal, thereby identifying improvement opportunities and solutions to the HTA framework that address future challenges.

Methods: The project comprised several phases, i.e., (1) mapping and evaluation of different HTA frameworks across Europe, identifying best practices and key variables to consider in future frameworks; (2) conduction of in-depth interviews with relevant stakeholders (n = 11); and (3) development of 2 workshops - one with young professionals (n = 12) and another with relevant HTA stakeholders (n = 19) - to consolidate and further explore vital elements of HTA, aimed at brainstorming ideas and developing solutions to improve some of the most critical points, with a view to addressing future challenges.

Results: The comparison of HTA frameworks showed that their purpose and sophistication vary across European countries. For example, the need for economic evidence is not unanimous, and reimbursement agreements vary considerably. Among the stakeholders interviewed there was a high level of agreement on priorities that should be addressed, e.g., expanding and creating national level registries and assuring patient participation throughout the HTA process. The possibility of using managed entry agreements to enhance patients' access, applying multi-indication pricing for medicines with different therapeutic values per indication, and improvement of registry/system interoperability gathered a moderate level of agreement.

Conclusions: The Portuguese HTA framework might be further adapted to upcoming challenges and should evolve to improve access to innovative therapies. There is still a long path towards the convergence of HTA frameworks in EU member states.

Introduction: The incidence of colorectal cancer is increasing worldwide. However, the screening uptake is generally low. We analyzed the association between sociodemographic, economic, and access-to-healthcare factors and the use of exams that are the basis for colorectal cancer screening in Portugal.

Methods: We conducted a cross-sectional study based on data from the 1st National Health Examination Survey. We used Poisson regression to estimate prevalence ratios and study factors associated with the use of fecal immunochemical tests (FIT) and colonoscopy in a Portuguese population aged 50-74 years (n = 2,489).

Results: 45.7% of the individuals reported using FIT in the previous 2 years; 37.3% reported using colonoscopy in the previous 5 years. The use of FIT was associated with age group, health region, and having a family doctor. It was higher in older individuals (47.6% in the age group 70-74 years vs. 38.1% in the age group 50-54 years; adjusted prevalence ratio [aPR] = 1.32; 95% CI 1.05-1.65), and in individuals assigned to a family doctor (47.6 vs. 30.3%; aPR = 1.50; 95% CI 1.14-1.98). Colonoscopy was associated with age group, health region, higher education, economic capacity, and having a family doctor. It was higher in older individuals (45.3% in the age group 70-74 years vs. 25.6% in the age group 50-54 years; aPR = 1.85; 95% CI 1.42-2.40), individuals with a higher economic capacity (40.5 vs. 32.4%; aPR = 1.19; 95% CI 1.01-1.40), and individuals assigned to a family doctor (38.7 vs. 25.6%; aPR = 1.43; 95% CI 1.08-1.91).

Discussion/conclusion: In our analysis, the use of FIT and colonoscopy was influenced by sociodemographic, economic, and access-to-healthcare factors. This is relevant to guide interventions in this area. It is essential to ensure an equitable and uniform implementation of the screening program, with family doctors as an important part of the process.