Portuguese Journal of Public Health最新文献

Introduction: Refractive error is a public health concern and even with relatively simple and cost-effective interventions it remains usually outside national health services (NHSs) not ensuring universal health coverage. This study aimed to generate evidence about the availability and accessibility of refractive services in Portugal and to present a plan for more efficient services.

Methods: A situation analysis of the Portuguese existing refractive services within the NHS was conducted based on three health systems building blocks: service delivery access, service coverage, and workforce. A strengths, weaknesses, opportunities, and threats analysis was performed based on existent evidence to identify internal and external factors that can facilitate or hinder the integration of refractive services within the NHS. The number of eye care personnel to be integrated in the NHS was calculated considering the minimum ratios recommended by national and international technical reports.

Results: Portugal has no specific services to address refractive errors within the NHS. Treatment of refractive error occurs at the level of eye care general services. There are 39 NHS eye care services, all hospital-centred and divided into three large groups, according to technical differentiation, the technology required, and workforce capacity. The workforce available is composed of ophthalmologists and orthoptists, together with nurses and other general paramedical assistants. 3 Portuguese municipalities have more than 1 NHS eye care service, 35 have 1 NHS eye care service, and 240 municipalities (in the mainland) have none. In 2021, 52% of the hospitals providing eye care services did not meet the recommended response times. Centralization of eye care services in urban areas, undifferentiated referral systems, and a shortage in the workforce per inhabitant was observed.

Conclusions: Portuguese NHS has all the requirements to reorientate refractive care from the current hospital-based model to primary care. The country also has a trained and qualified workforce to address this condition. Evidence demonstrates that the provision of refractive services at primary care is efficient and effective and translates into an opportunity to identify other visual conditions.

Background: During the COVID-19 pandemic, community pharmacy (CP) professionals were among those who experienced the greatest risk of contracting SARS-CoV-2, which forced major adaptations.

Objectives: The objectives of the study were to describe the changes implemented in CP professionals during the pandemic, understand the perception of professionals about their experience, and explore changes to remain.

Methods: An observational and cross-sectional study was conducted via an online questionnaire (June-September 2020). The target population was CP professionals working in Portugal for >2 years and serving the public during the pandemic.

Results: Of a total of 353 participants, 84% were female (mean age of 37.6 years), and 81% were pharmacists (mean professional experience of 12.9 years). In the management and organizational dimensions, the most mentioned changes were adaptation to legislative changes (90%), fluctuations in the treasury (82%), and reduction of working hours (46%). Only 2% resorted to simplified layoff. In the back office, there was a need to adapt stock management (93%) and purchase personal protective equipment (99%). In the front office, there was a change in service policies - wicket or conditional opening (92%), routes of the arrival of user requests (91%), and home delivery (82%). Physical changes occurred in 100% of pharmacies. The most frequently implemented procedures were the use of protection systems and PPE, articulation with hospital pharmacies for dispensing in proximity (75%), and training in this area (55%). Regarding interpersonal climate, improvements in the connection between team members are evident: increase in mutual help (57%), solidarity (54%), and group cohesion (50%); in the relationship with clients, the majority indicated the replacement of the usual user by third parties (71%), and changes in communication channels (increase in use of technological means 68%).

Conclusions: Results illustrate the profound impact of the pandemic on CP professionals, both professionally and personally. It also highlights the importance of their roles in proximity and community support.

Introduction: There is a linear association between pregestational body mass index (BMI) and almost all adverse pregnancy outcomes. Pregnancy is "a window of opportunities" in terms of changing behavior and improving awareness of healthy living. The proper assessment of physical activity levels, during pregnancy, determines trends, health benefits, and their effects over time. This study aims to describe maternal physical activity levels, stratified by pregestational BMI, verify the accomplishment of physical activity recommendations in pregnant women, and correlate pregestational BMI and physical activity accomplishment with maternal, delivery, and neonatal parameters.

Methods: A retrospective cohort study was carried out with 103 pregnant women. Physical activity levels were evaluated using a questionnaire and accelerometry. Pregestational BMI was obtained through the Quetelet formula and used the American College of Sports Medicine's guidelines were used to determine physical activity accomplishment levels. Continuous data were presented as mean and standard deviation and categorical data as numbers and percentages. The F test was used to examine the differences between groups.

Results: Pregnant women in the sample spent 42.9% of their time on household activities, and for pregnant women with obesity, 91.5% of the time was spent on sedentary activities. Women with normative BMI had higher levels of moderate-intensity activities. Only 15.8% of participants with obesity reached the international recommendations for physical activity practice and women who accomplished physical activity recommendations gained less weight during pregnancy. A high percentage of pre-obesity and obese pregnant women exceeded the recommendations for gestational weight gain and the gestational diabetes prevalence was higher in the obesity group (p = 0.03 between groups). Regarding delivery and neonatal parameters (Apgar score 1st, Apgar score 5th, birth weight, length and head circumference), no statistical differences were found when adjusted to a gestational week at birth, between BMI (p = 0.58; p = 0.18; p = 0.60; p = 0.34; p = 0.34, respectively) or physical activity (p = 0.12; p = 0.15; p = 0.83; p = 0.70; p = 0.70, respectively) groups.

Conclusion: Pregnant women with obesity, exhibit high levels of sedentary behavior, a high prevalence of gestational diabetes, and exceed recommended gestational weight gain. Healthcare professionals have a crucial role in promoting regular physical activity and lifestyle changes before and during pregnancy.

Introduction: Patient registries are one of the main sources of real-world data (RWD), which enables different healthcare stakeholders to analyse and benchmark clinical practice and foster better care. Despite the growing need for RWD, the current use of patient registries in Portugal is not fully understood. This study aimed to identify and provide an overview of patient registries in Portugal.

Methods: Registries identification included a systematic literature review (SLR) using PRISMA© methodology. An electronic search was conducted in Embase^®, MEDLINE©, and Cochrane Ovid^® software, considering a set of rules and relevant search terms. Patient registries and databases, hospital, primary healthcare, and population-based studies between January 1955 and March 2021 were considered while randomized controlled trials and transversal observational studies were excluded. A manual review for validation was performed to identify unique registries. To complement SLR, an additional hand search was conducted using the Google^® search engine. A literature and website search was conducted to provide an overview of the registries identified.

Results: From the 108 unique registries, 76 (70%) were classified as national and 32 (30%) as international (with data collected from the Portuguese population). Most national registries were found to be owned by medical societies and health authorities (88%) and are predominantly implemented in hospitals (82%). National registries cover 18 different medical specialities, mostly Cardiology and Oncology.

Discussion: This study identified and provided an overview of the registries collecting data from the Portuguese population. The study results aim to improve the information available to promote the increased utility of RWD at both national and international levels. In the future, an easy-access and centralized repository, aggregating all patient registries, should be created in Portugal to disseminate information. Additionally, an in-depth characterization of the 76 national registries must be performed to better understand and clarify their potential and usefulness.

Background: Alcohol consumption is widely recognized as a leading cause of premature mortality and a significant global health concern. This study aimed to investigate the trends in alcohol use disorders, including incidence, mortality, and disability-adjusted life years (DALYs), in Estonia from 1990 to 2019 using data from the Global Burden of Disease (GBD) dataset.

Methods: The GBD study is a comprehensive epidemiological research effort that analyzes various causes of death, diseases, injuries, and risk factors across multiple countries and territories. In this study, we utilized the GBD dataset to estimate annual incidence, prevalence, mortality, years of life lost, years living with disabilities, and DALY rates by gender and age from 1990 to 2019. To assess the trends in these indices, including DALY, incidence, mortality, and 1-mortality-to-incidence ratio (1-MIR), joinpoint regression analysis was employed. This allowed for the identification of significant changes in trends at specific time points and the calculation of annual percent change between these points.

Results: Our findings revealed an overall decreasing trend in the incidence rate of alcohol use disorder over the study period. However, the average DALY, mortality, and 1-MIR trends did not exhibit significant variation during this time. Moreover, we observed a more substantial decline in alcohol use disorders among men compared to women from 1990 to 2019. Specifically, the incidence of alcohol use disorders demonstrated a significant increase from 1990 to 2000, followed by a decline from 2010 to 2018, and continued to decrease from 2017 to 2019.

Conclusion: This study provides important insights into the changing trends of alcohol use disorders, including incidence and mortality, in Estonia from 1990 to 2019. Our findings indicate a decreasing pattern over time, suggesting a positive shift in alcohol consumption behavior. Additionally, we observed that men had higher rates of MIR, DALY, mortality, and incidence of alcohol use disorders compared to women. These results emphasize the need for targeted health prevention programs to sustain and further promote the downward trend in alcohol-related disorders.

Introduction: Food and cooking skills (FCSks) are defined as a complex, interrelated, and person-centred set of skills, necessary to provide and prepare safe, nutritious, and culturally acceptable meals for all members of the household. Recent studies have associated higher FCSk with healthier eating habits and better health. This study aimed to validate a Portuguese version of a tool to assess and describe FCSk in young adults.

Methods: A cross-sectional study used an online anonymous questionnaire that was disseminated to students from three Portuguese Higher Education Institutes. The questionnaire validation included Cronbach alpha and confirmatory factor analysis (CFA). The Mann-Whitney test was used for evaluating sample differences and Pearson correlation for association among variables.

Results: Internal consistency reliability was 0.89 for cooking skills (CSks) and 0.87 for food skills (FSks). A moderate positive correlation was found between CSks and FSks confidence (r = 0.658, p < 0.01). CFA presented a good adjustment model for most of the fit indices, indicating the adequacy of the questionnaire. The CSks score was 74.1 ± 21.2 (moderate) and the food Skills was 94.2 ± 20.8 (high). Cook pulses, steaming food, and planning meals ahead scored the lowest value, while boiling or simmering food, chopping, peeling vegetables, and reading the best-before date scored the highest value. No difference was found among sex (p _CSk = 0.576; p _FSk = 0.158), age (p _CSk = 0.566; p _FSk = 0.130), body mass index classes (p _CSk = 0.903; p _FSk = 0.320), or course (p _CSk = 0.169; p _FSk = 0.126). The greatest interest in gastronomy and frequency of meal preparation is associated with higher FCSk (p < 0.05).

Conclusion: This research validated a Portuguese version of a tool to assess FCSk among young adults. Internal consistency reliability was adequate. Confirmatory factor analysis returned good psychometric properties for the questionnaire. Authors identified lower FCSk competencies in cooking pulses and vegetables, which are healthy and sustainable foods. This may compromise the adoption of healthy eating behaviours, so promoting FCSk in young adults may pose a strategy for nutrition and public health in reducing diet-related diseases. This tool may be used to identify opportunities for intervention in public health nutrition.

High exposure to sedentary behavior and lower levels of physical activity can lead to excess body weight (EBW). The aim of this study was to estimate the prevalence of EBW and the direct association under the condition of sociodemographic, university, and behavioral moderating characteristics, between physical activity and sitting time related to EBW in Brazilian university students. A cross-sectional study was carried out with 1,110 university students from a federal public institution in Minas Gerais, Brazil. The outcome was the EBW (body mass index: ≥25.0 kg/m²) and the independent variables were physical activity (insufficiently active and active) and sitting time (<6 h/day; ≥6 h/day). Association analyses were estimated via odds ratio (OR) using binary logistic regression. The significance level was 5%. The prevalence of EBW was 27.8%. No direct association was observed between physical activity and time sitting related to EBW. However, insufficiently active university students were more likely to have EBW (OR = 1.91; 95% CI: 1.06-3.47) when they did not consume alcoholic beverages, and university students with a sitting time of ≥6 h/day had lower chances of having EBW (OR = 0.62; 95% CI: 0.40-0.95) when they had spent more time at university (3 years or more). It is concluded that the prevalence of EBW in university students was high and there was no direct association between physical activity and sitting time; however, alcohol consumption and university time moderated the association with higher and lower chances of occurrence of EBW in university students, respectively.

tHeat waves (HWs) are one of the most important atmospheric events that negatively affect human health. In this study, HWs which occurred between May 1 and September 30, 2019 in Fethiye Province (SW Turkey) were investigated for their effects on human health. For this purpose, as a first step, percentile-based threshold criteria and at least three consecutive days' methodology were applied to the daily maximum temperatures to identify HWs. Using these criteria, a total of 3 HWs (HW 1, HW 2, and HW 3) with lengths of 6, 7, and 5 days, respectively, were found in 2019. In statistical analyses, hospital data recorded on HW days (including the 3 lag days) on reference days were compared using the logarithmic Z test method. Hospital data between May 1 and September 30 in the 5 years between 2014 and 2018 were used as reference data. As a result, in the 3 HWs that occurred in 2019, the risk ratios (RRs) and their confidence intervals in HW 1, HW 2, and HW 3 at hospital admissions were 1.09 (95% CI: 1.06-1.12), 1.11 (95% CI: 1.08-1.14), and 1.13 (95% CI: 1.09-1.16), (p < 0.05), respectively. When the effect of HW on death was examined, the RR values and confidence intervals in HW 1, HW 2, and HW 3 were 1.90 (95% CI: 1.04-3.46), 1.96 (95% CI: 1.03-3.75), and 2.18 (95% CI: 1.13-4.20), (p < 0.005), respectively. As a result, it was found that a total of 22 extra deaths occurred when three HWs were recorded in 2019. When the deaths were analysed by age, it was seen that the most affected group was the elderly (≥65 years), accounting for 82% of deaths. It was determined that 64% of the deaths were male, and 36% were female. These results show that HWs in Fethiye are an important natural disaster that negatively affects human health.