Fernandes, Teresa; Freitas, Graça
Desde a sua criação em 1965, o panorama epidemiológico das doenças evitáveis por vacinação em Portugal era desfavorável em relação aos outros países da Europa. Assim, com o objetivo de prevenir a ocorrência de determinadas doenças infeciosas, foi criado o Programa Nacional
de Vacinação para vacinar a população, especialmente as crianças, de forma organizada, universal, gratuita e com continuidade.
Desde 1965, o PNV foi sendo atualizado em duas vertentes principais:
• Introdução progressiva de vacinas, determinada por fatores epidemiológicos e pela disponibilidade de novas e melhores vacinas.
• Atualização dos esquemas vacinais para melhor adaptação à realidade epidemiológica e adesão ao PNV.
Simões, Maria João; Fernandes, Teresa
Acompanhamento: Maria da Graça Freitas (Direção-Geral da Saúde), Jorge Machado (Instituto Nacional de Saúde Doutor Ricardo Jorge). Colaboradores: Paulo Gonçalves, Célia Betencourt, Ana Leça, Andreia Silva da Costa.
Costa, Nádia; Cruz, Rebeca; Graça, Pedro; Breda, João; Casal, Susana
Consistent evidence exist on the harmful health effects of industrial trans fatty acids (TFA). In order to
have accurate data on TFA intake and implement adequate measures to reduce their intake, each country
should have updated estimates of TFA content in the diet. The objective of the present study was to provide data on the TFA content in food commercialized in the Portuguese market. The results on the TFA content of 268 samples acquired between October and December 2013 are reported. Samples were categorized as margarines and shortenings (n ¼ 16), spreadable chocolate fats (n ¼ 6), fried potatoes and chips (n...
Ferrinho, Paulo; Guerreiro, Cátia Sá; Portugal, Rui
A adoção de planos em todos os setores da sociedade tem ganho em importância, pela sua capacidade de influenciar a tomada de decisão. O planeamento estratégico (PE), enquanto procedimento complexo, participado e mobilizador de todos os quadrantes da sociedade, contribui para ganhos em conhecimento e para a difusão do mesmo, legitimando visões estratégicas e clarificando áreas prioritárias de intervenção.
O PE no setor da saúde (PES) emergiu na década de 1990, fortemente impulsionado pela Global Strategy for Health for All by the Year 2000 e, mais recentemente, pela Health 21 – Health for All in the 21st Century. Com o intuito...
Coelho, Anabela P.; Sá, Helena O.; Diniz, José A.; Dussault, Gilles
Portugal was the first European country to introduce an integrated management of end-stage renal disease (IM ESRD). This new program integrates various dialysis services and products, which are reimbursed at a fixed rate/patient/week called “comprehensive price payment.” This initiative restructured the delivery of dialysis services, the monitoring of outcomes, and the funding of renal replacement therapy. This article described the implementation of a new model of comprehensive provision of hemodialysis (HD) services and aimed to assess its impact on dialysis care. Quality assessments and reports of patient satisfaction, produced by the Ministry of Health since 2008, as well as national...
Ribeiro, Joana Sousa; Conceição, Cláudia; Pereira, Joel; Leone, Cláudia; Mendonça, Pedro; Temido, Marta; Vieira, Carlota Pacheco; Dussault, Gilles
The mobility of health professionals in the European Union is a phenomenon which policymakers must take into account to provide the conditions to adjust for demand and supply of health services. This paper presents the case of Portugal, a country which at the same time imports and exports health workers. Since the early 1990s Portugal became a destination country receiving foreign health care professionals. This situation is now changing with the current economic situation as fewer immigrants come and more Portuguese emigrate. Foreigners coming to Portugal do so in part for similar reasons that bring Portuguese to want to emigrate,...
Ayres-De-Campos, Diogo; Cruz, Joana; Medeiros-Borges, Cláudia; Costa-Santos, Cristina; Vicente, Lisa
To evaluate national cesarean section (CS) rates and other obstetric indicators after a concerted action to reduce CS rates was undertaken in Portugal from 2010 onwards. This action was based on the transmission of information and training of healthcare professionals, together with the inclusion of CS rates as a criterion for hospital funding. Retrospective observational population-based study. SETTING: Portugal. POPULATION: Births occurring in Portugal between 2000 and 2014. METHODS: Governmental sources were used to obtain data on national CS, perinatal and maternal mortality rates. Rates of instrumental vaginal delivery, vaginal birth after cesarean (VBAC), hypoxia-related complications and perineal lacerations were...
Gardete-Correia, L.; Boavida, José; Raposo, J. F.; Mesquita, A. C.; Fona, C.; Carvalho, R.; Massano-Cardoso, S.
Aims Diabetes is a growing worldwide problem. Ascertaining its prevalence is vital as a starting point to establish and measure the success of health interventions. This study aimed to determine the prevalence of Type 2 diabetes and ‘pre-diabetes’, defined as impaired fasting glucose and impaired glucose tolerance, in the Portuguese population aged between 20 and 79 years. Methods Considering the number of inhabitants between 20 and 79 years old, statistical units were selected that were representative regionally and nationally. The total sample comprised 5167 subjects. National prevalence was calculated. Analyses were performedon all thosewithout previously knowndiabetes usingWorld Health Organization reference...
Nunes, Baltazar; Machado, Ausenda; Guiomar, Raquel; Pechirra, Pedro; Conde, Patrícia; Cristovão, Paula; Falcão, Isabel
Background: In recent years several reports of influenza vaccine effectiveness (VE) have been made early for public health decision. The majority of these studies use the case test-negative control design (TND),which has been showed to provide, under certain conditions, unbiased estimates of influenza VE. Nevertheless, discussions have been taken on the best influenza negative control group to use. The presentstudy aims to contribute to the knowledge on this field by comparing influenza VE estimates using three test-negative controls: all influenza negative, non-influenza respiratory virus and pan-negative.Methods: Incident ILI patients were prospectively selected and swabbed by a sample of general practitioners....
Bitzer, Johannes; Amy, Jean-Jacques; Beerthuizen, Rob; Birkhäuser, Martin; Bombas, Teresa; Creinin, Mitchell; Darney, Philip D; Vicente, Lisa Ferreira
The controversy around the combined hormonal contraceptives (CHCs) of the so-called third (containing gestodene or desogestrel) and fourth generation (containing drospirenone, DRSP) has reached a highly emotional political dimension in which all those who are professionally responsible for women’s health are involved: the national health authorities, the pharmaceutical companies, the professional organisations, the prescribers, the media and the public (i.e. the current or potential users of CHCs). The – initially scientific – controversy has now led to a public health dispute that culminated in the decision of the French authorities to withdraw the combination containing ethinylestradiol (EE) and cyproterone acetate...
Boavida, José Manuel
Late complications of type 1 and type 2 diabetes can also be effectively avoided or delayed using active intervention and available therapies. Despite these facts, the percentage of people with diabetes following the therapy proposed by health care professionals is quite low. People with diabetes or any other chronic disease have to be involved in their own treatment. Basic knowledge is very important for the patient but the reinforcement of appropriate attitudes and a continuous process of motivation is fundamental in changing habits and behaviour. We need to educate patients, giving them the tools and skills to manage their disease,...
George, Francisco; Shivaji, Tara; Pinto, Cátia Sousa; Serra, Luis; Valente, João; Albuquerque, Maria João; Vicêncio, Paula; San-Bento, Ana; Diegues, Paulo; Nogueira, Paulo; Marques, Teresa; et al
Background: We describe the investigation and control of an outbreak of Legionnaires’ disease in Portugal in October, November and December 2014. Methods: Confirmed cases were individuals with pneumonia, laboratory evidence of Legionella pneumophila serogroup 1 and exposure, by residence, occupational or leisure tothe affected municipalities. 49 possible sources were reduced to four potential sources, all industries with wet cooling system, following risk assessment. We geo-referenced cases’ residences and the location of cooling towers defining four study areas 10 km buffer centeredon each cooling tower system. We compared the number of cases with expected numbers,calculated from the outbreak’s attack rates applied...
Gonçalves, Carla; Abreu, Sandra; Padrão, Patrícia; Graça, Pedro; Breda, João; Moreira, Pedro; et al
Background: Hypertension is the leading cause for heart disease and stroke, for mortality and morbidity
worldwide, and a high sodium-to-potassium intake ratio is considered a stronger risk factor for hypertension
than sodium alone. Objective: This study aims to evaluate sodium and potassium urinary excretion, and assess the food sources of these nutrients in a sample of Portuguese adolescents.
Design: A cross-sectional study with a sample of 250 Portuguese adolescents. Sodium and potassium
excretion were measured by one 24-h urinary collection, and the coefficient of creatinine was used to validate completeness of urine collections. Dietary sources of sodium and potassium were assessed using a 24-h...
Shivaji, Tara; Martins, Helena Cortes
In a climate of public sector austerity, the demand for accurate information about disease epidemiology rises as health program managers try to align spending to health needs. A policy of case re-notification to improve HIV information quality resulted in a nine-fold increase in the number of case reports received in 2013 by the Portuguese HIV surveillance office. We used value stream mapping to introduce improvements to data processing practices, identify and reduce waste. Two cycles of improvement were trialled. Before intervention, processing time was nine minutes and 28 seconds (95%CI 8:53-10:58) per report. Two months
post intervention, it was six minutes...
Oliveira, Ana Catarina; Padrão, Patrícia; Moreira, André; Graça, Pedro; Breda, João; Moreira, Pedro; et al
Background: Data from studies assessing the intake of potassium, and the concomitant sodium-to-potassium ratio are limited. The aim of this study was to evaluate potassium and sodium-to-potassium ratio intake in 8–10 year-old children. Methods: A cross-sectional survey was carried out from January to June 2014 and data from 163 children (81 boys) were included. Potassium intake was estimated by 24-h urine collection and coefficient of creatinine was used to validate completeness of urine collections. Urinary sodium and sodium-to-potassium ratio were also analysed. A 24-h dietary recall was used to provide information on dietary sources of potassium. Height and weight were...
Machado, Maria do Céu; Alves, Maria Isabel; Couceiro, Luisa; Silva, Francisco Goiana; Almeida, Miguel Morais; Alves, Isa
Em Portugal, a taxa de natalidade não é suficiente para assegurar a renovação de gerações. A licenciatura e participação no mercado de trabalho das mulheres e a actual instabilidade económica são alguns determinantes e têm como consequência, o adiamento da parentalidade e infertilidade condicionada ainda pela obesidade, tabagismo e álcool. Estudo epidemiológico transversal, analítico, através de questionários auto-preenchidos, online, divulgados pelas Associações de estudantes das Universidades Portuguesas. A análise estatística da amostra de 3585 estudantes foi desenvolvida em SPSS, Excel nas representações gráficas e ArcMap, para os mapas. Predomínio de estudantes de Ciências de Saúde (40,6%), da Universidade de Lisboa...
A pneumonia adquirida na comunidade (PAC) é uma causa importante de morbilidade, mortalidade e consumo de recursos de saúde na população adulta. A incidência aumenta com a idade e é maior nos homens do que nas mulheres. Na última década, estudos em diferentes países documentaram um aumento do número de internamentos hospitalares por PAC. O aumento da esperança média de vida e, consequentemente, da população idosa, a par da crescente prevalência das doenças crónicas não transmissíveis são alguns dos principais fatores que explicam esta situação.
Graça, Pedro; Gregório, Maria João; Sousa, Sofia Mendes de; Camolas, José
In 2012 Portugal implemented a concerted set of actions aiming at improving its population's nutritional status, as it will be described in this article. This strategy on food and nutrition, conducted by the Ministry of Health, was the result of different initiatives and experiences that had been carried out in this field since 1974. In fact, the first steps for the development of a food and nutrition policy in Portugal were done in this period (1974), the time when the democracy was established in Portugal. It also coincides with Food and Agriculture Organization's First World Food Conference, which took place...
Gonçalves, C.; Padrão, P.; Abreu, S.; Graça, P.; Moreira, P.
Introduction: Type and quantity of beverages intake among adolescents may influence their hydration status.
Objective: To evaluate the association between hydration status assessed by Free Water Reserve (FWR) and consumption of 5 types of beverages (water, milk, soft drinks, fruit juices and hot beverages). Conclusions: In this sample of participants, euhydrated adolescents ingest more water and hot beverages than those at risk of hypo-hydration.
Costa, Andreia; Cortes, Maria; Sena, Catarina; Nunes, Emília; Nogueira, Paulo; Shivaji, Tara
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-focusedImpact 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...