http://hdl.handle.net/10400.18/83 2013-05-24T19:26:25Z http://hdl.handle.net/10400.18/1257 Title: Registo Nacional de Anomalias Congénitas – RENAC Authors: Dias, Carlos Matias; Braz, Paula; Machado, Ausenda Abstract: O Registo Nacional de Anomalias Congénitas (RENAC) é um registo epidemiológico de base populacional, que visa a vigilância epidemiológica e a investigação das anomalias congénitas em Portugal. São registadas anomalias congénitas em recém-nascidos (até ao final do período neonatal), fetos mortos e interrupções médicas de gravidez. Em 2011, enviaram registos 37 hospitais (públicos e privados) ou seja, 75% dos que manifestaram intenção de colaborar (67% em 1997). Nos últimos 11 anos, cerca de 80% dos casos foram enviados pelos serviços de Pediatria e 20% pelos serviços de Obstetrícia, o que indica a necessidade de uma maior participação dos serviços hospitalares desta área. Desde o início, as taxas de prevalência anuais de anomalias congénitas obtidas pelo registo são, frequentemente, inferiores aos valores considerados internacionalmente como mínimos na avaliação de qualidade de um registo deste tipo (entre 200 a 300 casos por 10 000 nascimentos, por ano). Este facto está, muito provavelmente, associado à sub-notificação pelo que é desejável aumentar o número e a regularidade do registo de casos de anomalias congénitas e o seu envio ao RENAC. A participação de um maior número de serviços no RENAC permitirá que os resultados sejam mais representativos, contribuindo para a vigilância epidemiológica e para a investigação de âmbito local, nacional ou internacional por parte dos médicos notificadores. Description: Livro de resumos disponível em: http://apdpn.org.pt/reunioes-cientificas 2012-09-29T00:00:00Z http://hdl.handle.net/10400.18/1088 Title: Hip fracture in elderly in Portugal – incidence from 2004 to 2010 Authors: Rodrigues, Emanuel; Leite, Andreia; Contreiras, Teresa Abstract: Background: Hip fractures related to osteoporosis and falls in elderly are an important cause of decreased health state. After Hip fracture older adults have a 5 to 8-fol increased risk of all-cause mortality, a 2.5-fold increase risk for the development of a new fracture and the majority of patients never regain previous level of independence. In Portugal, during 2006, Direcção Geral da Saúde (DGS) estimated that 52 million Euros were spending in hospitals direct costs related with Hip fractures, with a medium cost of 4.100 Euros per hospitalization. Objectives: Estimate the annual incidence of Hip fractures; describe the evolution between 2004 and 2010 Methods: Using Administração Central dos Sistemas de Saúde (ACSS) information from Hospitals Discharges (GHD) database, Hospitalization with code 8200 to 8201 (Classification of Diseases 9th Revision Clinical Modification – ICD-9-CM) as the main cause (DDX1) of hospitalization were considered as being due to hip fracture. Number of hospitalization by hip fracture were analyzed considering age (65-74 years, 75-84 years and ≥ 85 years) and sex of the patients. Incidence rates and respective confidence intervals for the hospitalization hip fracture were estimated for each age group and gender. For each age group and year official data (from Statistics Portugal) was considered as the number of people at risk of being hospitalized by a hip fracture. Results: For the group aged 65-74 years incidence rate varied between 0.49 by 1000 Persons-year of follow-up (PYFU) [95% confidence-interval (95%CI): 0.45; 0.54) in 2010 and 0.65 by 1000 PYFU (95%CI: 0.60; 0.70) in 2004. For the group aged 75-84 years incidence rate varied between 1.99 by 1000 PYFU (95%CI: 1.89; 2.10) in 2010 and 2.41 by 1000 PYFU (95%CI: 2.30; 2.54) in 2006 and 2007. Considering people aged 85 or more incidence were highest in 2009 [6.86/1000 PYFU (95%CI: 6.50; 7.24)] and lowest in 2010 [6.09/1000 PYFU (95%CI: 5.75; 6.44)]. As far as the difference between sexes are concerned risk of hospitalization by hip fracture is approximately twice in women of all ages above 65 years comparing with men of the same age. Conclusions: The incidence rate of hospitalization discharges by hip fracture has been constant in the analyzed years. Further analysis is needed in order to understand the reasons on this phenomenon. Being an important cause of fracture we highlight the importance of fall prevention in this population. Description: Abstrat publicado em: http://www.springerlink.com/content/45745132180p7215/fulltext.pdf 2012-09-01T00:00:00Z http://hdl.handle.net/10400.18/1087 Title: Excess pneumonia and influenza hospitalizations associated with influenza epidemics in Portugal from 1998 to 2010 Authors: Rodrigues, Emanuel; Machado, Ausenda; Nunes, Baltazar Abstract: Background: Influenza virus circulate every year, causing epidemics usually benign for the human population, but that can degenerate into severe disease, like pneumonia. This is particularly the case in specific groups, like the elderly, with higher risk of complications associated with influenza leading to hospitalization or death. Objective: Estimate excess number of hospitalizations from pneumonia or influenza (P&I) (ICD-9:480-487) as main diagnosis during influenza epidemics from seasons 1998-1999 to 2009-2010 in Portugal mainland (total and age groups). Measure the correlation between excess number of hospitalizations from P&I, and influenza vaccine coverage in the elderly. Compare P&I excess number of hospitalizations age distribution during seasonal epidemics with (H1N1) 2009. Methods: Weekly P&I hospitalizations extracted from the National Hospital Discharge database (1998-2010). Information on Influenza epidemic periods and dominant type of virus was defined from data from the national influenza surveillance system. Influenza vaccine coverage (IVC) was obtained from telephone surveys conducted by INSA. Age-specific baseline hospitalization rates, estimated by ARIMA model without time periods associated with excess number of hospitalizations, using Flubase R package. Excess numbers of hospitalizations were calculated by subtracting expected hospitalizations rates from the observed members during influenza epidemic periods. Correlation between excess number of hospitalizations and IVC was measured with Spearman rho coefficient. Results: Average excess number of hospitalizations per season was 1,826 (0 to 4,129), with seasonal average rate of 14.8 per 100,000 inhabitants. During epidemics with A(H3) age groups that most contributed for excess number of hospitalizations were 65+ (72%) and 0-4 (13%). On the other hand epidemics with influenza B dominance showed a reverse pattern with a higher contribution of 0-4 (62%) and the elderly (19%). Regarding the pandemic season, ages groups with most relevant contribution was 20-49 (50%); 5-19 (18%) and 50-64 (17%); extreme age groups 0-4 and 65+ contributed with 13% and 4% respectively. Excluding the pandemic season, correlation between excess number of hospitalizations and IVC in the elderly was -0.268, but not significant. Restricting to A(H3) dominant epidemics a significant correlation (-0.757) was observed. Conclusion: Influenza associated P&I excess number of hospitalizations pattern differs between age groups and dominant virus in different epidemic periods. Results suggest that at population level, increase in vaccine coverage is associated with a decrease of excess number of hospitalizations during A(H3) influenza dominated seasons. Description: Abstract publicado em: http://www.springerlink.com/content/45745132180p7215/ 2012-09-01T00:00:00Z http://hdl.handle.net/10400.18/1086 Title: Risk assessment in an estuarine environment: a case-study in the Sado estuary Authors: Machado, Ausenda; Paixão, Eleonora; Caeiro, Sandra; Dias, Carlos Matias Abstract: Introduction Previous environmental studies in the Sado estuary identified industrial and other anthropogenic contamination sources. Surrounding human populations have intense economic fishery and agriculture activities. Food usage previously characterized suggests exposure to estuarine products, farming products, and water in daily activities, as potential routes of contamination. In this geographical area no study relating the health effects due to exposure to heavy metals was ever conducted. Objective: To characterize exposure pathways to estuarine products and its potential health effects. Materials and Method A cross-sectional comparative study of residents in Carrasqueira (in Sado estuary) and residents in Vila Nova de Mil Fontes (VNMF), selected as the non-exposed population. VNMF sits near another river estuary with similar activities but no known contamination exposures. Simple random samples of individuals were selected in each study population from the National Health Service Lists. Face to face questionnaire data were collected at home and intended to characterize: 1) Health effects: diagnosed illnesses, reproductive history; 2) potential routes of exposure; 3) Potential routes of human contamination from the estuary. Statistical analysis included descriptive analysis and associations tests (Chi-squared test, alpha=0.05). The odds ratio of having an adverse outcome within Exposed and Non-Exposed groups was adjusted for possible confounders using the non conditional logistic regression. Potential confounders were investigated and included if they changed crude OR estimate in at least 10% after adjustment by the Mantel-Haenszel method. Results 202 participants of all ages were included. Participation rates were 62.5% in Carrasqueira and 48.3% in VNMF. Carrasqueira participants reported a significant higher proportion of professional tasks promoting direct (48.8%) and/or indirect (30.0%) exposure to contaminants (p<0.001 and p=0.006 respectively). Carrasqueira had higher period of time spent in fisher and agriculture activities than VNMF (90% of individuals had more than 8 years of exposure, p<0.001). A higher odd of having chronic heavy-metal related morbidity (OR= 1.91; CI95%: 1.01-3.64), and congenital anomalies (OR= 1.53; CI95%: 0.47- 4.92) were observed in Carrasqueira. Only age and years living in the local was retained as confounder in logistic regression, resulting in a 2,1 higher risk of having at least one of the diseases in Carrasqueira compared to VNMF (CI95%: 1.02-4.69). Conclusions Overall results indicate fragile but possible health effects of exposure to Sado estuary. Nevertheless, these results should be analyzed carefully since the outcomes in study are not specific and are based in small samples. Further studies should use bioindicators of exposure and outcome. Description: Abstract publicado em: http://www.springerlink.com/content/45745132180p7215/ 2012-09-01T00:00:00Z