Browsing by Author "Carvalho, Carlos"
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- Da Tuberculose ao COVID-19: Legitimidade Jurídico-Constitucional do Isolamento/Tratamento Compulsivo por Doenças Contagiosas em PortugalPublication . Peixoto, Vasco Ricoca; Mexia, Ricardo; Santos, Nina De Sousa; Carvalho, Carlos; Abrantes, AlexandreExtracto: Visto o enquadramento legislativo, interpretações e jurisprudência, verificamos que existe contexto para aplicar a medidas de isolamento/tratamento preventivo, pelo período de tempo estritamente necessário, perante riscos graves e incertos, mas potencialmente graves, em situações excecionais, ainda que não existam normas específicas fora de estados de emergência e a CRP não refira especificamente estas medidas nas exceções ao direito á liberdade. Importa referir que o ordenamento jurídico parece ser mais evidente perante casos de doença diagnosticada do que em relação a contactos de casos de doença contagiosa ou que permaneceram em zonas de transmissão da doença e que poderão vir a adoecer e infetar outros. No entanto, um artigo recente na JAMA16 sobre o enquadramento legal para o COVID-19 nos EUA refere que medidas de isolamento e vigilância no domicílio para regressados da China nos EUA são legais, eficazes e mais respeitadoras dos direitos individuais. Assim, considerar a dimensão do risco e das restrições será sempre fundamental para a tomada de decisão
- Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in PortugalPublication . de Morais, Margarida; Sousa, Sofia; Marques, Jéssica; Moniz, Marta; Duarte, Raquel; Leite, Andreia; Soares, Patricia; Carreira, Mário; Pereira, Sofia; Alves, Catarina; Alves, Filipe; Rodrigues, Ana; Moreira, Ana; Cardoso, Márcia; Mota, Sandra; Gomes, Ana; Ferreira, Liliana; Lopes, Marta; Correia, Isabel; Rachadell, Juan; Gameiro, Maria; Dias, Ângela; Pereira, Manuel; Gonçalves, Jorge; Gonçalves, Maria; Taveira, Adriana; Neves, Celene; Silva, Lucinda; Mendes, Maria; Teixeira, Maria; Pereira, Maria; Piedade, Milena; Teixeira, Antónia; Carvalho, CarlosBackground: Diagnosis delay contributes to increased tuberculosis (TB) transmission and morbimortality. TB incidence has been decreasing in Portugal, but median patient delay (PD) has risen. Symptom valorisation may determine PD by influencing help-seeking behaviour. We aimed to analyse the association between symptom valorisation and PD, while characterising individuals who disregarded their symptoms. Methods: A cross-sectional study was conducted among TB patients in Lisbon and Oporto in 2019 - 2021. Subjects who delayed seeking care because they did not value their symptoms or thought these would go away on their own were considered to have disregarded their symptoms. PD was categorised using a 21-day cut-off, and a 30-day cut-off for sensitivity analysis. We estimated the effect of symptom valorisation on PD through a directed acyclic graph. Then, a multivariable regression analysis characterised patients that disregarded their symptoms, adjusting for relevant variables. We fitted Poisson regression models to estimate crude and adjusted prevalence ratios (PR). Results: The study included 75 patients. Median PD was 25 days (IQR 11.5-63.5), and 56.0% of participants had PD exceeding 21 days. Symptom disregard was reported by 38.7% of patients. Patients who did not value their symptoms had higher prevalence of PD exceeding 21 days compared to those who valued their symptoms [PR 1.59 (95% CI 1.05-2.42)]. The sensitivity analysis showed consistent point estimates but wider confidence intervals [PR 1.39 (95% CI 0.77-2.55)]. Being a smoker was a risk factor for symptom disregard [PR 2.35 (95% CI 1.14-4.82)], while living in Oporto [PR 0.35 (95% CI 0.16-0.75)] and having higher household incomes [PR 0.39 (95% CI 0.17-0.94)] were protective factors. Conclusions: These findings emphasise the importance of symptom valorisation in timely TB diagnosis. Patients who did not value their symptoms had longer PD, indicating a need for interventions to improve symptom recognition. Our findings also corroborate the importance of the socioeconomic determinants of health, highlighting tobacco as a risk factor both for TB and for PD.