Percorrer por autor "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
- Evaluation of European severe acute respiratory infection (SARI) surveillance, 27 European countries, 2022/23Publication . Marques, Diogo Fp; Kovacs, Dory; Sanchez-Ruiz, Miguel-Angel; Rodrigues, Ana Paula; Machado, Ausenda; Mazagatos, Clara; Monge, Susana; Domegan, Lisa; O'Donnell, Joan; Hooiveld, Mariette; Emborg, Hanne-Dorthe; Nunes, Baltazar; Carvalho, Carlos; Rose, Angela McBackground: Between 2020 and 2023, ECDC has supported 21 of 30 EU/EEA and six Western Balkan countries by enhancing severe acute respiratory infection (SARI) surveillance to monitor trends, detect unexpected events, evaluate public health interventions, identify risk factors and support vaccine effectiveness studies. Using diverse strategies, countries have implemented SARI surveillance and reported data at national/European levels.AimWe evaluated European-level SARI surveillance and provided recommendations to achieve objectives and improve key attribute performance.MethodsWe analysed 2022/23 surveillance data for completeness. We administered a questionnaire, targeting country-level representatives, to evaluate surveillance attributes (meeting objectives, usefulness, acceptability, timeliness, representativeness) and identify strengths, weaknesses, opportunities and threats.ResultsThirteen countries (13/27) reported data at European level. Data showed good overall completeness but varied across countries and some variables need improvement (vaccination, sequencing). The questionnaire was completed by all 27 countries. Most countries (23/27) reported that the system effectively monitored trends and considered it useful and acceptable (25/27), but only 16 found it timely and 14 representative. Challenges included insufficient case-based data, data linkage issues and insufficient data completeness. Slow/inefficient manual data extraction affected timeliness, while insufficient geographical coverage affected representativeness. Multi-pathogen surveillance was identified as the main strength, heterogeneity of systems the main weakness, improvements of hospital information systems the main opportunity, and lack of sustainable funding the main threat.ConclusionsSARI surveillance was perceived as effective in monitoring trends, useful and acceptable. To achieve additional objectives and enhance timeliness and representativeness, we recommend improving data completeness, digitalisation/automation and geographical coverage.
- 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.
- Surveillance of severe acute respiratory infections associated with SARS-CoV-2, influenza virus and RSV using ICD-10 codes: a case definition accuracy study across five European countries, 2021 to 2023Publication . Sanchez Ruiz, Miguel Angel; Marques, Diogo Fp.; Lomholt, Frederikke Kristensen; Vestergaard, Lasse Skafte; Monge, Susana; Lozano Álvarez, Marcos; Aspelund, Gudrun; Thordardottir, Marianna; Dziugyte, Ausra; Cauchi, John-Paul; Boere, Tjarda M.; Veldhuijzen, Irene K.; Seppälä, Elina; Bøås, Håkon; Paulsen, Trine Hessevik; Machado, Ausenda; Rodrigues, Ana Paula; Hooiveld, Mariette; Alves de Sousa, Luis; Torres, Ana; Carvalho, Carlos; Nunes, BaltazarBackgrounds: Surveillance of severe acute respiratory infections (SARI) using ICD-10 codes from electronic health records (EHR) lacks consensus on optimal case-defining codes.AIMWe determined codes that maximise sensitivity (Se) and positive predictive value (PPV) for SARI associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza virus and respiratory syncytial virus (RSV) in Denmark, Iceland, Malta, Norway and Spain.METHODSWe included hospitalisations from week 21/2021 to 39/2023, with ICD-10 diagnostic codes for respiratory disease (three-character codes J00-J99) or COVID-19 (U07.1, U07.2, country-specific codes for Denmark). We assessed Se and PPV of individual codes against laboratory results. Based on Se and PPV rank-sum, we selected the top 10 codes and combined them into 10 sets per pathogen. We identified sets that maximised the clinical utility index (CUI = Se × PPV), categorised as excellent (≥ 0.81), good (0.64-0.80), satisfactory (0.49-0.63) and poor (< 0.49).RESULTSWe assessed 395,163 hospitalisations for SARI-SARS-CoV-2, 313,418 for SARI-influenza and 192,936 for SARI-RSV, all tested. For SARI-SARS-CoV-2, code U07.1 (B34.2A, B97.2A for Denmark) had excellent utility in Denmark, Malta, Norway, Spain (≥ 0.82), and good utility in Iceland (0.79). For SARI-influenza, J09, J10 and J11 performed excellently in Denmark, Norway, Spain (≥ 0.83), satisfactorily in Malta (0.52), and poorly in Iceland (0.43). For SARI-RSV, J12, J20 and J21 achieved highest CUI but had poor utility (0.17-0.34).CONCLUSIONSCOVID-19- and influenza-specific three-character ICD-10 codes accurately identified SARI associated with SARS-CoV-2 and influenza virus. For SARI-RSV, four-character codes should be explored. We recommend context-specific assessments in countries adopting EHR-based surveillance.