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- Patrones Espaciales de Mortalidad Municipal por Cáncer en Portugal y España: Proyecto AMOCAPEPublication . Fernández Navarro, Pablo; Roquette, Rita; Núñez, Olivier; Sousa-Uva, Mafalda; Nunes, Baltazar; López-Abente, GonzaloAntecedentes/Objetivos: Los patrones espaciales de la mortalidad por cáncer sugieren la existencia de factores ambientales importantes en su etiología. Estos patrones pueden no ser hechos aislados y tener una prolongación más allá de las fronteras de los países. El proyecto “Atlas de mortalidad por cáncer en Portugal y España AMOCAPE” tie-ne por objetivo proporcionar imágenes de alta resolución que mues-tren la distribución espacial de la mortalidad municipal por cáncer en España y Portugal (archipiélagos incluidos) para el periodo 2003-2012.Métodos: Los datos de mortalidad por 33 tipos de cáncer y los de población fueron proporcionados por los Institutos Nacionales de Es-tadística de cada país. Se calcularon los casos esperados municipales utilizando como referencia las tasas específicas por grupo de edad y sexo del conjunto de Portugal y España. Se obtuvieron estimadores municipales de riesgo relativo suavizados usando el modelo espacial autorregresivo de Besag-York-Mollié utilizando Integrated nested La-place approximations (INLAs) como instrumento de inferencia Baye-siana. Los resultados se presentan gráficamente.Resultados: Se observan patrones de mortalidad por distintos ti-pos de cáncer que abarcan regiones en ambos países. Así, por ejemplo, se observa un exceso de riesgo de mortalidad por cáncer de esófago que se extiende por el norte de Portugal y Noroeste de España, tanto en mujeres como en hombres. O un patrón de exceso de riesgo por cáncer de mama en la suroeste de la península Ibérica incluyendo municipios de ambos países.Conclusiones/Recomendaciones: Existen patrones de mortalidad municipal por distintos tipos de cáncer que trascienden las fronteras entre España y Portugal sugiriendo la presencia de factores de riesgo comunes en ambos países.
- Influenza Vaccine Effectiveness in the Portuguese elderly during 2017-18 seasonPublication . Gómez, Verónica; Kislaya, Irina; Guiomar, Raquel; Panarra, António Carlos; Poças, José; Pechirra, Pedro; Nunes, Baltazar; Machado, Ausenda; EVA Working GroupVaccination is one of the main measures to prevent influenza.
- Influenza-attributable mortality in the Iberian Peninsula, seasons 2012/13 - 2017/18Publication . Mazagatos, Clara; Silva, Susana Pereira; Delgado-Sanz, Concha; Rodrigues, Ana Paula; Oliva, Jesus; Nunes, Baltazar; Larrauri, AmparoIntroduction / Objectives: Influenza has a considerable impact on mortality. Significant excess all-cause mortality is often observed during winter seasons, mainly among the elderly. Quantifying the mortality associated to influenza is important to estimate the real impact of seasonal influenza epidemics on the population. Our objective is to estimate the influenza-attributable mortality in Portugal and Spain for seasons 2012-13 to 2017-18 Methodology: To estimate influenza-attributable mortality in both countries, a multiplicative Poisson regression time-series model (FluMOMO) with over-dispersion corrected for trend and seasonality, with ISO-week as time unit was used. We estimated influenza-attributable deaths and mortality rates (and their 95% CIs), for all ages and by age group (<5, 5–14, 15–64 and ≥65 years). Weekly all-cause deaths were obtained from computerized civil registers, covering 100% of the Portuguese population and 92% of the Spanish population. Information on influenza activity is included in the model as the Goldstein proxy (weekly ILI rates x weekly positivity rate – For Portugal the same over-all data was used for each age group) and temperature as the difference between the observed and predicted average weekly mean temperatures (NOAA database). Mortality rates (by 100 000 persons) were calculated using national population data, by January 1st every year, linearly interpolated through the year to obtain weekly data Results: Influenza-attributable mortality showed variation by season and age. In both Portugal and Spain, the highest influenza-attributable mortality rates for the ≥65 age group were observed in seasons 2014-15 and 2016-17, when A(H3N2) was dominant or in codominance (219 and 204 in Portugal, and 228 and 169 in Spain, respectively). For the 15-64 age group, in Portugal we observed the highest and lowest mortality rates in seasons 2016-17 and 2013-14 (6 and 3, respectively), in which A(H3N2) was dominant or codominant; in Spain, highest and lowest rates were estimated in seasons 2017-18 and 2012-13 (4 and 1, respectively), in which B was dominant. For all ages, seasons 2014-15, 2016-17 and 2017-18 yielded the highest influenza-attributable mortality rates in both countries (48, 48 and 34 in Portugal and 41, 31 and 30 in Spain, respectively). These results are provisional and will be updated by the end of the season Discussion/Conclusions: The FluMOMO model approach provides a valuable estimation of the impact of influenza-attributable mortality by season and age group. The quantification of the mortality attributable to influenza at national level is essential for the evaluation of the impact of control measures, such as influenza vaccination programs.
- Role of influenza vaccine in pneumococcal pneumonia using the Screening Method: a pilot studyPublication . Rodrigues, Ana Paula; Kislaya, Irina; Machado, Ausenda; Gómez, Verónica; Bárbara, Cristina; Gonçalves, Paulo; Nunes, BaltazarBackground: Influenza viruses can induce pneumonia and also favour bacterial co-infections and secondary bacterial infections and pneumococci exhibit a special synergism with influenza and other respiratory viruses. As consequence, there is plausibility that influenza vaccination may also protect against pneumococcal outcomes. The aim of this pilot study was to estimate the influenza vaccine effectiveness against hospitalized pneumococcal pneumonia (PP) using the screening method. Methods: A pilot study using the screening method was set up between week 40/2014 and week 22/2016, using as cases PP (lab confirmed) admitted in one central hospital in Lisbon. A sample of households of Lisbon region that participated in a telephone interview was used as reference population. Cases were considered vaccinated against influenza if they had registry of seasonal influenza vaccine until 14 before the hospitalization. Influenza vaccine coverage (IVC) within the reference population was estimated by telephone interview. Results: 162 pneumonia cases were enrolled, 45 were excluded (nosocomial infection, co-infection, occurred out of influenza circulation period, living out of study area). Of the 117 selected cases, 24 had PP. Differences on IVC were found between PP (29.2%), pneumonia with no identified agent (46.2%) and reference population (52.3%). Crude influenza vaccine effectiveness against hospitalized pneumococcal pneumonia was 62.4% (IC95: 17.4%; 85.9%). Considering that vaccine coverage in cases could be underestimated, as 32 % people aged 65 and more living in Lisbon region was vaccinated out of the National Health System, we maximized the vaccine coverage in cases according this hypothesis until 42.9%, and thus the vaccine effectiveness decreased to 42.3% (IC95: -30.1%; 74.6%). Discussion: IVE was higher than reported in Japan (31.7%; CI: 0.6%; 53.1%), but with overlapping confidence intervals. Regarding the IVE against severe Influenza cases observed in 2015/16 in Europe and Portugal, we considered that our IVE against PP is probably overestimated. However, it may indicate some level of protection of the influenza vaccine against PP. Besides the limitations of screening method, given the improvement in data quality and the perspective of using alternative reference populations we consider this study design feasible to rapidly access the IVE against PP.
- Colorectal Cancer Incidence And Mortality In Mainland Portugal (2007-2011)Publication . Roquette, Rita; Painho, Marco; Nunes, BaltazarBackground/Objectives: Colorectal cancer is one of most common cancers in the world. That’s also the reality in Portugal where has the second highest cancer incidence rate for both sexes. With this in mind, is important to study colorectal cancer’s incidence and mortality evo-lution and to define measures that diminish the effect of this disease. One relevant issue in this analysis is to identify their spatial patterns and to find explanations to them. Our work’s main goal is to describe and compare spatial patterns of incidence and mortality by colorectal cancer, by sex, at mainland Portugal municipalities in 2007-2011.Methods: Cancer data were collected at Regional Oncologic Regis-tries (ROR). Mortality and Population data were available at Statistics Portugal (INE). All data were aggregated by municipalities and disag-gregated by sex and 17 quinquennial age groups – from 0-4 to 80 and more years old. We used Besag, York and Mollié (BYM) model to com-pute relative risk (RR) and posterior probability (PP). The choice of the geographic unit of analysis and applied model were based on results of our previous published researches.Results: Geographical distribution of incidence and mortality RR present spatial differences around mainland Portugal. Moreover, spatial patterns of incidence RR and PP are more heterogeneous than mortality RR and PP patterns. Colorectal cancer’s incidence RR is higher at Norte and at west coast municipalities. Mortality RR’s maps, in turn, present fewer municipalities classified in extreme classes than incidence’s maps. LVT and Alentejo stand out as the regions with higher mortality’s RR, particularly to men. PP maps strengthen higher heterogeneity of inci-dence comparing to mortality. Incidence maps show high PP values clus-tering in Norte and Centro coast and in LVT. Mortality maps display a wide cluster at LVT and Alentejo, particularly remarkable at men map.Conclusions/Recommendations: We found geographical differ-ences in colorectal cancer’s incidence and mortality rates. It is impor-tant to take into account these patterns when establishing measures to fight cancer. It is relevant to take particularly attention to the mu-nicipalities which register high values of both incidence and mortal-ity RR and PP.
- Infográfico - Higiene oralPublication . Departamento de EpidemiologiaPara uma melhor disseminação dos resultados do Inquérito Nacional de Saúde com Exame Físico (INSEF), o Instituto Nacional de Saúde Doutor Ricardo Jorge, através do seu Departamento de Epidemiologia, disponibiliza em infográfico uma mensagem clara e sucinta sobre este tópico relacionado com a saúde dos portugueses. Os dados apresentados referem-se à população residente em Portugal em 2015 com idades compreendidas entre os 25 e os 74 anos e são relativos à questão «Com que regularidade escova os dentes?», tendo 4.4 milhões de portugueses (65,0%) referiam escovar os dentes pelo menos duas vezes por dia. A escovagem de dentes pelo menos duas vezes por dia foi mais frequente nas mulheres (71,5%), nos grupos etários mais jovens (71,5% entre os 25-34 anos), na região do Algarve (75,8%), nos indivíduos com atividade profissional (68,2%) e nos indivíduos com mais escolaridade (84,6%). A informação está estratificada por sexo, grupo etário, região, situação perante o trabalho e grau de escolaridade. Promovido e coordenado pelo Departamento de Epidemiologia do Instituto Ricardo Jorge, o primeiro Inquérito Nacional de Saúde com Exame Físico (INSEF) foi desenvolvido em 2015 para recolha de informação epidemiológica sobre o estado, determinantes e cuidados de saúde da população portuguesa. Este Inquérito tem como mais-valia o facto de conjugar informação colhida por entrevista direta ao indivíduo com dados de uma componente objetiva de exame físico e recolha de sangue.