DEP - Apresentações orais em encontros internacionais
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- Desigualdade socioeconómica e paralisia cerebral, padrões geográficos na coorte nascida em 2006-2015Publication . de Carvalho Aniceto, Carlos André; Sousa Uva, Mafalda; folha, teresa; Braz, Paula; Matias Dias, CarlosAntecedentes/Objetivos. A Paralisia Cerebral (PC) é a deficiência motora mais frequente na criança, com implicações ao longo da vida. O European Deprivation Index (EDI) materializa num score um conjunto de indicadores socioeconómicos que permitem aferir a ocorrência de desigualdades territoriais, utilizado em desigualdades em saúde. Existe evidência sobre a associação entre fatores socioeconómicos e PC, mas pouco conhecimento sobre esta problemática em Portugal. Foi objetivo do presente estudo analisar a distribuição geográfica da taxa de incidência (TI) de PC e do EDI, e a sua autocorrelação espacial em Portugal Continental, nas crianças nascidas em 2006-2015. Métodos. Estudo observacional, ecológico, com crianças nascidas de 2006 a 2015 (referenciadas ao Programa de Vigilância Nacional da Paralisia Cerebral entre 2011-2024) e dados do EDI (índice disponibilizado online, baseado nos censos 2011). No cálculo da TI de PC utilizou-se como denominador o total de nados vivos (Instituto Nacional de Estatística.) Para avaliar a distribuição espacial da PC aplicaram-se técnicas de análise estatística e espacial, calculando-se os seguintes indicadores espaciais: (i) taxa de incidência bayesiana de PC, pelo método Bayesiano empírico (TPC); (ii) índice de concentração espacial de incidência de PC, pelo Índice Local de Moran I univariado; (iii) índice de concentração espacial de incidência de PC e do EDI, pelo Índice Local de Moran I bivariado. Resultados. Registaram-se TPC mais elevadas nos concelhos da região Alentejo, destacando-se o concelho do Alvito com taxa mais elevada (TPC=3,5crianças/10³nados-vivos). Observaram-se as taxas mais baixas em concelhos da região Norte, nomeadamente, Tabuaço (TPC=0crianças/10³nados-vivos). Identificaram-se 5 clusters de TPC elevadas, estatisticamente significativos (p≤0,05), em alguns concelhos: interior das regiões Alentejo e Centro; Área Metropolitana de Lisboa (AML); região Norte. Em 13 concelhos da região Alentejo, 4 no Algarve e 2 na AML, observaram-se clusters de valores elevados de TPC e EDI, estatisticamente significativos (p≤0,05). Conclusões. No período em estudo, destacou-se uma concentração de incidência de PC associada a scores de EDI mais elevados nos concelhos do interior do Alentejo. A aplicação dos métodos de autocorrelação espacial, revelaram-se úteis para identificar e comparar padrões geográficos de PC e do EDI. Estes resultados, integrados numa análise mais complexa, podem contribuir para o estabelecimento de estratégias de saúde pública na prevenção de PC e intervenção junto desta população.
- Direct costs with dementia hospitalization and its determinants in Portugal in 2018Publication . Madeira, Francisco; Moniz, Marta; Leite, Andreia; Alves, JoanaBackground/Objectives: Major neurocognitive disorders, as is the case of dementia, are characterised by a decline in cognitive abilities, leading to adverse health outcomes and deterioration in quality of life. The projected rise in diagnoses for the coming decades represent a public health concern, impacting patients and society, and placing a considerable financial burden on healthcare systems. This study aims to estimate hospitalisation costs with dementia in Portugal in 2018, and its determinants. Methods: We used inpatient data from the Portuguese publicly financed hospitals database (Base de Dados de Morbilidade Hospitalar, ACSS) for 2018. We selected hospitalization records (n = 25,830) with dementia-related diagnosis, either primary or non-primary, based on ICD-10. We computed average costs for inpatient cases, using tariffs from national legislation, stratifying by dementia type. We performed a multivariate regression analysis (gamma, log link) for assessing costs’ determinants (sex, age, region, number of comorbidities, type of dementia, medical or surgical inpatient, and destination after discharge). Results: The average cost per hospitalisation was 3,084 €. Stratifying by type of dementia, Alzheimer's patients accounted for 2,441 €, vascular dementia for 4,079 €, and other degenerative diseases (including Lewy body and frontotemporal dementia) for 2,515 €. This represented a national economic burden of 79.7 million €. Younger individuals (55-64, 65-74, and 75-84) incurred significantly higher inpatient costs of 1,042 €, 676 €, and 216 €, respectively, compared to 85+. Compared to unspecified dementia, Alzheimer's was associated with higher costs, while patients with other dementia showed no significant cost differences. The costs were higher (p < 0.001) with each additional comorbidity (+23 €) and severity level (+1,439 €). Compared to deceased (p < 0.001), patients discharged home had lower costs (-328 €), while those discharged to other settings incurred higher costs (+471 €). Non-surgical cases were 3,961€ less costly than surgical ones (p < 0.001). Conclusions/Recommendations: Dementia-related hospitalisations imposed a substantial financial burden on the Portuguese public healthcare system in 2018 and are expected to rise in the future. Costs were driven by key factors such as age, number of comorbidities, severity, destination of discharge, and hospitalisation type.
- High-Dose Quadrivalent vs Standard Dose Influenza Vaccine Effectiveness using EHR in PortugalPublication . Brito, André; Soares, Patrícia; Gómez, Verónica; Rodrigues, Ana Paula; Leite, Andreia; Machado, AusendaThis study presents an updated protocol to assess the effectiveness of the high-dose quadrivalent influenza vaccine (HD-QIV) in preventing hospitalisation due to influenza-like illness among older adults in Portugal. Using routinely collected electronic health records, we will conduct a retrospective cohort study covering the 2022/23 to 2025/26 influenza seasons, including residents of long-term care facilities and community-dwelling individuals eligible for HD or standard-dose vaccination. Vaccine exposure will be defined 14 days post-administration, and outcomes will include first hospitalisation related to influenza or associated complications. Relative and absolute vaccine effectiveness will be estimated using Cox proportional hazards models. Key challenges include potential misclassification of residence and outcomes, uneven vaccine rollout, and small sample sizes in some groups; we will address these through sensitivity analyses, spatio-temporal assessments, and propensity-score matching where appropriate. The study will provide timely evidence on HD-QIV performance in real-world conditions, supporting national vaccination strategies for high-risk populations. This was a presentation made at the annual VEBIS Consortium LOT 4.
- Review of adherence to the acute respiratory infection (ARI) case definition in a primary care vaccine effectiveness study in PortugalPublication . Santos, João Almeida; Kissling, Esther; Rodrigues, Ana PaulaBackground/Aim: To expand surveillance to include respiratory viruses other than influenza, many European countries adapted their approach after the COVID-19 pandemic by transitioning from solely using the influenza-like illness (ILI) case definition to incorporating both ILI and acute respiratory infection (ARI) definitions, or ARI case definition alone. The aim of this study was to assess adherence to the application of the ARI case definition by sentinel general practitioners (GPs) in Portugal integrated in a primary care vaccine effectiveness (VE) study - VEBIS. Methods: An anonymous online questionnaire was sent to 119 Portuguese sentinel GPs for influenza surveillance between April 16th-May 9th, 2024. Invitation to the questionnaire was sent four times during this period, by email. A descriptive analysis of the responses was performed. Results: The participation rate was 46% (55/119). The majority of GPs indicated ARI case definition identifies influenza (85%) and COVID-19 patients (73%) well. There was no clear pattern in GPs agreeing that the ARI case definition was appropriate for selecting young children, with 36% agreeing and 31% disagreeing. Conversely, 56% agreed that the ARI case definition works for the selection of older patients. 27% percent indicated immunocompromised, patients with COPD and cardiac diseases, children and elderly were not well captured by the ARI case definition. Although the majority (85%) indicated that no change is needed in the surveillance questionnaire, some GPs (11%) indicated that diarrhea, vomiting, fever, wheezing, and fever duration were variables that should be considered including in case definitions. 45% of GPs agreed that they select patients they highly suspect of having influenza/COVID-19, even if they do not meet the case definition. Regarding clinical presentation, 71% of GPs agreed being more likely to select patients with a more severe clinical presentation. The majority (75%) reported not using any additional criterion for patient selection during weeks of high workload. However, 22% reported that older and more symptomatic patients were chosen preferentially during these periods. Conclusions: The results indicate Portuguese sentinel GPs consider the proposed case definition identifies patients with influenza and COVID-19, consequently, the majority do not suggest changes to the ARI case definition. However, 27% reported the case definition does not adequately capture children, elderly and patients with chronic conditions, and some GPs indicated the inclusion of other signs and symptoms.
- The rise and fall of SARS-CoV-2 rapid antigen self-tests at primary care level: a Portuguese case-studyPublication . Santos, João Almeida; Gomez, Verónica; Rodrigues, Ana PaulaBackground/Aim: SARS-CoV-2 rapid antigen self-tests are available, allowing individuals to diagnose a SARS-CoV-2 infection prior to a consultation with a healthcare professional. Self-testing may affect the general practitioner (GP) consultation behaviour and represent a selection bias in primary care vaccine effectiveness (VE) studies. The aim of this study was to describe self-testing patterns and differences between self-testers and non-self-testers in primary care in Portugal in the 2022-23, 2023-24 and 2024-25 seasons. Methods: Data (September 2022-March 2025) from a primary care VE study (VEBIS Primary Care study) was used, and were included patients aged 60+ with Acute Respiratory Infection (ARI) consulting a GP. Data on demographics, vaccination, self-test use, laboratory results (RT-PCR positive for SARS-CoV-2 - Cases; Negative - Controls) and clinical status was collected. Results: Of the 382 patients included (47 cases, 335 controls), 67 (40%), 53 (43%) and 10 (11%) performed a self-test in the 2022-23, 2023-24 and 2024-25 seasons, respectively. Patients that self-tested were more likely to be female (72%, 57%, and 90%) and aged 60–79yo (94%, 62%, 70%) across all seasons. Self-tests positivity increased across the seasons (6%, 25%, 80%). Those who self-tested had a lower SARS-CoV-2 positivity rate in 2022-23 (10% vs. 14%) but higher in 2023-24 (23% vs. 14%) and 2024-25 (10% vs. 4%) season than those that not self-tested. Similarly, a lower prevalence of chronic conditions (64% vs. 79%) was observed in 2022-23 but higher in 2023-24 (85% vs. 84%) and 2024-25 (100% vs. 82%) seasons. Seasonal COVID-19 vaccination rate was lower in 2022-23 (39% vs. 53%) and 2023-24 (30% vs. 33%) but higher in 2024-25 (30% vs. 26%) season for those who self-tested. In the 2022-23 and 2023-24 seasons, the increase and decrease of self-testing overlapped with the months with the highest prevalence of ARI cases. In the 2024-25 season, self-testing was lower and did not overlap with trends of ARI cases. Conclusions: Results suggest that the potential negative association between vaccination and self-testing (unvaccinated patients were more likely to self-test) practically disappeared in the following seasons. In the present season, the use of self-tests decreased and their use does not reflect the notification of ARI cases, that is, in periods with a greater number of cases there is no increase in self-testing. However, the small sample size limited further analysis, highlighting the need for larger studies with vaccine effectiveness estimates stratified by self-testing.
- Socioeconomic deprivation and congenital anomalies: spatial patterns in Portugal, 2010–2021Publication . de Carvalho Aniceto, Carlos André; Braz, Paula; Machado, Ausenda; Matias Dias, CarlosBackground: Congenital anomalies (CA) include structural/functional malformations, chromosomal anomalies, and other genetic diseases arising during intrauterine life. Although a link between socioeconomic inequalities and CA is suggested evidence in Portugal remains scarce. This study analyzed the geographic distribution of CA prevalence rate (PR) and the European Deprivation Index (EDI), and their spatial autocorrelation in mainland Portugal, using national CA registry data from 2010-2021. Methods: Observational ecological study using cases reported to the national CA registry (2010-2021). EDI data, based on the 2011 census, were retrieved from public sources. CA prevalence by municipality was calculated using live births and fetal deaths from the National Institute of Statistics. Spatial statistical analyses evaluated geographic patterns. Two periods were considered (2010-2015 and 2016-2021), estimating: (i) Bayesian smoothed prevalence rates (PRCA) using empirical Bayes; (ii) univariate spatial clustering of PRCA using Local Moran’s I; and (iii) bivariate spatial clustering of PRCA and EDI using bivariate Local Moran’s I. Results: Between 2010-2015, PRCA ranged from 17 to 513/10000 live births. Three significant high-rate clusters (p<0.05) were identified in the Centro and Algarve regions. A high-high cluster (p<0.05) of PRCA and EDI was detected in the Algarve. Between 2016-2021, PRCA ranged from 3 to 610/10000 live births. Two clusters of high PRCA (p<0.05) were observed in Centro. Bivariate analysis revealed high-high clusters (p<0.05) of PRCA and EDI in the Algarve and Norte regions. Conclusions: A consistent concentration of high CA prevalence associated with greater socioeconomic deprivation was found in the Algarve region across both periods. Spatial autocorrelation methods proved effective in identifying and comparing geographic patterns of CA and EDI. Findings highlight the need for public health interventions targeting vulnerable populations and CA prevention.