Departamento de Epidemiologia
URI permanente desta comunidade:
Navegar
Percorrer Departamento de Epidemiologia por Domínios Científicos e Tecnológicos (FOS) "Ciências Médicas::Ciências da Saúde"
A mostrar 1 - 10 de 36
Resultados por página
Opções de ordenação
- 4P-CAN: Deliverable 2.2 – Paper on countries’ stakeholder profiles for CPPPublication . Roxo, Luis; Carvalho da Silva Santos, Ana João; Girvalaki, Charis; Geantă, Marius; 4P-CAN WP2 study team; Sousa Uva, MafaldaOver the last decades, cancer incidence has been increasing in Europe, being cancer one the leading causes of death. Meaningful differences persist in cancer incidence and mortality between Western and Eastern European countries, highlighting regional differences regarding risk factors (e.g., smoking habits). Cancer Primary Prevention (CPP) aims to tackle these modifiable factors and to decrease individual risk of cancer. Yet, implementing CPP goes beyond the actions of the governments, and involves a complexity of actions from different stakeholders in society. In this study, we use mixed methods to characterize CPP stakeholders of public sector, academia/research, private sector, media and civil society. We also aim to get a deeper understanding on the regional differences in cancer incidence and mortality. Descriptive statistics were performed to analyze survey results - relative frequencies (%) were computed for each variable, and are presented for the total sample and stratified by country group (Western and Eastern). Data from interviews were analyzed by thematic analysis
- Associação entre o Índice de Vulnerabilidade à Pobreza Energética e os Níveis de Tensão Arterial na População PortuguesaPublication . Rodrigues, Madalena; Gouveia, João Pedro; Sousa-Uva, MafaldaEm Portugal, estima-se que entre 1,8 e 3 milhões de pessoas vivam em situação de pobreza energética, estando entre 609 mil e 660 mil em condição severa. A exposição a temperaturas extremas dentro das habitações pode agravar problemas de saúde existentes e aumentar o risco de doenças cardiovasculares, como a hipertensão arterial, que afeta cerca de 36% da população portuguesa entre 25 e 74 anos. A pobreza energética resulta da combinação de baixos rendimentos, má eficiência energética das habitações e dificuldades no pagamento das faturas de energia. Este problema é intensificado pelas alterações climáticas, que elevam a frequência de eventos extremos. Apesar das preocupações expressas em políticas europeias, poucos estudos populacionais avaliaram a associação entre pobreza energética e saúde utilizando medidas objetivas. Este trabalho tem como objetivo estimar a associação entre o Índice de Vulnerabilidade à Pobreza Energética (IVPE) desenvolvido ao nível da freguesia (#3092) e os níveis de tensão arterial na população adulta portuguesa. Trata-se de um estudo epidemiológico, observacional, transversal e analítico, com dados do Inquérito Nacional de Saúde com Exame Físico 2015 (INSEF), abrangendo 4911 indivíduos de 25 a 74 anos. O IVPE foi categorizado em tercis (baixo, médio e alto) e as associações foram analisadas por regressão linear, ajustada para fatores sociodemográficos e económicos. Os resultados evidenciam que viver em áreas com elevada vulnerabilidade à pobreza energética está associado a um aumento significativo da tensão arterial. No contexto do arrefecimento, observou-se um acréscimo de 2,28% na Tensão Arterial Sistólica (TAS) e de 2,08% na Tensão Arterial Diastólica (TAD), enquanto para o aquecimento verificou-se um aumento significativo na TAS, mas sem relevância na TAD. Estes reforçam a pobreza energética como um fator de risco relevante para a saúde, sublinhando a necessidade de políticas públicas eficazes para mitigar os seus impactos. Num contexto de alterações climáticas e envelhecimento da população portuguesa, garantir condições habitacionais adequadas pode ser uma estratégia essencial para reduzir desigualdades sociais, promover a saúde e o bem-estar, bem como aliviar a pressão sobre os sistemas de saúde pública.
- Attainment of global diabetes targets in 2021: a pooled analysis of individual-level data from national surveys in 100 low-income, middle-income, and high-income countriesPublication . Global Health and Population Project on Access to Care for Cardiometabolic Diseases CollaboratorsBackground: WHO launched the Global Diabetes Compact in 2021 to improve worldwide diabetes outcomes by scaling up access to comprehensive, affordable, and high-quality care. This initiative established population diabetes metrics and targets for countries to attain by 2030, namely, 80% of all people with diabetes are diagnosed; and, among people with diagnosed diabetes, 80% have good glycaemic control (HbA1c <8·0%), 80% have good blood pressure control (<140/90 mm Hg), and 60% of people older than 40 years use statins. We aimed to estimate attainment of global diabetes targets worldwide and across country and individual characteristics in 2021. Methods: We analysed pooled, individual participant data from nationally representative household health surveys done in 100 low-income, middle-income, and high-income countries between 2010 and 2023. The sample included non-pregnant adults aged 30-69 years. Diabetes was defined as use of glucose-lowering medications or biochemical evidence of diabetes (fasting plasma glucose ≥7·0 mmol/L or HbA1c ≥6·5% [48 mmol/mol]). The primary outcomes were the proportion of people attaining each diabetes metric. We analysed data using hierarchical Bayesian logistic regression models with the survey year set to 2021. We estimated the age-standardised proportion attaining each metric across the pooled dataset, by country-level characteristics such as World Bank income group, by country, and by individual-level characteristics including age, sex, educational attainment, and BMI. Findings: In 2021, across the pooled dataset, the age-standardised proportion of people with diabetes who had been diagnosed was 63·2% (95% CI 61·8-64·6). Among those diagnosed, 63·2% (62·1-64·4) achieved glycaemic control (HbA1c <8·0%), 70·8% (69·8-71·9) achieved blood pressure control (<140/90 mm Hg), and 31·8% (30·4-33·2) were using statins. Of the 100 included countries, eight met the target for diabetes diagnosis, seven met the target for glycaemic control, 15 met the target for blood pressure control, and eight met the target for statin use. By country income group, the age-standardised proportion of people with diabetes who had been diagnosed ranged from 35·3% (33·5-37·1) in low-income countries to 69·9% (68·3-71·5) in high-income countries. Among those with diagnosed diabetes, glycaemic control ranged from 56·0% (54·2-57·8) in lower-middle-income countries to 73·7% (72·7-74·6) in high-income countries; blood pressure control ranged from 58·3% (57·3-59·4) in lower-middle-income countries to 82·4% (81·4-83·4) in high-income countries; and statin use ranged from 9·7% (8·0-11·4) in low-income countries to 58·7% (57·4-59·9) in high-income countries. Across individual-level characteristics, patterns of inequities were observed in the attainment of each metric. Interpretation: There are pronounced inequities at multiple levels in the attainment of global diabetes metrics. Substantial progress is needed to reduce inequities and to achieve the 2030 targets.
- Cancer Prevention Literacy Questionnaire (CPL-Q): development and validation within the World Code Against Cancer FrameworkPublication . Feliu, Ariadna; Islam, Rubana; Romeo-Cervera, Paula; Bouaoun, Liacine; Whitelock, Victoria; Pirvan, Mirela; Roxo, Luis; Carvalho da Silva Santos, Ana João; Espina, CarolinaBackground: Health literacy is a key determinant of health, shaping individuals ability to understand and act on health information. Low cancer literacy is associated with fatalistic beliefs and reduced participation in prevention and screening programmes. Although around 40% of all cancers are preventable, public awareness of modifiable risk factors remains low. The European Code Against Cancer (ECAC), developed under the World Code Against Cancer Framework, aims to strengthen prevention knowledge; however, tools to measure cancer prevention literacy, and therefore evaluate its impact, are lacking. This study aimed to develop and validate a questionnaire to assess ‘cancer prevention literacy’ in adults from the general population. Methods: We conducted a methodological study to develop a questionnaire measuring ‘cancer prevention literacy’ in adults from the general population using the Integrative Model of Behavioural Prediction as theoretical framework. Questionnaire development followed a three-stage process: (1) a literature review and two-round Delphi process to select and refine items; (2) a third Delphi round, complemented by readability checks, face-validity assessment, and cognitive testing to evaluate item relevance, clarity, and representativeness; and (3) a pre-test and psychometric analysis to assess construct validity. Results: The final Cancer Prevention Literacy Questionnaire (CPL-Q) consists of a 10-question validated instrument comprising 58 items, with selected items incorporating the verbatim wording of the recommendations from the ECAC, 4th edition. Strong expert agreement was achieved through an iterative Delphi process, and content and face validity indicated that the items were comprehensible, relevant, and appropriate. Psychometric analyses, including exploratory and confirmatory factor analysis, provide preliminary support for the instrument’s construct validity, with initial evidence suggesting acceptable reliability. Conclusion: The CPL-Q provides a standardised instrument to measure ‘cancer prevention literacy’ and to assess the impact of Regional Codes Against Cancer through monitoring and benchmarking changes over time. It also offers a practical tool to identify gaps in ‘cancer prevention literacy’ within specific populations and to support international comparisons and longitudinal evaluations, thereby contributing to the evidence base for cancer prevention policies.
- Characteristics and incidence trends of adults hospitalized with community-acquired pneumonia in Portugal, pre-pandemicPublication . Carneiro, Joana; Teixeira, Rita; Leite, Andreia; Lahuerta, Maria; Catusse, Julie; Ali, Mohammad; Lopes, SílviaCommunity-acquired pneumonia (CAP) is a major cause of hospitalization that leads to substantial morbidity, mortality, and costs. Evaluating CAP trends over time is important to understand patterns and the impact of public health interventions. This study aims to describe the characteristics and trends in the incidence of adults hospitalized with CAP in Portugal between 2010 and 2018. In this study, we included hospitalization data, prevalence of comorbidities, and population data. CAP hospitalizations of adults (≥18y) living in mainland Portugal discharged from public hospitals were identified using ICD-9-CM or ICD-10-CM codes. Based on previous CAP studies, we selected nine relevant comorbidities. We described the frequency and incidence of CAP hospitalizations per sex, age group, comorbidity, and year of discharge. Trends were explored using Joinpoint regression. We observed 470,545 CAP hospitalizations falling into the 2010-18 period. The majority were males (54.8%) and aged ≥75 years (65.3%). Most often recorded comorbidities were congestive heart failure (26.4%), diabetes (25.5%), and chronic pulmonary disease (19.2%). The Joinpoint regression identified a gradual decline in the incidence rates of CAP hospitalizations for both sexes and all age groups. Of the nine comorbidities selected, seven showed a progressive increase in incidence rates followed by a subsequent decline (all except HIV/AIDS and chronic renal disease). Our findings offer valuable insights for selecting priority groups for public health interventions and design strategies to mitigate the burden of CAP.
- Characterizing stakeholders for cancer primary prevention: An exploration of opportunities and challenges using a penta-helix frameworkPublication . Roxo, Luis; 4P-CAN TeamBackgroung: -Cancer remains a major public health concern, being associated with meaningful mortality, disability and economic costs. -Upward trend in the number of new cases of cancer in Europe. -Cancer Primary Prevention is cost-beneficial approach with a large potential of reducing incidence and mortality. - Individual lifestyle actions (e.g., smoking cessation). -○ Regulatory actions (e.g., taxation of beverages) -Other policies at the populational level (e.g., reducing air pollution) - The full potential of cancer primary prevention does not seem to be developed.
- Characterizing stakeholders in cancer primary prevention in European countries: an exploration of challenges and opportunities using a penta-helix frameworkPublication . Roxo, Luis; Carvalho da Silva Santos, Ana João; Girvalaki, Charis; Geantă, Marius; 4P-CAN WP2 study team; Sousa Uva, MafaldaObjectives: Cancer incidence has been increasing in Europe, with stark disparities between Western and Eastern regions. Cancer primary prevention (CPP) is a cost-effective strategy tackling lifestyle and risk factor exposure, but its implementation goes beyond the actions of the governments. This study aims to characterize stakeholders’ role in CPP, using a penta-helix approach, with the objective of shedding a new light in the Iron Curtain of Cancer Cases. Methods: We followed a mixed-methods approach, with quantitative and qualitative data from CPP stakeholders from the public sector, academia/research, private sector, media and civil society. Snowball sampling was used to distribute a survey where participants (n = 110) were asked which sector was the main driver of change, the most proactive and the most influential. Purposive sampling was used for semi-structured interviews (n = 33), where stakeholders were asked about their CPP activities, motivations, barriers and opportunities, and the role of other sectors. Countries were coded as Western or Eastern. Descriptive analysis was used for quantitative data, while thematic analysis was used for qualitative data. Results: The public sector is viewed as the main driver of change, and the most proactive and influential in both Western and Eastern Europe. However, Eastern European countries emphasize the role of other sectors in CPP more strongly. Thematic analysis identified key roles and themes for the public sector (Strategy: “Looking after citizen’s health,” “Making the system work,” “Operational Engagement”), academia/research (Knowledge: “Scientific credibility,” “Diversity of approaches,” “Getting out of the lab,” “Life in academia/research”), private sector (Responsibility: “Profit-oriented,” “Resources and operational activities,” “Ethics and responsibility”), media (Dissemination: “Capacity to reach people,” “Diversity and scope,” “Information and dissemination”) and civil society (Engagement: “Proximity to people,” “Advocacy and voice,” “Do what others do not do”). Although no meaningful differences were identified between Western and Eastern countries, the results highlight opportunities for Eastern countries to reduce regional disparities. Conclusion: Overall, results point to the complementary role of the sectors, emphasizing that involving different stakeholders and promoting adequate collaborations between them is crucial to unravel the full potential of CPP.
- Comparative Analysis of Direct Costs of Cancer and Risk Factors in EuropePublication . Herțeliu, Claudiu; Horobeț, Alexandra; Nerău, Vlad; Paraschiv, Anca (Gherman); Ștefan, George; Volintiru, Clara; Zaharia, Rodica Milena; Geantă, Marius; Boata Azis, Adriana Elena; Popescu, Ramona; Semenov, Viktor; Kriachkova, Lilia; Kuzmanovska, Milica; Carvalho da Silva Santos, Ana João; Boccia, Stefania; Villani, Leonardo; Espina, Carolina; Mileva, Bilyana; Tchalakov, Ivan; Petrov, Ivaylo; Roxo, Luis Filipe de Almeida; Sousa Uva, Mafalda; Loghin, Cornel Radu; Girvalaki, CharisThis study explores the direct costs and risk factors associated with cancer across European Union member states, emphasizing the economic and public health implications. A Cancer Risk Factors Index (CRFI) is developed to quantify and compare the impact of various determinants, including obesity, smoking, alcohol consumption, socioeconomic conditions, and pollution. Using data from Eurostat and other authoritative sources, we analyze the correlation between CRFI scores, healthcare expenditures, and cancer mortality rates. Results reveal significant disparities in cancer risk factors and healthcare investments across countries, with lower CRFI scores generally associated with higher healthcare spending and improved outcomes. The findings underscore the importance of comprehensive public health strategies and targeted interventions to address modifiable risk factors, reduce cancer-related mortality, and promote equitable healthcare access.
- COVID-19 Vaccine Effectiveness among older adultsPublication . Laniece Delaunay, Charlotte; Mateo-Urdiales, Alberto; Pérez-Gimeno, Gloria; O'Reilly, Karen; Uras, Marina; Erdwiens, Annika; Mlinaric, Ivan; Túri, Gergo; Martínez-Baz, Iván; Meijer, Adam; Rodrigues, Ana Paula; Lazar, Mihaela; Latorre-Margalef, Neus; Lucaccioni, Héloïse; Verdasca, Nuno; Bella, Antonino; Rafael de la Cruz Lopez, Maria Angeles; Kelly, Eva; Enouf, Vincent; Tolksdorf, Kristin; Puzelli, Simona; Ibáñez Pérez, Ana Carmen; Fitzgerald, Margaret; Masse, Shirley; Oh, Djin-Ye; Kaczmarek, Marlena; Bacci, Sabrina; Kissling, Esther; VEBIS Primary Care Vaccine Effectiveness GroupIntroduction: From September to November 2025, many European countries launched COVID-19 vaccination campaigns, when SARS-CoV-2 incidence was decreasing after a period of high circulation.1 These campaigns targeted specific groups, including older adults (ie, individuals aged at or above a minimum threshold that varied from age 60 to 70 years across countries). We estimated the effectiveness of COVID-19 vaccines administered during these seasonal vaccination campaigns in Europe against medically attended, symptomatic SARS-CoV-2 infection among older adults, from September 29, 2025, to January 10, 2026.
- COVID-19 vaccine effectiveness in the paediatric population aged 5-17 years: a multicentre cohort study using electronic health registries in six European countries, 2021 to 2022Publication . Soares, Patricia; Machado, Ausenda; Nicolay, Nathalie; Monge, Susana; Sacco, Chiara; Hansen, Christian Holm; Meijerink, Hinta; Martínez-Baz, Iván; Schmitz, Susanne; Humphreys, James; Fabiani, Massimo; Echeverria, Aitziber; AlKerwi, Ala'a; Nardone, Anthony; Mateo-Urdiales, Alberto; Castilla, Jesús; Kissling, Esther; Nunes, Baltazar; VEBIS-Lot 4 working groupBackground: During the first year of the COVID-19 pandemic, vaccination programmes targeted children and adolescents to prevent severe outcomes of SARS-CoV-2 infection. Aim: To estimate COVID-19 vaccine effectiveness (VE) against hospitalisation due to COVID-19 in the paediatric population, among those with and without previously documented SARS-CoV-2 infection. Methods: We established a fixed cohort followed for 12 months in Denmark, Norway, Italy, Luxembourg, Navarre (Spain) and Portugal using routine electronic health registries. The study commenced with paediatric COVID-19 vaccination campaign at each site between June 2021 and January 2022. The outcome was hospitalisation with a laboratory-confirmed SARS-CoV-2 infection or COVID-19 as the main diagnosis. Using Cox proportional hazard models, VE was estimated as 1 minus the confounder-adjusted hazard ratio of COVID-19 hospitalisation between vaccinated and unvaccinated. A random-effects meta-analysis was used to pool VE estimates. Results: We included 4,144,667 5-11-year-olds and 3,861,841 12-17-year-olds. In 12-17-year-olds without previous infection, overall VE was 69% (95% CI: 40 to 84). VE declined with time since vaccination from 77% ≤ 3 months to 48% 180-365 days after immunisation. VE was 94% (95% CI: 90 to 96), 56% (95% CI: 3 to 80) and 41% (95% CI: -14 to 69) in the Delta, Omicron BA.1/BA.2 and BA.4/BA.5 periods, respectively. In 12-17-year-olds with previous infection, one dose VE was 80% (95% CI: 18 to 95). VE estimates were similar for 5-11-year-olds but with lower precision. Conclusion: Vaccines recommended for 5-17-year-olds provided protection against COVID-19 hospitalisation, regardless of a previously documented infection of SARS-CoV-2, with high levels of protection in the first 3 months of the vaccination.