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- A Systematic Review and Meta analysis on the Effectiveness of Antimicrobial Interventions to Tackle Antimicrobial Resistance in Animal ProductionPublication . Costa, Miguel Mendes; Cardo, Miguel; Ruano, Zita; Alho, Ana Margarida; Teixeira, José Dinis; Aguiar, Pedro; Leite, AndreiaIn animal production, the rational use of antimicrobials has been promoted to decrease antimicrobial resistance (AMR) in microorganisms. This systematic review evaluated the effectiveness of interventions to reduce/adequate antimicrobial use and decrease AMR.
- Impacte direto e indireto da Pandemia COVID-19 na mortalidade por todas as causas e por causas específicas em Portugal entre março de 2020 e dezembro de 2021Publication . Rodrigues, Ana Paula; Leite, Andreia; Machado, Ausenda; Nunes, Baltazar; Matias Dias, Carlos; Barreto, Marta; Soares, Patricia; Sá, Regina; Silva, SusanaIntrodução: Durante a pandemia de COVID-19 foram observados excessos de mortalidade muito elevados e muito superiores aos observados no período pré-pandemia. No entanto, é menor a evidência sobre o impacte direto (devido à infeção e suas complicações) e indireto (em consequência das medidas não farmacológicas e das alterações no acesso e procura de cuidados de saúde). Este trabalho teve como objetivo colmatar essa lacuna do conhecimento, e pretendeu: i) estimar o excesso de mortalidade por todas as causas e por causas específicas; ii) estimar o impacte direto e indireto da COVID-19. Material e Métodos: Foi realizado um estudo quasi-experimental de séries temporais no qual se estimou o excesso de mortalidade por todas as causas e por causas específicas, como a diferença entre a mortalidade observada e esperada tendo em conta condições atmosféricas (temperaturas, poluição atmosférica) e epidemiológicas (incidência de gripe). Numa segunda fase foram considerados os efeitos diretos da COVID-19 (mortalidade por COVID-19) e efeitos indiretos da COVID-19 (Índice de Contingência; ocupação hospitalar por COVID-19) para estimar a fração do excesso de mortalidade diretamente atribuível à COVID-19. Resultados: Foram estimados 21 243 (204 por 100 000) óbitos em excesso por todas as causas, 90 % dos quais foram diretamente atribuíveis à COVID-19. Ainda na mortalidade por todas as causas, estimaram-se excessos significativos nos grupos etários acima dos 65 anos de idade e nas regiões do Norte até ao Alentejo. Observou-se um aumento do excesso de mortalidade com a idade (2 924 óbitos em excesso por 100 000 no grupo etário ≥ 85 anos) e um aumento crescente de norte para sul (174 por 100 000 no Norte a 413 por 100 000 no Alentejo). Quanto ao impacto direto da COVID-19, este variou inversamente com a idade (95 % entre os 65-74 anos até 85 % ≥ 85 anos) e entre regiões (63 % no Alentejo a 83 % no Centro). Foram estimados 187 óbitos em excesso por 100 000 nas causas respiratórias, 98 % dos quais diretamente atribuíveis à COVID-19 e 18 óbitos em excesso por 100 000 nas causas acidentais. O aumento das mortes por causas acidentais ocorreu em períodos de menor intensidade das medidas restritivas. Foi ainda observado um aumento nas causas de mortes mal-definidas ou desconhecidas, que parece maioritariamente associado ao efeito direto da COVID-19 (69 %). Nas restantes causas de morte estudadas não foram identificados excessos de mortalidade para todo o período. Contudo, no primeiro ano da pandemia observou-se um aumento da mortalidade, em períodos específicos, de várias causas de morte, seguido de uma diminuição da mortalidade abaixo da linha de base após fevereiro de 2021. Esta evolução temporal não é habitual e deverá ser analisada em estudos específicos para identificação dos mecanismos subjacentes. Conclusão: A pandemia de COVID-19 teve um impacte de muito elevada intensidade na mortalidade, principalmente devido às mortes por COVID-19. Estes impactes não foram iguais para toda a população, tendo sido mais intensos nos grupos etários mais idosos e nos indivíduos com doenças crónicas. Tal reforça a necessidade de dar prioridade a estes grupos populacionais na preparação e resposta a futuras pandemias, quer na proteção em relação à infeção e suas complicações, quer na prevenção e mitigação dos efeitos secundários das medidas não farmacológicas.
- 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.
- Where you live matters how degree of urbanization influences healthcare utilization in PortugalPublication . Martinho, Julia; Leite, AndreiaThe degree of urbanization is a health determinant, causing inequalities in exposure to risk factors, influencing health services’ territorial organization and enabling healthcare utilization. Since Portugal’s proportion of population residing in urban areas is higher than the world average, we aimed to estimate the magnitude of the association between the place of residence’s degree of urbanization and healthcare utilization in the country.
- Effectiveness of antimicrobial interventions directed at tackling antimicrobial resistance in animal production: A systematic review and meta-analysisPublication . Costa, Miguel Mendes; Cardo, Miguel; Ruano, Zita; Alho, Ana Margarida; Dinis-Teixeira, José; Aguiar, Pedro; Leite, AndreiaBackground: In the last decades, a more prudent and rational use of antimicrobials has been progressively directed towards animal production to reduce antimicrobial selective pressure and antimicrobial resistance (AMR) in microorganisms and safeguard the antimicrobial efficacy of treatments in human medicine. This systematic review evaluated the effectiveness of interventions that have been applied to reduce or improve veterinary antimicrobial usage and aimed at decreasing resistant bacteria in chicken broiler and pig production contexts. Methods: Original articles were identified by searching PubMed™, Scopus™, The Cochrane Library™, and Web of Science™, and grey literature by searching DANS EASY™, WorldCat™ and RCAAP™. Inclusion criteria included: chicken broiler or pig populations (predestined for meat production), interventions intended to reduce/improve antimicrobial use, comparator with standard or no use of antimicrobials, outcomes related to prevalence of resistant bacteria, farm level studies, original data, and analytical observational studies. Data was extracted from eligible studies and meta-analysis using random or fixed effects models was conducted for combinations including type of intervention, bacterial species, production type and animal populations. Models were selected according to heterogeneity between studies. The effectiveness of interventions was assessed using pooled odds ratio of resistance to antimicrobial substances/classes by bacteria for associations between animal populations with and without intervention. Results: A total of 46 studies were eligible for review. For chicken broilers, most interventions were identified as antimicrobial restrictions on all non-therapeutic use (46%), complete restriction (27%), and prohibition on antimicrobials used for growth promotion (23%). As for pig populations, restrictions were mainly observed on all non-therapeutic use (37%), complete restriction (37%) and group treatments (22%). For meta-analysis, 21 studies were pooled after assessment of existing combinations. These combinations demonstrated a protective effect for most antimicrobial classes in Escherichia coli, Campylobacter and Enterococcus isolates from samples of chicken broilers as well in Escherichia coli and Campylobacter spp. from samples of pigs, compared to animals raised under conventional production or without intervention. Increased odds of resistance were only observed for cephalosporins in E. coli and broilers raised without antimicrobials, and to fluoroquinolones and quinolones in Campylobacter and pigs raised without antimicrobials, compared to conventional production. Conclusions: Our study indicates that organic production, antimicrobial-free farms, and group treatment restrictions are recommended for AMR reduction, providing information that may support decision-making to tackle AMR and better reporting to improve comparability of results between studies.
- Assessing the use and understanding of the Portuguese Heat–Health Warning System (ÍCARO)Publication . Leite, Andreia; Santos, Ana João; Pereira Silva, Susana; Nunes, Baltazar; Mexia, Ricardo; Rodrigues, Ana PaulaHeatwaves can lead to increased mortality. Portugal has a Heat–Health Warning System (HHWS) in place (ÍCARO system). Researchers at the Instituto Ricardo Jorge send a daily report with heat-related mortality forecasts to key stakeholders (e.g. Heat–Health Action Plans (HHAP)). HHAP practitioners issue warnings and implement measures to prevent heatwaves-related mortality. ICARO is amongst the recommended data sources to assess risk and issue warnings but its use and understanding is unknown. Therefore, we aimed to assess ÍCARO’s use and understanding by key HHAP practitioners.
- Depression and multimorbidity - Results from a nationwide studyPublication . Pedrosa, Bárbara; Neto, Mariana; Namorado, Sónia; Leite, AndreiaBackground and objectives: Most studies concerning the relationship between depression and chronic physical disease focused on a single physical disease and did not consider multimorbidity or depression severity. We aimed to characterize this relationship considering chronic physical diseases’ type and number, and depression severity. Methods: We undertook a cross-sectional study, using data from a phone household panel, with “chronic physical disease” as the exposure and “depression” as the outcome. The sample is representative of the Portuguese population. Adjusted logistic and multinomial regression analyses were conducted between depression presence/severity and chronic physical disease presence/type/number. Odds ratio and 95% confidence intervals adjusted for possible confounders were calculated. Results: 1027 individuals were included. Of the population, 8.9% had depression and 72.1% had at least one chronic physical disease. There was no statistically significant relationship between depression and physical disease in general (OR=1.68 [CI95%:0.55, 5.15]), but there was with allergy (OR=2.08 [CI95%:1.02, 4.25]) and COPD (OR=3.04 [CI95%:1.21, 7.61]). The risk of depression was smaller with two physical diseases (vs. three or more, OR=0.32 [CI95%:0.15, 0.68]). Conclusions: A relationship between COPD, allergy and a higher number of physical diseases and depression was observed. Clinicians should be aware of these relationships. Evaluating the presence of depression in people with multimorbidity, COPD and allergy is recommended.
- LOCUS (LOng Covid-Understanding Symptoms, events and use of services in Portugal): A three-component study protocolPublication . Dinis Teixeira, J.P.; Santos, Mário J.D.S.; Soares, Patricia; Azevedo, Luísa de; Barbosa, Patrícia; Boas, Andreia Vilas; Cordeiro, João V.; Dias, Sónia; Fonseca, Marta; Goes, Ana Rita; Lobão, Maria João; Moniz, Marta; Nóbrega, Sofia; Peralta-Santos, André; Ramos, Víctor; Rocha, João Victor; da Silva, António Carlos; Brazão, Maria da Luz; Leite, Andreia; Nunes, CarlaApproximately 10% of patients experience symptoms of Post COVID-19 Condition (PCC) after a SARS-CoV-2 infection. Akin acute COVID-19, PCC may impact a multitude of organs and systems, such as the cardiovascular, respiratory, musculoskeletal, and neurological systems. The frequency and associated risk factors of PCC are still unclear among both community and hospital settings in individuals with a history of COVID-19. The LOCUS study was designed to clarify the PCC’s burden and associated risk factors. LOCUS is a multi-component study that encompasses three complementary building blocks. The “Cardiovascular and respiratory events following COVID-19” component is set to estimate the incidence of cardiovascular and respiratory events after COVID-19 in eight Portuguese hospitals via electronic health records consultation. The “Physical and mental symptoms following COVID-19” component aims to address the community prevalence of self-reported PCC symptoms through a questionnaire-based approach. Finally, the "Treating and living with Post COVID-19 Condition" component will employ semi-structured interviews and focus groups to characterise reported experiences of using or working in healthcare and community services for the treatment of PCC symptoms. This multi-component study represents an innovative approach to exploring the health consequences of PCC. Its results are expected to provide a key contribution to the optimisation of healthcare services design.
- Consumo de tabaco - o que está a mudar em Portugal e na EuropaPublication . Leite, AndreiaApresentação realizada no Congresso de Pneumologia relativa à evolução de consumo do tabaco em Portugal e na Europa. Enquadramento: i) O consumo de tabaco é um importante fator de risco para várias doenças (neoplasias, doenças do aparelho respiratório e doenças cardiovasculares); está associado a mortalidade prematura; pode contribuir para o agravamento de doenças transmissíveis; ii) Existem diferenças sociodemográficas no consumo de tabaco.
- The effect of TB patient delay on loss to follow-up in PortugalPublication . Marques, J.; Rocha, J.V.; Soares, Patricia; Leite, Andreia; Duarte, R.; Nunes, C.BACKGROUND: Early identification of TB cases, followed by treatment to completion, are essential for controlling and preventing the disease. Previous studies have found some factors associated with both loss to follow-up (LTFU) and patient delay. We aim to build a causal model to investigate the association between TB patient delay and LTFU.METHODS: Pulmonary TB cases were identified using the national surveillance system in Portugal between 2008 and 2017. A directed acyclic graph was used to identify the minimal set of variables to adjust for when studying the association between delay (exposure) and LTFU (outcome). Crude and adjusted hazard were estimated using Cox regression.RESULTS: Nearly 4% of the patients did not follow up treatment. There was no association between patient delay and LTFU, even after adjustment with the minimal set of covariates. Factors associated with a higher risk of LTFU were being younger, being unemployed, living in urban areas, having HIV and the abuse of alcohol and drugs.CONCLUSION: Patient delay was not associated with LTFU, while social conditions were. Future research should investigate the underlying reasons why patients discontinue TB treatment and use these findings to develop targeted interventions that can support patients in completing their treatment regimen.