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- Association between the adrenoreceptor β2 gene and pediatric asthma severity – a study of the PACMAN cohortPublication . Caleiro, Maria Leonor; Soares, Patricia; Antunes, Marilia"Pharmacogenetics of Asthma medication in Children: Medication with Anti-Inflammatory effects" (PACMAN) is an observational retrospective pharmacy-based study carried out in 2009, in the Netherlands, aiming to investigate the effects of genetic variation on treatment response to asthma medication in children and to identify (profiles of) SNPs that characterize response phenotypes. Data on respiratory symptoms and medication use, including medication type and amount, was collected from pharmaceutical records of asthmatic children and data on the children’s sex, age, genetic traits, and ethnicity. We aimed to assess the association between asthma severity and the Arg16Glu polymorphism of the β2 adrenoreceptor gene (ADRB2). This gene is expressed in bronchial muscle cells, which is involved in the physiological response of the airway response and has been associated with clinical drug response and asthma exacerbations. We used the PACMAN data and considered the dispensing of oral corticosteroid prescriptions as a proxy of the disease severity since corticoids are commonly used in uncontrolled asthmatic states (exacerbations). We considered two different genetic models – additive and genotypic, which can be translated for analysis purposes into a numeric format, corresponding to the number of copies of the minor allele, and categorical (each genotype representing a category), respectively. We used models of the class of the Generalized Linear Mixed Models for count data with excess of zeros, namely zero-inflated and hurdle models, considering a Negative Binomial distribution to account for overdispersion. Both models included the polymorphism in the zero and count components and were adjusted for children’s baseline characteristics. In both approaches to deal with the excess of zeros, a significant effect of the polymorphism was found only in the binary component of the models. In the count component, only sex and age showed a significant effect. This points towards the existence of an effect of the polymorphism in the presence of asthma exacerbations, with not shown effect in the frequency of OCS prescription.
- 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.
- REVIVE - Rede de Vigilância de Vetores: a chegada do invasor asiático, Aedes albopictusPublication . Alves, Maria João; Amaro, Fátima; Amaro F.; Osório, Hugo; Zé-Zé, Líbia; Silva, Manuel; Soares, PatriciaO programa REVIVE (Rede de Vigilância de Vectores resulta de protocolo entre a Direção-Geral da Saúde, as Administrações Regionais de Saúde do Algarve, Alentejo, Centro, Lisboa e Vale do Tejo e do Norte, o Instituto dos Assuntos Sociais e da Saúde da Madeira, a Direção Regional de Saúde dos Açores e o Instituto Nacional de Saúde Doutor Ricardo Jorge Este programa de vigilância entomológica visa - monitorizar a atividade de artrópodes hematófagos, nomeadamente mosquitos Culicidae carraças Ixodidae e flebótomos Psychodidae - caracterizar as espécies e sua ocorrência sazonal, - e identificar agentes patogénicos importantes em saúde pública.
- Mark-Release-Recapture of Aedes albopictus in Portugal: the influence of climatic factorsPublication . Soares, Patricia; Carvalho, Danilo O.; Silva, Susana Pereira; Gomez Pacheco, Maylen; Amaro, Fátima; Amaro F.; Osório, HugoAedes albopictus mosquitoes spread diseases like dengue, Zika, yellow fever, and chikungunya. The Sterile Insect Technique (SIT), which is based on production of male sterile mosquitoes through radiation and in the release in target areas, can be used as a prevention and control tool against Ae. albopictus native populations. Mark-Release-Recapture trials (MRR) estimate the number of mosquitoes to release during the SIT, but weather conditions can affect results. Thus, we aimed to understand the influence of climatic factors on mosquito collection. MRRs were conducted in October 2022 in Faro, Southern Portugal. Mosquito sterilisation, marking and transport followed protocols from the International Atomic Energy Agency. Releases occurred weekly for three consecutive weeks at two different sites, and mosquitoes were collected using Human Landing Collections (HLC) one, two, four and six days after release. Climatic data, such as temperature, humidity, wind intensity (moderate 15-35 km/h vs weak <15 km/h) and precipitation, were obtained from the Portuguese Institute of the Sea and the Atmosphere. We used generalised linear models with a negative binomial family and log function to estimate factors associated with the number of captured mosquitoes, estimated prevalence ratios (PRs), and the 95% confidence intervals (CI). We released 84 000 marked sterile male mosquitoes and recaptured 528 marked males (0.7%) by HLC. The prevalence of captured mosquitoes was 23% lower when the wind intensity was moderate compared with a weak wind intensity (PR: 0.77, 95% CI: 0.61−0.98). We did not find a statistically significant association between the number of captured mosquitoes and humidity (PR: 0.98, 95% CI: 0.96−1.00), temperature (PR: 1.03, 95% CI: 0.83−1.28) and precipitation (PR: 1.07, 95% CI: 0.60−2.03). Conclusion: It is crucial to plan MRRs carefully and consider weather conditions during their execution to avoid underestimating the population needed for the SIT and compromising the effectiveness of this control method.
- 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.
- Avaliação de conhecimentos, atitudes e práticas em relação a mosquitos enquanto vetores de doença numa comunidade estudantil em LisboaPublication . Simplício, Leonor; Soares, Patricia; Anjos, João; Almeida-Silva, Marina; Osório, HugoIntrodução: Os agentes infeciosos transmitidos por mosquitos vetores que provocam doenças como o dengue, Zika ou chikungunya são uma ameaça à saúde pública. Os mosquitos das espécies Aedes aegypti e Ae. albopictus são atualmente os principais vetores e responsáveis por surtos na região europeia (WHO, 2020). Torna-se crucial avaliar o conhecimento, atitudes e práticas em relação aos mosquitos e às doenças associadas, de modo a aumentar a adesão da população às medidas de controlo. Alguns exemplos destas medidas são a eliminação de criadouros domésticos, o uso de inseticidas e a aplicação da Técnica do Inseto Estéril (SIT), que consiste num método de controlo biológico com a aplicação de insetos machos estéreis em áreas alvo de intervenção, com o objetivo de suprimir a população (IAEA, 2023). Objetivos: Avaliar os conhecimentos, atitudes e práticas em relação aos mosquitos vetores, doenças associadas e medidas de controlo numa comunidade estudantil em Lisboa. Metodologia: Foi desenvolvido um questionário com recurso à ferramenta Google Forms e dividido em quatro secções: 1. Perceção sobre mosquitos na zona de residência, 2. Avaliação do conhecimento sobre mosquitos, 3. Prevenção individual e controlo vetorial e 4. Dados do participante. Este questionário foi aplicado à população alvo de uma escola de ensino superior localizada em Lisboa e divulgado em 2021 internamente via email, tendo ficado disponível à participação durante todo o mês de março. Posteriormente, foi feita uma análise descritiva dos resultados através da determinação da frequência absoluta e relativa. Resultados: Obteve-se um total de 140 questionários completos, dos quais 81% dos participantes correspondiam ao género feminino e 73% tinha uma idade inferior a 25 anos. Verificou-se que apenas duas pessoas acertaram todas as questões de conhecimento. Em relação à questão da técnica SIT, 86% dos participantes desconheciam esta técnica, contudo, 73% concorda totalmente com a sua aplicação. Apenas 13 participantes identificam que são os mosquitos do género feminino que picam e conhecem a técnica SIT e apenas um destes 13 participantes não concorda com a aplicação desta técnica. Em relação às práticas verificou-se que 16% dos participantes adotam medidas de proteção individual contra mosquitos e medidas de controlo nas suas residências e que cinco destes não considera estas medidas suficientes e eficazes. Outro resultado foi o facto de 7,1% dos participantes afirmarem extrema preocupação pelos mosquitos transmitirem doenças, contudo apenas cinco adotam medidas de proteção tanto individual como de controlo. Em relação ao nível de incomodidade, 89% dos participantes não sente qualquer incómodo em relação aos mosquitos e 25% dos participantes que sentem desconforto alteram as suas atividades ao ar livre. Conclusão: Os resultados evidenciam a importância de manter a população informada e de a integrar em atividades que visem o aumento do conhecimento em relação aos vetores e às doenças associadas, uma vez que um elevado número das doenças transmitidas por vetores pode ser evitável através de medidas de proteção e mobilização da comunidade (WHO, 2020).
- 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.
- 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.
- Evolution of the risk perception of infection by COVID-19 – Evidence from the COVID-19 Barometer: Social OpinionPublication . Paixão, Inês; Antunes, Marília; Soares, PatriciaSince the beginning of the COVID-19 pandemic, several non-phar-maceutical interventions (NPI) have been adopted worldwide in an attempt to keep the growing transmission of the virus under control. Several factors might influence the effectiveness of NPI. This study aimed to evaluate the evolution of the perception of the risk of infection by COVID-19 in Portugal between March 2020 and March 2022, and to identify associated factors. We used the "Covid-19 Barometer: Social Opinion" barometer, which was launched at the beginning of the pan-demic in Portugal to identify and monitor the evolution of the Portuguese population's perception of the pandemic and its impact on daily life and was online during two years. We also considered COVID-19 incidence, stringency data, COVID-19 variants’ prevalence and Google searches on COVID-19.The outcome considered was the per-ceived risk of infection by COVID-19, which was classified into low versus high/moderate. The explanatory variables from the Barometer were grouped into dimensions: general factors (socio-demographic and health-related variables), adherence to protection measures, vaccine hesitancy and coping mechanisms.Considering the nature of this study and the outcome variable, generalized linear models were used to study the temporal evolution of the considered variables – in particular, mixed effects logistic regressions. One model was fit per group of vari-ables/dimension. Preliminary results show that, linked to a higher risk perception are lower levels of education, poor health status and working full-time at the workplace (as opposed to remote working) – the last two with a growing tendency over time. On the other hand, individuals with a previous COVID-19 diagnosis and a better mental health status are more likely to perceive lower risks, a propensity that diminishes over time.Students and unemployed individuals are also more likely to have a lower perception of risk, when compared to employed individuals of the same age and sex. Additionally, there is in general a higher probabil-ity of perceiving a lower risk of infection as time progresses.
- Is a tiered restrictions system an effective intervention for COVID-19 control? Results from Portugal, November-December 2020Publication . Moniz, Marta; Soares, Patricia; Nunes, Baltazar; Leite, AndreiaBackground: In November 2020, similar to other European countries, Portugal implemented a tiered restrictions system to control the COVID-19 pandemic. We aimed to compare the COVID-19 growth rate across tiers to assess the effect of a tiered restrictions system in Portugal, using models with different times between tiers assessment. Our hypothesis was that being in a higher tier brings a faster deceleration in the growth rate than being in a lower tier. Methods: The national database of notified COVID-19 cases and publicly available data were used to analyse the effect of the tiered restrictions system on the COVID-19 incidence growth rate. The tiers were based on the European Centre for Disease Control risk classification: moderate, high, very and extremely high. We used a generalised mixed effects regression model to estimate the growth rate ratio (GRR) for each tier, comparing the growth rates of higher tiers using moderate tier as reference. Three models were fitted using different times between tiers assessment, separated by 14 days. Results: We included 156 034 cases. Very high tier was the most frequent combination in all the three moments assessed (21.2%), and almost 50% of the municipalities never changed tier during the study period. Immediately after the tiers implementation, a reduction was identified in the municipalities in high tier (GRR high tier: 0.90 [95%CI: 0.79; 1.02]) and very high tier (GRR very high tier: 0.68 [95%CI: 0.61; 0.77]), however with some imprecision in the 95% confidence interval for the high tier. A reduction in very high tier growth rate was identified two weeks (GRR: 0.79 [95%CI: 0.71; 0.88]) and four weeks (GRR: 0.77 [95%CI: 0.74; 0.82]) after the implementation, compared to moderate tier. In high tier, a reduction was also identified in both times, although smaller. Conclusions: We observed a reduction in the growth rate in very high tier after the tiered restriction system was implemented, but we also observed a lag between tiered restriction system implementation and the onset of consequent effects. This could suggest the importance of early implementation of stricter measures for pandemic control. Thus, studies analysing a broader period of time are needed.