Browsing by Author "Nunes, Baltazar"
Now showing 1 - 10 of 10
Results Per Page
Sort Options
- Effect of lifestyle on blood pressure in patients under antihypertensive medication: An analysis from the Portuguese Health Examination SurveyPublication . Salvador, Mário Rui; Cunha Gonçalves, Susana; Quinaz Romana, Guilherme; Nunes, Baltazar; Kislaya, Irina; Matias Dias, Carlos; Rodrigues, Ana PaulaIntroduction and Objectives Hypertension is one of the main risk factors for disability and death from cardiovascular disease. Current guidelines include initiatives to control blood pressure in hypertensive patients that focus on lifestyle changes. The main objective of this study was to analyze the association between lifestyle and blood pressure in patients under antihypertensive medication. Methods Data collected in the Portuguese National Health Examination Survey (INSEF) were analyzed. Individuals who met INSEF inclusion criteria and reported being under antihypertensive medication in the two weeks prior to the questionnaire were studied. Lifestyle variables (alcohol consumption, smoking, added salt intake, fruit and vegetable consumption, and physical activity) were assessed by questionnaire, and systolic and diastolic blood pressure were measured by physical examination. Associations between lifestyle factors and blood pressure, stratified by gender and adjusted for sociodemographic variables and obesity, were estimated through a multiple linear regression model. Results Alcohol consumption (beta=6.31, p=0.007) and smoking (beta=4.72, p=0.018) were positively associated with systolic blood pressure in men. Added salt intake, fruit and vegetable consumption, and physical activity were not associated with blood pressure in men. In women, no association was observed for any behavioral variable. Conclusions These conclusions highlight the need in the population under antihypertensive medication, particularly in men, to focus on the fight against high systolic blood pressure in the two modifiable and preventable behaviors of smoking and alcohol consumption.
- Estimates of 2012/13 influenza vaccine effectiveness using the case test-negative control design with different influenza negative control groupsPublication . Nunes, Baltazar; Machado, Ausenda; Guiomar, Raquel; Pechirra, Pedro; Conde, Patrícia; Cristovão, Paula; Falcão, IsabelBackground: In recent years several reports of influenza vaccine effectiveness (VE) have been made early for public health decision. The majority of these studies use the case test-negative control design (TND),which has been showed to provide, under certain conditions, unbiased estimates of influenza VE. Nevertheless, discussions have been taken on the best influenza negative control group to use. The presentstudy aims to contribute to the knowledge on this field by comparing influenza VE estimates using three test-negative controls: all influenza negative, non-influenza respiratory virus and pan-negative.Methods: Incident ILI patients were prospectively selected and swabbed by a sample of general practitioners. Cases were ILI patients tested positive for influenza and controls ILI patients tested negative forinfluenza. The influenza negative control group was divided into non-influenza virus control group andpan-negative control group. Data were collected on vaccination status and confounding factors. InfluenzaVE was estimated as one minus the odds ratio of been vaccinated in cases versus controls adjusted for confounding effect by logistic regression.Results: Confounder adjusted influenza VE against medically attended laboratory-confirmed influenza was 68.4% (95% CI: 20.7–87.4%) using all influenza negatives controls, 82.1% (95% CI: 47.6–93.9%) usingnon-influenza controls and 49.4% (95% CI: −44.7% to 82.3%) using pan-negative controls.Conclusions: Influenza VE estimates differed according to the influenza negative control group used.These results are in accordance with the expected under the hypothesis of differential viral interference between influenza vaccinated and unvaccinated individuals. Given the wide importance of TND study further studies should be conducted in order to clarify the observed differences.
- Final report on the mortality from flu pandemic (H1N1) 2009 in Portugal (April 2009–August 2010)Publication . Froes, Filipe; Diniz, António; Falcão, Isabel; Nunes, Baltazar; Catarino, JuditeWe analyzed the 124 deaths reported in Portugal form flu pandemic. The estimated mortality rate was 1.17/100 000 population. 60% were males, the average age was 47.6 and 66.1% had at least one risk factor. Chronic lung and heart diseases were the most common risk factors. Viral pneumonia was the major cause of death. 11% of the deceased had no treatment with neuraminidase inhibitors and none was vaccinated against the pandemic strain of flu. Compared to average life expectancy, we estimated that 3859 years of potential life were lost. In the future, we should work on improved strategies for risk communication for health professionals and general public.
- Hospital-acquired pneumonia is more frequent and lethal in stroke patients: A nationwide 4-year studyPublication . Gonçalves-Pereira, João C.; Marino, Flavio; Mergulhão, Paulo; Nunes, Baltazar; Froes, Filipe
- A large community outbreak of Legionnaires’ disease in Vila Franca de Xira, Portugal, October to November 2014Publication . Shivaji, Tara; Pinto, Cátia Sousa; San-Bento, Ana; Serra, Luis A Oliveira; Valente, João; Machado, J; Marques, Teresa; Carvalho, L; Nogueira, Paulo; Nunes, Baltazar; Vasconcelos, PaulaAn outbreak of Legionnaires’ disease with 334 confirmed cases was identified on 7 November 2014 in Vila Franca de Xira, Portugal and declared controlled by 21 November. Epidemiological, environmental and microbiological analysis identified industrial wet cooling systems to be the probable source of infection. Preliminary results from sequence-based typing of clinical specimens and environmental isolates confirmed this link. A series of meteorological phenomena are likely to have contributed to the scale of this outbreak.
- Monitoring influenza vaccine effectiveness using the national influenza surveillance systemPublication . Machado, Ausenda; Freitas, Graça; Guiomar, Raquel; Dias, Carlos Matias; Nunes, BaltazarBackground: Flu vaccine composition is reformulated on a yearly basis. As such, the vaccine effectiveness (VE) from previous seasons cannot be considered for subsequent years, and it is necessary to monitor the VE for each season. This study (MonitorEVA- monitoring vaccine effectiveness) intends to evaluate the feasibility of using the national influenza surveillance system (NISS) for monitoring the influenza VE. Material and methods: Data was collected within NISS during 2004 to 2014 seasons. We used a case-control design where laboratory confirmed incident influenza like illness (ILI) patients (cases) were compared to controls (ILI influenza negative). Eligible individuals consisted on all aged individuals that consult a general practitioner or emergency room with ILI symptoms with a swab collected within seven days of symptoms onset. VE was estimated as 1- odds ratio of being vaccinated in cases versus controls adjusted for age and month of onset by logistic regression. Sensitivity analyses were conducted to test possible effect of assumptions on vaccination status, ILI definition and timing of swabs (<3 days after onset). Results: During the 2004-2014 period, a total of 5302 ILI patients were collected but 798 ILI were excluded for not complying with inclusion criteria. After data restriction the sample size in both groups was higher than 148 individuals/ season; minimum sample size needed to detect a VE of at least 50% considering a level of significance of 5% and 80% power. Crude VE point estimates were under 45% in 2004/05, 2005/06, 2011/12 and 2013/14 season; between 50%-70% in 2006/07, 2008/09 and 2010/11 seasons, and above 70% in 2007/08 and 2012/13 season. From season 2006/07 to 2013/14, all crude VE estimates were statistically significant. After adjustment for age group and month of onset, the VE point estimates decreased and only 2008/09, 2012/13 and 2013/14 seasons were significant. Discussion and Conclusions: MonitorEVA was able to provide VE estimates for all seasons, including the pandemic, indicating if the VE was higher than 70% and less than 50%. When comparing with other observational studies, MonitorEVA estimates were comparable but less precise and VE estimates were in accordance with the antigenic match of the circulating virus/ vaccine strains. Given the sensitivity results, we propose a MonitorEVA based on: a) Vaccination status defined independently of number of days between vaccination and symptoms onset; b) use of all ILI data independent of the definition; c) stratification of VE according to time between onset and swab (< 3 and ≥3 days).
- Multimorbilidade em Portugal: Dados do Primeiro Inquérito Nacional de Saúde com Exame FísicoPublication . Quinaz Romana, Guilherme; Kislaya, Irina; Salvador, Mário Rui; Gonçalves, Susana Cunha; Nunes, Baltazar; Dias, CarlosIntrodução: A presença de múltiplas doenças crónicas, em simultâneo, no mesmo indivíduo é um problema de saúde reconhecido. Os doentes com multimorbilidade têm necessidades de saúde acrescidas, o que representa um ónus elevado para os cuidados de saúde. Embora não exista uma defiição consensual do conceito, a multimorbilidade é defiida habitualmente pela presença de duas ou mais doenças crónicas. A existência de evidência, para a realidade nacional, quanto à multimorbilidade poderá contribuir para a gestão e tratamento destes doentes de forma mais efiiente. Material e Métodos: Com o objetivo de estimar a prevalência de multimorbilidade e identifiar os fatores associados foi realizado um estudo epidemiológico transversal com base nos dados do INSEF, um inquérito de base populacional desenvolvido com uma amostra probabilística representativa da população portuguesa (n = 4911). A prevalência de multimorbilidade foi estimada para o total da população e para cada um dos sexos, estratifiada por grupo etário, região de saúde, educação e rendimento. As magnitudes das associações foram medidas pelas razões de prevalências ajustadas calculadas pelo modelo de regressão de Poisson. Resultados: A prevalência de multimorbilidade foi de 38,3% (IC 95%: 35,4% a 41,3%), com maior frequência nas mulheres, nos indivíduos mais velhos, nas regiões de Lisboa e Vale do Tejo, Norte, Algarve e Alentejo e em níveis educacionais mais baixos. Não foi observada associação estatisticamente signifiativa entre a multimorbilidade e o rendimento. Discussão: A multimorbilidade é um problema que afeta mais de um terço da população portuguesa. O conhecimento epidemiológico sobre a multimorbilidade em Portugal permite identifiar os grupos populacionais onde esta realidade é mais prevalente. Conclusão: Os valores observados apontam para maior risco de multimorbilidade entre os indivíduos mais velhos e menos diferenciados e está em consonância com os resultados da literatura. Estes dados demonstram a relevância dos doentes com multimorbilidade e têm especial importância na forma com os cuidados de saúde são organizados e prestados.
- Óbitos por gripe pandémica A (H1N1) 2009 em Portugal Período de Abril de 2009 a Março de 2010Publication . Froes, Filipe; Diniz, António; Falcão, Isabel; Nunes, Baltazar; Catarino, JuditeProcedeu-se à análise dos 124 óbitos notificados em Portugal por gripe pandémica A (H1N1) 2009 no período de Abril de 2009 a Março de 2010. A taxa de mortalidade estimada foi de 1,17/100.000 habitantes. Cerca de 60% dos falecidos eram do sexo masculino, a idade média foi de 47,6 anos e 66,7% apresentavam, pelo menos, um factor de risco para doença grave. As doenças pulmonar e cardíaca crónicas foram os factores de risco mais prevalentes, identificados em 24,7% e 20,7% dos casos, respectivamente. Mais de ¾ dos doentes foram internados em Unidades de Cuidados Intensivos (UCI). A pneumonia viral primária foi a principal causa de morte, diagnosticada em 79,7% dos doentes. Constatou-se haver diferença estatisticamente significativa em relação à distribuição da causa de morte nos grupos dos indivíduos com e sem factores de risco (p=0.048). Estimaram-se em 2 853 os anos potenciais de vida perdidos, o que equivale a 30,8 anos por 100.000 habitantes. Os valores encontrados são comparáveis, na generalidade, com os encontrados noutros países com o mesmo nível de desenvolvimento. Em futuras circunstâncias semelhantes deverá ser equacionada a notificação obrigatória dos casos de maior gravidade.
- Prevalência de síndrome de apneia obstrutiva do sono : um estudo da Rede Médicos-SentinelaPublication . Rodrigues, Ana Paula; Pinto, Paula; Nunes, Baltazar; Bárbara, CristinaA síndrome de apneia obstrutiva do sono (SAOS) é caracterizada por episódios recorrentes de cessação total ou parcial do fluxo aéreo oro-nasal, secundários a um colapso da via aérea superior durante o sono. Afeta preferencialmente indivíduos do sexo masculino, de meia-idade e obesos, estimando-se que a prevalência de SAOS em homens adultos varie entre 1 e 5%. A evidência atual aponta que a prevalência não diagnosticada possa variar entre 0,3 e 5%.
- Trends in diabetes incidence from 1992 to 2015 and projections for 2024: A Portuguese General Practitioner’s Network studyPublication . Uva, Mafalda Sousa; Antunes, L; Nunes, Baltazar; Rodrigues, AP; Simões, JA; Ribeiro, RT; Boavida, José Manuel; Dias, Carlos MatiasBackground: Diabetes is known as a major cause of morbidity and mortality worldwide. Portugal is known as the European country with the highest prevalence of this disease. While diabetes prevalence data is updated annually in Portugal, the General Practitioner’s (GP) Sentinel Network represents the only data source on diabetes incidence. This study describes the trends in Diabetes incidence, between 1992 and 2015, and estimate projections for the future incidence rates in Portugal until 2024. Methods: An ecological time-series study was conducted using data from GP Sentinel Network between 1992 and 2015. Family doctors reported all new cases of Diabetes in their patients’ lists. Annual trends were estimated through Poisson regression models as well as the future incidence rates (until 2024), sex and age group stratified. Incidence rate projections were adjusted to the distribution of the resident Portuguese population given Statistics Portugal projections. Results: The average increase in Diabetes incidence rate was in total 4.29% (CI95% 3.80–4.80) per year under study. Until 1998–2000, the annual incidence rate was higher in women, and from 1998–2000 to 2013–2015 turn out to be higher in men. The incidence rate projected for 2022–2024 was 972.77/105 inhabitants in total, and 846.74/105 and 1114.42/105, respectively, in women and men. Conclusions: This is the first study in Portugal to estimate diabetes incidence rate projections. The disturbing reported projections seem realistic if things continue as in the past. Actually, effective public health policies will need to be undertaken to minimize this alarming future scenario.