Showing papers by "Baltazar Nunes published in 2019"
Shanghai Jiao Tong University1, University of Ottawa2, AmeriCorps VISTA3, Nagasaki University4, Seoul National University5, National Taiwan University6, Yale University7, Czech University of Life Sciences Prague8, University of Tartu9, Huazhong University of Science and Technology10, University of Washington11, Health Effects Institute12
TL;DR: The data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe, and reinforce the evidence of a link between mortality and PM concentration established in regional and local studies.
Abstract: BACKGROUND: The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias.METHODS: We evaluated the assoc ...
896 citations
TL;DR: Some epidemiologic evidence supporting the association between PM10 and NO2 exposures and increased TG levels is suggested, but more studies are needed to clarify the role of lipid profile dysregulation as a mediator on the AAP adverse cardiovascular effects.
65 citations
Seoul National University1, University of London2, Yale University3, University of Ottawa4, University of Buenos Aires5, Queensland University of Technology6, University of Technology, Sydney7, University of São Paulo8, University of Los Andes9, Fudan University10, AmeriCorps VISTA11, Czech University of Life Sciences Prague12, Academy of Sciences of the Czech Republic13, University of Tartu14, University of Oulu15, Dublin Institute of Technology16, Brunel University London17, Nagasaki University18, University of Tsukuba19, Kyoto University20, Instituto Nacional de Saúde Dr. Ricardo Jorge21, University of Valencia22, Umeå University23, Swiss Tropical and Public Health Institute24, National Taiwan University25, Harvard University26, Duy Tan University27, Ho Chi Minh City Medicine and Pharmacy University28, Hakim Sabzevari University29, Monash University30
TL;DR: It is observed that the projectedTemperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population.
31 citations
TL;DR: The results show the relevance of multimorbidity patients and are especially important in the way how healthcare is organized and provided, which highlight the greater risk of multimOrbidity among older and less instructed people.
Abstract: Introduction: The simultaneous presence of multiple chronic diseases in the same individual is recognized as an important public health problem. Patients with multimorbidity have greater healthcare needs, which represents a higher burden on health services. Although there is no consensual definition of this concept, multimorbidity is usually defined as the presence of two or more chronic diseases in the same patient. The existence of evidence regarding multimorbidity will lead to more efficient management and treatment of these patients. Material and Methods: In order to estimate the prevalence of multimorbidity and to identify the associated factors, a cross-sectional epidemiological study was developed based on data from the INSEF, a population-based survey conducted on a representative probability sample of the Portuguese population (n = 4911). The prevalence of multimorbidity was estimated for the total population and separately for men and women, stratified by age group, region, education and income. The magnitudes of the associations were measured by the adjusted prevalence ratios calculated by the Poisson regression model. Results: Prevalence of multimorbidity was 38.3% (95% CI: 35.4% to 41.3%), with higher frequency in women, older people, Lisbon and Tagus Valley; Northern Portugal; Algarve and Alentejo regions and in those with lower academic qualifications. No association was found between multimorbidity and income. Discussion: Multimorbidity affects more than one third of the Portuguese population. Epidemiological data about multimorbidity in Portugal allows the identification of population groups with higher multimorbidity prevalence. Conclusion: Our results, which highlight the greater risk of multimorbidity among older and less instructed people, are in line with the literature. These results show the relevance of multimorbidity patients and are especially important in the way how healthcare is organized and provided.
22 citations
TL;DR: The first Portuguese Health Examination Survey (INSEF) has set up an experienced national and regional structure for HES implementation andNationally representative quality epidemiological data is now available for public health monitoring, planning and research.
Abstract: The Portuguese National Health Examination Survey 2015
(INSEF) was developed as part of the Pre-defined project
of the Public Health Initiatives Program (reference 000039_
PDP), ‘‘Improvement of epidemiological health information
to support public health decision and management in
Portugal. Towards reduced inequalities, improved health,
and bilateral cooperation”, that benefits from a 1.500.000€
Grant from Iceland, Liechtenstein and Norway through the
European Economic Area Financial Mechanism (EEA
Grants), 85%, and from the Portuguese Government, 15%.
21 citations
TL;DR: The results show the relevance of multimorbidity patients and are especially important in the way how healthcare is organized and provided, which highlight the greater risk of multimOrbidity among older and less instructed people.
Abstract: O Inquerito Nacional de Saude com Exame Fisico 2013-2016 (INSEF) desenvolvido como parte integrante do projeto “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation” beneficiou de um apoio financeiro de 1.500.000€ concedido pela Islândia, Liechtenstein e Noruega, atraves das EEA Grants.
19 citations
TL;DR: A need for integrated approaches, from measures tackling social inequalities to actions focused on improving health literacy, are suggested to expand dental healthcare services and improve effective coverage to increase access for rural population.
Abstract: Oral health is a determinant for quality of life and preventive behaviours such as regular tooth brushing can reduce the risk of a wide spectrum of oral diseases. Adopting preventive behaviours increases the likelihood of being healthy and can be conditioned by demographic and socio-economic factors.Objective: This study aims to describe preventive oral hygiene behaviours in the Portuguese population and assess their association with sociodemographic and socioeconomic factors.Material and methods: A cross-sectional epidemiologic study was developed using data from the first Portuguese National Health Examination Survey. The target population comprised Portuguese community-dwelling residents aged between 25 and 74 years old. The percentage of individuals who brushed their teeth at least twice a day, provided that once was before sleeping, was considered the indicator showing a preventive behaviour, as this is recommended by the General Directorate of Health in Portugal. Poisson regression was used ...
15 citations
TL;DR: A large majority of the adult Portuguese population are likely to reach blood pressure levels defined as hypertension in adulthood, which highlights the importance of population strategies in public health policies.
Abstract: Introduction Cardiovascular disease is an important cause of death and disability worldwide, and hypertension is responsible for at least 45% of all deaths due to heart disease and 51% of deaths due to stroke. This study aimed to estimate and describe the distribution of prevalence, awareness, treatment and control of hypertension in the Portuguese population in 2015. Methods A national survey using a representative sample of 4911 individuals residing in Portugal and aged between 25 and 74 years was implemented. Trained nurses performed a health interview and a physical examination, including blood pressure measurement (right arm, three measurements at 1-min intervals). The prevalence of hypertension was stratified by gender, age group, marital status, education, occupation and type of residential area. Associations between hypertension prevalence and sociodemographic factors were assessed using bivariate and multivariate Poisson regression. Results The overall hypertension prevalence was 36.0%. The highest rates were observed in males (39.6%), in individuals aged between 65 and 74 years (71.3%), and in those with low levels of education (62.6%) and with no formal occupation (64.5%). Among hypertensive individuals, 69.8% were aware of their condition and 69.4% were under treatment, of whom 71.3% were controlled. Rates of awareness and medical treatment were significantly higher among women and older individuals. Conclusions A large majority of the adult Portuguese population are likely to reach blood pressure levels defined as hypertension in adulthood. Significant differences in hypertension prevalence were found according to gender, age and socioeconomic status, which highlights the importance of population strategies in public health policies.
14 citations
TL;DR: A retrospective analysis of adult patients admitted with CAP in mainland Portugal between the years 2000 and 2009 found community-acquired pneumonia remains an important cause of hospital mortality in all age groups.
13 citations
TL;DR: Estimating the impact of PCV7 and PCV13 on pneumococcal pneumonia hospitalizations in adults aged 65 years or more in Portugal suggests that introduction of both PCV 7 andPCV13 vaccines resulted in the reduction of PP hospitalizations rates among older adults.
Abstract: The IMOVE+ project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634446
12 citations
TL;DR: The results show a greater healthcare use in multimorbidity patients, both in primary and hospital care, which may support health policy changes, which could allow a more efficient management of these patients.
Abstract: O primeiro Inquerito Nacional de Saude com Exame Fisico foi desenvolvido como parte integrante do projeto “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, que beneficiou de um apoio financeiro de 1.500.000€ concedido pela Islândia, Liechtenstein e Noruega, atraves do Programa Iniciativas em Saude Publica (PT06) financiado pelas EEA Grants 2009-2014.
TL;DR: The results suggest that influenza vaccination programmes reduced a substantial number of MAICC, and will contribute to the evaluation of the impact of vaccination strategies and strengthen public health communication.
Abstract: Background
To increase the acceptability of influenza vaccine, it is important to quantify the overall benefits of the vaccination programme.
Aim
To assess the impact of influenza vaccination in Portugal, Spain and the Netherlands, we estimated the number of medically attended influenza-confirmed cases (MAICC) in primary care averted in the seasons 2015/16 to 2017/18 among those ≥65 years.
Methods
We used an ecological approach to estimate vaccination impact. We compared the number of observed MAICC (n) to the estimated number that would have occurred without the vaccination programme (N). To estimate N, we used:
(i) MAICC estimated from influenza surveillance systems,
(ii) vaccine coverage,
(iii) pooled (sub)typespecific influenza vaccine effectiveness estimates for seasons 2015/16 to 2017/18, weighted by the proportion of virus circulation in each season and country.
We estimated the number of MAICC averted (NAE) and the prevented fraction (PF) by the vaccination programme.
Results
The annual average of NAE in the population ≥65 years was 33, 58 and 204 MAICC per 100,000 in Portugal, Spain and the Netherlands, respectively. On average, influenza vaccination prevented 10.7%, 10.9% and 14.2% of potential influenza MAICC each season in these countries. The lowest PF was in 2016/17 (4.9–6.1%) with an NAE ranging from 24 to 69 per 100,000.
Conclusions
Our results suggest that influenza vaccination programmes reduced a substantial number of MAICC. Together with studies on hospitalisations and deaths averted by influenza vaccination programmes, this will contribute to the evaluation of the impact of vaccination strategies and strengthen public health communication.
TL;DR: The primeiro Inquerito Nacional de Saude com Exame Fisico foi desenvolvido como parte integrante do projeto "Improvement of epidemiological health information to support public health decision and management in Portugal".
Abstract: O primeiro Inquerito Nacional de Saude com Exame Fisico foi desenvolvido como parte integrante do projeto “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, que beneficiou de um apoio financeiro de 1.500.000€ concedido pela Islândia, Liechtenstein e Noruega, atraves do Programa Iniciativas em Saude Publica (PT06) financiado pelas EEA Grants 2009-2014.
TL;DR: There are differences in the geographical distribution of the RR incidence and RR mortality of colorectal cancer in mainland Portugal municipalities and it may be relevant to develop an analysis focused on municipalities where the incidence values explain the mortality values poorly (or well).
Abstract: Cancer is a leading cause of morbidity and mortality in the world. In Portugal, colorectal cancer is one of the most incident cancers; thus, it is crucial to act to fight it. Knowledge of the geographical distribution of the incidence and mortality of colorectal cancer can facilitate the execution of these actions and make them more effective. Our paper aims to describe and discuss the geographical patterns of colorectal cancer incidence and mortality in mainland Portugal municipalities (2007–2011). We used the Besag, York and Mollie (BYM) model to compute the relative risk (RR) and posterior probability (PP). We performed a cluster analysis with Global Moran’s Index and Local Moran’s Index (LISA). We ran a geographically weighted regression (GWR) to compare incidence and mortality patterns. Incidence and mortality have different distributions of RR values. The interval of RR concerning incidence was higher than the interval of RR concerning mortality. PP values reinforce the finding of higher heterogeneity of the incidence of colorectal cancer. The comparison of the cluster maps for incidence and mortality shows a few municipalities classified with the same cluster type in both maps. Additionally, the GWR results show that the percentage of RR mortality explained by RR incidence differs throughout mainland Portugal. From the comparison of our results with the prevalence of risk factors (at NUTS II level), the need to be aware of smoking habits, alcohol consumption and the unhealthy diet of the Portuguese population stands out. There are differences in the geographical distribution of the RR incidence and RR mortality of colorectal cancer in mainland Portugal municipalities. Likewise, it is relevant to highlight the cluster of two municipalities with high RR values concerning colorectal cancer’s incidence and mortality. Future research is necessary to explain the geographical differences in the distribution of colorectal cancer in mainland Portugal municipalities. Based on our findings, it may be interesting to examine the influence of smoking, alcohol consumption, diet and screening on colorectal cancer in greater detail. Additionally, it may be relevant to develop an analysis focused on municipalities where the incidence values explain the mortality values poorly (or well).
TL;DR: O INSEF foi desenvolvido como parte integrante do projeto "Improvement of epidemiological health information to support public health decision and management in Portugal" as mentioned in this paper.
Abstract: O INSEF foi desenvolvido como parte integrante do projeto “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, beneficiando de apoio financeiro de 1.500.000€ concedido pela Islândia, Liechtenstein e Noruega, atraves das EEA Grants.
TL;DR: The yearly influenza vaccination campaigns had a sustained positive benefit for the high- risk population, reducing hospitalizations and deaths, and can support public health plans toward increased vaccine coverage in high-risk groups.
Abstract: All aged individuals with a chronic condition and those with 65 and more years are at increased risk of severe influenza post-infection complications. There is limited research on cases averted by the yearly vaccination programs in high-risk individuals. The objective was to estimate the impact of trivalent seasonal influenza vaccination on averted hospitalizations and death among the high-risk population in Portugal. The impact of trivalent seasonal influenza vaccination was estimated using vaccine coverage, vaccine effectiveness and the number of influenza-related hospitalizations and deaths. The number of averted events (NAE), prevented fraction (PF) and number needed to vaccinate (NVN) were estimated for seasons 2014/15 to 2016/17. The vaccination strategy averted on average approximately 1833 hospitalizations and 383 deaths per season. Highest NAE was observed in the ≥65 years population (85% of hospitalizations and 95% deaths) and in the 2016/17 season (1957 hospitalizations and 439 deaths). On average, seasonal vaccination prevented 21% of hospitalizations in the population aged 65 and more, and 18.5% in the population with chronic conditions. The vaccination also prevented 29% and 19.5% of deaths in each group of the high-risk population. It would be needed to vaccinate 3360 high-risk individuals, to prevent one hospitalization and 60,471 high-risk individuals to prevent one death. The yearly influenza vaccination campaigns had a sustained positive benefit for the high-risk population, reducing hospitalizations and deaths. These results can support public health plans toward increased vaccine coverage in high-risk groups.
TL;DR: The results support the possibility of the multidimensionality of elder abuse not being accounted by the “classical” abuse typologies and suggest elder abuse victims seeking help may represent a distinct group from that included in population-based prevalence studies.
Abstract: Research on elder abuse has defined it as a multidimensional construct that encompasses a set of different abusive behaviours, victims, perpetrators and settings. The array of possible elder abuse configurations is difficult to capture. This study sought to identify victimization patterns that represent distinct elder abuse configurations based on specific abusive behaviours and on the relationship with the perpetrator; it also sought to determine the association between these latent classes with victims’ characteristics. Data comes from two elder abuse surveys: a representative sample of community-dwelling adults and a convenience sample of older adults reporting elder abuse to four state and NGOs institutions. Latent Class Analysis (LCA) was used to categorize victimization in the population-based (N = 245) and in the victims’ sample (N = 510) using 7 items measuring physical, psychological and financial abuse, and appointed perpetrators. Association tests were conducted to determine differences and similarities of victims’ characteristics between the different obtained classes. The LCA procedure identified six different latent classes of victimization experiences in each of the samples, which were statistically and plausibly distinct. In the population-based survey: verbal abuse by others (29%); psychological abuse from children/grandchildren (18%); overlooked by others (18%); stolen by others (15%); verbal Intimate Partner Violence (IPV) (14%) and physical and psychological IPV (6%). In the victims’ survey: physical abuse by children/grandchildren (29%); physical IPV (26%); psychological abuse by children/grandchildren (18%); polyvictimization by others (16%); physical abuse by others (6%) and physical and psychological IPV (4%). In the victims survey the 6 groups significantly differ in age, gender, civil status, living arrangements, perceived social support and functional status. The results support the possibility of the multidimensionality of elder abuse not being accounted by the “classical” abuse typologies. Elder abuse victims seeking help may represent a distinct group from that included in population-based prevalence studies. The appointed perpetrators may be the most meaningful and relevant aspect in distinguishing victimization experiences. Further research is needed to develop tailored interventions to specific elder abuse cases and enhance successful outcomes.
TL;DR: FluHMM, a simple but flexible Bayesian algorithm to detect and monitor the seasonal epidemic on sentinel surveillance data from Greece, is introduced and it is shown that it achieves very good sensitivity, timeliness and perfect specificity, thereby demonstrating its usefulness.
Abstract: Timely detection of the seasonal influenza epidemic is important for public health action. We introduce FluHMM, a simple but flexible Bayesian algorithm to detect and monitor the seasonal epidemic ...
01 Jan 2019
TL;DR: The validity of the short Geriatric Depression Scale (GDS) version (5 items) was assessed in two samples of older adults aged 60 or more years as mentioned in this paper, and the results indicated its reliability and adequate sensitivity, and specificity values for screening for depressive symptoms in the elderly population.
Abstract: The validity of the short Geriatric Depression Scale (GDS) version (5 items) was assessed in two samples of older adults aged 60 or more years. Concurrent validity, specificity, and sensitivity were obtained in a convenience sample of 66 individuals (mean of 70 years) by comparison to the Beck Depression Inventory (IDB-II). Factorial analysis was conducted in a population-based sample of 1023 participants (mean of 71 years). The 5-item version of the Geriatric Depression Scale presented adequate internal consistency values and good correlation results with the IDB-II. These results suggest its reliability and adequate sensitivity, and specificity values for screening for depressive symptoms in the elderly population. The results obtained by the Confirmatory Factor Analysis (CFA) suggest that the one-factor model does not have the desired characteristics – one of the items (item 4) may have a lower discriminative power and a better fit in the model obtained by the CFA for 4 items was observed.
TL;DR: Changing smoking prevalence and inequalities in associated socioeconomic factors in Portugal between 1987 and 2014 showed decreasing prevalences and diminishing inequalities, particularly among men, and increasing consumption among women.
Abstract: Introduction and Objectives Smoking patterns inform tobacco control policies. This study aimed to assess trends in smoking prevalence and associated socioeconomic factors in Portugal between 1987 and 2014. Methods We used data from National Health Interview Surveys (NHIS) conducted in 1987, 1995/96, 1998/99, 2005/06 and 2014/15. For each NHIS, we estimated gender-specific and age-standardized smoking prevalences, stratified by education, occupation, marital status and region. We constructed NHIS- and gender-specific logistic regression models, adjusting for the above-mentioned variables. We describe changes in smoking prevalence and inequalities in associated socioeconomic factors between 1987 and 2014. Results In men, smoking prevalence (32.2% and 26.7%, respectively) and inequalities for all factors except for education decreased between 1987 and 2014. For women, inequalities decreased for region, age and occupation, and these changes occurred through increasing smoking prevalence in all groups. For marital status and education, inequalities were stable but smoking prevalence increased for all groups within these variables. In both sexes, the unemployed (adjusted odds ratio [aOR] 2014: men 2.33, women 2.76) and divorced (aOR 2014: men 2.12, women 3.18) consistently had the highest prevalences and aORs of smoking. For the first three NHIS higher aORs of smoking were observed among less-educated men and highly-educated women, while for the last two the higher odds were for the less-educated in both sexes. Conclusions Smoking trends among men showed decreasing prevalences and diminishing inequalities. For women, inequalities were stable but there was an overall increase in prevalence. The unemployed and divorced had the highest smoking prevalences in both sexes. Smoking prevention and cessation policies in Portugal should take into consideration inequalities, particularly among men, and increasing consumption among women.
TL;DR: It is demonstrated that older adults present very similar patterns of emotional reactions, but individual characteristics and the established relationship with the perpetrator might mediate the emotional response.
Abstract: Elder abuse has been gaining public, state, and scientific attention for the past 40 years, but research focusing on emotional reactions of older adults to victimisation is still scarce. The study describes the emotions and feelings of older adults who experienced abuse in a community setting, and the association between these emotions and individual or abuse characteristics. The cross-sectional study comprises 510 older adults who were identified and referred by four institutions. Participants answered a questionnaire on elder abuse experiences, including the emotion or feeling brought out by the act of abuse that was perceived to be the most serious. Fear and sadness comprised 67.1% of all provided responses. Emotional reactions were associated with functional status, the presence of depressive symptoms, relationship with the perpetrator and, to a limited degree, to the experience of multiple types of abuse. The most significant and meaningful variable was the relationship with the perpetrator. This study demonstrates that older adults present very similar patterns of emotional reactions, but individual characteristics and the established relationship with the perpetrator might mediate the emotional response. Implications for prevention and intervention of elder abuse are discussed.
TL;DR: 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 is highlighted.
Abstract: Introduction 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.
TL;DR: The current results suggest the influence of the occurrence of extreme hydro-meteorological events on the variability of the hospitalization rate by Leptospirosis in the state of Santa Catarina, with significant differences found for the coastal and inland regions.
Abstract: Extreme climatic events (ECE) are beginning to be perceived as potential causes of health disturbances. The assessment of the impacts of certain ECE to human health has become essential to health managers and caregivers. The objective of this study was to identify the association between rates of hospitalization for Leptospirosis and the occurrence of extreme hydrological events in the state Santa Catarina (Brazil) between the years 2005 and 2014. The association between Leptospirosis hospitalizations and the occurrence of floods, flash floods, and flooding events was measured through Spearman’s bivariate correlation coefficient. Flash floods corresponded to 92.6% of the total hydrological events. Coastal regions presented higher admission rates than inland. The Leptospirosis presented a seasonal pattern, with a peak in the summer months. Positive and significant correlations for monthly and annual analyzes were identified for some of the analyzed macro-regions, with higher values of correlation in the coastal region. The current results suggest the influence of the occurrence of extreme hydro-meteorological events on the variability of the hospitalization rate by Leptospirosis in the state of Santa Catarina, with significant differences found for the coastal and inland regions.
01 Jan 2019
TL;DR: The IMOVE+ project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634446 as discussed by the authors, which is the first project to receive such a grant.
Abstract: The IMOVE+ project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634446.
01 Jan 2019
01 Jan 2019
TL;DR: Self-reported data underestimated educational inequalities among 25–49-yo men and overestimated them in older individuals, and inequality indicators derived from self-report should be interpreted with caution, and examination-based values should be preferred, when available.
Abstract: This study aimed to compare the magnitude of educational inequalities in self-reported and examination-based hypertension and hypercholesterolemia and to assess the impact of self-reported measurement error on health inequality indicators. We used the Portuguese National Health Examination Survey data (n = 4911). The slope index of inequality (SII) and the relative index of inequality (RII) were used to determine the magnitude of absolute and relative education-related inequalities. Among the 25–49-year-old (yo) men, absolute and relative inequalities were smaller for self-reported than for examination-based hypertension (SIIeb = 0.18 vs. SIIsr = − 0.001, p < 0.001; RIIeb = 1.99 vs. RIIsr = 0.86, p = 0.031). For women, the relative inequalities were similar despite differences in self-reported and examination-based hypertension prevalence. For hypercholesterolemia, self-reported relative inequalities were larger than examination-based inequalities among the 50–74-yo men (RIIsr = 2.28 vs. RIIeb = 1.21, p = 0.004) and women (RIIsr = 1.22 vs. RIIeb= 0.87, p = 0.045), while no differences were observed among 25–49-yo. Self-reported data underestimated educational inequalities among 25–49-yo men and overestimated them in older individuals. Inequality indicators derived from self-report should be interpreted with caution, and examination-based values should be preferred, when available.
TL;DR: In this article, the authors compared the magnitude of educational inequalities in self-reported and examination-based hypertension and hypercholesterolemia and assessed the impact of selfreported measurement error on health inequality indicators.
Abstract: This study aimed to compare the magnitude of educational inequalities in self-reported and examination-based hypertension and hypercholesterolemia and to assess the impact of self-reported measurement error on health inequality indicators. We used the Portuguese National Health Examination Survey data (n = 4911). The slope index of inequality (SII) and the relative index of inequality (RII) were used to determine the magnitude of absolute and relative education-related inequalities. Among the 25–49-year-old (yo) men, absolute and relative inequalities were smaller for self-reported than for examination-based hypertension (SIIeb = 0.18 vs. SIIsr = − 0.001, p < 0.001; RIIeb = 1.99 vs. RIIsr = 0.86, p = 0.031). For women, the relative inequalities were similar despite differences in self-reported and examination-based hypertension prevalence. For hypercholesterolemia, self-reported relative inequalities were larger than examination-based inequalities among the 50–74-yo men (RIIsr = 2.28 vs. RIIeb = 1.21, p = 0.004) and women (RIIsr = 1.22 vs. RIIeb= 0.87, p = 0.045), while no differences were observed among 25–49-yo. Self-reported data underestimated educational inequalities among 25–49-yo men and overestimated them in older individuals. Inequality indicators derived from self-report should be interpreted with caution, and examination-based values should be preferred, when available.
TL;DR: Assessment of ÍCARO’s use and understanding by key HHAP practitioners in Portugal stresses the need for an integrated collaboration between experts within HHWS and HHAP.
Abstract: Background Heatwaves can lead to increased mortality. In the Portuguese heat-health warning system (HHWS), ICARO, a daily report with heat-related mortality prediction is sent to heat-health action plan (HHAP) practitioners. HHAP practitioners assess risk and implement measures to prevent heatwave-related impact, but ICARO's use and understanding are unknown. We assessed ICARO's use and understanding by key HHAP practitioners. Methods We conducted semi-structured interviews with national/regional HHAP practitioners. Interviews were recorded, transcribed and analysed using thematic content analysis. To maximize credibility a validation process was implemented through researcher triangulation; a sample of 30 segments was recorded by independent researchers. Results We conducted six interviews with nine professionals (mean time 52 min) from five regions. We identified four categories: report's content and presentation, report's reception and communication, ICARO and risk assessment and other issues. Practitioners use ICARO and perceived it as relevant; they raised issues on its interpretation and felt these were not fully addressed, given researchers' use of statistical/epidemiological terms. We identified the need for improved communication and report's clarity. Conclusions Our study stresses the need for collaboration between experts within HHWS/HHAP. Despite ICARO's understanding being challenging, practitioners consider it a relevant tool. Researchers should use less statistical language and clarify ICARO's interpretation. Practitioners' needs should be considered when developing/revising tools.