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PubMed2002

Population data of five STRs in three regions from Portugal.

Allele and haplotype frequencies of five chromosome STR loci (CD4, TPO, FES, TH01 and VWA) were determined for unrelated males throughout Portugal. This report presents STR data for three separate regions of Portugal, being the first time that data on the south of the country is presented. This study reveals that the three regions from Portugal are not genetically homogeneous. The north of Portugal presents significant differences in the CD4 locus, when compared with the other two populations. When compared with Madeira and Açores, the three regions show a different behavior at TPO and VWA loci.

Alleles↗

PubMedDate not supplied

[Pneumonia in the adult population in continental Portugal -- incidence and mortality in hospitalized patients from 1998 to 2000].

OBJECTIVE: To characterise the incidence and mortality in adult inpatients with community-acquired pneumonia at a global and regional level in mainland Portugal. PATIENTS AND METHODS: We used the clinical database belonging to the Ministry of Health's Instituto de Gestão e Informática Financeira (Institute of Financial Management and Informatics), which contains the encoded information from the discharge letters from all hospitalisations at National Health Service institutions in mainland Portugal. We conducted a retrospective analysis of all hospitalisations in 1998, 1999 and 2000 with a main diagnosis of pneumonia on admission (ICD9: 480 to 486 and 487.0), excluding patients infected with the human immunodeficiency virus. RESULTS: From 1998 to 2000, hospitalisation of adults with pneumonia represented about 3% of the total number of admissions. We determined an average annual incidence of 2.66 hospitalisations for pneumonia per 1,000 adult inhabitants and of 9.78 per 1,000 inhabitants aged > or =65. The average age of the adults interned was 70, with 71.6% of the patients aged > or =65. We believe that 25 to 50% of adults with community-acquired pneumonia are hospitalised. The mortality rate of adults hospitalised was 17.3%, with no significant difference between the sexes. Mortality rose to 21.5% and 24.8% in individuals aged > or =65 and > or =75, respectively. On average, 2.8% of the adults admitted were given mechanical ventilation and their mortality rate was 43.9%. The incidence of hospitalisations for community-acquired pneumonia and its mortality differed from region to region in mainland Portugal. The annual incidence of admissions for pneumonia per 1,000 adult inhabitants in the central region was double that in the northern region and the Algarve and the mortality rate increased from north to south of the country, with a difference of more than 50% in the Algarve in relation to the northern region. CONCLUSIONS: The incidence of hospitalisations for community-acquired pneumonia is comparable to the figures published in the international literature, though the hospital mortality rate is higher. We feel that it is essential to conduct more studies with a view to a more detailed characterisation of the situation in Portugal and a better understanding of the reasons for the discrepancies between the regions. This would possibly also enable us to implement measures to reduce the mortality rate.

Adolescent↗

PubMed2004

Prospective community-based study of stroke in Northern Portugal: incidence and case fatality in rural and urban populations.

BACKGROUND AND PURPOSE: Mortality statistics indicate that Portugal has the highest stroke mortality in Western Europe. Data on stroke incidence in Northern Portugal, the region with the highest mortality, are lacking. This study was designed to determine stroke incidence and case fatality in rural and urban populations in Northern Portugal. METHODS: All suspected first-ever-in-a-lifetime strokes occurring between October 1998 and September 2000 in 37,290 residents in rural municipalities and 86,023 living in the city of Porto were entered in a population-based registry. Standard definitions and comprehensive sources of information were used for identification of patients who were followed-up at 3 and 12 months after onset of symptoms. RESULTS: During a 24-month period, 688 patients with a first-ever stroke were registered, 226 in rural and 462 in urban areas. The crude annual incidence was 3.05 (95% CI, 2.65 to 3.44) and 2.69 per 1000 (95% CI, 2.44 to 2.93) for rural and urban populations, respectively; the corresponding rates adjusted to the European standard population were 2.02 (95% CI, 1.69 to 2.34) and 1.73 (95% CI, 1.53 to 1.92). Age-specific incidence followed different patterns in rural and urban populations, reaching major discrepancy for those 75 to 84 years old, 20.2 (95% CI, 16.1 to 25.0) and 10.9 (95% CI, 9.0 to 12.8), respectively. Case fatality at 28 days was 14.6% (95% CI, 10.2 to 19.3) in rural and 16.9% (95% CI, 13.7 to 20.6) in urban areas. CONCLUSIONS: Stroke incidence in rural and urban Northern Portugal is high compared to that reported in other Western Europe regions. The high official mortality in our country, which could be explained by a relatively high incidence, was not because of a high case fatality rate.

Aged↗

PubMed2006

Listeriosis in Portugal: an existing but under reported infection.

BACKGROUND: Listeriosis is a rare disease caused by the bacterium Listeria monocytogenes, the normal vehicle of which is food. The disease, which is largely confined to its risk groups of pregnant women, the elderly and immunocompromised individuals, has increased in incidence in recent years. In Portugal, listeriosis is not a notifiable infection and available data are scarce. The objective of this work was to collate the available information concerning listeriosis in Portugal by compiling a retrospective study of cases recorded over a decade. METHODS: Requests for case data on clinically confirmed listeriosis, recorded over the previous decade, were replied to by 23 hospitals and a National Institute of Health delegation. RESULTS: 35 cases of listeriosis were identified for the period between 1994 and 2003 inclusive, the mortality rate being greater than 17%. According to the data collected in this study for the year 2003, the incidence of this disease in Portugal was at least 1.4 cases per million inhabitants in that year. CONCLUSION: The study demonstrates, for the first time in the widely available literature, that despite their being no cases of listeriosis in Portugal recorded in official reports, the threat of L. monocytogenes to public health is of a similar dimension to that in other countries.

Adolescent↗

PubMed1989

Prevalence of anti BK virus antibody in Portugal and Norway.

Specific IgG antibodies against BK virus measured by ELISA were used as a marker of previous infection. Results with sera from healthy people of different counties in Portugal were compared with previous findings in Norwegian sera. No significant difference between the prevalence and level of BKV IgG could be found between Portugal and Norway, and when comparing the different counties of Portugal. Thus, the way of transmission seemed to follow the same routes both in rural and urban counties in Portugal, and in Norway.

Antibodies, Viral↗

PubMed1999

BSE in Portugal: anticipating the decline of an epidemic.

BACKGROUND: Attention throughout Europe continues to focus on bovine spongiform encephalopathy (BSE), with increasing evidence linking it to the new variant of Creutzfeldt-Jakob disease in humans. In particular, recent attention has been directed at Portugal, where the incidence of confirmed BSE cases continues to rise. METHODS: We modelled the age-specific incidence of BSE in Portuguese-born cattle by birth cohort as a function of: the survival distribution; the cohort-specific incidence of BSE infection; the age-specific probability, conditional on survival, that an infected animal will experience clinical onset; and the under-reporting rate of BSE cases prior to 1998. RESULTS: We obtained good fits to the age-specific incidence of BSE by birth cohort in Portugal. Under a range of assumptions, the estimated incidence of BSE infection was relatively low initially, except possibly in the 1989 cohort, and then rose gradually between the 1992 and 1994 cohorts. The estimated decrease in infection incidence between the 1994 and 1995 cohorts probably reflects the effectiveness of the ban on the use of mammalian meat and bone-meal introduced in Portugal in mid-1994. Assuming no infections in animals born after June 1995, the models predict that the incidence of BSE cases in Portugal will peak in 1999 with BSE case-incidence declining thereafter. DISCUSSION: Our results illustrate the power of epidemiological analysis to detect decreasing trends in infection incidence prior to the resulting decrease in case incidence. The findings should inform the deliberations of the European Commission, which recently reported concerns about the sharp increase in case incidence from 1997 to 1998.

Adolescent↗

PubMed1999

[Rickettsia infections in Portugal].

After a brief introduction about rickettsioses, we analyse Mediterranean Spotted Fever (MSF) in Portugal, and review Portuguese medical literature. We focussed on the seasonal summer pattern of the disease. MSF is very frequent in Portugal, nearly 1,000 cases are reported every year and young age groups are the most afflicted. Although usually regarded as a benign condition, MSF has emerged as a potentially lethal disease in recent years. The clinical presentation is protean, but usually suggestive enough to allow a clinical diagnosis. The complications are well documented, elderly and people with chronic debilitating diseases being the most affected. Q fever is also endemic in Portugal, although with more modest numbers (about 50 cases a year). Serological studies, however, suggest a higher incidence, probably because the disease is unfamiliar to many clinicians and, as such, it is difficult to diagnose and, consequently, then an important number of subclinical or self-limited cases. In Portugal, fever with hepatic involvement is the most common clinical presentation. Other less frequent clinical forms are atypical pneumonia and CNS involvement. Chronic Q fever is a rare condition.

Humans↗

PubMed2001

National survey of cardiac rehabilitation programs in Portugal--situation in 1999.

In order to study the status of Cardiac Rehabilitation (CR) in Portugal in 1998 and 1999, a questionnaire was drafted and sent to all the heads of the CR centres in Portugal, with questions about their nature, location, staff, type of activity, movement, diagnosis leading to patient referral and funding. The rate of coronary patients admitted to the programs existing in the cities of Lisbon and Oporto was calculated. The total number of patients included in all the CR centres in both cities was subtracted from the total number of public hospital discharges of coronary patients in 1998, patients admitted due to acute ischaemic coronary syndrome or for revascularization in Portugal and in each of the two cities. We found that there were CR centres in only the two main cities (Lisbon and Oporto), with organization and types of activity in accordance with international guidelines and recommendations. The overall admission rate of coronary patients in Portugal in 1998 was 0.7%, with 0.9% and 1.9% in Lisbon and Oporto, respectively. These rates are well below the figures for countries of the European Union and for the USA. It is very important to increase the establishment and spread of CR centres throughout the country, creating the financial conditions and promoting a change in culture regarding physical activity and CR on the part of the Portuguese population, patients and health care providers responsible for the referral of cardiac patients to a therapeutic intervention that can increase quality of life and longevity. Doctors should be involved in programs that will train them to recognize the benefits of physical activity and secondary prevention.

Heart Diseases↗

PubMed2003

Incidence and prevalence of hypercholesterolemia in Portugal: a systematic review. Part I.

INTRODUCTION: Over 50% of the mortality and disability caused by ischemic heart disease and stroke could be avoided by controlling individual risk factors (hypertension, hypercholesterolemia, smoking and obesity). The ignorance of the extent and impact of hypercholesterolemia (HC) in Portugal prompted us to undertake this systematic review of the prevalence and incidence of hyperlipidemia in Portugal, based exclusively on work published nationally. METHODS: We included every study published in the country that could provide data on the prevalence or incidence of hypercholesterolemia. The search strategy included an electronic search of national and international biomedical databases (Medline, Index Revistas Médicas Portuguesas, the Portuguese Directorate-General for Health and the Portuguese National School of Public Health), screening of reference lists from the individual studies, and personal contacts with institutions, groups and authors (such as the Portuguese Foundation of Cardiology). The data--recorded in electronic format--was collected independently by two of the authors (JC and MB), with consensus achieved with a third (AVC) when there were differences in the study coding. RESULTS: We could only identify one paper on the incidence of HC in Portugal, which gave an incidence of 559 new cases per 100,000 inhabitants, increasing with age up to 54 years for men and 64 years for women. There was a higher incidence in men than in women up to the age of 54, but at more advanced ages this relationship was reversed. Prevalence studies on HC included 53,445 individuals overall, with sample size lower than 1000 in most of the individual studies. The most frequently used criterion for HC was > 200 mg/dL, with the mean level being higher in most studies. We calculated the mean prevalence for several cut-off points (190 mg/dL: 63.8%; 200 mg/dL: 56.7%; 240 mg/dL: 31.7%; 250 mg/dL: 21%). Due to the heterogeneity of the data, these results are to be interpreted with caution, even though they are consistent across individual studies. The prevalence of hypertriglyceridemia (HTG) was highly variable across studies. Most of them used a baseline criterion of 150 mg/dL (11-26%) or 200 mg/dL (8.9-33.9%). CONCLUSIONS: Despite the obvious heterogeneity and a certain paucity of studies, we found consistent results concerning the prevalence of hypercholesterolemia in Portugal, and we can state that this constitutes a serious health problem in our country. The prevalence of hypercholesterolemia was higher than that of arterial hypertension in our population. The results of this study should serve as a basis for a commitment to action from the health authorities and health professionals as well as patients.

Humans↗

PubMed2003

Incidence and prevalence of hypercholesterolemia in Portugal: a systemic review. Part II.

Humans↗

PubMed2003

Incidence and prevalence of hypercholesterolemia in Portugal: a systematic review. Part III.

INTRODUCTION: Over 50% of the mortality and disability caused by ischemic heart disease and stroke could be avoided by controlling individual risk factors (hypertension, hypercholesterolemia, smoking and obesity). The ignorance of the extent and impact of hypercholesterolemia (HC) in Portugal prompted us to undertake this systematic review of the prevalence and incidence of hyperlipidemia in Portugal, based exclusively on work published nationally. METHODS: We included every study published in the country that could provide data on the prevalence or incidence of hypercholesterolemia. The search strategy included an electronic search of national and international biomedical databases (Medline, Index Revistas Médicas Portuguesas, the Portuguese Directorate-General for Health and the Portuguese National School of Public Health), screening of reference lists from the individual studies, and personal contacts with institutions, groups and authors (such as the Portuguese Foundation of Cardiology). The data--recorded in electronic format--was collected independently by two of the authors (JC and MB), with consensus achieved with a third (AVC) when there were differences in the study coding. RESULTS: We could only identify one paper on the incidence of HC in Portugal, which gave an incidence of 559 new cases per 100,000 inhabitants, increasing with age up to 54 years for men and 64 years for women. There was a higher incidence in men than in women up to the age of 54, but at more advanced ages this relationship was reversed. Prevalence studies on HC included 53,445 individuals overall, with sample size lower than 1000 in most of the individual studies. The most frequently used criterion for HC was > 200 mg/dL, with the mean level being higher in most studies. We calculated the mean prevalence for several cut-off points (> or = 190 mg/dL: 63.8%; > or = 200 mg/dL: 56.7%; > or = 240 mg/dL; 31.7%; > or 250 mg/d; 21%). Due to the heterogeneity of the data, these results are to be interpreted with caution, even though they are consistent across individual studies. The prevalence of hypertriglyceridemia (HTG) was highly variable across studies. Most of them used a baseline criterion of 150 mg/dL (11-26%) or > or = 200 mg/dL (8.9-33.9%). CONCLUSIONS: Despite the obvious heterogeneity and a certain paucity of studies, we found consistent results concerning the prevalence of hypercholesterolemia in Portugal, and we can state that this constitutes a serious health problem in our country. The prevalence of hypercholesterolemia was higher than that of arterial hypertension in our population. The results of this study should serve as a basis for a commitment to action from the health authorities and health professionals as well as patients.

Humans↗

PubMed2003

[Epidemiologic features of Mediterranean spotted fever in Portugal].

Mediterranean spotted fever (MSF) is a tick-borne rickettsial disease. It is endemic in Portugal and Ricardo Jorge recognized it in 1930. Rhipicephalus sanguineus is the main vector and reservoir of the disease. In Portugal the etiologic agents are two strains of Rickettsia conorii complex: R. conorii Malish and "Israeli tick typhus". MSF is clinically characterized by a vasculitis process with the classical clinical triad of fever, rash, and lesion at the site of tick bite. Although the majority MSF cases are considered benign, last years some districts presented more severe cases than expected. The reported incidence of MSF in Portugal for 1989 to 2000 was 9.8/10(5) inhabitants, the highest incidence compared to other mediterranean countries. Alentejo was the region who presents the highest incidence with 31/10(5) inhabitants. Nevertheless, Bragança was the district which appears with greater number of cases, 62/10(5) inhabitants. The highest annual incidence rate reported was among children, peaking in those 1-4 years of age with 60.2/10(5) inhabitants. Observation of mortality rates have shown that Beja district have the highest mortality rates for MSF in Portugal, but in 1997 in this district, mortality have unexpected values with 7.6 deaths per 100,000 inhabitants have occurred. Although is an obligatory notifiable disease, high number of underreported cases are detected.

Adolescent↗

PubMed2005

Mortality in Portugal associated with the heat wave of August 2003: early estimation of effect, using a rapid method.

During the first two weeks of August 2003, Portugal was affected by a severe heat wave. Following the identification in Portugal of the influence of heat waves on mortality in 1981 and 1991 (estimated excess of about 1900 and 1000 deaths respectively), the Observatorio Nacional de Saude (ONSA) - Instituto Nacional de Saude Dr. Ricardo Jorge, together with the Vigilancia Previsao e Informacao - Instituto de Meteorologia, created a surveillance system called iCARO, which has been in operation since 1999. iCARO identifies heat waves with potential influence on mortality [1]. Before the end of the 2003 heat wave, ONSA had produced a preliminary estimate of its effect on mortality. The results based on daily number of deaths from 1 June to 12 August 2003 were presented within 4 working days. Data was gathered from 31 National Civil registrars, covering the district capitals of all 18 districts of mainland Portugal, and representing approximately 40% of the mainland's mortality. The number of deaths registered in the period 30 July to 12 August was compared with the ones registered during 3 comparison periods: (in July): 1-14 July, 1-28 July, and 15-28 July). 15-28 July, the period best resembling the heat wave in time and characteristics, produced an estimation of 37.7% higher mortality rate then the value expected under normal temperature conditions. From this value, an estimate of 1316 death excess was obtained for mainland Portugal. The main purpose of this article is to present the method used to identify and assess the occurrence of an effect (excess mortality) during the heat wave of summer 2003.

Epidemiologic Methods↗

PubMed1989

Years of potential life lost: application of an indicator for assessing premature mortality in Spain and Portugal.

In this article, the authors present an analysis of causes of death in Spain and Portugal in 1984 based on a calculation of the "years of potential life lost" (YPLL) between the first and the 70th birthdays, the latter age corresponding approximately to the average life expectancy in both countries. This analysis of the YPLL led to a substantially different ranking of the main causes of death, based on what might be termed "premature mortality" compared with that obtained from more conventional mortality indices. According to this criterion, which is especially appropriate for the planning and evaluation of health interventions, the main causes of premature death (1-69 years) in the two countries of the Iberian peninsula are malignant tumours and, particularly in Portugal, violent deaths (especially motor-vehicle accidents, but also suicides). This is in contrast to the predominance of cardiovascular diseases indicated by other weightings of age-specific mortality rates. Portugal shows significantly worse YPLL rates than Spain not only for general mortality (45% higher than in Spain), but also for several major groups of causes. In Spain only malignant neoplasms, diabetes and chronic rheumatic heart diseases show higher specific mortality rates than in Portugal, based on traditional mortality indicators.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

[Health behaviors in Portugal. Epidemiological studies].

It is necessary to evaluate habitudes and behaviours in health in Portugal. The purpose of this review is to analyse some portuguese epidemiological studies. CINDI-Portugal, ERICA-Portugal and the National Health Inquiry were national studies regarding multiple health data. Nutritional attitudes and practices have been evaluated since 1940. The National Food Study and the Study of Prevalence of Obesity in Portugal studied Portuguese nutritional attitudes. There are studies of the prevalence of eating disorders i school populations. Some research about the association between food and disease is reported. The Portuguese Food Balance is reviewed. Some methodological problems are pointed out and the results discussed. The results of Portuguese studies suggest that our country is in danger of errors in the course of consumption attitudes.

Adult↗

PubMed2004

Emergence of invasive erythromycin-resistant Streptococcus pneumoniae strains in Portugal: contribution and phylogenetic relatedness of serotype 14.

OBJECTIVES: To study the phenotype and phylogenetic relatedness of invasive Streptococcus pneumoniae strains isolated in Portugal. METHODS: A total of 614 invasive S. pneumoniae strains, isolated in Portugal from 1999 to the first 6 months of 2002, were characterized using serotyping and antimicrobial susceptibility testing. National outpatient sale data for macrolides were compared with erythromycin resistance. We investigated the main clonal lineages from erythromycin-resistant strains of serotype 14 by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). RESULTS: The emergence of erythromycin-resistant strains correlated well with the usage of azithromycin in Portugal during the period of the study (r=0.900, P=0.001). Serotype 14 made the largest contribution to this emergence. We found two clonal complexes (CC) among erythromycin-resistant strains: CC1 was formed by three sequence types (ST), ST156, ST143 and ST1042, and CC2 by ST15 and ST9. All STs described, except ST1042, are putative founders of clonal groups or subgroups from serotype 14 as defined in the pneumococcal MLST database. CONCLUSIONS: This study suggests that macrolides usage is an important factor enhancing the spread of invasive erythromycin-resistant S. pneumoniae clones in Portugal. The study also makes a contribution to the understanding of spread of erythromycin-resistant clones in an international context.

Anti-Bacterial Agents↗

PubMedDate not supplied

Update on the Spoligotypes of Mycobacterium tuberculosis complex isolates from the Fernando Fonseca Hospital (Amadora-Sintra, Portugal).

The present population study, from 1999 to 2003, has been based on the use of Spoligotyping in the genotyping of 452 isolates of the Mycobacterium tuberculosis complex from tuberculosis patients of the Fernando Fonseca Hospital. Spoligotypes were identified as "shared types" (STs) with the aid of an international database. Eleven rarely found STs, not identified in the database, grouped 8.4% of the isolates. Moreover, particular to Portugal, may be the predominance of STs identified in the database but not previously classified as genotypic families, such as ST244, ST150 and ST389, representing 13.3 % of the total. The identification of clinical isolates of M. africanum genotype Afri1 and of M. tuberculosis genotype CAS1 may confirm import of isolates of African and Asian origin. M. tuberculosis of the Beijing family was first reported by us as of 1999. Since then, the number of isolates at the Hospital has passed from one to five annually, representing 2.2% of the total and the tenth most predominant family in the present study. M. tuberculosis Beijing may correspond to an emerging problem in Portugal due to recent immigration from Eastern Europe and Asia. Other genotypes, ST150 and ST389, have shown increase, the significance of which is not clear. However, the relative frequencies of the predominant families LAM, T1 and Haarlem remained relatively stable. The present study confirms the genetic variability in Portugal of M. tuberculosis complex isolates. These studies may contribute to the definition of priorities in the national tuberculosis control programs.

Hospitals↗

PubMed2006

The prevalence of multiple sclerosis in the District of Santarém, Portugal.

The prevalence of multiple sclerosis (MS) in Portugal is still unknown. Recent studies conducted in southern European countries showed higher than expected rates of MS prevalence. In an attempt to evaluate the MS prevalence in Santarém--a district with 62621 inhabitants (1991 census) located in the centre of Portugal--we have conducted a population survey in this district for five years. The crude prevalence rate found was 46.3/100,000. This figure is not different from findings recently reported in studies conducted at similar latitudes in neighbour southern European countries. This was the first population survey conducted in Portugal, and it is the first accurate contribution to the knowledge of the MS prevalence in this country.

Adolescent↗