Ambient air pollution and lipid profile: Systematic review and meta-analysis.

Ambient air pollution (AAP) is recognized a cardiovascular risk factor and lipid profile dysregulation seems to be one of the potential mediators involved. However, results from epidemiologic research on the association between exposure to AAP and altered lipid profile have been inconsistent. This study aims to systematically review and meta-analyse epidemiologic evidence on the association between exposure to ambient air pollutants (particulate matter, nitrogen oxides, sulphur dioxide, ozone, carbon monoxide, back carbon) and lipid profile parameters (Total cholesterol; High-Density Lipoprotein Cholesterol; Low-Density Lipoprotein Cholesterol; TG-Triglycerides) or dyslipidaemia. Systematic electronic literature search was performed in PubMed, Web of Science and Scopus databases (last search on 24th May 2019) using keywords related to the exposure (ambient air pollutants) and to the outcomes (lipid profile parameters/dyslipidaemia). Qualitative and quantitative information of the studies were extracted and fixed or random-effects models were used to obtain a pooled effect estimate per each pollutant/outcome combination. 22 studies were qualitatively analysed and, from those, 3 studies were quantitatively analysed. Particulate matters were the most studied pollutants and a considerable heterogeneity in air pollution assessment methods and outcomes definitions was detected. Age, obesity related measures, tobacco consumption, sex and socioeconomic factors were the most frequent considered variables for confounding adjustment in the models. In a long-term exposure scenario, we found a 3.14% (1.36%-4.95%) increase in TG levels per 10 µg/m3 PM10 increment and a 4.24% (1.37%-7.19%) increase in TG levels per 10 µg/m3 NO2 increment. No significant associations were detected for the remaining pollutant/outcome combinations. Despite the few studies included in the meta-analysis, our study suggests some epidemiologic evidence supporting the association between PM10 and NO2 exposures and increased TG levels. Due to the very low level of evidence, more studies are needed to clarify the role of lipid profile dysregulation as a mediator on the AAP adverse cardiovascular effects.

Estimating Global Burden of Disease due to congenital anomaly: an analysis of European data.

OBJECTIVE: To validate the estimates of Global Burden of Disease (GBD) due to congenital anomaly for Europe by comparing infant mortality data collected by EUROCAT registries with the WHO Mortality Database, and by assessing the significance of stillbirths and terminations of pregnancy for fetal anomaly (TOPFA) in the interpretation of infant mortality statistics. DESIGN, SETTING AND OUTCOME MEASURES: EUROCAT is a network of congenital anomaly registries collecting data on live births, fetal deaths from 20 weeks' gestation and TOPFA. Data from 29 registries in 19 countries were analysed for 2005-2009, and infant mortality (deaths of live births at age <1 year) compared with the WHO Mortality Database. Eight EUROCAT countries were excluded from further analysis on the basis that this comparison showed poor ascertainment of survival status. RESULTS: According to WHO, 17%-42% of infant mortality was attributed to congenital anomaly. In 11 EUROCAT countries, average infant mortality with congenital anomaly was 1.1 per 1000 births, with higher rates where TOPFA is illegal (Malta 3.0, Ireland 2.1). The rate of stillbirths with congenital anomaly was 0.6 per 1000. The average TOPFA prevalence was 4.6 per 1000, nearly three times more prevalent than stillbirths and infant deaths combined. TOPFA also impacted on the prevalence of postneonatal survivors with non-lethal congenital anomaly. CONCLUSIONS: By excluding TOPFA and stillbirths from GBD years of life lost (YLL) estimates, GBD underestimates the burden of disease due to congenital anomaly, and thus declining YLL over time may obscure lack of progress in primary, secondary and tertiary prevention.

[Diabetes: Socioeconomic Inequalities in the Portuguese Population in 2014]. / Diabetes: Desigualdades Socioeconómicas na População Portuguesa em 2014.

INTRODUCTION: Diabetes is a major public health problem and it is related to socioeconomic factors. The aim of this study is to describe socioeconomic inequalities in the distribution of diabetes in the population with 25 years or more, resident in Portugal in 2014. MATERIAL AND METHODS: Data from the Health National Survey 2014 was analysed, n = 16 786. We estimated the prevalence of diabetes in the population and stratified by socioeconomic variables namely educational level and income. The extent of socioeconomic inequalities was assessed using concentration index and the relative index of inequality. RESULTS: Diabetes was found to be concentrated among the people with lower educational levels (concentration index = -0.26) and lower income quintiles (concentration index = -0.14). Relative index of inequality also showed a lower degree of inequality among the most educated (0,20; CI 95% = [0,12; 0,32]) and with higher income (0,59; CI 95% = [0,48; 0,74]). DISCUSSION: Distribution of diabetes is associated with education and income. Previous studies have shown that although income might reflect lifestyle patterns, education reflects better social factors that are important for establishing healthier behaviours. Also, the National Health Service, of universal coverage and free of charge, might have contributed to reduce inequalities in the access to health by those with the lowest income. CONCLUSION: Supporting 'Health in All Policies' might reduce inequalities, namely by improving population educational level and actions that promote health literacy.

Introdução: A diabetes é considerada um dos maiores problemas de saúde pública e está associada a fatores socioeconómicos. O objetivo deste estudo foi descrever as desigualdades socioeconómicas na distribuição da diabetes na população com idade igual ou superior a 25 anos, residente em Portugal em 2014. Material e Métodos: Foram analisados dados do Inquérito Nacional de Saúde de 2014, n = 16 786. Calcularam-se estimativas da prevalência da diabetes total e estratificada por variáveis de caracterização socioeconómica designadamente o nível de escolaridade e o rendimento. O grau de desigualdade socioeconómica foi estimado através do índice de concentração e do índice relativo de desigualdade. Resultados: A diabetes concentrou-se na população com menor nível de escolaridade (índice de concentração = -0,26) e nos quintis de menor rendimento (índice de concentração = -0,14). O índice relativo de desigualdade evidenciou menor desigualdade nos grupos com um maior nível de escolaridade (0,20; IC 95% = [0,12; 0,32]) e com maior rendimento (0,59; IC 95% = [0,48; 0,74]). Discussão: A distribuição da diabetes está associada ao nível educacional e ao rendimento. Estudos anteriores mostraram que, apesar do rendimento poder refletir o padrão de vida das pessoas, a educação reflete o contexto social imediato em que o individuo se integra e que contribui para adotar estilos de vida mais saudáveis. Ainda, o Serviço Nacional de Saúde, por ser universal e tendencialmente gratuito, pode ter contribuído para reduzir desigualdades no acesso à saúde por grupos de menor rendimento. Conclusão: Integrar a 'Saúde em Todas as Políticas' pode reduzir as desigualdades, nomeadamente através da melhoria do nível educacional da população e do desenvolvimento de ações que promovam a literacia em saúde.

Trends and determinants of alcohol consumption in Portugal: results from the national health surveys 1995 to 1996 and 1998 to 1999.

BACKGROUND: There is very little information on trends and determinants of alcohol consumption in the Portuguese population, which is usually characterized by high wine consumption. METHODS: A cross-sectional studies was conducted in 1995/1996 and 1998/1999 in a representative sample of 0.5% of the mainland Portuguese population (49,768 participants in 1995/1996 and 48,606 in 1998/1999), aged 15 years or more. Alcohol consumption was assessed by asking whether the participants had consumed alcohol in the previous week and how many drinks of wine/beer/whiskey/Port wine they consumed on average during that week. RESULTS: Prevalence of reported alcohol consumption decreased slightly between 1995/1996 and 1998/1999 (men: 65.7 vs. 64.0%, p < 0.001; women: 26.9 vs. 26.0%, p < 0.001). Among drinkers, the most frequently consumed alcoholic beverage was wine, followed by beer, whiskey, and Port wine. The amount of alcohol and wine consumed decreased in both sexes, whereas the amount of beer, whiskey, and Port wine consumed increased in men and the increase in beer consumption was borderline significant in women (p = 0.056). In both sexes, participants <50 years of age tended to consume less wine and more beer, whiskey, and Port wine than their older counterparts. Also, higher education was related to a higher frequency of alcohol consumption, whereas smoking was related to a lower consumption of wine [odds ratio (OR): 0.69 (95% confidence interval [CI]: 0.62-0.77) for men and OR: 0.76 (95% CI: 0.61-0.95) for women] and a higher consumption of beer [OR: 1.43 (95% CI: 1.33-1.54) for men and OR: 2.13 (95% CI: 1.84-2.42) for women and whiskey [OR: 1.28 (95% CI: 1.21-1.35) for men and OR: 2.61 (95% CI: 2.25-3.02) for women]. CONCLUSIONS: The pattern of alcohol consumption is changing in Portugal: the prevalence of drinkers is decreasing, and younger generations are shifting from wine to beer and spirits. Educational level seems to be a powerful mediator in the choice of alcoholic beverage.

Health care systems in transition: Portugal

The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability).