Seroprevalence of SARS-CoV-2 and assessment of epidemiologic determinants in Portuguese municipal workers.

OBJECTIVES: To assess the seroprevalence of SARS-CoV-2 antibodies in municipal employees of Northern Portugal during the first pandemic wave (May-June 2020) and its association with potentially related risk factors for infection. MATERIAL AND METHODS: The authors assessed municipal employees of 2 cities in Northern Portugal, in whom serological tests to SARS-CoV-2 and an epidemiological survey were applied. The authors assessed the proportion of individuals presenting IgM and/or IgG antibodies to SARS-CoV-2, and evaluated the association between having positive serological test results, epidemiologic variables and clinical presentations. Reported symptoms were evaluated on their sensitivity, specificity, and predictive values. RESULTS: The authors assessed 1696 employees, of whom 22.0% were firefighters, 10.4% were police officers, 10.3% were maintenance workers, and 8.1% were administrative assistants. The seroprevalence of SARS-CoV-2 infection was 2.9% (95% CI: 2.1-3.7%). Administrative assistants comprised the professional group with highest seroprevalence of SARS-CoV-2 (OR = 1.9 in the comparison with other occupational groups, 95% CI: 0.8-4.3, p = 0.126). The seroprevalence of SARS-CoV-2 infection among those who were in direct contact with COVID-19 patients in their professional activity was 3.9%, compared to 2.7% among those who were not in direct contact with such patients (OR = 1.5, 95% CI: 0.8-2.8, p = 0.222). The highest risk of infection was associated with the presence of a confirmed SARS-CoV-2 infection in the household (OR = 17.4, 95% CI: 8.3-36.8, p < 0.001). Living with a healthcare professional was not associated with a higher risk of infection (OR = 1.0, 95% CI: 0.4-2.5, p = 0.934). Anosmia/ dysgeusia was the symptom with the highest positive predictive value (52.2%, 95% CI: 31.8-72.6, p < 0.001) and specificity (99.3%, 95% CI: 98.9-99.7, p < 0.001), while cough was the most prevalent symptom among SARS-CoV-2 seropositive participants (36%). CONCLUSIONS: The authors observed a SARS-CoV-2 seroprevalence of 2.9% among assessed municipal employees. Anosmia/dysgeusia was the COVID-19 symptom which displayed the highest positive predictive value and specificity. Int J Occup Med Environ Health. 2022;35(3):297-307.

HIV disease burden, cost, and length of stay in Portuguese hospitals from 2000 to 2010: a cross-sectional study.

BACKGROUND: The number of HIV-related hospitalizations has decreased worldwide in recent years owing to the availability of highly active antiretroviral therapy. However, the change in HIV-related hospitalizations in Portugal has not been studied. Using comprehensive hospital discharge data from mainland Portuguese hospitals, we examined trends in HIV-related inpatient admissions, length of stay (LOS), Elixhauser comorbidity measures, in-hospital mortality, and mean cost from 2000 to 2010. METHODS: The hospital administrative data from inpatient admissions and discharges at 75 public acute care hospitals in the Portuguese National Health Service from 2000 to 2010 were included. HIV-related admissions were identified using the International Classification of Diseases, 9(th) Revision, Clinical Modification diagnosis codes 042.x-044.x. The effect of Elixhauser comorbidity measures on extending the LOS was assessed by comparing admissions in HIV patients with and without comorbidities using the Mann-Whitney U test. Multivariate logistic regression was performed to estimate the odds of having a decreased discharge. RESULTS: A total of 57,027 hospital admissions were analyzed; 73% of patients were male, and the mean age was 39 years. The median LOS was 11 days, and the in-hospital mortality was 14%. The mean cost per hospitalization was 5,148.7€. A total of 83% of admissions were through the emergency room. During the period, inpatient HIV admissions decreased by 22%, LOS decreased by 9%, and in-hospital mortality dropped by 12%. Elixhauser comorbidities increased the median LOS in nearly all admissions. CONCLUSIONS: Despite small regional variations, a strong, consistent decrease was observed in the hospital admission rate, mean cost, length of stay, and mortality rate for HIV-related admissions in Portugal during 2000-2010.

Definition of a core set of quality indicators for the assessment of HIV/AIDS clinical care: a systematic review.

BACKGROUND: Several organizations and individual authors have been proposing quality indicators for the assessment of clinical care in HIV/AIDS patients. Nevertheless, the definition of a consensual core set of indicators remains controversial and its practical use is largely limited. This study aims not only to identify and characterize these indicators through a systematic literature review but also to propose a parsimonious model based on those most used. METHODS: MEDLINE, SCOPUS, Cochrane databases and ISI Web of Knowledge, as well as official websites of organizations dealing with HIV/AIDS care, were searched for articles and information proposing HIV/AIDS clinical care quality indicators. The ones that are on patient's perspective and based on services set were excluded. Data extraction, using a predefined data sheet based on Cochrane recommendations, was done by one of the authors while a second author rechecked the extracted data for any inconsistency. RESULTS: A total of 360 articles were identified in our search query but only 12 of them met the inclusion criteria. We also identified one relevant site. Overall, we identified 65 quality indicators for HIV/AIDS clinical care distributed as following: outcome (n=15) and process-related (n=50) indicators; generic (n=36) and HIV/AIDS disease-specific (n=29) indicators; baseline examinations (n=19), screening (n=9), immunization (n=4), prophylaxis (n=5), HIV monitoring (n=16), and therapy (=12) indicators. CONCLUSIONS: There are several studies that set up HIV clinical care indicators, with only a part of them useful to assess the HIV clinical care. More importantly, HIV/AIDS clinical care indicators need to be valid, reliable and most of all feasible.

Promoting spontaneous adverse drug reaction reporting in hospitals using a hyperlink to the online reporting form: an ecological study in Portugal.

BACKGROUND: Spontaneous adverse drug reaction (ADR) reporting has been described as an efficient method to detect drug safety signals. However, under-reporting is a major issue undermining the effectiveness of spontaneous reports. Among hospitalized patients, ADRs are a particularly serious problem because these patients are often treated with more than one drug, and these drugs are often new and aggressive. OBJECTIVE: To promote spontaneous ADR reporting by healthcare professionals working in hospitals in the northern regions of Portugal, we propose the inclusion of a hyperlink to an online ADR reporting form on hospitals' electronic patient records (EPRs). The main aim of this study was to evaluate the impact of these hyperlinks on the number of spontaneous ADR reports to the Northern Pharmacovigilance Centre (UFN - Unidade de Farmacovigilância do Norte). We also assess the number of daily UFN website visits before and after the inclusion of the hyperlinks. METHODS: An ecological study was performed in northern Portuguese hospitals from 2006 to 2010. The hyperlinks were included in either EPRs or on computer desktops. The median of spontaneous ADR reports (total and online) per month and the respective ranges were presented before and after the intervention in all hospitals in this study. The comparisons were performed using the Mann-Whitney U-test. RESULTS: Sixteen hospital centres were involved in the study (27 hospitals). Eleven centres (18 hospitals) included the hyperlinks. Considering the hospitals with hyperlink access to the EPRs, the median ADR reports per month significantly increased, from two (range 0-12) to five reports (range 1-17). The median of ADR reports per month using the online form also increased significantly, from one (range 0-5) before the intervention to four (range 1-17) after it. Moreover, serious ADRs increased 3-fold, and non-previously described ADRs increased 4.5-fold. None of these significant increases were observed in the hospitals where the hyperlink was not installed. We also found a significant increase in daily UFN website visits, from ten before the intervention to 27 after it (p < 0.001). CONCLUSION: The increase in ADR reporting shows that the inclusion of hyperlinks to online ADR reporting forms is an easy and cost-effective way to change health professional behaviours with regard to spontaneous ADR reports.

Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia.

BACKGROUND: The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia may lead to early diagnosis of gastric cancer. However, to-date no cost-effective model has been proposed. Improved endoscopic examination using magnification chromoendoscopy together with non-invasive functional assessment with pepsinogen serum levels are accurate in the diagnosis of intestinal metaplasia (extension) and minute dysplastic lesions. The aim of this study was to assess the feasibility and cost-effectiveness of a follow-up model for patients with atrophic chronic gastritis and intestinal metaplasia based on gastric mucosal status using magnification chromoendoscopy and pepsinogen. METHODS: A cohort of patients with lesions as severe as atrophic chronic gastritis were followed-up according to a standardized protocol using magnification chromoendoscopy with methylene blue and measurement of serum pepsinogen I and II levels. A single node decision tree and Markov chain modeling were used to define cost-effectiveness of this follow-up model versus its absence. Transition rates were considered time-independent and calculated using primary data following cohort data analysis. Costs, quality of life and survival were estimated based on published data and extensive sensitivity analysis was performed. RESULTS: A total of 100 patients were successfully followed-up over 3 years. Seven cases of dysplasia were diagnosed during follow-up, all among patients with incomplete intestinal metaplasia at baseline, six of whom had extensive (pepsinogen I to II ratio <3) incomplete intestinal metaplasia. For those individuals with atrophic chronic gastritis or complete intestinal metaplasia, a yearly measurement of pepsinogen levels or an endoscopic examination on a 3-yearly basis would cost 455 euros per quality-adjusted life year (QALY) gain. Endoscopic examination and pepsinogen serum level measurement on a yearly basis would cost 1868 euros per QALY for patients with extensive intestinal metaplasia. CONCLUSIONS: The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia is both feasible and cost-effective if improved accurate endoscopic examination of gastric mucosa together with non-invasive assessment of gastric mucosal status are used to identify individuals at high-risk for development of gastric cancer.