Cost-effectiveness of semaglutide 2.4 mg in chronic weight management in Portugal.

BACKGROUND: Obesity and overweight are a significant public health concern. Subcutaneous semaglutide 2.4 mg injection is a glucagon-like peptide-1 (GLP-1) analogue approved by the European Medicines Agency as an adjunct to a reduced calorie diet and increased physical activity (diet and exercise, D&E) for the treatment obesity and overweight in the presence of at least one weight related comorbidity. This study aimed to assess the cost-effectiveness of semaglutide 2.4 mg in combination with D&E compared to D&E alone for the Portuguese setting. METHODS: Analysis were conducted using the Core Obesity Model (COM) version 18, a Markov state transition cohort model, to predict the health outcomes and costs of weight related complications based on changes in surrogate endpoints. Efficacy and safety data were sourced from the STEP trials (Body Mass Index, systolic blood pressure and glycemic status) from a cohort of adults aged on average 48 years with obesity (BMI ≥ 30 kg/m2) and ≥ 1 obesity-related comorbidities, over a time horizon of 40 years. Costs were estimated from the perspective of the Portuguese National Health Service. Sensitivity analyses were conducted to test the robustness of results across a range of assumptions. RESULTS: On a patient level, Semaglutide 2.4 mg in addition to D&E compared to D&E alone, improved QALYs by 0.098 and yielded higher costs by 1,325 EUR over a 40-year time horizon, with an ICER of 13,459 EUR per QALY gained and 100% probability of cost-effectiveness at the given WTP. Semaglutide 2.4 mg remained cost-effective across all different scenarios and sensitivity analysis at a WTP of 20,000 EUR per QALY. Among the subpopulations examined, Semaglutide 2.4 mg yielded ICERs of 18,459 EUR for patients with BMI ≥ 30 kg/m2 and of 22,657 EUR for patients with BMI ≥ 35 kg/m2. CONCLUSIONS: Semaglutide 2.4 mg was cost-effective compared to D&E alone for patients with obesity (BMI ≥ 30 kg/m2) and weight related comorbidities in Portugal, over a 40-year time horizon.

Raw milk cheeses from Beira Baixa, Portugal-A contributive study for the microbiological hygiene and safety assessment.

Due to specific bacterial microbiota, raw milk cheeses have appreciated sensory properties. However, they may pose a threat to consumer safety due to potential pathogens presence. This study evaluated the microbiological contamination of 98 raw milk cheeses from Beira Baixa, Portugal. Presence and enumeration of Coagulase Positive Staphylococci (CPS), Listeria monocytogenes, Salmonella spp., pathogenic Escherichia coli, and indicator microorganisms (non-pathogenic E. coli and Listeria spp.) was attained. E. coli antimicrobial resistance (AMR) was also evaluated. PCR and/or Whole genome sequencing (WGS) was used to characterize E. coli, Salmonella spp. and L. monocytogenes isolates. Sixteen cheeses (16.3%) were classified as Satisfactory, 59 (60.2%) as Borderline and 23 (23.5%) as Unsatisfactory/Potential Injurious to Health. L. monocytogenes, CPS > 104 cfu g-1, Extraintestinal pathogenic E. coli (ExPEC) and Salmonella spp. were detected in 4.1%, 6.1%, 3.1% and 1.0% of the samples, respectively. Listeria innocua (4.1%) and E. coli > 104 cfu g-1 (16.3%) were also detected. AMR E. coli was detected in 23/98 (23.5%) of the cheese samples, of which two were multidrug resistant. WGS identified genotypes already associated to human disease and Listeria spp. cluster analysis indicated that cheese contamination might be related with noncompliance with Good Hygiene Practices during cheese production.

Contribution of high-technology procedures to public healthcare expenditures: the case of ischemic heart disease in Portugal, 2002-2015.

The magnitude of the impact of technological innovations on healthcare expenditure is unclear. This paper estimated the impact of high-technology procedures on public healthcare expenditure for patients with ischemic heart disease (IHD) in Portugal. The Blinder-Oaxaca decomposition method was applied to Portuguese NHS administrative data for IHD discharges during two periods, 2008-2015 vs. 2002-2007 (N = 434,870). We modelled per episode healthcare expenditures on the introduction of new technologies, adjusting for GDP, patient age, and comorbidities. The per episode healthcare expenditure was significantly higher in 2008-2015 compared to 2002-2007 for IHD discharges. The increase in the use of high-technology procedures contributed to 28.6% of this growth among all IHD patients, and to 18.4%, 6.8%, 11.1%, and 29.2% for acute myocardial infarction, unstable angina, stable angina, and other IHDs, respectively. Changes in the use of stents and embolic protection and/or coronary brachytherapy devices were the largest contributors to expenditure growth. High-technology procedures were confirmed as a key driver of public healthcare expenditure growth in Portugal, contributing to more than a quarter of this growth.

Cost-Effectiveness of Inpatient Continuous Glucose Monitoring.

Introduction Our department conducted a retrospective cohort study to compare the efficacy of continuous glucose monitoring devices versus capillary blood glucose in the glycemic control of inpatient type 2 diabetes on intensive insulin therapy in a Portuguese hospital. The use of continuous glucose monitoring devices was associated with improved glycemic control, including an increased number of glucose readings within target range and reduced hyperglycemic events, being safe concerning hypoglycemias. This is the cost-effectiveness analysis associated with these results. Aim The primary objective was to compare the cost-effectiveness of achieving glycemic control, defined as the number of patients within glycemic goals, between groups. Secondary endpoints included cost-effectiveness analyses of each time in range goal, and each percentual increment in time in range. Methods We defined each glycemic goal as: "readings within range (70-180 mg/dL) >70%", "readings below range (below 70 mg/dL) <4%", "severe hypoglycemia (below 54 mg/dL) <1%", "readings above range (above 180 mg/dL) <25%", "very high glycemic readings (above 250 mg/dL) <5%". Results Continuous glucose monitoring showed lower median cost per effect for the primary outcome (€11.1 vs. €34.9/patient), with lower cost for readings in range (€7.8 vs. €11.6/patient) and for both readings above range goals ("above 180mg/dL": €7.4 vs. €9.9/patient, and "above 250mg/dL": €6.9 vs. €17.4/patient). Conclusions There are no published data regarding the cost-effectiveness of continuous glucose monitoring devices in inpatient settings. Our results show that continuous glucose monitoring devices were associated with an improved glycemic control, at a lower cost, and endorse the feasibility of incorporating these devices into hospital settings, presenting a favorable cost-effective option compared to capillary blood glucose.

Assessment of physical activity levels and back pain among poles and Portuguese in the further year of the COVID-19 pandemic - a pilot study.

BACKGROUND: The vast majority of people have experienced the problem of back pain at least once in their lives for a variety of reasons. It is well known that regular physical activity at a moderate level has a number of health benefits regardless of age or gender with positive effects on the musculoskeletal, cardiovascular, respiratory or nervous systems improving fitness levels. During the pandemic, Poland experienced one of the longest periods of school lockdown in Europe. In Portugal, this period was considerably shorter. The aim of this study was to determine the level of physical activity and back pain as well as relationship between physical activity and back pain in a group of Polish and Portuguese students in the following year the COVID-19 pandemic. METHODS: The study was conducted via the Internet among students from Poland and Portugal (398 respondents - 229 from Poland and 169 from Portugal) in October 2022. In the pilot study, the International Physical Activity Questionnaire and The Oswestry Disability Index and Neck Disability Index questionnaires were used to assess the level of back pain. RESULTS: There are no statistically significant differences in the level of physical activity and pain complaints of respondents from the two countries. At least half of the students do not report any pain complaints (median in some groups being 0). In the Portuguese men, there is a correlation between the level of physical activity and the Neck Disability Index score (p = 0.0304). CONCLUSIONS: The following year, after the pandemic COVID-19 was declared, the prevalence of back pain among students in Poland and Portugal is still significant.

Social prescribing for older adults in mainland Portugal: Perceptions and future prospects.

Background: In order to address health inequalities, which have been exacerbated by the COVID-19 pandemic, and promote older adults' quality of life, it is necessary to explore non-medical approaches such as social prescribing. Social prescribing is a person-centered approach that allows health professionals to refer patients to services provided by the social and community sectors. This study aimed to explore older adults' perceptions of social prescribing in mainland Portugal and to identify factors associated with these perceptions, providing insights for future implementation strategies. Methods: A cross-sectional study was conducted with 613 older adults aged 65 to 93. Participants' sociodemographic, economic, and health characteristics were assessed, along with their perceptions of social prescribing's benefits and activity interest. Results: Over 75% of respondents agreed that social prescribing would benefit the health system and their community. Most participants (87.7% and 89.7%, respectively) thought that activities like personal protection and development activities and cultural enrichment would be particularly relevant to them. Factors such as marital status, education, health status, and pain/discomfort levels influenced the perceived relevance of these activities. Conclusion: This study reveals that older adults in mainland Portugal are open to social prescribing and suggests that tailored interventions considering individual preferences and characteristics can lead to more effective implementation and equal access to social prescribing. Further research and policy efforts should focus on integrating social prescribing into the healthcare system to support healthy aging in Portugal.

Assessment and Psychometric Properties of the 21-Item Depression Anxiety Stress Scale (DASS-21) among Portuguese Higher Education Students during the COVID-19 Pandemic.

The COVID-19 pandemic has caused substantial disruptions in the lives of higher education students, with detrimental repercussions for academic performance and overall mental health. Therefore, we aimed to evaluate the prevalence of depression, anxiety, and stress symptoms among Portuguese higher education students during the first wave of the coronavirus pandemic and investigate DASS-21's psychometric characteristics and whether it functions effectively during a pandemic. A convenience sampling procedure was used to recruit 1522 participants (75.1% women and 79.2% undergraduate students) for this cross-sectional research. Participants completed an e-survey created using DASS-21. The results revealed a considerable prevalence of symptoms of depression [≥10] (N = 434, 28.5%), anxiety [≥7] (N = 551, 36.2%), and stress [≥11] (N = 544, 35.7%). Confirmatory factor analysis (CFA) revealed the scale's three-factor structure, which matched the three DASS-21 subscales. Subsequently, the heterotrait-monotrait (HTMT) correlation ratio evaluated the scale's discriminant validity, which was relatively good. Cronbach's alpha measured the internal consistency of the DASS subscales, which was excellent (Cronbach's α > 0.90). DASS-21 was shown to be a reliable and appropriate measure for assessing students' mental health. Furthermore, DASS-21 is recommended for use by academics and healthcare professionals in measuring students' psychological distress. Further validation studies of this scale are needed with larger and more representative samples.

Impact of sociodemographic and economic determinants of health on COVID-19 infection: incidence variation between reference periods.

OBJECTIVES: The COVID-19 pandemic hit Portugal in March 2020, causing widespread disruption to various aspects of society. While extensive research has been conducted on the significance of socio-economic disparities in infection risk, this study aims to enhance our understanding of their evolving relationship over time by analysing four distinct periods in 2020. STUDY DESIGN AND METHODS: This retrospective observational ecological study included individuals residing in the Primary Healthcare Cluster areas of Almada-Seixal and Western Lisbon and Oeiras, who tested positive for SARS-CoV-2 through a polymerase chain reaction (PCR) test between the 2nd of March and the 8th of November of 2020. Using incidence rates for each specific neighbourhood (n = 29) and period, we explored the relationship between neighbourhood-level socio-economic variables and the risk of infection using negative-binomial regression models. RESULTS: In the analysed period, a total of 8562 confirmed COVID-19 cases were identified. Overall incidence rates for each period were sequentially 2.74, 5.03, 3.99 and 14.29 COVID-19 cases per 100,000 person-days. Housing overcrowding, illiteracy rate and place of birth were associated with increased risk of infection, while age, congregate living, and employment in the secondary sector exhibited the opposite association. No association was consistent across all time periods. CONCLUSIONS: Our findings support the idea that the influence of socio-economic determinants of health is not immutable throughout time. In a pandemic context where information, knowledge, beliefs, and behaviours are ever-changing and evolving, a dynamic, inclusive, and adaptable approach to disease control can lead to a more equitable distribution of improved outcomes, benefiting all strata of society.

Prevalence and Risk Factors for Hepatitis E Virus in Wild Boar and Red Deer in Portugal.

Hepatitis E virus (HEV) is a zoonotic foodborne virus with an annual infection prevalence of 20 million human cases, which seriously affects public health and economic development in both developed and developing countries. To better understand the epidemiology of HEV in Central Portugal, a cross-sectional study was conducted from 2016 to 2023 with sera samples from wild ungulates. The seroprevalence and risk factors for HEV seropositivity were evaluated in the present study. Specifically, antibodies against HEV were determined by a commercial enzyme-linked immune-sorbent assay (ELISA). Our results show that in the 650 sera samples collected from 298 wild red deer and 352 wild boars in Portugal, 9.1% red deer and 1.7% wild boar were positive for antibodies to HEV. Regarding age, the seropositivity in juvenile wild ungulates was 1.3%, whereas it was 7.2% in adults. Logistic regression models investigated risk factors for seropositivity. The odds of being seropositive was 3.6 times higher in adults than in juveniles, and the risk was 4.2 times higher in red deer than in wild boar. Both wild ungulate species were exposed to HEV. The higher seroprevalence in red deer suggests that this species may make a major contribution to the ecology of HEV in Central Portugal. Further research is needed to understand how wildlife affects the epidemiology of HEV infections in Portugal.

Cystoisospora suis in Portugal: an observational study of prevalence, management, and risk factors.

BACKGROUND: Neonatal coccidiosis is a common and important disease of suckling piglets in modern farming caused by Cystoisospora suis. Prevalence rates are high, namely, in Portugal, although no recent data are available. The metaphylactic administration of a single dose of toltrazuril and hygienic measures are the backbone of control strategies on positive farms. However, several studies have shown that these programs are not always effective, underlining the need to revise the risk factors and control strategies currently applied. The present study evaluated C. suis prevalence on Portuguese farms and assessed the risk factors associated with facilities and farm rearing practices. RESULTS: From the 27 tested farms, 23 were positive to Cystoisopora suis (85.2%). In total, 258 litters were sampled (accounting for 516 samples-2 samples per litter), with an average of 59.7% of positive litters per positive farm. Faecal pools from litters, in which liquid faeces predominated had a higher probability of containing oocysts than litter pools with mainly solid (Odds Ratio: 9.87; p < 0.0001) or pasty faeces (OR: 7.05; p = 0.001), and samples obtained from younger animals had higher oocyst counts (coefficient: - 0.0720; 95% CI - 0.125; - 0.019). No significant effect of toltrazuril administration was observed on the positivity rate, and none of the tested farms used disinfectants with official claims against parasites and known anticoccidial effects (e.g., cresol-based products). CONCLUSIONS: The C. suis prevalence on Portuguese swine farms appears to be similar to the prevalence found in other European countries. Repeated sampling of the same litter and the use of autofluorescence microscopy after a modified Ritchie technique seems to have increased sensitivity and consequently the detection rate of positive litters. Finally, despite the common use of oral toltrazuril, C. suis control programs appear to not always be effective (based on the detection of oocysts in faecal samples), suggesting the need to revise the control strategies applied in the field, including management factors and choices of disinfectant products.

Picturing Prevalence and Inequalities in Cancer Screening Attendance to Population-Based Programs in Portugal.

INTRODUCTION: Screening is effective in reducing cancer-related morbidity and mortality. The aim of this study was to analyze the level of, and income-related inequalities in, screening attendance, in Portugal for population-based screening programs. METHODS: Data from the Portuguese Health Interview Survey 2019 was used. Variables included in the analysis were self-reported: mammography, pap smear test, fecal occult blood test. Prevalence and concentration indices were computed at national/regional level. We analyzed: up-to-date screening (within recommended age/interval), under-screening (never or overdue screening), and over-screening (due to frequency higher than recommended or screening outside target group). RESULTS: Up-to-date screening rates were 81.1%, 72%, and 40%, for breast, cervical and colorectal cancer, respectively. Never-screening was 3.4%, 15.7%, and 39.9%, for breast, cervical, and colorectal cancer, respectively. Over-screening related with frequency was highest for cervical cancer; in breast cancer, over-screening was observed outside recommended age, affecting one third of younger women and one fourth of older women. In these cancers, over-screening was concentrated among women with higher income. Never-screening was concentrated among individuals with lower income for cervical cancer and higher income for colorectal cancer. Beyond the recommended age, 50% of individuals never underwent screening for colorectal cancer and 41% of women never underwent screening for cervical cancer. CONCLUSION: Overall, screening attendance was high, and inequalities were low in the case of breast cancer screening. The priority for colorectal cancer should be to increase screening attendance.

Socio-economic factors affecting the distribution of marine litter: The Portuguese case study.

Marine litter is a growing global problem with serious environmental, economic, social, and health threats. Understanding the socio-economic factors that influence the types and amounts of litter is of utmost importance. In this study, an integrative analysis of the socio-economic factors that characterize the beach litter distribution in continental Portugal and the Azores archipelago was conducted via a cluster analysis, implementing a novel technique to support the difficult task of marine litter characterization. The results highlighted that the most abundant beach litter material is plastic (92.9 %), followed by paper (2.2 %), wood (1.5 %), and metal (1.3 %). The majority of the items could not be attributed to a specific source (46.5 %). The remaining were attributed to public litter (34.5 % of total aggregated items), fishing (9.8 %), sewage-related debris (6.4 %) and shipping (2.2 %). The top-three beach litter categories were small plastic pieces (0-2.5 cm, 43.5 %), cigarette butts (30.1 %), and medium plastic pieces (2.5-50 cm, 26.4 %). A positive relation between both municipality environment expenditures and population density and the quantity and typology of litter was found. Beach litter quantity and categories were also associated with specific economic sectors, as well as with geographical/hydrodynamic conditions, demonstrating the utility of the technique and its applicability to other regions.

Active aging awareness and well-being among older adults in Portugal.

Objective: This study aims to assess the active aging awareness of older adults in mainland Portugal and their levels of overall well-being and to identify social and health-related factors. Methods: A cross-sectional study was conducted with a representative sample of 613 older adults, aged 65 or older, who participated in the PROKnos - Knowing Social Prescribing needs of the elderly study in Portugal. The questionnaire consisted of the Active Ageing Awareness Questionnaire and the World Health Organization - Five Well-Being Index, as well as sociodemographic, economic, and health status questions. Correlation coefficients, t-tests for independent samples, and one-way ANOVA were used to explore potential associations between variables. Results: The active aging awareness levels were significantly higher for women (p = 0.031), and those who were younger (p = 0.011), more educated (p < 0.001), had a better financial situation (p < 0.001), and had better health (p < 0.001). The same pattern was found for well-being, except in relation to gender, as men had higher levels (p = 0.016). These variables were found to be correlated. Discussion: Even though active aging is an important strategy to implement, it is indispensable to consider the perceptions and conditions that need to be in place before that. This study reveals that several social and health-related factors are associated with well-being and active aging awareness, as well as the differences between groups that exist in mainland Portugal in relation to that. This emphasizes how vital it is to address social inequalities in active aging efforts, which are not necessarily uncovered when only considering actual active aging measures.

Health outcomes and budget impact projection of anti-PD-(L)1s in cancer care in Portugal.

Introduction: PD-[L]1 inhibitors revolutionized cancer treatment but challenge the affordability of health systems. This policy-focused model aimed to estimate the health and budget impact of anti-PD-(L)1s in Portugal and inform current discussions. Materials and methods: The Health Impact Projection (HIP) model estimates clinical (life years, progression-free survival [PFS] years, and quality-adjusted life years [QALY] gained and adverse events [AEs] incurred) and economic (direct and indirect costs) outcomes in a world where cancer patients are initiating treatment with standard-of-care (SOC) versus SOC plus anti-PD-(L)1s over a 3-year time horizon. Indications included adjuvant and metastatic melanoma, non-small cell lung cancer (first and second line), metastatic triple-negative breast cancer, head and neck cancer, urothelial carcinoma, and renal cell carcinoma. Model inputs were based on publicly available literature data and expert opinion. Results: The model estimated that, over 3 years, 7,773 patients would be treated with anti-PD-(L)1s, realizing a gain of 4,787 life years, 6,901 PFS years, and 4,214 QALYs and avoiding 399 AEs. The introduction of anti-PD-(L)1s had a projected average annual impact of ≈ €108 million and a share of 20% of total cancer medicines expenditure and 0.6% of total healthcare expenditure in 2021. Although higher disease management costs are expected for patients living longer with anti-PD-(L)1s and drug acquisition costs are considerable, that is partially offset by a reduction in end-of-life costs (€611,092/year) and costs associated with patient productivity lost to cancer (€9,128,142/year). Discussion: This model highlights the significant survival and QoL benefit of anti-PD-(L)1s for cancer patients in Portugal, with a relatively low increased cost in total healthcare expenditure.

[Prescribing Trends of Benzodiazepine and other Sedatives in the Lisbon and Tagus Valley Regional Health Administration between 2013 and 2020: A Retrospective Study]. / Prescrição de Benzodiazepinas e outros Sedativos na Administração Regional de Saúde de Lisboa e Vale do Tejo de 2013 a 2020: Um Estudo Retrospetivo.

INTRODUCTION: Among the Organization for Economic Co-operation and Development members, Portugal has the highest reported consumption of anxiolytics, hypnotics, and sedatives, of which a large proportion are benzodiazepines or related drugs. These are known to cause tolerance and dependence. Other drugs with hypnotic effect, such as antidepressants, antihistamines, antipsychotics, or anticonvulsants have been identified by some reports as alternatives to benzodiazepines for the treatment of insomnia. In this regard, the aim of this study was to characterize the consumption of benzodiazepines, non-benzodiazepine anxiolytic, hypnotic or sedative effect drugs and other drugs with the potential to be used off-label to treat insomnia, and the results concerning benzodiazepine consumption related indicators in the primary health care setting in the Lisbon and Tagus Valley region. MATERIAL AND METHODS: From 2013 to 2020, a census, descriptive and retrospective study was conducted. The evolution of the variables total defined daily doses, defined daily doses per 1000 inhabitants per day (DHD) and relevant indicators were characterized. Data were extracted from the SIARS platform used in the Lisbon and Tagus Valley regional Health Administration. RESULTS: There was a decrease in the consumption of benzodiazepines (from 57.44 to 63.11 DHD) and an increase of non-benzodiazepines and of drugs with potential off-label use (from 6.56 to 8.56 DHD and from 14.70 to 25.95 DHD, respectively). Among non-benzodiazepines, zolpidem was the most consumed drug, also showing an increasing trend (from 4.86 to 6.96 DHD). For the group of drugs with off-label use potential, there was an increased consumption of trazodone (from 3.81 to 7.92 DHD), mirtazapine (from 3.52 to 6.48 DHD), pregabalin (from 3.15 to 4.87 DHD), quetiapine (from 2.68 to 4.59 DHD) and gabapentin (from 1.32 to 1.90 DHD), which was only the case (or, at least, more significantly) for the lower dose formulations. The median of results of the Primary Health Care setting indicator "proportion of elderly patients without prescription of sedatives, anxiolytics, and hypnotics", was 81.0 in 2015 and increased to 84.9 in 2020. For the indicator "proportion of patients without prolonged prescription of sedatives, anxiolytics, and hypnotics", the median was 93.6 in 2019 and 94.3 in 2020. CONCLUSION: There was, overall, a decreasing trend in the dispensing of benzodiazepines in the Lisbon and Tagus Valley Region. Even though this data suggests a change in the therapeutic pattern for insomnia, more robust studies are needed to confirm this observation.

Introdução: Portugal é o país da Organização para a Cooperação e Desenvolvimento Económico com maior consumo de ansiolíticos, hipnóticos e sedativos, sendo uma proporção significativa constituída por benzodiazepinas ou análogos, associados a efeitos de tolerância e dependência. Por este motivo, em alternativa às benzodiazepinas para tratamento da insónia, algumas publicações identificam outros fármacos com efeito hipnótico, como antidepressivos, anti-histamínicos, antipsicóticos ou anticonvulsivantes. Assim, torna-se necessário compreender a evolução do consumo destes medicamentos, pelo que foi objetivo deste estudo avaliar a evolução da dispensa de benzodiazepinas, outros fármacos ansiolíticos, hipnóticos ou sedativos não benzodiazepínicos, fármacos com potencial uso off-label na insónia e os resultados de indicadores dos Cuidados de Saúde Primários neste âmbito na região de Lisboa e Vale do Tejo. Material e Métodos: Realizou-se um estudo em base de dados, censitário e retrospetivo, no período de 2013 até 2020, avaliando-se a evolução das variáveis total de doses diárias definidas, doses diárias definidas por 1000 habitantes por dia (DHD) e dos indicadores relevantes. Os dados foram extraídos da plataforma SIARS da Administração Regional de Saúde de Lisboa e Vale do Tejo. Resultados: Verificou-se uma diminuição da dispensa de benzodiazepinas (de 57,44 para 51,77 DHD) mas o aumento da dispensa de não benzodiazepinas e de fármacos com potencial uso off-label (de 6,56 para 8,56 DHD e de 14,70 para 25,92 DHD, respetivamente). O zolpidem foi o mais dispensado entre os fármacos não benzodiazepínicos, acompanhando a tendência crescente de dispensa (de 4,86 para 6,96 DHD). Do conjunto de fármacos com potencial para uso off-label verificaram-se aumentos da dispensa para a trazodona (de 3,81 para 7,92 DHD), mirtazapina (de 3,52 para 6,48 DHD), pregabalina (de 3,15 para 4,87 DHD), quetiapina (de 2,68 para 4,59 DHD) e gabapentina (de 1,32 para 1,90 DHD), mas mais significativo ou apenas verificado nas formulações com dosagem mais baixa. A mediana dos resultados do indicador "proporção de idosos sem prescrição de sedativos, ansiolíticos e hipnóticos" em 2015 foi de 81,0, tendo em 2020 aumentado para 84,9. A mediana do indicador "proporção de utentes sem prescrição prolongada de ansiolíticos, sedativos e hipnóticos" em 2019 foi de 93,6 e aumentou para 94,3 em 2020. Conclusão: Globalmente, verificou-se uma redução da dispensa de benzodiazepinas prescritas na Região de Lisboa e Vale do Tejo. Parece existir uma alteração do padrão de prescrição no tratamento da insónia. São necessários estudos mais robustos para confirmar esta observação.

Enhancing environmental quality in Portugal: can CO2 intensity of GDP and renewable energy consumption be the solution?

Despite Portugal's effort to reduce carbon emissions, the country still emits about 1.6% of the European Union's CO2 emissions. Meanwhile, limited empirical studies have been undertaken in the context of Portugal. As a result, this study examines the asymmetric and long-term impact of CO2 intensity of GDP, energy consumption, renewable energy and economic growth on CO2 emissions in Portugal from 1990 to 2019. The nonlinear autoregressive distributed lag (NARDL) is employed to uncover the asymmetric connection. The findings show that there is nonlinear cointegration among the variables. The long-run estimation reveals a positive change in energy consumption positively affects CO2 emissions, while a negative shock in energy consumption has a neutral effect on CO2 emissions. Furthermore, positive shocks of economic growth and CO2 intensity of GDP enhance environmental deterioration by increasing CO2 emissions. Meanwhile, the negative shock of these regressors positively impacts CO2 emissions. In addition, positive shocks in renewable energy enhance environmental quality, while negative shocks in renewable energy increase environmental deterioration in Portugal. Policymakers should focus on reducing per-unit energy usage and CO2 efficiency gains, which would necessitate a significant reduction in CO2 intensity and energy density of GDP.

Prevalence and Predictive Factors of Exclusive Breastfeeding in the First Six Months of Life.

INTRODUCTION: Exclusive breastfeeding (EBF) is currently recommended until six months of age. The Baby-friendly Hospital (BFH) initiative an international program to promote breastfeeding, was launched in Portugal in 1994. The aim of this study was to identify the prevalence and factors influencing breastfeeding in the first six months of life and to compare the results with a study carried out in 1999 including population from the same geographic area. MATERIAL AND METHODS: A prospective, longitudinal and observational study was carried out in two hospitals in the Lisbon metropolitan area, one BFH and another non-BFH. It consisted of different questionnaires answered by mothers at three distinct moments (zero, three and six months). The first questionnaire was applied between February and June 2019. RESULTS: A total of 423 infants were included, 324 from the BFH and 99 from the non-BFH. The breastfeeding rate was 94.3% at discharge, 78.2% at three months and 64.4% at six months, whereas EBF rate was 74.2%, 51.8% and 25.6% respectively. All women on EBF at six months, except one, were breastfeeding on demand. The discontinuation of EBF was associated with delayed skin-to-skin contact, Neonatal Intensive Care Unit admission, pacifier and artificial teats use, mother's return to work earlier and lower education levels. Conversely, factors that promote EBF were older gestational age, adequate birthweight, breastfeeding initiation in the first hour of life, rooming-in practice, shorter hospital stay and absence of infant's illnesses. Compared with 1999, although there was a significant improvement of breastfeeding rates at three and six months, the EBF rate was similar at six months (23%). Both studies identified the mother's lower education level and mother's return to work as contributing factors to breastfeeding discontinuation. CONCLUSION: Our results are in agreement with previously reported causes of breastfeeding discontinuation and emphasize the importance of sociocultural factors. Compared with 1999, the breastfeeding rates in this Portuguese population increased significantly at three and six months. However, it is still necessary to improve in order to achieve the World Health Organization global target.

Cost-effectiveness of influenza vaccination with a high dose quadrivalent vaccine of the elderly population in Belgium, Finland, and Portugal.

BACKGROUND: Seasonal influenza may result in severe outcomes, resulting in a significant increase of hospitalizations during the winter. To improve the protection provided by the standard dose influenza quadrivalent vaccine (SDQIV), a high-dose vaccine (HDQIV) has been developed specifically for adults aged 60 and older who are at higher risk of life-threatening complications. OBJECTIVES: The aim of this study was to determine the cost-effectiveness of HD QIV vs. SD-QIV in the recommended population of three European countries: Belgium, Finland and Portugal. METHODS: A cost-utility analysis comparing HDQIV vs. SDQIV was conducted using a decision tree estimating health outcomes conditional on influenza: cases, general practitioner and emergency department visits, hospitalizations and deaths. To account for the full benefit of the vaccine, an additional outcome-hospitalizations attributable to influenza-was also evaluated. Demographic, epidemiological and economic inputs were based on the respective local data. HDQIV relative vaccine efficacy vs. SDQIV was obtained from a phase IV efficacy randomized clinical trial. The incremental cost-effectiveness ratios (ICER) were computed for each country, and a probabilistic sensitivity analysis (1,000 simulations per country) was performed to assess the robustness of the results. RESULTS: In the base case analysis, HDQIV resulted in improved health outcomes (visits, hospitalizations, and deaths) compared to SDQIV. The ICERs computed were 1,397, 9,581, and 15,267 €/QALY, whereas the PSA yielded 100, 100, and 84% of simulations being cost-effective at their respective willingness-to-pay thresholds, for Belgium, Finland, and Portugal, respectively. CONCLUSION: In three European countries with different healthcare systems, HD-QIV would contribute to a significant improvement in the prevention of influenza health outcomes while being cost-effective.

[Validation of the European Portuguese Version of a Pediatric Palliative Needs Assessment Tool: The Pediatric Palliative Screening Scale]. / Validação da Versão Portuguesa de um Instrumento de Avaliação de Necessidades Paliativas Pediátricas: A Pediatric Palliative Screening Scale.

INTRODUCTION: The Pediatric Palliative Screening Scale (PaPaS Scale) was designed to help professionals to identify life-limiting or life-threatening children/young people with complex chronic conditions who would benefit from pediatric palliative care and facilitate their timely and appropriate referral. The aim of this study was to translate, culturally adapt and validate the PaPaS Scale for the Portuguese pediatric population. MATERIAL AND METHODS: A quantitative methodological study involving translation, cultural adaptation and validation of a scale was performed. In the first phase, the translation and cultural adaptation of the original version of the PaPaS Scale from English to European Portuguese was undertaken. The second phase consisted of evaluating the psychometric properties of the Portuguese version of the PaPaS Scale. RESULTS: Fifty-one enquires pertaining to children/young adults with complex chronic conditions were completed and returned, the sum of the responses to the items on the scale revealed that 84.4% of the patients had an indication for referral to pediatric palliative care. The internal consistency analysis obtained a value of Cronbach's alpha above 0.80, so the scale was considered adequate for the analyzed data. In our sample, the item-total correlation values indicated that the 11 variables measured the PaPaS Scale with good reliability and unidimensionally. The confirmatory factor analysis suggested that the items were significant, consistent, and presented convergent validity globally. Only item "2.2. Treatment side effects" obtained a value below the defined threshold. CONCLUSION: The PaPaS Scale was translated and adapted to the European Portuguese version, allowing its immediate use in the Portuguese population. It will be essential to design multicentric studies to expand the knowledge about the psychometric characteristics of this scale.

Introdução: A Pediatric Palliative Screening Scale (PaPaS Scale) foi desenhada para ajudar os profissionais a identificar as crianças/jovens com doença crónica complexa, limitante ou ameaçadora da vida que beneficiariam de cuidados paliativos pediátricos e facilitar referenciação atempada e apropriada. O objetivo deste estudo foi traduzir, adaptar culturalmente e validar a PaPaS Scale para a população pediátrica portuguesa. Material e Métodos: Realizou-se um estudo metodológico quantitativo de tradução, adaptação cultural e validação de uma escala. Numa primeira fase, procedeu-se à tradução e adaptação cultural da versão original da PaPaS Scale de inglês para português europeu. A segunda fase consistiu na avaliação das propriedades psicométricas da versão portuguesa da Escala PaPaS. Resultados: Numa amostra de 51 questionários referentes a crianças/jovens com doença crónica complexa, a soma das respostas aos itens da escala revelou que 84,4% dos doentes tinham indicação para ser referenciados aos cuidados paliativos pediátricos. Na análise de consistência interna obteve-se um valor do alfa de Cronbach superior a 0,80, pelo que se pôde considerar a escala como adequada aos dados analisados. De facto, os valores de correlação item-total indicaram que as 11 variáveis mediram com boa fiabilidade e de forma unidimensional a escala PaPaS. Na análise fatorial confirmatória, os resultados obtidos indicaram que globalmente os itens eram significativos, consistentes e apresentaram validade convergente. Apenas o item "2.2. Efeitos secundários do tratamento" obteve um valor abaixo do limiar definido. Conclusão: A PaPaS Scale foi traduzida e adaptada para a versão em português europeu, o que permite a sua utilização imediata na população portuguesa. Torna-se importante o desenho de estudos, preferencialmente multicêntricos, que aprofundem as características psicométricas desta escala.