The new automated daily mortality surveillance system in Portugal.

The experience reported in an earlier Eurosurveillance issue on a fast method to evaluate the impact of the 2003 heatwave on mortality in Portugal, generated a daily mortality surveillance system (VDM) that has been operating ever since jointly with the Portuguese Heat Health Watch Warning System. This work describes the VDM system and how it evolved to become an automated system operating year-round, and shows briefly its potential using mortality data from January 2006 to June 2009 collected by the system itself. The new system has important advantages such as: rapid information acquisition, completeness (the entire population is included), lightness (very little information is exchanged, date of death, age, sex, place of death registration). It allows rapid detection of impacts (within five days) and allows a quick preliminary quantification of impacts that usually took several years to be done. These characteristics make this system a powerful tool for public health action. The VDM system also represents an example of inter-institutional cooperation, bringing together organisations from two different ministries, Health and Justice, aiming at improving knowledge about the mortality in the population.

Early estimates of the excess mortality associated with the 2008-9 influenza season in Portugal.

The aim of this study was to estimate the excess mortality associated with the influenza activity registered in Portugal between week 49 of 2008 and week 5 of 2009. For this purpose available mortality data from the Portuguese Daily Mortality Monitoring (VDM) System was used. Several estimates of excess deaths associated with the recent recorded influenza activity were determined through statistical modelling (cyclic regression) for the total population and disaggregated by gender and age group. The results show that the impact of the 2008-9 influenza season was 1,961 excess deaths, with approximately 82% of these occurring in the age group of 75 years and older.

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.

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 Observatório Nacional de Saúde (ONSA) - Instituto Nacional de Saúde Dr. Ricardo Jorge, together with the Vigilância Previsão e Informação - Instituto de Meteorologia, created a surveillance system called ÍCARO, which has been in operation since 1999. ÍCARO 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.

Leptospirosis in Portugal: epidemiology from 1991 to 1997.

The term leptospirosis describes a group of diseases caused by members of the order Spirochaetales, mainly the species Leptospira interrogans. Infection can be asymptomatic but disease of differing severity and clinical features (often suggestive of menin

Programme for the surveillance of influenza in Portugal: results of the period 1990-1996.

OBJECTIVES: To describe the situation of the influenza in Portugal through the estimates of the incidence rates and the identification of the viral strains implicated on it during the period 1990-1996. DESIGN: The integrated clinical and laboratory surveillance system for influenza in Portugal is based on the Portuguese sentinel network. Influenza cases are identified by general practitioners (GP) and notified to Division of Epidemiology (DEP) and to National Influenza Centre. Clinical and epidemiological data based on the clinical diagnosis are recorded and incidence rates are computed for the whole country. Throat swabs and blood samples are taken from the patients with influenza and sent to the National Influenza Centre to identify and classify the viral strains implicated. PARTICIPANTS: Lists of patients of the GPs collaborating on "Médicos-Sentinela" network. RESULTS: In 1990-1991, 1992-1993, and 1994-1995 there was a higher prevalence of influenza B virus and the highest influenza activity occurred in February and March in contrast with 1991-1992, 1993-1994, and 1995-1996 where the highest numbers of influenza cases occurred in November and December, and were associated with influenza A. CONCLUSIONS: During the past six years, 1990-1996, the influenza activity has been moderate in Portugal. From 1990-1996 influenza A and B viruses were prevalent every second year. The prevalence of influenza A was associated with the occurrence of the highest number of influenza cases during December and January and the prevalence of influenza B with the occurrence of the highest number of influenza cases during February and March.

[Cerebrovascular diseases in Portugal: some epidemiological aspects]. / Doenças cerebrovasculares em Portugal: alguns aspectos epidemiológicos.

The Portuguese population is affected by the highest mortality rates in all the countries of the European Union. The highest mortality rates occur in some districts on the north coast where, in 1995, the rates standardised by age were above 200/100,000/annum, with the lowest figures in some districts in the interior and in Lisbon. These mortality rates have had a downward trend, but inferior to what is desired, or what occurs in other developed countries. The Autonomous Region of Madeira had a more significant percentage reduction (40%), followed by the Autonomous Region of the Azores (25%). Little is known of the effects of sporadic occurrences on the mortality associated to cerebrovascular disease. The consequences of two of these occurrences are described: the heat wave in June 1981 and the influenza epidemic in 1988-89. The number of deaths due to cerebrovascular diseases in the period corresponding to the heat wave was 2.2 times higher than expected, while during the influenza epidemic cerebrovascular diseases were the most common cause of death (25.8%) contributing to excess mortality. It is imperative that instruments be created to more accurately estimate the importance of this group of diseases in Portugal in what concerns incidence, resulting disability and health care requirements as well as social and financial costs for the individuals, the families and the community.

The prevalence of Parkinson's disease in Portugal. A population approach.

Most of the epidemiological studies designed to determine the prevalence of Parkinson's disease (PD) in Portugal were hospital-based and the rates reported were around 1/1000. A sentinel network of general practitioners (GPs) has been in effect in the country since 1989, involving doctors with a relatively stable list of patients. This group of doctors notifies, every week, all the cases of certain selected diseases that may occur among the patients under their surveillance. On average, each doctor is responsible for 1500 to 1800 persons, of all ages and both sexes, whose main descriptive characteristics are known and updated every year. This led us to the idea of estimating the prevalence of Parkinson's disease in the community and to compare the estimated rates with hospital-based rates. One hundred and fifty general practitioners agreed to participate in a cross-sectional study which included a sample of 220,000 persons. The study took place between March and April 1992 and information on 291 PD patients was collected. Results show that among the study population, age-standardized rates were 1.4/1000 for males and 1.3/1000 for females. Sex-specific rates increase consistently with age in both sexes, reaching a level of 9/1000 in the oldest age group, '75 and more' years. These results estimate a higher prevalence of PD than was determined previously through hospital-based studies and allowed us to determine that patients aged 65 years and more are much likely to be followed by their own GP, either because the disease its already controlled and they are specifically seeking medication or because they find it difficult to attend neurology clinics.(ABSTRACT TRUNCATED AT 250 WORDS)

Red wine consumption and gastric cancer in Portugal: a case-control study.

The present case-control study was designed mainly to estimate the risk of gastric cancer associated with consumption of alcoholic beverages. Seventy-four cases were selected from patients undergoing endoscopy with a histologically confirmed diagnosis of gastric cancer and matched by age and sex to a pool of controls (193) from three different sources, at the same hospital ward. After adjustment for several confounders, consumption of more than one bottle of red wine per day 20 years prior to the interview showed an odds ratio (OR) = 2.61 (P = 0.049), with a dose-response relationship increasing from 1.36 for those consuming less than one glass of wine per meal, up to 3.67 if the daily consumption exceeded one bottle of red wine. Other statistically significant determinants of the disease occurrence were low education level (OR = 4.33; P = 0.0008) and low social class (OR = 2.77; P = 0.016), as well as the regular practice of preserving food by smoke at home (OR = 1.91; P = 0.032).