Publications by authors named "Alberto Freitas"

89 Publications

Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal.

Acta Med Port 2021 Sep 9. Epub 2021 Sep 9.

Serviço de Neurorradiologia. Centro Hospitalar Universitário do Porto. Porto. Portugal.

Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts.

Material And Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture.

Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity.

Discussion: Overall endovascular treatment rates and procedural times in Portugal are comparable to other international registries. We found geographic heterogeneity, with lower endovascular treatment rates and longer onset-to-puncture time in southern and inner regions.

Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20344/amp.15031DOI Listing
September 2021

Risk factors and their contribution to population health in the European Union (EU-28) countries in 2007 and 2017.

Eur J Public Health 2021 Sep 1. Epub 2021 Sep 1.

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.

Background: The Global Burden of Disease (GBD) study has generated a wealth of data on death and disability outcomes in Europe. It is important to identify the disease burden that is attributable to risk factors and, therefore, amenable to interventions. This paper reports the burden attributable to risk factors, in deaths and disability-adjusted life years (DALYs), in the 28 European Union (EU) countries, comparing exposure to risks between them, from 2007 to 2017.

Methods: Retrospective descriptive study, using secondary data from the GBD 2017 Results Tool. For the EU-28 and each country, attributable (all-cause) age-standardized death and DALY rates, and summary exposure values are reported.

Results: In 2017, behavioural and metabolic risk factors showed a higher attributable burden compared with environmental risks, with tobacco, dietary risks and high systolic blood pressure standing out. While tobacco and air quality improved significantly between 2007 and 2017 in both exposure and attributable burden, others such as childhood maltreatment, drug use or alcohol use did not. Despite significant heterogeneity between EU countries, the EU-28 burden attributable to risk factors decreased in this period.

Conclusion: Accompanying the improvement of population health in the EU-28, a comparable trend is visible for attributable burden due to risk factors. Besides opportunities for mutual learning across countries with different disease/risk factors patterns, good practices (i.e. tobacco control in Sweden, air pollution mitigation in Finland) might be followed. On the opposite side, some concerning cases must be highlighted (i.e. tobacco in Bulgaria, Latvia and Estonia or drug use in Czech Republic).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurpub/ckab145DOI Listing
September 2021

Transition from ICD-9-CM to ICD-10-CM/PCS in Portugal: An heterogeneous implementation with potential data implications.

Health Inf Manag 2021 Aug 16:18333583211027241. Epub 2021 Aug 16.

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/18333583211027241DOI Listing
August 2021

Portuguese Primary Healthcare and Prevention Quality Indicators for Diabetes Mellitus - A Data Envelopment Analysis.

Int J Health Policy Manag 2021 Jul 26. Epub 2021 Jul 26.

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.

Background: Diabetes mellitus (DM) is a worldwide public health priority. The increasing prevalence and the budget constraints force to have effective healthcare, especially at the primary healthcare (PHC) level. We aim to assess primary care efficiency considering the best use of human resources to produce optimal diabetes care in terms of prevention quality indicators (PQIs) rates across national ACES (health centre groupings).

Methods: We conducted a two-stage data envelopment analysis (DEA) to assess the technical efficiency of 54 Portuguese primary care health centre groupings for the 2016-2017 biennium. In the first stage, efficiency scores were obtained through five output-oriented DEA models under vector return to scale (VRS) assumption, using three input variables representing key primary care human resources and one output representing each one of the five PQIs related to diabetes. In the second stage, Tobit regression models were estimated to assess the determinants of primary care efficiency in diabetes care.

Results: A total of 13 ACES reached the efficiency frontier. Better managing human resources could reduce PQI rates by 52.3% in 2016 and 49.1% in 2017. Higher proportion of patients under 65 years old and better controlled with a hemoglobin A1c (HbA1c) ≤6.5% were associated with better efficiency in diabetes care, whereas higher prevalence of DM and unemployment worsened hospitalizations rates by diabetes short-term complications and lower-extremity amputation.

Conclusion: Inefficiency in DM care was found in most of the primary care settings which can substantially improve the avoidable hospitalization rates by DM using their current level human resources. These findings help to improve diabetes care by targeting human resources at primary care level, which should be integrated into performance assessments considering broader and integrated scopes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34172/ijhpm.2021.76DOI Listing
July 2021

Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015.

PLoS One 2021 22;16(7):e0255134. Epub 2021 Jul 22.

Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS) and Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.

Aims: Assess trends and factors associated with interhospital transfers (IHT) and 30-day acute coronary syndrome (ACS) rehospitalizations in a national administrative database of patients admitted with an ACS between 2000-2015.

Methods And Results: Cohort study of patients hospitalized with ACS from 2000 to 2015, using a validated linkage algorithm to identify and link patient-level sequential hospitalizations occurring within 30 days from first admission (considering all hospitalizations within the 30-day timeframe as belonging to the same ACS episode of care-ACS-EC). From 212,481 ACS-EC, 42,670 (20.1%) had more than one hospitalization. ACS-EC hospitalization rates decreased throughout the study period (2000: 207.7/100.000 person-years to 2015: 185,8/100,000 person-years, p for trend <0.05). Proportion of IHT increased from 10.5% in 2000 to 20.1% in 2015 compared to a reduction in both planned and unplanned 30-day ACS rehospitalization from 9.0% in 2000 to 2.7% in 2015. After adjusting for patient and first admission hospital's characteristics, compared to 2000-2003, in 2012-2015 the odds of IHT increased by 3.81 (95%CI: 3.65-3.98); the odds of unplanned and planned 30-day ACS rehospitalization decreased by 0.36 (95%CI: 0.33; 0.39) and 0.47 (95%CI: 0.43; 0.53), respectively. Female sex, older age and the presence and severity of comorbidities were associated with lower likelihood of being transferred or having a planned 30-day ACS rehospitalization. Unplanned 30-day ACS rehospitalization was more likely in patients with higher comorbidity burden.

Conclusion: IHT and 30-day ACS rehospitalization reflect coronary referral network efficiency and access to specialized treatment. Identifying factors associated with higher likelihood of IHT and 30-day ACS rehospitalization may allow heightened surveillance and interventions to reduce rehospitalizations and inequities in access to specialized treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255134PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297861PMC
July 2021

Varicella Admissions in Children and Adolescents in Portugal: 2000-2015.

Hosp Pediatr 2021 Aug 20;11(8):856-864. Epub 2021 Jul 20.

Department of Pediatrics, Centro Hospitalar São João, Porto, Portugal

Objectives: Varicella is a common, usually benign, and autolimited disease in children but can lead to severe complications and hospitalization. With this study, we aim to analyze all varicella hospitalizations to provide epidemiological information to help outline preventive policies.

Methods: We assessed all varicella hospitalizations in children aged 0 to 17 years, from 2000 to 2015, in mainland, public Portuguese hospitals using a Portuguese administrative database. Seasonality, geographic distribution, severity, complications, risk factors, use of diagnostic and treatment procedures and hospitalization costs were analyzed.

Results: A total of 5120 hospitalizations were registered, with an annual rate of 17.3 hospitalizations per 100 000 inhabitants. A higher number of hospitalizations occurred during the summer period and in Southern regions. The median length of stay was of 4 days (interquartile range: 3.0-7.0). We found a high rate of severe complications, mostly dermatologic (19.6%), neurologic (6.0%), and respiratory (5.1%). Of the total number of patients, 0.8% were immunocompromised and 0.1% were pregnant. Total direct hospitalization costs during the 16-year period were estimated to be 7 110 719€ (8 603 970 USD), with a mean annual cost of 444 419.92€ (537 748.10 USD).

Conculsions: This is the first national study in which useful epidemiological data to evaluate the burden and impact of varicella in Portugal is provided.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/hpeds.2020-004275DOI Listing
August 2021

Prediction of Asthma Hospitalizations for the Common Cold Using Google Trends: Infodemiology Study.

J Med Internet Res 2021 Jul 6;23(7):e27044. Epub 2021 Jul 6.

MACVIA-France, Montpellier, France.

Background: In contrast to air pollution and pollen exposure, data on the occurrence of the common cold are difficult to incorporate in models predicting asthma hospitalizations.

Objective: This study aims to assess whether web-based searches on common cold would correlate with and help to predict asthma hospitalizations.

Methods: We analyzed all hospitalizations with a main diagnosis of asthma occurring in 5 different countries (Portugal, Spain, Finland, Norway, and Brazil) for a period of approximately 5 years (January 1, 2012-December 17, 2016). Data on web-based searches on common cold were retrieved from Google Trends (GT) using the pseudo-influenza syndrome topic and local language search terms for common cold for the same countries and periods. We applied time series analysis methods to estimate the correlation between GT and hospitalization data. In addition, we built autoregressive models to forecast the weekly number of asthma hospitalizations for a period of 1 year (June 2015-June 2016) based on admissions and GT data from the 3 previous years.

Results: In time series analyses, GT data on common cold displayed strong correlations with asthma hospitalizations occurring in Portugal (correlation coefficients ranging from 0.63 to 0.73), Spain (ρ=0.82-0.84), and Brazil (ρ=0.77-0.83) and moderate correlations with those occurring in Norway (ρ=0.32-0.35) and Finland (ρ=0.44-0.47). Similar patterns were observed in the correlation between forecasted and observed asthma hospitalizations from June 2015 to June 2016, with the number of forecasted hospitalizations differing on average between 12% (Spain) and 33% (Norway) from observed hospitalizations.

Conclusions: Common cold-related web-based searches display moderate-to-strong correlations with asthma hospitalizations and may be useful in forecasting them.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/27044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292933PMC
July 2021

Spatial Patterns in Hospital-Acquired Infections in Portugal (2014-2017).

Int J Environ Res Public Health 2021 04 28;18(9). Epub 2021 Apr 28.

INEB-Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal.

Background: Hospital-Acquired Infections (HAIs) represent the most frequent adverse event associated with healthcare delivery and result in prolonged hospital stays and deaths worldwide.

Aim: To analyze the spatial patterns of HAI incidence from 2014 to 2017 in Portugal.

Methods: Data from the Portuguese Discharge Hospital Register were used. We selected episodes of patients with no infection on admission and with any of the following HAI diagnoses: catheter-related bloodstream infections, intestinal infections by , nosocomial pneumonia, surgical site infections, and urinary tract infections. We calculated age-standardized hospitalization rates (ASHR) by place of patient residence. We used empirical Bayes estimators to smooth the ASHR. The Moran Index and Local Index of Spatial Autocorrelation (LISA) were calculated to identify spatial clusters.

Results: A total of 318,218 HAIs were registered, with men accounting for 49.8% cases. The median length of stay (LOS) was 9.0 days, and 15.7% of patients died during the hospitalization. The peak of HAIs ( = 81,690) occurred in 2015, representing 9.4% of the total hospital admissions. Substantial spatial inequalities were observed, with the center region presenting three times the ASHR of the north. A slight decrease in ASHR was observed after 2015. Pneumonia was the most frequent HAI in all age groups.

Conclusion: The incidence of HAI is not randomly distributed in the space; clusters of high risk in the central region were seen over the entire study period. These findings may be useful to support healthcare policymakers and to promote a revision of infection control policies, providing insights for improved implementation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph18094703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124660PMC
April 2021

The effect of commissioning on Portuguese Primary Health Care units' performance: A four-year national analysis.

Health Policy 2021 06 26;125(6):709-716. Epub 2021 Feb 26.

CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Family Health Unit, Unidade de Saúde Familiar Marginal, ACES Cascais, ARS Lisboa e Vale do Tejo, Portugal.

Background: Portugal underwent a paradigmatic Primary Health Care (PHC) reform in 2005. The reform implemented better health information systems, goal-oriented management, pay-for-performance schemes, functional autonomy for the front-line units, and the general adoption of commissioning processes. Since the implementation of the reform, the same set of indicators have been monitored nationally every year. However, from 2014-2016, the five Regional Health Administrations could individually select part of set of indicators to be commissioned. As the same some indicators were used commissioned in some regions, but not in others, a natural experimental setting to observe the impact of commissioning on the results by comparing the performance of commissioned versus non-commissioned indicators emerged and the effects of commissioning on PHC performance could be evaluated.

Aim: Our article aims to clarify the effect of commissioning on the results achieved by PHC units in Portugal following the implementation of the reform.

Results: In general, the indicator values improved with time in the three types of units that existed after the reform. However, Model B Family Health Units ('Unidades de Saúde Familiar' or USFs that use pay-for-performance and are more mature) obtained the highest absolute indicator values, followed by Model A USFs (newer units with a fixed salary) and Personalised Health Care Units ('Unidades de Cuidados de Saúde Personalizados' that were created under the model before the reform and offer a fixed salary), respectively.

Conclusion: The results show a general increase in indicators in all PHC units. However, the indicators used in the commissioning processes exhibited a greater increase. There was no evidence that the better results exhibited by the commissioned indicators were achieved at the expense of a detrimental effect on non-commissioned indicators.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2021.02.008DOI Listing
June 2021

Electroconvulsive Therapy Use in Psychiatric Hospitalizations in Portugal: A Nationwide Descriptive Study.

J ECT 2021 Mar 4. Epub 2021 Mar 4.

From the Department of Psychiatry and Mental Health, Centro Hospitalar do Tâmega e Sousa, Penafiel Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto Center for Health Technology and Services Research (CINTESIS) Hospital de Magalhães Lemos, Porto, Portugal Portuguese Society for ECT, Porto, Portugal.

Objectives: The primary aim of this study was to describe a Portuguese nationwide epidemiological perspective on the use of electroconvulsive therapy (ECT) in hospitalized psychiatric patients. The secondary aims of the study were to characterize clinical and sociodemographic trends of hospitalized patients treated with ECT.

Methods: A retrospective-observational study was conducted using an administrative database gathering every registered Portuguese public hospital hospitalizations from 2008 to 2015. We selected all hospitalizations with a procedure code 94.27 (Other electroshock therapy) defined by the International Classification of Diseases version 9, Clinical Modification. Variables included birth date, sex, address, primary and secondary diagnoses, admission/discharge date, length of stay, and discharge status from each single hospitalization episode. We also calculated Portugal's inpatient ECT prevalence rate (iP%).

Results: There were a total of 879 registered hospitalizations with ECT within the 8-year period of this study. Most occurred in female patients (53.4%), belonging to the age group of 51 to 70 years old, with a mean age of 50.5 years. The median length of stay was 43.0 days with an interquartile range of 27.0 to 68.0. The most frequent primary diagnosis was major depressive disorder, recurrent episode, representing 19.6% of all hospitalizations. The iP% for the study period was 0.71%.

Conclusions: In Portugal, most of the patients who received ECT were women above middle age, and depressive disorders were the most common indication. Portugal's iP% represents a low rate when compared with other European countries, which might indicate an underutilization of ECT in Portuguese psychiatric hospitals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/YCT.0000000000000754DOI Listing
March 2021

A Multipurpose Platform for Ambient Assisted Living (ActiveAdvice): Usability Study.

JMIR Aging 2021 Mar 1;4(1):e18164. Epub 2021 Mar 1.

Center for Health Technology and Services Research, University of Porto, Porto, Portugal.

Background: Aging of the global population is slowly paving the way for new markets for care products and services. The desire of older people to maintain their independence while remaining at home is boosting the development of ambient assisted living (AAL) solutions. Lack of user awareness of AAL solutions paired with an insufficient use of user-centered and participatory design approaches in the development of these products has hindered the uptake of these solutions by end users.

Objective: This study aims to describe the usability and users' experiences within a novel platform, ActiveAdvice, aimed at offering advice and a holistic market overview of AAL products and services.

Methods: Usability tests were performed on the developed platform among identified prospective end users, with 32 older adults and informal carers from 4 European countries being part of the user tests. The usability and appeal of the web interface design, information flow, and information architecture were analyzed by collecting both objective and subjective measures. These would include pretest and posttest surveys, along with a series of think-aloud tasks to be performed within the platform.

Results: The outcomes suggest that the ActiveAdvice platform's objectives and functionalities are mostly aligned with the needs and expectations of end users, who demonstrated interest in using it, stressing its purpose along with its simple and intuitive interaction. Task completion rates were high, and participants had good satisfaction rates when navigating the platform. However, the tests still advocate for an improved design at some points and better disclosure of information.

Conclusions: Our findings shed light on a few peculiarities of interface design, information architecture, user needs, and preferred functionalities, which should be applied to future developments of similar platforms with related services. The AAL field could benefit from tools supporting the dissemination of available AAL solutions and how they can improve one's quality of life. These tools may benefit not only older adults but also caregivers, business owners, and governmental employees.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/18164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081161PMC
March 2021

A Hybrid Model to Classify Patients with Chronic Obstructive Respiratory Diseases.

J Med Syst 2021 Jan 30;45(3):31. Epub 2021 Jan 30.

Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development (GECAD), Institute of Engineering, Polytechnic of Porto, Porto, Portugal.

Over the last decades, an increase in the ageing population and age-related diseases has been observed, with the increase in healthcare costs. As so, new solutions to provide more efficient and affordable support to this group of patients are needed. Such solutions should never discard the user and instead should focus on promoting more healthy lifestyles and provide tools for patients' active participation in the treatment and management of their diseases. In this concern, the Personal Health Empowerment (PHE) project presented in this paper aims to empower patients to monitor and improve their health, using personal data and technology assisted coaching. The work described in this paper focuses on defining an approach for user modelling on patients with chronic obstructive respiratory diseases using a hybrid modelling approach to identify different groups of users. A classification model with 90.4% prediction accuracy was generated combining agglomerative hierarchical clustering and decision tree classification techniques. Furthermore, this model identified 5 clusters which describe characteristics of 5 different types of users according to 7 generated rules. With the modelling approach defined in this study, a personalized coaching solution will be built considering patients with different necessities and capabilities and adapting the support provided, enabling the recognition of early signs of exacerbations and objective self-monitoring and treatment of the disease. The novel factor of this approach resides in the possibility to integrate personalized coaching technologies adapted to each kind of user within a smartphone-based application resulting in a reliable and affordable alternative for patients to manage their disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10916-020-01704-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847234PMC
January 2021

Health expectancies in the European Union: same concept, different methods, different results.

J Epidemiol Community Health 2021 Aug 15;75(8):764-771. Epub 2021 Jan 15.

MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.

Background: Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods. In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on self-perceived health (SPH-HLE) and the Institute for Health Metrics and Evaluation's HLE based on disability weight (DW-HLE), by sex, and comparing these results with LE and proportion of life spent in good health (%GH).

Methods: We performed a retrospective study in the EU28 countries, between 2010 and 2017. The HLE methods differ in definition, measurement and valuation of health states. While SPH-HLE relies directly on one question, DW-HLE relies on epidemiological data adjusted for DW. Spearman's r, intraclass correlation coefficient, information-based measure of disagreement and Bland-Altman plots were used to assess reliability, correlation and disagreement in HLE resulting from both methods and in LE or %GH measured by both institutions.

Results: Correlation and reliability between SPH-HLE and DW-HLE were good (better for males), with low disagreement, and were even better for LE between both institutions. The HLE Bland-Altman plots suggest a variability range of approximately 6 years for both sexes, higher for females. There was also an increasing HLE difference between methods with higher average HLE for both sexes.

Conclusion: We showed wide variations between both methods with a clear and different high impact on female and male HLE, showing a tendency for countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/jech-2020-213791DOI Listing
August 2021

Health expectancies in the European Union: same concept, different methods, different results.

J Epidemiol Community Health 2021 Aug 15;75(8):764-771. Epub 2021 Jan 15.

MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.

Background: Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods. In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on self-perceived health (SPH-HLE) and the Institute for Health Metrics and Evaluation's HLE based on disability weight (DW-HLE), by sex, and comparing these results with LE and proportion of life spent in good health (%GH).

Methods: We performed a retrospective study in the EU28 countries, between 2010 and 2017. The HLE methods differ in definition, measurement and valuation of health states. While SPH-HLE relies directly on one question, DW-HLE relies on epidemiological data adjusted for DW. Spearman's r, intraclass correlation coefficient, information-based measure of disagreement and Bland-Altman plots were used to assess reliability, correlation and disagreement in HLE resulting from both methods and in LE or %GH measured by both institutions.

Results: Correlation and reliability between SPH-HLE and DW-HLE were good (better for males), with low disagreement, and were even better for LE between both institutions. The HLE Bland-Altman plots suggest a variability range of approximately 6 years for both sexes, higher for females. There was also an increasing HLE difference between methods with higher average HLE for both sexes.

Conclusion: We showed wide variations between both methods with a clear and different high impact on female and male HLE, showing a tendency for countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/jech-2020-213791DOI Listing
August 2021

Geospatial Analysis of Environmental Atmospheric Risk Factors in Neurodegenerative Diseases: A Systematic Review.

Int J Environ Res Public Health 2020 11 13;17(22). Epub 2020 Nov 13.

CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal.

Despite the vast evidence on the environmental influence in neurodegenerative diseases, those considering a geospatial approach are scarce. We conducted a systematic review to identify studies concerning environmental atmospheric risk factors for neurodegenerative diseases that have used geospatial analysis/tools. PubMed, Web of Science, and Scopus were searched for all scientific studies that included a neurodegenerative disease, an environmental atmospheric factor, and a geographical analysis. Of the 34 included papers, approximately 60% were related to multiple sclerosis (MS), hence being the most studied neurodegenerative disease in the context of this study. Sun exposure ( = 13) followed by the most common exhaustion gases ( = 10 for nitrogen dioxide (NO) and = 5 for carbon monoxide (CO)) were the most studied atmospheric factors. Only one study used a geospatial interpolation model, although 13 studies used remote sensing data to compute atmospheric factors. In 20% of papers, we found an inverse correlation between sun exposure and multiple sclerosis. No consensus was reached in the analysis of nitrogen dioxide and Parkinson's disease, but it was related to dementia and amyotrophic lateral sclerosis. This systematic review (number CRD42020196188 in PROSPERO's database) provides an insight into the available evidence regarding the geospatial influence of environmental factors on neurodegenerative diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17228414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697835PMC
November 2020

Landscapes on Prevention Quality Indicators: A Spatial Analysis of Diabetes Preventable Hospitalizations in Portugal (2016-2017).

Int J Environ Res Public Health 2020 11 12;17(22). Epub 2020 Nov 12.

MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.

Preventable hospitalizations due to complications of diabetes mellitus (DM), represented by the related prevention quality indicators (PQI), are ambulatory care-sensitive conditions that can be prevented and controlled through effective primary health care (PHC) treatment. It is important to reduce mortality and promote the quality of life to diabetic patients in regions with higher hospitalization rates. The study aims to analyze the results of the DM age-sex-adjusted PQI, by groups of health centers (ACES), distributed in the Portuguese territory. The most representative PQI at a national level were identified, and the trends were mapped and analyzed. Also, it presents the ACES with the highest age-adjusted rates of avoidable hospitalizations for DM. The absolute number of preventable hospitalizations for all DM complications in Portugal has decreased by 20%, thus passing from the rate of 79 in 2016 to 65.2/100,000 inhabitants in 2017. Despite the improvement in results for PQI 03, 20 of 48 ACES that were above the national 2017 median rate in 2016, achieved better results the following year, and for the overall preventable diabetes hospitalizations (PQI 93) only 11 out 39, revealing the need for further studies and PHC actions to improve the diabetic quality of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17228387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697335PMC
November 2020

Comparison and Impact of Four Different Methodologies for Identification of Ambulatory Care Sensitive Conditions.

Int J Environ Res Public Health 2020 11 3;17(21). Epub 2020 Nov 3.

Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal.

Ambulatory care sensitive conditions (ACSCs) are conditions for which hospitalizations are thought to be avoidable if effective and accessible primary health care is available. However, to define which conditions are considered ACSCs, there is a considerable number of different lists. Our aim was to compare the impact of using different ACSC lists considering mainland Portugal hospitalizations. A retrospective study with inpatient data from Portuguese public hospital discharges between 2011 and 2015 was conducted. Four ACSC list sources were considered: Agency for Healthcare Research and Quality (AHRQ), Canadian Institute for Health Information (CIHI), the Victorian Ambulatory Care Sensitive Conditions study, and Sarmento et al. Age-sex-adjusted rates of ACSCs were calculated by district (hospitalizations per 100,000 inhabitants). Spearman's rho, the intraclass correlation coefficient (ICC), the information-based measure of disagreement (IBMD), and Bland and Altman plots were computed. Results showed that by applying the four lists, different age-sex-adjusted rates are obtained. However, the lists that seemed to demonstrate greater agreement and consistency were the list proposed by Sarmento et al. compared to AHRQ and the AHRQ method compared to the Victorian list. It is important to state that we should compare comparable indicators and ACSC lists cannot be used interchangeably.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17218121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662634PMC
November 2020

Body composition in women with premature ovarian insufficiency using hormone therapy and the relation to cardiovascular risk markers: A case-control study.

Clin Endocrinol (Oxf) 2021 01 5;94(1):111-118. Epub 2020 Oct 5.

Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.

Objective: To compare body composition between women with premature ovarian insufficiency (POI) using hormone therapy and controls with normal ovarian function, and to correlate body composition with cardiovascular risk markers in the POI group.

Patients And Design: A case-control study of 70 women with POI matched by age and body mass index with 70 controls.

Measurements: All were submitted to whole-body dual-energy X-ray absorptiometry (DXA) to analyse body composition. In the POI group, total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol, triglycerides, glucose, insulin, transaminases and C-reactive protein levels were measured, as well as the thickness of the carotid artery intima-media complex.

Results: Total mass, fat mass, lean mass (total, percentage and index) and the android/gynoid (A/G) ratio were similar in both groups; however, bone mineral content was lower (P < .001) in the POI group. Lean and fat mass indexes were 14.19 ± 1.63 and 11.04 ± 3.58, respectively, and the percentage of gynoid to android fat was higher (51.17 ± 6.71% versus 47.74 ± 9.19%; A/G ratio = 0.93 ± 0.15) in the POI group. In addition, the increase in total mass correlated positively with glucose and ALT levels and negatively with HDL-cholesterol. Increased A/G ratio was the measurement most frequently associated with cardiovascular risk markers.

Conclusion: The body composition of women with POI using hormone therapy is similar to that of women with normal ovarian function with regard to lean and fat mass content and fat distribution. In women with POI, the higher the A/G ratio, the worse the cardiovascular risk markers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cen.14331DOI Listing
January 2021

The Impact of COVID-19 Pandemic on Psychiatric Emergency Department Visits - A Descriptive Study.

Psychiatr Q 2021 06;92(2):621-631

Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.

The coronavirus disease 2019 pandemic (COVID-19) has an important direct and indirect impact on both physical and mental health. We aim to describe the impact of an emergency state period due to COVID-19 on psychiatric emergency department (ED) visits. We conducted a retrospective observational study analysing all emergency visits occurring at a metropolitan psychiatric ED between March 19th and May 2nd 2019 and 2020 (the beginning/end date of the emergency state which Portugal was under due to COVID-19). Data regarding age, sex, diagnoses, admission date, discharge destiny and status were collected. Diagnoses were classified using the International Classification of Diseases version 9, Clinical Modification (ICD-9-CM). There was a 52·2% decrease on the number of psychiatric emergency visits during the emergency state period (n = 780 vs n = 1633 episodes). The decrease on psychiatric ED visits was greater in the female sex and in the younger age groups. Episodes with a primary diagnosis of Mood disorders lead the decrease on psychiatric ED visits with 68·3% less episodes. Schizophrenia and other psychotic disorders was the diagnosis group with the smaller decline (9·8% decrease). COVID-19 emergency state period had an important impact on the number and characteristics of psychiatric ED visits, reinforcing the great indirect effects of COVID-19 on mental health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11126-020-09837-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445073PMC
June 2021

Trend of depression and its association with sociodemographic and clinical factors among multiple myeloma hospitalizations: A Portuguese nationwide study from 2000 to 2015.

Psychooncology 2020 10 13;29(10):1587-1594. Epub 2020 Aug 13.

Center for Health Technology and Services Research (CINTESIS), FMUP, Porto, Portugal.

Objective: Patients hospitalized with multiple myeloma (MM) are particularly vulnerable to depression. The present study aims to determine the frequency of depression among MM hospitalized patients, in order to assess the possible differences between those with and without depression in relation to sociodemographic and clinical variables and to measure the impact of depression on hospitalization outcomes.

Methods: An observational retrospective study was performed using an administrative data set of all hospitalizations with a primary diagnosis of MM between 2000 and 2015 in Portuguese mainland public hospitals. Codes related to depressive disorders were grouped to generate the dichotomous variable of depression (yes/no). A multivariate analysis was conducted and adjusted odd ratios (aOR) calculated between different variables and depression.

Results: Of a total of 14.575 MM hospitalizations studied, a concurrent code of depression was registered in 666 patients (4.6%). A greater odds of depression was observed in female patients (aOR = 2.26; 95%CI = 1.91-2.66), transplanted patients (aOR = 1.78; 95%CI = 1.44-2.20), patients with plasma cell leukemia (aOR = 1.79; 95%CI = 1.22-2.64) and patients with a higher Charlson Comorbidity Index (CCI) (aOR = 1.10; 95%CI = 1.05-1.15). Length of stay was longer in patients with a registered diagnosis of depression (aOR = 1.01; 95%CI = 1.01-1.02) while the odds of in-hospital mortality were lower in these patients (aOR = 0.53; 95%CI = 0.41-0.68).

Conclusions: These results may help identify MM inpatients at higher risk of presenting depression (female gender, younger age, high CCI, plasma cell leukemia, transplant procedure). This will enable timely psychological assessment and treatment to prevent worse outcomes and higher healthcare costs associated with depression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pon.5469DOI Listing
October 2020

Schizophrenia Related Hospitalizations - a Big Data Analysis of a National Hospitalization Database.

Psychiatr Q 2021 03;92(1):239-248

Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, 4200 - 450, Porto, Portugal.

Schizophrenia is a mental disorder characterized by long hospitalizations and frequent need for chronic/acute psychiatric care. Hospitalizations represent a valuable quality of care indicator in schizophrenia patients. The aim of this study was to describe a nationwide perspective of schizophrenia related hospitalizations. We performed a retrospective observational study using a nationwide hospitalization database containing all hospitalizations registered in Portuguese public hospitals from 2008 to 2015. Hospitalizations with a primary diagnosis of schizophrenia were selected based on the definition by CCS - Clinical Classification Software diagnostic single-level 659. Schizophrenia subtypes were identified based on International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 295.xx. A total of 25,385 hospitalizations were registered belonging to 14,279 patients. 68.0% of the hospitalizations occurred in male patients and the median length of stay was 18.0 days. In male patients' hospitalizations, the most frequent age group was 31-50 years followed by the age group of 18-30 years (55.9 and 24.0% respectively). For female patients, the most frequent age group was 31-50 years followed by 51-70 years (54.1 and 22.6%, respectively). There were 73 hospitalization with a deadly outcome (0.29%). Paranoid type was the most frequent subtype of schizophrenia (50.5%). The mean hospitalization charges were 3509.7€ per episode, with a total charge of 89.1 M€ in the 8-year period. This is a nationwide study using Big Data analysis giving a broad perspective of schizophrenia hospitalization panorama at a nationwide level. We found differences in hospitalization characteristics according to patients' gender, age and primary diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11126-020-09793-8DOI Listing
March 2021

Understanding the large heterogeneity in hospital readmissions and mortality for acute myocardial infarction.

Health Policy 2020 07 19;124(7):684-694. Epub 2020 May 19.

Armando Teixeira-Pinto, School of Public Health, The University of Sydney, Sydney, NSW, Australia.

This study aims to investigate the variation in two acute myocardial infarction (AMI) outcomes across public hospitals in Portugal. In-hospital mortality and 30-day unplanned readmissions were studied using two distinct AMI cohorts of adults discharged from all acute care public hospital centers in Portugal from 2012-2015. Hierarchical generalized linear models were used to assess the association between patient and hospital characteristics and hospital variability in the two outcomes. Our findings indicate that hospitals are not performing homogeneously-the risk of adverse events tends to be consistently larger in some hospitals and consistently lower in other hospitals. While patient characteristics accounted for a larger share of the explained between-hospital variance, hospital characteristics explain an additional 8% and 10% of hospital heterogeneity in the mortality and the readmission cohorts respectively. Admissions to hospitals with low AMI caseloads or located in Alentejo/Algarve and Lisbon had a higher risk of mortality. Discharges from larger-sized hospitals were associated with increased risk of readmissions. Future health policies should incorporate these findings in order to incentivize more consistent health care outcomes across hospitals. Further investigation addressing geographical disparities, hospital caseload and practices is needed to direct actions of improvement to specific hospitals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2020.04.004DOI Listing
July 2020

Cost of cardiovascular disease prevention: towards economic evaluations in prevention programs.

Ann Transl Med 2020 Apr;8(7):512

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/atm.2020.01.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210201PMC
April 2020

Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015).

Eur J Vasc Endovasc Surg 2020 Jul 16;60(1):27-35. Epub 2020 Apr 16.

Centre for Health Technology and Services Research (CINTESIS) and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal.

Objective: Ruptured abdominal aortic aneurysm (rAAA) is a lethal condition that requires acute repair to prevent death. This analysis aims to assess the nationwide trends in rAAA admission, repair and mortality in a country, Portugal, without national screening for AAA.

Methods: rAAA registered in the hospital administrative database of the National Health Service and all nationally registered deaths due to rAAA based on death certificate data were analysed. Three time periods (2000-2004, 2005-2009, and 2010-2015) were compared in patients ≥ 50 years old to assess the variations over time.

Results: A total of 2 275 patients ≥50 years old with rAAA were identified in the two databases from 2000 to 2015. The age standardised incidence of rAAA was 2.78 ± 0.24/100 000/year in 2000-2004, 3.17 ± 0.39/100 000/year in 2005-2009 and 3.21 ± 0.28/100 000/year in 2010-2015 (p < .001). When comparing the time periods 2000-2004 to 2005-2009, the age standardised rate of admission (n = 1460) increased from 1.57 ± 0.25/100 000/year to 2.24 ± 0.32/100 000/year (p < .001). The operative mortality rates decreased during this time period (from 55.3 ± 4.7% to 48.8 ± 4.7%, p < .001). In 2010-2015, the age standardised rate of admissions due to rAAA decreased (1.98 ± 0.22/100 000/year). Operative mortality remained stable (48.9 ± 6.2%). The rate of patient deaths outside the hospital decreased from the first to the second period (1.21 ± 0.10/100 000/year and 0.93 ± 0.29/100 000/year, respectively) but later increased (1.14 ± 0.22/100 000/year). This resulted in a higher overall rAAA related mortality in Portugal in the third period (2.20 ± 0.18/100 000/year, 2.21 ± 0.27/100 000/year and 2.26 ± 0.26/100 000/year in 2000-2004, 2005-2009, and 2010-2015, respectively, p < .001).

Conclusion: Overall, the incidence of rAAA in Portugal has been stable over the past 10 years. The rates of admission, repair, and death due to rAAA repair seem to have reached an inflection point and are now decreasing. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejvs.2020.02.024DOI Listing
July 2020

European Union state of health from 1990 to 2017: time trends and its enlargements' effects.

Int J Public Health 2020 Mar 17;65(2):175-186. Epub 2020 Feb 17.

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.

Objectives: We aimed to study health status' time trends in the European Union (EU) during 1990-2017 and its enlargements' impact.

Methods: Using estimates from the Global Burden of Disease 2017 study and calculating age-sex-standardized rates, we have described time trends and analysed the differences between EU groups regarding the state of health. Interrupted time-series analyses were also performed in order to assess the enlargement impact in the EU state of health.

Results: All age-sex-standardized rates (mortality, years of life lost, years lived with disability and disability-adjusted life years) declined (annualized rates of change of - 1.7%, - 1.52%, - 0.06% and - 1.01%, respectively) between 1990 and 2017 (except between 2014 and 2015). For EU-28, life expectancy and healthy life expectancy increased 5.9 and 4.6 years, respectively. With the EU-25 and EU-27 enlargements, all age-sex-standardized rates and life expectancies worsened (with statistical significance). The EU-28 enlargement revealed the same tendency, contrasting with the EU-15 one.

Conclusions: Overall, the EU health status is improving, despite changes in its composition over the years. However, the average EU state of health declined with the 2004, 2007 and 2013 EU enlargements.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00038-020-01335-0DOI Listing
March 2020

Problems and Barriers during the Process of Clinical Coding: a Focus Group Study of Coders' Perceptions.

J Med Syst 2020 Feb 8;44(3):62. Epub 2020 Feb 8.

Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.

Coded data are the basis of information systems in all countries that rely on Diagnosis Related Groups in order to reimburse/finance hospitals, including both administrative and clinical data. To identify the problems and barriers that affect the quality of the coded data is paramount to improve data quality as well as to enhance its usability and outcomes. This study aims to explore problems and possible solutions associated with the clinical coding process. Problems were identified according to the perspective of ten medical coders, as the result of four focus groups sessions. This convenience sample was sourced from four public hospitals in Portugal. Questions relating to problems with the coding process were developed from the literature and authors' expertise. Focus groups sessions were taped, transcribed and analyzed to elicit themes. Variability in the documents used for coding, illegibility of hand writing when coding on paper, increase of errors due to an extra actor in the coding process when transcribed from paper, difficulties in the diagnoses' coding, coding delay and unavailability of resources and tools designed to help coders, were some of the problems identified. Some problems were identified and solutions such as the standardization of the documents used for coding an episode, the adoption of the electronic coding, the development of tools to help coding and audits, and the recognition of the importance of coding by the management were described as relevant factors for the improvement of the quality of data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10916-020-1532-xDOI Listing
February 2020

Seasonal variation of diabetes with hyperosmolarity hospitalizations and its characteristics in mainland Portugal.

Prim Care Diabetes 2020 10 11;14(5):445-447. Epub 2020 Jan 11.

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.

Aims: The family physician devotes a part of his care to the surveillance of diabetic patients. Hyperosmolarity is a severe acute complication. The aim of this study was to analyse seasonal variation of type 2 diabetes with hyperosmolarity hospitalizations, regarding their occurrence, mortality, length of stay, Charlson comorbidity index and its factors.

Methods: The authors analysed all hospitalizations in Portuguese Mainland public sector hospitals between 2000 and 2015 with primary diagnosis of type 2 diabetes with hyperosmolarity (ICD-9-CM codes 250.20 or 250.22), using a national administrative database. Cases were classified into four seasons according to date of admission. The authors compared the occurrence, length of stay, in-hospital mortality and Charlson comorbidity index and its factors.

Results: A total of 6596 hospitalization episodes were included. The authors found that admissions occurred more in winter, being 23% more common. No seasonal statistically significant differences were found considering the other variables.

Conclusions: There is an increased occurrence of this acute metabolic complication during the winter in patients with type 2 diabetes. These results should be taken into account by the family physician when planning surveillance to this risk group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pcd.2019.12.011DOI Listing
October 2020

Nationwide Analysis of Intact Abdominal Aortic Aneurysm Repair in Portugal from 2000 to 2015.

Ann Vasc Surg 2020 Jul 7;66:54-64.e1. Epub 2020 Jan 7.

Department of Angiology and Vascular Surgery, São João Hospital University Center, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS) and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.

Background: Results on the management of infrarenal abdominal aortic aneurysm (AAA) from Mediterranean countries are scarce. The aim of this study was to evaluate trends in rate of and mortality after repair of intact AAA (iAAA) in Portugal.

Methods: iAAA repairs registered in the hospitals' administrative database of the National Health Service from 2000 to 2015 were retrospectively analyzed regarding demographics (age and gender) and type of repair (open surgery [OS] or endovascular repair [EVAR]). Rate and mortality were compared among three time periods: 2000-2004, 2005-2009, and 2010-2015.

Results: Age-standardized rate of iAAA repair increased consistently across the time periods under analysis from 3.6 ± 0.6/100,000/year in 2000-2004, to 5.6 ± 0.4/100,000/year in 2005-2009 and to 7.1 ± 0.9/100,000/year in 2010-2015 (P < 0.001). The percentage of EVAR among all iAAA repairs rose steeply from 0 to 21 ± 19% and then to 58 ± 7% (P < 0.001). The rate of OS also increased from the first to the second period, but there was a decrease in the third period (P < 0.001). The in-hospital mortality after iAAA repair decreased from 7.5 ± 1.3% to 6.6 ± 1.6% and then to 5.1 ± 1.9% (P < 0.001). This variation corresponded to a decrease in in-hospital mortality after EVAR (from 4.0 ± 3.5% to 2.8 ± 0.9%, P < 0.001) and increased in-hospital mortality after OS (7.5 ± 1.3% to 7.4 ± 1.1% to 8.3 ± 3.7%, P < 0.001). Low-volume centers (< 15 repairs/year) did not present higher mortality rates. The number of EVARs per year in a center presented a positive association with EVAR mortality (Spearman correlation of 0.696, P = 0.004).

Conclusions: The rate of repair of iAAA continues to grow, especially in patients aged ≥ 75 years and did not reach an inflection point yet. This is happening along with decreased repair mortality mainly because of the increased use of EVAR. Hospital mortality for iAAA repair is still a matter of concern, warranting further investigation and planning of vascular surgical services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.avsg.2019.12.013DOI Listing
July 2020

Internal deterministic record linkage using indirect identifiers for matching of same-patient hospital transfers and early readmissions after acute coronary syndrome in a nationwide hospital discharge database: a retrospective observational validation study.

BMJ Open 2019 12 30;9(12):e033486. Epub 2019 Dec 30.

Department of Health Information and Decision Sciences (CIDES) & Center for Health Technology and Services Research (CINTESIS), University of Porto-Faculty of Medicine, Porto, Portugal.

Objectives: To assess validity of record linkage using multiple indirect personal identifiers to identify same-patient hospitalisations and definition of episode of care (EC) due to acute coronary syndrome (ACS).

Methods: Using national hospital discharge data to identify all admissions due to ACS, we used six different linkage rules using indirect identifiers with increasing level of detail and compared validity against a pseudonymised unique identifier used as gold standard (GS). Contiguous hospitalisations within each matched group of hospitalizations occurring within 28 days of each other were considered one EC. We classified hospitalisations according to time between the first pair of hospitalisations as hospital transfer (HT: ≤1 day), early readmission (ER: 2-28 days) or recurrent cases (>28 days).

Results: There were 146 671 hospitalisations (unlinked), 121 987 ACS 28-day EC (linked GS), with 18 398 HTs (≤1 day), and 6286 ERs (≤28 days). Linkage rules using demographic and residence code variables produced linkage rates with highest validity for rule using sex, date of birth and four-digit residence code with sensitivity of 98.4 (95% CI: 98.4 to 98.5); specificity of 97.8 (95% CI: 97.6 to 98.0) and Cohen's κ of 0.9 to detect ACS-EC, compared with GS linkage rule. Similarly, validity for HT and ER was high and of similar magnitude, with sensitivity ranging between 97.2% and 98.1%, and specificity between 98.8% and 99.9%, respectively.

Conclusions: Our internal linkage validation study using indirect patient identifiers will allow calibration of incidence rates and performance indicators, accounting for the effect of HT and readmissions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-033486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955528PMC
December 2019

The state of health in the European Union (EU-28) in 2017: an analysis of the burden of diseases and injuries.

Eur J Public Health 2020 06;30(3):573-578

MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.

Background: The Global Burden of Disease study has generated a wealth of data on death and disability in Europe. At a time of change for the European Union and European Region of WHO, with a new Health Commissioner and Regional Director, respectively, a review of health trends can contribute to identify outstanding needs and gaps. This paper reports a summary of the burden of disease in the European Union (EU) in 2017 (compared with 2007).

Methods: For the whole EU and each country, mortality by causes of death, disability-adjusted life years (DALYs) and life expectancies are reported.

Results: In 2017, the age-standardized mortality and DALY rates were of 452.6 and 19 663.3 per 100 000 inhabitants, respectively. The diseases contributing most to mortality were ischaemic heart disease (IHD), dementias and stroke, while low back pain and IHD accounted for the highest burden of DALYs.

Conclusions: Overall, there was an improvement in the state of health in the EU but substantial differences between countries remain. Cardiovascular diseases still represent the major burden, although there have been substantial improvements. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurpub/ckz203DOI Listing
June 2020
-->