José M. Calheiros

National assessment of human health effects of climate change in Portugal: approach and key findings.

In this study we investigated the potential impact of climate change in Portugal on heat-related mortality, air pollution–related health effects, and selected vectorborne diseases. The assessment used climate scenarios from two regional climate models for a range of future time periods. The annual heat-related death rates in Lisbon may increase from between 5.4 and 6 per 100,000 in 1980–1998 to between 8.5 and 12.1 by the 2020s and to a maximum of 29.5 by the 2050s, if no adaptations occur. The projected warmer and more variable weather may result in better dispersion of nitrogen dioxide levels in winter, whereas the higher temperatures may reduce air quality during the warmer months by increasing tropospheric ozone levels. We estimated the future risk of zoonoses using ecologic scenarios to describe future changes in vectors and parasites. Malaria and schistosomiasis, which are currently not endemic in Portugal, are more sensitive to the introduction of infected vectors than to temperature changes. Higher temperatures may increase the transmission risk of zoonoses that are currently endemic to Portugal, such as leishmaniasis, Lyme disease, and Mediterranean spotted fever.

Effects of apparent temperature on daily mortality in Lisbon and Oporto, Portugal.

BackgroundEvidence that elevated temperatures can lead to increased mortality is well documented, with population vulnerability being location specific. However, very few studies have been conducted that assess the effects of temperature on daily mortality in urban areas in Portugal.MethodsIn this paper time-series analysis was used to model the relationship between mean apparent temperature and daily mortality during the warm season (April to September) in the two largest urban areas in Portugal: Lisbon and Oporto. We used generalized additive Poisson regression models, adjusted for day of week and season.ResultsOur results show that in Lisbon, a 1°C increase in mean apparent temperature is associated with a 2.1% (95%CI: 1.6, 2.5), 2.4% (95%CI: 1.7, 3.1) and 1.7% (95%CI: 0.1, 3.4) increase in all-causes, cardiovascular, and respiratory mortality, respectively. In Oporto the increase was 1.5% (95%CI: 1.0, 1.9), 2.1% (95%CI: 1.3, 2.9) and 2.7% (95%CI: 1.2, 4.3) respectively. In both cities, this increase was greater for the group >65 years.ConclusionEven without extremes in apparent temperature, we observed an association between temperature and daily mortality in Portugal. Additional research is needed to allow for better assessment of vulnerability within populations in Portugal in order to develop more effective heat-related morbidity and mortality public health programs.

The effect of social support on the quality of life of patients with multiple sclerosis

OBJECTIVE To determine the predictive value of social support on health related quality of life (HRQoL) in multiple sclerosis (MS) patients. METHODS The sample is composed by 150 MS consecutive patients. We used the Medical Outcomes Study Social Support Survey to assess social support and the Health Status Questionnaire to assess HRQoL. For inferential analysis, we used the Multiple Linear Regression with stepwise selection of variables. RESULTS The age, basic education, psychological support and disability explains 41.6% of the variance in physical function, 29.4% in physical performance and 30.6% in emotional performance. Age and psychological support explains 23.1% of the variance in physical function and 29.4% in vitality. CONCLUSION This study demonstrated that social support is a predictor with a significant effect on HRQoL in MS.

Short-term association between exposure to ozone and mortality in Oporto, Portugal.

Exposures to air pollution in developed countries have generally decreased over the last two decades. However, many recent epidemiological studies have consistently shown positive associations between low-level exposure to air pollutants and health outcomes. In Portugal, very few studies have analysed the acute effect of air pollutants on health. The present study evaluates the association between exposure to air pollution and daily mortality in the Oporto Metropolitan Area, Portugal. Generalised additive models were used for this analysis. Pollutants assessed were ozone, nitrogen dioxide, and particulate matter (PM(10)). Models were adjusted for time trend, seasonality, and weather. We report that an increase of 10 μg/m(3) in the daily ozone 8-h maximum moving-average corresponds to an increase of 0.95% (95%CI: 0.30, 1.60) and 1.58% (95%CI: 0.45, 2.73) in non-accidental mortality and cardiovascular mortality, respectively, in the summer season. A significant effect of 0.67% (95% CI: 0.03:1.32) was also found for the association between PM(10) and non-accidental mortality in the summer season. Associations with ozone and PM(10) exposures were higher in the elderly people. No significant effects on mortality were observed during the summer season with nitrogen dioxide exposures. Our analyses provide the first significant evidence in Oporto that exposures to O(3) and PM(10) have adverse effects on the health of the general population in the summer months.

Compliance and enforcement of a partial smoking ban in Lisbon taxis: an exploratory cross-sectional study

BackgroundResearch evaluating enforcement and compliance with smoking partial bans is rather scarce, especially in countries with relative weak tobacco control policies, such as Portugal. There is also scarce evidence on specific high risk groups such as vehicle workers. In January 2008, Portugal implemented a partial ban, followed by poor enforcement. The purpose of this study was to explore the effectiveness of a partial smoking ban in a pro-smoking environment, specifically transportation by taxi in the city of Lisbon. Ban effectiveness was generally defined by ban awareness and support, compliance and enforcement.MethodsExploratory cross-sectional study; purposive sampling in selected Lisbon streets. Structured interviews were conducted by trained researchers while using taxi services (January 2009-December 2010). Participants: 250 taxi drivers (98.8% participation rate). Chi-square, McNemar, Man Whitney tests and multiple logistic regression were performed.ResultsOf the participants, 249 were male; median age was 53.0 years; 43.6% were current smokers. Most participants (82.8%) approved comprehensive bans; 84.8% reported that clients still asked to smoke in their taxis; 16.8% allowed clients to smoke. Prior to the ban this value was 76.9% (p < 0.001). The major reason for not allowing smoking was the legal ban and associated fines (71.2%). Of the smokers, 66.1% admitted smoking in their taxi. Stale smoke smells were detected in 37.6% of the cars. None of the taxi drivers did ever receive a fine for non-compliance. Heavy smoking, night-shift and allowing smoking prior the ban predicted non-compliance.ConclusionsDespite the strong ban support observed, high smoking prevalence and poor enforcement contribute to low compliance. The findings also suggest low compliance among night-shift and vehicle workers. This study clearly demonstrates that a partial and poorly-enforced ban is vulnerable to breaches, and highlights the need for clear and strong policies.

Smoking behaviour trends among Portuguese physicians: are they role models? A conference-based survey

Tobacco is the single most preventable cause of premature death and a leading cause of disease and disability. One of the most powerful tobacco control tools is to decrease tobacco use by physicians and other healthcare providers (HCPs) and engage them in tobacco control activities. All HCPs, and specially physicians, can be positive role models as nonsmokers and promote smoking cessation. In recent decades, the worldwide rate of smoking among physicians has declined. Nevertheless, physicians smoking rates remain high in several developed and in developing countries, including Eastern and Southern Europe. Although WHO has stressed the importance of surveying tobacco use among HCPs, few studies have compared smoking behaviour trends among physicians with the general population, according to gender,

Social Characteristics and Quality of Life of Portuguese Multiple Sclerosis Patients

IntroductionFew studies have analyzed the importance of socio-demographic variables on the perception of health-related quality of life (HRQoL) in patients with multiple sclerosis (MS).MethodsThe sample was composed of 150 patients with MS. Statistical analysis was performed using Mann–Whitney U and Kruskal–Wallis H non-parametric tests comparing socio-demographic items with HRQoL.ResultsWe found statistically significant differences between age, education levels, employment status, disability and all dimensions of HRQoL.DiscussionThis study contributes to a more systematic knowledge about the relationship between social characteristics and HRQoL, which is important to improve the planning of health care in MS patients.ConclusionWe found that younger patients, those with higher education level, those who were employed, and with lower disease progression and lower disability, had better HRQoL.

Delivery and recording of smoking cessation advice in a Portuguese teaching hospital: the need for a systemic approach

Background: Smoking cessation should be a top priority in hospitals. In November 2007, a Portuguese teaching hospital carried out a survey to evaluate cessation attitudes, clinical practices and cessation training needs among hospital-based healthcare providers (HCPs). The study also aimed to identify factors associated with cessation attitudes and practices, self-confidence to intervene and awareness of training programs. Method: This is a cross sectional questionnaire-based study including all HCPs. Sample: The study sample covers 424 HCPs, of which 65.4% were females. Mean age of these HCPs was 38.7 ± 10.1 years and the overall response rate was 50.5%. For data analyses, chi-squared tests, McNemar tests and multiple logistic regression models were used. Results: Most physicians and nurses reported “Asking” and “Advising” always or often. Other HCPs reported low frequencies of “Asking” and “Advising” (p < 0.001). Systematic “Asking” was reported less often than “Advising” (p < 0.001). Most HCPs did not record cessation practices, lacked specific training, and were not aware of their training needs. Reported self-confidence, positive attitudes and being a physician or non-smoker were the factors that influenced cessation practices the most. Conclusion: The findings suggest that there is reason to doubt that cessation practices are being undertaken effectively. Hospitals should audit smoking status recording, delivery of effective cessation advice and post-discharge support. Cessation indicators should be mandatory in all healthcare settings. To achieve these goals, undergraduate and graduate cessation training must be given higher priority.

Tobacco control progress in Portugal: The need for advocacy and civil society leadership

Formato ISO 690-2 (Articulos de revistas electronicas) Ravara, S.B., Miranda, N., Calheiros, J.M., Berteletti, F., Joossens, L., Tobacco control progress in Portugal: The need for advocacy and civil society leadershipRevista Portuguesa de Pneumologia [en linea] 2014, 20 (Noviembre-Diciembre) : [Fecha de consulta: 18 de diciembre de 2017] Disponible en: ISSN 0873-2159

Towards a 100% smoke-free Portugal: No more delays

In 2013, a similar survey conducted in Covilhã observed the same trends. Furthermore, several studies have reported: (1) high SHSe in restaurants/casinos/bars/ discos/mental health services; (2) patchy compliance with the ban, specially in settings which allow exemptions; (3) poor ban enforcement (non-published research: Calheiros et al., 2010; Ravara et al., 2012; Reis et al., 2011). Moreover, Portuguese children’s exposure to SHS is high; one of the highest in the EU (non-published research: Reis et al., Democophes 2012), several studies have reported low motivation to quit, few attempts at giving up, and an increasing prevalence among youth and females. These indicators mirror the failure of tobacco control policies enacted by successive governments/legislators. At the moment, the Portuguese government is about to revise the smoke-free policy (SFP). The government has publicly announced its intention to pass a 100% SFP. However, an 8 years moratorium has been proposed for hospitality venues, allowing smoking and ventilation systems, in order to ‘‘compensate for the investment made’’. While governments and legislators are elected to promote the health and well-being of all Portuguese citizens, they have mostly protected tobacco industry and other ‘‘vested interests’’. The consequence of this is a major toll of death, disability, and suffering and it promotes health and social inequalities and threatens the country economy and welfare. WHO clearly emphasises that only 100% SFPs protect against SHSe and stresses that exemptions, such as the moratorium presented by the current Portuguese government, are common tactics of the tobacco industry to block SFP implementation. Moreover, an eminent Portuguese constitutionalist has stated that SFP exemptions are unconstitutional: while failing to protect all citizens, they violate the general principle of health protection of Portuguese law. The Portuguese public health community should publicly denounce the interference of the tobacco industry in policy-making, accordingly to article 5.3 of WHO-FCTC treaty; and demand a 100% smoke-free Portugal without any exemptions or delays; as part of a comprehensive, adequately funded and enforced tobacco control programme. This would comply with the Portuguese government’s obligation following the WHO-FCTC ratification in 2005.