Milton Severo

Determinants of health care utilization by immigrants in Portugal

BackgroundThe increasing diversity of population in European Countries poses new challenges to national health systems. There is a lack of data on accessibility and use of health care services by migrants, appropriateness of the care provided, client satisfaction and problems experienced when confronting the health care system. This limits knowledge about the multiple determinants of the utilization of health services. The aim of this study was to describe the access of migrants to health care and its determinants in Portugal.MethodsThe study sample included 1513 immigrants (53% men), interviewed at the National Immigrant Support Centre, in Lisbon. Data were collected using questionnaires. The magnitude of associations between use of National Health Service and socio-demographic variables was estimated by means of odds ratios (OR) at 95% confidence intervals, calculated using logistic regression.ResultsAmong participants, 3.6% stated not knowing where to go if facing a health problem. Approximately 20% of the respondents reported that they had never used the National Health Service, men more than women. Among National Health Service users, 35.6% attended Health Centres, 12% used Hospital services, and 54.4% used both. Among the participants that ever used the health services, 22.4% reported to be unsatisfied or very unsatisfied. After adjusting for all variables, utilization of health services, among immigrant men, remained significantly associated with length of stay, legal status, and country of origin. Among immigrant women, the use of health services was significantly associated with length of stay and country of origin.ConclusionThere is a clear need to better understand how to ensure access to health care services and to deliver appropriate care to immigrants, and that special consideration must be given to recent and undocumented migrants. To increase health services use, and the uptake of prevention programs, barriers must be identified and approaches to remove them developed, through coherent and comprehensive strategies.

Screening for twin–twin transfusion syndrome at 11–14 weeks of pregnancy: the key role of ductus venosus blood flow assessment

A discrepancy in crown–rump length (CRL) and/or nuchal translucency thickness (NT) between monochorionic twins has been found to be associated with an increased risk of twin–twin transfusion syndrome (TTTS). As one of the most plausible mechanisms for increased NT is hemodynamic imbalance and cardiac dysfunction, indirectly manifested by abnormal blood flow in the ductus venosus (DV), we aimed to clarify the role of DV blood flow assessment in identifying those monochorionic twins more prone to develop TTTS.

Sociodemographic Determinants of Prevalence and Incidence of Helicobacter pylori Infection in Portuguese Adults

Understanding the determinants of Helicobacter pylori infection in adults is essential to predict the burden of H. pylori‐related diseases. We aimed to estimate the prevalence and incidence of H. pylori infection and to identify its major sociodemographic correlates in an urban population from the North of Portugal.

Translation of Berlin Questionnaire to Portuguese language and its application in OSA identification in a sleep disordered breathing clinic

BACKGROUND Berlin Questionnaire (BQ), an English language screening tool for obstructive sleep apnea (OSA) in primary care, has been applied in tertiary settings, with variable results. AIMS Development of BQ Portuguese version and evaluation of its utility in a sleep disordered breathing clinic (SDBC). MATERIAL AND METHODS BQ was translated using back translation methodology and prospectively applied, previously to cardiorespiratory sleep study, to 95 consecutive subjects, referred to a SDBC, with OSA suspicion. OSA risk assessment was based on responses in 10 items, organized in 3 categories: snoring and witnessed apneas (category 1), daytime sleepiness (category 2), high blood pressure (HBP)/obesity (category 3). RESULTS In the studied sample, 67.4 % were males, with a mean age of 51 ± 13 years. Categories 1, 2 and 3 were positive in 91.6, 24.2 and 66.3 %, respectively. BQ identified 68.4 % of the patients as being in the high risk group for OSA and the remaining 31.6 % in the low risk. BQ sensitivity and specificity were 72.1 and 50 %, respectively, for an apnea-hipopnea index (AHI) > 5, 82.6 and 44.8 % for AHI > 15, 88.4 and 39.1 % for AHI > 30. Being in the high risk group for OSA did not influence significantly the probability of having the disease (positive likelihood ratio [LR] between 1.44-1.49). Only the items related to snoring loudness, witnessed apneas and HBP/obesity presented a statistically positive association with AHI, with the model constituted by their association presenting a greater discrimination capability, especially for an AHI > 5 (sensitivity 65.2 %, specificity 80 %, positive LR 3.26). CONCLUSIONS The BQ is not an appropriate screening tool for OSA in a SDBC, although snoring loudness, witnessed apneas, HBP/obesity have demonstrated being significant questionnaire elements in this population.

Sleep Duration and Adiposity During Adolescence

BACKGROUND AND OBJECTIVE: The association between sleep and obesity has been described in different age groups. However, there are not sufficient data to clarify the inconsistent results reported in adolescents. Our objective was to study the associations between sleep duration and adiposity at 13 and at 17 years of age, with both cross-sectional and longitudinal approaches. METHODS: We evaluated, as part of an urban population-based cohort (EPITeen), 1171 adolescents at both 13 and 17 years of age. Sleep duration was estimated by self-reported bedtimes and wake-up times. Age- and gender-specific BMI z scores were calculated based on Centers for Disease Control and Prevention references. Body fat percentage (BF%) was assessed by bioelectrical impedance. Regression coefficients (β) and respective 95% confidence intervals (CIs) were used to estimate the association between sleep and BMI z scores and BF%. Additionally, a cross-lagged analysis was performed to investigate the causal relations. RESULTS: In the cross-sectional analysis, at 13 years, sleep duration was inversely associated with BMI z score only in boys (β = −0.155, 95% CI: −0.267 to −0.043); at 17 years, a positive association was found among girls but was only significant for BF% (β = 0.510, 95% CI: 0.061–0.958). In the longitudinal approach, sleep duration at age 13 was inversely associated with BMI z score (β = −0.123, 95% CI: −0.233 to −0.012) and BF% (β = −0.731, 95% CI: −1.380 to −0.081) at 17 years only in boys. These significant associations disappeared after adjustment for adiposity at 13 years. These results were corroborated by those from cross-lagged analysis. CONCLUSIONS: Our results showed an effect of sleep duration in adiposity at younger ages of adolescence and suggested gender differences in this association.

Validity and reproducibility of a semi-quantitative food frequency questionnaire for use among Portuguese pregnant women

This study aimed to evaluate the validity and reproducibility of a semi-quantitative food frequency questionnaire (FFQ) to estimate nutrient intake among Portuguese pregnant women. A sample of 101 pregnant women completed a 3-day food diary (FD) in each pregnancy trimester (reference method) and an interviewer-administered FFQ in the immediate post-partum period. Ranking women according to their usual intake showed that, on average, 65% were classified into the same +/-1 quintile and 2.4% into opposite quintiles by the two methods. Energy-adjusted and de-attenuated correlation coefficients ranged from 0.20 (protein) to 0.58 (riboflavin). Similar results were obtained when the FFQ was compared to each trimester-specific FD. To assess the FFQ reproducibility, 70 women in their third pregnancy trimester were interviewed twice within a 2-week interval. The level of agreement was high, with > or = 75% of the participants being classified into the same +/-1 quintile by the two administrations for 13 of the 15 nutrients examined. A review of the published literature revealed that this is the first FFQ to take the whole pregnancy as its reference time window. Our findings showed that a single administration of this FFQ in the immediate post-partum period is a valid tool to rank Portuguese pregnant women according to their intakes.

Incidence and risk factors for the metabolic syndrome in an urban South European population

OBJECTIVE To estimate the incidence of the metabolic syndrome in a Portuguese sample and to evaluate its specific risk factors. METHODS During a follow-up evaluation (May 2005-September 2008) of a Portuguese community cohort, 1377 participants were eligible for this study. Data on social, demographic, personal and family medical history and behavioral characteristics (including alcohol consumption and smoking habits) were collected. The metabolic syndrome was defined according to the AHA/NHLBI criteria Crude incidence rates were calculated for the total sample, by sex and age classes, and Poisson generalized linear models were used, with the default log link and offset in the variable time. RESULTS The incidence rate of metabolic syndrome in this population was 47.2 /1000 person-years (95% CI: 41.2-53.9), similar in females and in males. The incidence of metabolic syndrome increased with age and in less educated participants. No significant association was observed between the occurrence of metabolic syndrome and the behavioral characteristics evaluated. High waist circumference presented the strongest association with the occurrence of the metabolic syndrome, even after adjustment for other confounders (IRR=1.68; 95% CI: 1.47-1.93). CONCLUSION Older and less educated participants had a higher syndrome incidence. In this population, central obesity was the strongest predictor of metabolic syndrome.

Testing an adaptation of the EPIC Physical Activity Questionnaire in Portuguese adults: A validation study that assesses the seasonal bias of self-report

Abstract Background: No self-report method to measure different types and intensities of physical activity (PA) in adults has been tested in the Portuguese population. We assessed the validity, reproducibility and seasonal bias on past-year PA reporting. Subjects and methods: A sample of 953 Portuguese adults was evaluated between 2001 and 2003. A 4 × 7-day PA diary was used as a reference method to evaluate the validity of the EPIC questionnaire adapted for the Portuguese population (n = 114). Spearmans correlation coefficients were calculated and agreement was tested using Bland–Altman plots. Trigonometric linear models were used to assess the seasonal variation. Results: Correlations between the questionnaire and the diaries were 0.56, 0.50, 0.88 and 0.78 for total, rest, occupational and leisure-time PA, respectively. The coefficients for reproducibility (2–3 months interval) ranged between 0.80 for leisure and 0.91 for occupational. Visualizing Bland–Altman plots, only rest PA revealed a tendency towards an increase in differences with increasing rest reported. Males interviewed in April and August reported the highest and lowest mean of leisure-time PA, respectively. For professional activities, the probability of amplitude being over one-half standard deviation was 33%. Conclusions: The questionnaire is a valid and reproducible instrument for the brief assessment of usual energy expenditure in adults, detailing different types of PA. In males, seasonal bias on reporting leisure-time and professional PA was found.

Bidirectional association between parental child-feeding practices and body mass index at 4 and 7 y of age

BACKGROUND Evidence of the association between parental child-feeding practices and the childs body mass index (BMI) is controversial, and bidirectional effects have been poorly studied. OBJECTIVE We aimed to examine bidirectional associations between parental child-feeding practices and BMI at 4 and 7 y of age. DESIGN This study included 3708 singleton children from the Generation XXI birth cohort with data on parental child-feeding practices and BMI at 4 and 7 y old. Feeding practices were assessed through a self-administered questionnaire by combining the Child Feeding Questionnaire and the Overt/Covert Control scale and then adapting it to Portuguese preschool children. Weight and height were measured according to standardized procedures, and age- and sex-specific BMI z scores were computed based on the WHO Growth References. Linear regression models were used to estimate the bidirectional associations between each practice and BMI z score. Crosslagged analyses were performed to compare the directions of those associations (the mean score of each practice and BMI z score at both ages were standardized to enable effect size comparisons). RESULTS After adjustments, pressure to eat and overt control at 4 y of age were associated with a lower BMI z score 3 y later (β: -0.05; 95% CI: -0.08, -0.03 and β: -0.05; 95% CI: -0.09, -0.01, respectively). Regarding the opposite direction of association, a higher BMI z score at 4 y of age was significantly associated with higher levels of restriction and covert control at 7 y of age (β: 0.06; 95% CI: 0.03, 0.08 and β: 0.06; 95% CI: 0.04, 0.08, respectively) and with lower levels of pressure to eat (β: -0.17; 95% CI: -0.20, -0.15). The only bidirectional practice, pressure to eat, was more strongly influenced by the BMI z score than the reverse (βstandardized: -0.17 compared with βstandardized: -0.04; likelihood ratio test: P < 0.001). CONCLUSIONS We found that parents both respond to and influence the childs weight; thus, this child-parent interaction should be considered in future research.

Patterns of breast cancer mortality trends in Europe.

OBJECTIVES To identify patterns of variation in breast cancer mortality in Europe (1980-2010), using a model-based approach. METHODS Mortality data were obtained from the World Health Organization database and mixed models were used to describe the time trends in the age-standardized mortality rates (ASMR). Model-based clustering was used to identify clusters of countries with homogeneous variation in ASMR. RESULTS Three patterns were identified. Patterns 1 and 2 are characterized by stable or slightly increasing trends in ASMR in the first half of the period analysed, and a clear decline is observed thereafter; in pattern 1 the median of the ASMR is higher, and the highest rates were achieved sooner. Pattern 3 is characterised by a rapid increase in mortality until 1999, declining slowly thereafter. CONCLUSION This study provides a general model for the description and interpretation of the variation in breast cancer mortality in Europe, based in three main patterns.