Browsing by Author "Santana, Paula"
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- Assessing the impact of poor housing conditions on human health in PortugalPublication . Vasconcelos, João; Freire, Elisabete; Almendra, Ricardo; Machado, João Reis; Santana, PaulaImprovement on the quality housing is fundamental for reducing thermal discomfort and thus exposure to cold and a better health. Morbidity and mortality has obviously a multivariable cause and one of them is the thermal discomfort in our homes where, as a sedentary being, we spend most of our daily life. A continuous exposure to cold surely debilitates our health and will lead to cardiovascular and respiratory diseases. Most of the Portuguese dwellings show a poor building quality. There are several origins for these deficiencies and with consequences at different levels, in particular, in terms of human comfort. In fact, Portugal is one of the southern European countries that have higher mortality in winter. However, the number of studies relating cold weather and morbidity/mortality is still very rare. These occurrences are suspected to be associated with housing quality especially thermal insulation. In order to assess the relation between the incidence of coronary events and housing, a national survey on patients with acute coronary syndromes in several regions of Portugal was realized during the winter months and data on the housing conditions and behavior attitudes against cold exposure were asked. A better knowledge about the influence of weather and climate on such ailment may be applied to built up a guide for housing design (to new and restorations of old dwellings), inpolicies and strategies for protection and adaptation, health planning, as well as alert systems in order to reduce the number of deaths by cardiovascular failure.
- Evidence of social deprivation on the spatial patterns of excess winter mortalityPublication . Almendra, Ricardo; Santana, Paula; Vasconcelos, JoãoObjectives: The aims of this study are to identify the patterns of excess winter mortality (due to diseases of the circulatory system) and to analyse the association between the excess winter deaths (EWD) and socio-economic deprivation in Portugal. Methods: The number of EWD in 2002–2011 was estimated by comparing the number of deaths in winter months with the average number in non-winter months. The EWD ratio of each municipality was calculated by following the indirect standardization method and then compared with two deprivation indexes (socio-material and housing deprivation index) through ecological regression models. Results: This study found that: (1) the EWD ratio showed considerable asymmetry in its geography; (2) there are significant positive associations between the EWD ratio and both deprivation indexes; and (3) at the higher level of deprivation, housing conditions have a stronger association with EWD than socio-material conditions. Conclusions: The significant association between two deprivation dimensions (socio-material and housing deprivation) and EWDs suggests that EWD geographical pattern is influenced by deprivation.
- Excess winter mortality and morbidity before, during, and after the Great Recession: the Portuguese casePublication . Almendra, Ricardo; Perelman, Julian; Vasconcelos, João; Santana, PaulaAlthough winter mortality and morbidity are phenomena common to most European countries, their magnitude varies significantly from country to country. The geographical disparities among regions with similar climates are the result of several social, economic, demographic, and biological conditions that influence an individual’s vulnerability to winter conditions. The impact of poor socioeconomic conditions may be of such magnitude that an economic recession may aggravate the seasonal mortality pattern. This paper aims to measure the seasonal winter mortality, morbidity, and their related costs during the Great Recession (2009–2012) in mainland Portugal and its Regional Health Administrations (RHAs) and to compare it with the periods preceding and following it. Monthly mortality and morbidity data were collected and clustered into three periods: Great Recession (2009–2012), Pre-Recession (2005–2008), and Post-Recession (2013–2016). The impact of seasonal winter mortality and morbidity during the Great Recession in Portugal and its Regional Health Administrations was measured through the assessment of agestandardized excess winter (EW) death and hospital admissions rate and index, expected life expectancy gains without EW deaths, EWrate of potential years of life lost, and EWrate of emergency hospital admission costs. Important increases of winter deaths and hospital admissions were identified, resulting in an important number of potential years of life lost (87 years of life lost per 100,000 inhabitants in 2009–2012), life expectancy loss (1 year in 2009–2012), and National Health Service costs with explicit temporal and spatial variations. These human and economic costs have decreased consistently during the analyzed periods, while no significant increase was found during the Great Recession. Despite its reduction, the winter excess morbidity and mortality highlight that Portugal still faces substantial challenges related to a highly vulnerable population, calling for investments in better social and health protection.
- Excess winter mortality patterns and regional differences in PortugalPublication . Freire, Elisabete; Santana, Paula; Almendra, Ricardo; Vasconcelos, JoãoThe mortality fluctuation over the year is associated with increases in both the warm and cold seasons. Portugal is often described as the European country with highest excess winter mortality. The main aim of this study is to identify the seasonal patterns of mortality within Portugal and to assess their geography. The chi-square goodness of fit test was used to identify the existence of a significant seasonal increase in mortality by cause of death. The number of excess winter deaths and the excess winter death index were calculated to measure the winter death toll. The main results shown important seasonal mortality increases in almost all causes of death, the mortality due to cardiovascular and respiratory diseases are the main responsible for the winter burden. The number of excess winter death is related to the overall incidence of the disease and their determinants, but the seasonal increase is related to other socioeconomic and behavior factors.
- Excesso de mortalidade no inverno nos países da Europa mediterrâneaPublication . Almendra, Ricardo; Freire, Elisabete; Vasconcelos, João Viljoen de; Santana, PaulaO objetivo deste estudo é identificar e analisar a evolução da incidência da doença cerebrovascular e da doença isquémica cardíaca, e os padrões do excesso de mortalidade no Inverno em quatro países da Europa mediterrânea: Portugal, Espanha, Itália e Grécia. Apesar da mortalidade por doença cardiovascular estar a diminuir a sua sazonalidade é evidente nos países mediterrâneos, onde, apesar de invernos amenos, o excesso de mortes associadas ao frio é mais importante. Portugal apresenta as taxas mais elevadas, e em vários anos regista resultados piores que a média do Mediterrâneo.
- Mortalidade sazonal em PortugalPublication . Almendra, Ricardo; Santana, Paula; Freire, Elisabete; Vasconcelos, JoãoO principal objetivo deste estudo é analisar os padrões geográficos da mortalidade sazonal em Portugal, para tal serão identificadas as causas de morte com maior componente sazonal e os territórios mais vulneráveis. Utilizou-se o chi-square goodness of fit teste para comparar o número de óbitos mensais observados com os esperados (considerando que a mortalidade se encontraria distribuída de forma homogénea ao longo do ano) e identificar a existência de aumentos sazonais estatisticamente significativos. Estimou-se o número de óbitos em excesso no inverno comparando o número de óbitos verificados nos meses de inverno (Dezembro a Março) com a média dos registados no período não-inverno (de Agosto a Novembro e de Abril a Julho). O impacte sazonal das causas de morte foi analisado através do índice de excesso de óbitos no inverno, e dos seus intervalos de confiança; este índice indica o aumento percentual do número de óbitos durante o inverno, comparando-o com o que se verifica no período não-inverno. As regiões foram classificadas em quatro classes conforme sejam territórios com: elevada mortalidade geral e elevada mortalidade sazonal; baixa mortalidade geral e elevada mortalidade sazonal; elevada mortalidade geral e baixa mortalidade sazonal; baixa mortalidade geral e baixa mortalidade sazonal. Verificaram-se importantes aumentos sazonais no inverno em quase todas as causas de morte, sendo as doenças do sistema respiratório e circulatório as principais responsáveis por este aumento. O número de óbitos em excesso encontra-se estreitamente relacionado com a mortalidade geral e os seus determinantes, mas o aumento sazonal da mortalidade poderá encontrar-se relacionado com outros determinantes socioeconómicos ou com fatores comportamentais. Estes resultados revelam que as condições meteorológicas influenciam a saúde, mas que não têm o mesmo impacte em todos os grupos populacionais.
- Padrões e sazonalidade do enfarte agudo do miocárdio em PortugalPublication . Almendra, Ricardo; Santana, Paula; Vasconcelos, João; Freire, ElisabeteApesar do decréscimo verificado nos últimos anos, a mortalidade por doença cardiovascular em Portugal continua a ser a principal causa de morte e de internamento hospitalar. Esta patologia apresenta uma forte sazonalidade, verificando-se a concentração de óbitos e de internamentos durante os meses de inverno. A análise dos padrões e da sazonalidade do enfarte agudo do miocárdio possibilita a reconhecimento de populações em risco e a identificação de situações em que é necessário intervir. Foi observada uma distribuição espacial contrastada no risco de internamento durante os meses de inverno, tendo sido identificado o sul e o interior do país como áreas onde o problema é mais evidente.
- Seasonal mortality patterns and regional contrasts in PortugalPublication . Almendra, Ricardo; Santana, Paula; Freire, Elisabete; Vasconcelos, JoãoThe main aim of this study is to identify the geographical seasonal mortality patterns in Portugal and, for the first time, to assess the relationship between seasonal and overall mortality. Monthly data from the Portuguese mortality database (2000-2009) by major cause of death were analysed and standardized to 30 days with adjustments for leap years. The chi-square goodness-of-fit test was used to compare the observed monthly deaths with deaths that could be expected if mortality were randomly distributed throughout the year. The seasonal burden was measured using the excess winter deaths (EWD) rate and the seasonal impact of winter on mortality was assessed through the EWD Index. The regions were clustered according to the overall mortality rate and the seasonal impact: 1–low seasonality and high values of overall mortality; 2–high seasonality and high values of overall mortality; 3–low values of seasonality and low overall mortality; 4–high seasonality and low overall mortality. Significant seasonal mortality increases were found in all causes of death. There were 86,000 EWDs, mostly through circulatory and respiratory diseases. 73% of the population lives in regions with high winter vulnerability to respiratory mortality and 60% in regions with high winter vulnerability to circulatory mortality. This study reinforces the idea that vulnerability to cold weather may play an important role in the public health in Portugal. This knowledge may be used to construct a set of regulations or policies designed to implement better health planning procedures and more effective warning systems.
- Seasonal mortality patterns due to diseases of the circulatory system in PortugalPublication . Almendra, Ricardo; Santana, Paula; Vasconcelos, João; Freire, ElisabeteExposure to cold weather has negative consequences on human health. Studies have been showing that the seasonality of mortality has an evident peak during winter months in European countries. However, the highest increases in mortality are registered in countries with mild winters. According to several studies winter deaths seem to be associated with low socioeconomic conditions. The main aims of this study are to identify the trends of mortality due to diseases of the circulatory system and excess winter deaths in Portugal and to assess the geographical pattern of seasonal mortality. In the 20 years under analyses, mortality due to diseases of the circulatory system increased 38% during winter months when compared to the non-winter period. Important regional disparities were found, the Excess Winter Death index ranged from 21% to 48%, the central regions tend to have better results. Our results indicate that although circulatory mortality is significantly decreasing in Portugal, the vulnerability to seasonal cold weather remains as an important public health issue. These findings suggest that the exposure to cold weather is an important determinant of cardiovascular diseases that is still neglected in Portugal.
- Short-term impacts of air temperature on hospitalizations for mental disorders in LisbonPublication . Almendra, Ricardo; Loureiro, Adriana; Silva, Giovani; Santana, Paula; Vasconcelos, JoãoIndividuals with mental disorders are often susceptible to the effects of extreme ambient temperatures. The aim of this study is to assess the short-term impacts of daily mean temperature on hospitalizations for mental disorders in the Lisbon Metropolitan Area, Portugal. Methods: To assess the short-term impacts of daily mean temperature on hospitalizations for mental disorders (2008–2014), a quasi-Poisson generalized additive model combined with a distributed lag non-linear model was applied. The model was adjusted for day of the week, air pollution, relative humidity, time and seasonality. Results: The number of hospital admissions for mental disorder during the study period was 30,139. Hospital admissions increase significantly with high temperatures on day of exposure, at lag 0–1 and at lag 0–2.Women are more vulnerable than men, and there was no difference between the age groups studied. Conclusions: The exposure to high temperatures should be considered a significant risk factor for mental disorders; therefore, patient management services may need to be strengthened when extreme high temperature alerts are given