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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.
- Tourism environmental attitudes in Berlengas Biosphere Reserve, PortugalPublication . Santos, Nelson; Vasconcelos, João; Lopes, Maria Sofia; Mouga, TeresaBerlengas archipelago is located in the Atlantic Ocean, on the Portuguese continental shelf, on the western side of Iberian Peninsula. Berlengas is a marine reserve since 1981, a marine protected area since 1998 and, in 2011, it was included into the World Network of Biosphere Reserves (WNBR). As Berlengas is a relatively accessible archipelago from the west coast, it attracts all sorts of visitors during summer period. As a consequence, Berlengas has been facing a stronger demand for tourism activities each year that, in some cases, may conflict with the sustainable tourism principles desired for this kind of natural areas. The afflux of tourists is regulated by the management plan of the protected area, which defines a carrying capacity of 350 people daily but it is believed that this threshold is widely exceeded, by a factor of 2 or 3 during summer months. The delicate balance between the conservancy and human visitation can be obtained if tourism respects the natural values in Berlengas. Therefore, it is expected that the visitors of a biosphere reserve should demonstrate a high level of environmental concern and pro-ecological attitudes, especially those tourists who chose to visit such a location motivated by Berlengas’ worldwide recognized natural resources. In this work, the pro-ecological behavior and attitudes of tourists visiting Berlengas biosphere reserve are studied. A questionnaire was developed, using the New Ecological Paradigm (NEP) survey, and responded by 309 tourists visiting the islands in July and August 2014. The main results show that only 38% of the visitors are pro-ecological and most have mid-ecological views and 9% of the respondents showed anti-ecological views. These results suggest that a higher level of concern should be considered for the tourism industry in Berlengas, and that increasing the environmental awareness of visitors through education and information programs could contribute to a better environmental experience in this UNESCO Biosphere Reserve.
- 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.
- Can cold weather be a cardiovascular determinant in warm countries?Publication . Vasconcelos, J.; Freire, E.; Almendra, R.; Santana, P.In almost every temperate region of the world, the number of cardiovascular mortality increases significantly during winter months. This phenomenon has been considered as a public health issue in several countries as many of these deaths are considered to be avoidable. The cause for the excess of winter deaths can be attributed to a number of factors, such as diet, exercise and exposure to cold weather. Curiously, southern European countries, such as Portugal, seem to have the highest excess winter deaths that seem to be related to exposure of cold. However, very few studies have addressed this relationship in Portugal and no quantification of the role of cold weather on cardiovascular diseases has been published. The main goal of this study is to quantify the short effect of cold weather on the cardiovascular morbidity in Portugal Generalized additive Poisson regression models were used in order to obtain the influence of a thermal comfort index (PET) on daily hospitalizations for acute myocardial Infarction in the two most developed metropolitan areas of Portugal: Lisbon and Oporto. All models were adjusted for time and other environmental variables. Influenza was also considered as a confounder. The main results reveal an increase up to 2.2% (95% CI = 0,9%; 3,3%) of daily hospital admissions in winter per degree fall in PET. The increase in daily hospitalizations was greater for the entire population than when only the elderly (>65 years) were considered. View publication
- Avaliação do potencial dos centros de alto rendimento para o desenvolvimento do turismo desportivo em PortugalPublication . Sousa, Diogo; Correia, João Paulo; Vasconcelos, João; Carvalho, MárioO turismo desportivo tem vindo assumir uma relevância crescente no turismo mundial. É atualmente um setor altamente competitivo que não se esgota na organização de grandes eventos desportivos. Hoje em dia o turismo é um campo muito amplo, sendo um mar de oportunidades para difundir a sua identidade enquanto potenciais destinos desportivos, gerarem novos negócios e obterem o reconhecimento internacional para os seus territórios e culturas. O alto rendimento desportivo é um importante segmento do turismo desportivo, assumindo-se como um fator de afirmação nacional e projeção internacional, sendo por isso um potenciador do desenvolvimento das Nações. Nesse sentido, a provisão de instalações e serviços desportivos de qualidade torna-se uma componente vital para a estruturação de adequados sistemas desportivos nacionais, bem como para a construção de uma oferta capaz de responder às necessidades da procura internacional. Em Portugal existem 14 Centros de Alto Rendimento Desportivos (CAR) reconhecidos como tal pela Fundação do Desporto, para além de um conjunto vasto de outros centros desportivos com condições para a prática desportiva no segmento do alto rendimento e que poderão contribuir para a dinamização do turismo desportivo. O diagnóstico da atual e potencial oferta desportiva dos CAR, visando a obtenção de fenómenos de sustentabilidade, torna-se fundamental para a definição de uma adequada gestão estratégica promocional e comercial. Naquele sentido foi identificado um vasto conjunto de dimensões e variáveis, passíveis de ser avaliadas, tidas como fundamentais na estrutura organizacional e na oferta dos CAR. Estas dimensões foram identificadas após pesquisa junto de federações desportivas internacionais, solicitando e medindo a importância das diferentes componentes disponibilizadas pelos CAR. Foram realizadas duas rondas de visitas técnicas a todos os CAR nacionais, com o recurso a entrevistas semiestruturadas aos diferentes representantes das Comissões de Gestão Local. Paralelamente foram também realizadas entrevistas às federações nacionais que usufruem dos CAR. Com base na informação recolhida foi construída uma base de dados com cerca de 117 indicadores avaliados. As dimensões identificadas permitiram avaliar diferentes aspetos, tais como a estratégia a gestão global, os serviços para o alto rendimento, os equipamentos e infraestruturas entre outros. A análise dos resultados do trabalho de investigação evidenciou a heterogeneidade da oferta disponibilizada pelos diferentes Centros. Ainda que existam alguns CAR com uma organização profissional e potencial competitivo de dimensão internacional, a maioria revela ainda uma oferta de serviços que dificilmente se coaduna com as exigências dos mercados internacionais no segmento do alto rendimento. Foram no entanto identificados alguns aspetos de âmbito complementar, com elevado valor acrescentado para os mercados emissores internacionais, tais como o clima, a segurança, a hospitalidade e a proximidade geográfica entre os CAR.
- Identificação de mercados-alvo estratégicos para a promoção do turismo desportivo em Portugal: caso de estudo aplicado aos Centros de Alto RendimentoPublication . Carvalho, Mário; Correia, João Paulo; Sousa, Diogo; Vasconcelos, JoãoOs atletas de alto rendimento desportivo deslocam-se regularmente para locais de treino fora da sua sede de treino habitual com o propósito de i) melhorar as sessões de treino existentes nos seus locais de origem; ii) para se adaptar a condições ambientais regionais específicas (clima, altitude, entre outros) e/ou iii) simplesmente para diversificar os exercícios diários e os cenários de treino como forma de estímulo dos atletas. Portugal tem 14 Centros de Alto Rendimento (CAR) classificados que oferecem várias disciplinas desportivas e que podem ser utilizados para promover o turismo desportivo nacional. Alguns desses centros desportivos têm tentado encontrar o equilíbrio entre a concentração no desempenho de atletas de alto rendimento desportivo (que geralmente são um minoria) e a necessidade de maximizar o uso dessas infraestruturas e serviços (geralmente dirigindo serviços a um maior leque de atletas e à população em geral). Nesse sentido, a Fundação do Desporto definiu a necessidade de promover os CAR nacionais nos mercados internacionais. No âmbito desta estratégia, havia que identificar dez mercados internacionais para a promoção do turismo desportivo no segmento do alto rendimento. Tendo em mente que os atletas de alto rendimento desportivos não adotam os padrões típicos internacionais de income tourism a identificação dos mercados internacionais não pôde seguir as estratégias típicas da segmentação turística. Nesse sentido foi proposta uma metodologia inovadora, para não só identificar os mercados internacionais que já utilizavam os CAR nacionais, como para identificar todos os que possam ser considerados emergentes e com elevado potencial para gerar um fluxo de atletas internacionais por modalidade desportiva. Esta identificação foi obtida através de entrevistas semiestruturadas às federações desportivas nacionais e às Comissões de Gestão Local dos CAR nacionais, este modelo permitiu a identificação de 25 mercados potenciais. Com base nos 25 mercados potenciais, foi definida uma abordagem quantitativa para definir a pontuação e subsequentemente um índice por país. Foram assim considerados os dados: desempenho nas disciplinas desportivas nos dois últimos ciclos olímpicos; o número de atletas que participaram em cada ciclo olímpico; Produto interno bruto per capita; número de atletas em cada disciplina e a zona climática.
- 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.
- Human thermal discomfort and health in Portugal: a geographical assessmentPublication . Vasconcelos, J.; Freire, E.; Almendra, R.; Machado, J.R.; Santana, P.
- 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.
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