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- Effectiveness of social prescribing programs in the primary health-care context: a systematic literature reviewPublication . Costa, Andreia; Sousa, C. Joana; Seabra, Paulo Rosário Carvalho; Virgolino, Ana; Santos, Osvaldo; Lopes, Joaquim; Henriques, Adriana; Nogueira, Paulo; Alarcão, VioletaSocial prescribing (SP) is an approach that promotes the use of local non-clinical activities by people. The referral is usually made by primary health-care professionals, in a process wherein local providers play a pivotal role. The main objective of this study was to identify domains of intervention and evidence about the effectiveness of SP programs regarding health-related outcomes. A systematic literature review was carried out following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was conducted in PubMed, CINHAL, and SCOPUS. Inclusion criteria of the reviewed papers were as follows: (i) effectiveness studies of interventions designated as SP or interventions entailing SP conceptual components; (ii) interventions with adults. Quality assessment was performed with the Cochrane tool for assessing risk of bias in randomized trials; an assessment tool developed by the US National Heart, Lung and Blood Institute was applied to observational studies. Overall, 13 articles were included for analysis, with a total of 4603 patients. Although three studies comprised a control group, only two followed a randomized controlled trials (RCT) design. Nine principal domains of intervention within SP were identified, with three categories of outcome measures: Physical and psychological wellbeing; Health behaviors and self-efficacy; and Health care resources end economic evaluation. SP is an emergent and promising health-care intervention, and it has been used to promote different health behaviors. Evidence of SP effectiveness on patient’s health and wellbeing is not strong. Further research is needed for understanding how SP can be applied efficiently.
- Social jetlag, a novel predictor for high cardiovascular risk in blue-collar workers following permanent atypical work schedulesPublication . Madeira, Sara Gamboa; Reis, Cátia; Paiva, Teresa; Moreira, Carlos Santos; Nogueira, Paulo; Roenneberg, TillCardiovascular diseases cause >4 million deaths each year in Europe alone. Preventive approaches that do not only consider individual risk factors but their interaction, such as the Systematic COronary Risk Evaluation (SCORE), are recommended by European guidelines. Increased cardiovascular risk is associated with shift-work, surely interacting with the concurrent conditions: disruption of sleep, unhealthy behaviours, and circadian misalignment. Social jetlag (SJL) has been proposed as a way to quantify circadian misalignment. We therefore investigated the association between SJL and cardiovascular health in a cross-sectional observational study involving blue-collar workers, who either worked permanent morning, evening, or night shifts. Sociodemographic, health and productivity data were collected through questionnaires. Blood pressure and cholesterol were measured and the cardiovascular risk was estimated according to the relative risk SCORE chart. Bivariate analysis was performed according to the cardiovascular risk and the relationship between SJL and high cardiovascular risk was analysed through logistic regression. Cumulative models were performed, adjusted for various confounding factors. After 49 exclusions, the final sample comprised 301 workers (56% males; aged <40 years, 73%). Mean standard deviation (SD) SJL was 1:57 (1:38) hr (59.4% ≤2 hr). Cardiovascular risk was high in 20% of the sample. Multivariate analysis revealed SJL to be an independent risk factor for high cardiovascular risk. Each additional hour of SJL increased this risk by >30% (odds ratio 1.31, 95% confidence interval 1.02-1.68). This is the first study indicating that SJL potentially increases cardiovascular risk, and suggests that sleep and individual circadian qualities are critical in preventing negative health impacts of shift-work.
- Active and healthy aging after COVID-19 pandemic in Portugal and other European countries: time to rethink strategies and foster actionPublication . Costa, Andreia; Camara, Gisele; Arriaga, Miguel Telo de; Nogueira, Paulo; Miguel, José PereiraThe population aging in Europe imposes challenges to societies that require adaptations and responses at various levels to minimize impacts and figuring out opportunities. Portugal has been committed to the World Health Organization and European Union's values and policy frameworks concerning active and healthy aging. In 2017, an inter-ministerial working group developed the National Strategy for Active and Healthy Aging. In the face of the COVID-19 pandemic that exposed the vulnerabilities of older populations, the launch of the Decade of Healthy Aging 2021-2030 and its baseline report and the 2018 Active Aging Index Analytical Report may constitute an opportunity to strategically think about the aging of the population as a national purpose in Portugal and in the other European countries that face similar challenges.
- The role of health preconditions on COVID-19 deaths in Portugal: evidence from surveillance data of the first 20293 infection casesPublication . Nogueira, Paulo Jorge; Nobre, Miguel de Araújo; Costa, Andreia; Ribeiro, Ruy M.; Furtado, Cristina; Nicolau, Leonor Bacelar; Camarinha, Catarina; Luís, Márcia; Abrantes, Ricardo; Carneiro, António VazBackground: It is essential to study the effect of potential co-factors on the risk of death in patients infected by COVID-19. The identification of risk factors is important to allow more efficient public health and health services strategic interventions with a significant impact on deaths by COVID-19. This study aimed to identify factors associated with COVID-19 deaths in Portugal. Methods: A national dataset with the first 20,293 patients infected with COVID-19 between 1 January and 21 April 2020 was analyzed. The primary outcome measure was mortality by COVID-19, measured (registered and confirmed) by Medical Doctors serving as health delegates on the daily death registry. A logistic regression model using a generalized linear model was used for estimating Odds Ratio (OR) with 95% confidence intervals (95% CI) for each potential risk indicator. Results: A total of 502 infected patients died of COVID-19. The risk factors for increased odds of death by COVID-19 were: sex (male: OR = 1.47, ref = female), age ((56-60) years, OR = 6.01; (61-65) years, OR = 10.5; (66-70) years, OR = 20.4; (71-75) years, OR = 34; (76-80) years, OR = 50.9; (81-85) years, OR = 70.7; (86-90) years, OR = 83.2; (91-95) years, OR = 91.8; (96-104) years, OR = 140.2, ref = (0-55)), Cardiac disease (OR = 2.86), Kidney disorder (OR = 2.95), and Neuromuscular disorder (OR = 1.58), while condition (None (absence of precondition); OR = 0.49) was associated with a reduced chance of dying after adjusting for other variables of interest. Conclusions: Besides age and sex, preconditions justify the risk difference in mortality by COVID-19.