During the first two weeks of August 2003, Portugal was affected by a severe heat wave. Following the identification in Portugal of the influence of heat waves on mortality in 1981 and 1991 (estimated excess of about 1900 and 1000 deaths respectively), the Observatório Nacional de Saúde (ONSA) - Instituto Nacional de Saúde Dr. Ricardo Jorge, together with the Vigilância Previsão e Informação - Instituto de Meteorologia, created a surveillance system called ÍCARO, which has been in operation since 1999. ÍCARO identifies heat waves with potential influence on mortality [1]. Before the end of the 2003 heat wave, ONSA had produced a preliminary estimate of its effect on mortality. The results based on daily number of deaths from 1 June to 12 August 2003 were presented within 4 working days. Data was gathered from 31 National Civil registrars, covering the district capitals of all 18 districts of mainland Portugal, and representing approximately 40% of the mainland's mortality. The number of deaths registered in the period 30 July to 12 August was compared with the ones registered during 3 comparison periods: (in July): 1-14 July, 1-28 July, and 15-28 July). 15-28 July, the period best resembling the heat wave in time and characteristics, produced an estimation of 37.7% higher mortality rate then the value expected under normal temperature conditions. From this value, an estimate of 1316 death excess was obtained for mainland Portugal. The main purpose of this article is to present the method used to identify and assess the occurrence of an effect (excess mortality) during the heat wave of summer 2003.

Within I-MOVE (European programme to monitor seasonal and pandemic influenza vaccine effectiveness (IVE)) five countries conducted IVE pilot case-control studies in 2008-9. One hundred and sixty sentinel general practitioners (GP) swabbed all elderly consulting for influenza-like illness (ILI). Influenza confirmed cases were compared to influenza negative controls. We conducted a pooled analysis to obtain a summary IVE in the age group of ≥65 years. We measured IVE in each study and assessed heterogeneity between studies qualitatively and using the I2 index. We used a one-stage pooled model with study as a fixed effect. We adjusted estimates for age-group, sex, chronic diseases, smoking, functional status, previous influenza vaccinations and previous hospitalisations. The pooled analysis included 138 cases and 189 test-negative controls. There was no statistical heterogeneity (I2=0) between studies but ILI case definition, previous hospitalisations and functional status were slightly different. The adjusted IVE was 59.1% (95% CI: 15.3-80.3%). IVE was 65.4% (95% CI: 15.6-85.8%) in the 65-74, 59.6% (95% CI: -72.6 -90.6%) in the age group of ≥75 and 56.4% (95% CI: -0.2-81.3%) for A(H3). Pooled analysis is feasible among European studies. The variables definitions need further standardisation. Larger sample sizes are needed to achieve greater precision for subgroup analysis. For 2009-10, I-MOVE will extend the study to obtain early IVE estimates in groups targeted for pandemic H1N1 influenza vaccination.

Receive free email alerts when new articles cite this article. Sign up in the Notes articles must include the digital object identifier (DOIs) and date of initial publication. priority; they are indexed by PubMed from initial publication. Citations to Advance online prior to final publication). Advance online articles are citable and establish publication yet appeared in the paper journal (edited, typeset versions may be posted when available Methods Historical cohort study design including all patients aged 45 or more who were hospitalised in the 7 days before the heatwave. The outcome was survival during the 18 days the heatwave lasted and during the 2 days after the end of the heatwave. A comparison group was also selected in four analogous periods without any heatwave event during January to May 2003. Data were obtained from the 2003 hospital discharges database. Air conditioning presence in hospital wards was determined using a survey sent to hospital administrations. A Cox-regression model was used to estimate the confounder-adjusted HR of death, during the heatwave and the comparison period, in patients in wards with air conditioning (AC+) versus patients in wards without air conditioning (ACÀ). Results 41 hospitals of mainland Portugal (49% of all hospitals in mainland Portugal) participated, and 2093 patients were enrolled. The overall confounder-adjusted HR of death in AC+ patients versus ACÀ patients was 0.60 (95% CI 0.37 to 0.97) for the heatwave period and 1.05 (95% CI 0.84 to 1.32) for the comparison group. Conclusions The study found strong evidence that, during the August 2003 heatwave, the presence of air conditioning in hospital wards was associated with an increased survival of patients admitted before the beginning of the climate event. The reduction of the risk of dying is estimated to be 40% (95% CI 3% to 63%). INTRODUCTIONIn Portugal, the consequences of heatwaves in mortality have been studied since 1988, 1 leading to the recognition of the magnitude and importance of this problem and to the development of a national Contingency Plan for Heatwaves, in operation since 2004. These studies also led to the observation that more than half of the excess deaths occurred in hospitalised patients, especially during the 2003 heatwave in Portugal, 3 raising the discussion about the role that absent or insufficient air conditioning of many hospital wards could have played in intrahospital mortality during heatwaves.Since then, Health Ministry directives were issued, and efforts have been made by hospital administration boards to install air conditioning equipments in hospital wards.International literature shows that the risk of death associated with excess heat is higher in patients with pre-existing cardiovascular and respiratory diseases than in the general population. 5The occurrence of heatwaves can increase mortality in patients with chronic diseases, namely pre-existing cardiovascular and respiratory diseases, older people, children and individuals from a low socio-economical background. 4e6St...

The aim of this study was to estimate the excess mortality associated with the influenza activity registered in Portugal between week 49 of 2008 and week 5 of 2009. For this purpose available mortality data from the Portuguese Daily Mortality Monitoring (VDM) System were used. Several estimates of excess deaths associated with the recent recorded influenza activity were determined through statistical modelling (cyclic regression) for the total population and disaggregated by gender and age group. The results show that the impact of the 2008-9 influenza season was 1,961 excess deaths, with approximately 82% of these occurring in the age group of 75 years and older.

Most of the epidemiological studies designed to determine the prevalence of Parkinson's disease (PD) in Portugal were hospital-based and the rates reported were around 1/1000. A sentinel network of general practitioners (GPs) has been in effect in the country since 1989, involving doctors with a relatively stable list of patients. This group of doctors notifies, every week, all the cases of certain selected diseases that may occur among the patients under their surveillance. On average, each doctor is responsible for 1500 to 1800 persons, of all ages and both sexes, whose main descriptive characteristics are known and updated every year. This led us to the idea of estimating the prevalence of Parkinson's disease in the community and to compare the estimated rates with hospital-based rates. One hundred and fifty general practitioners agreed to participate in a cross-sectional study which included a sample of 220,000 persons. The study took place between March and April 1992 and information on 291 PD patients was collected. Results show that among the study population, age-standardized rates were 1.4/1000 for males and 1.3/1000 for females. Sex-specific rates increase consistently with age in both sexes, reaching a level of 9/1000 in the oldest age group, '75 and more' years. These results estimate a higher prevalence of PD than was determined previously through hospital-based studies and allowed us to determine that patients aged 65 years and more are much likely to be followed by their own GP, either because the disease its already controlled and they are specifically seeking medication or because they find it difficult to attend neurology clinics.(ABSTRACT TRUNCATED AT 250 WORDS)

This study supports the need for children to avoid unnecessary exposure in medical settings during measles outbreaks, especially if those settings are crowded and result in long waiting periods before a consultation.

BackgroundVaccination is the key measure available for prevention of the public health burden of annual influenza epidemics. This article describes national trends in seasonal influenza vaccine (IV) coverage in Portugal from 1998/99 to 2010/11, analyzes progress towards meeting WHO 2010 coverage goals, and addresses the effect of major public health threats of the last 12 years (SARS in 2003/04, influenza A (H5N1) in 2005/06, and the influenza A (H1N1)2009 pandemic) on vaccination trends.MethodsThe National Institute of Health surveyed (12 times) a random sample of Portuguese families. IV coverage was estimated and was adjusted for age distribution and country region. Independence of age and sex coverage distribution was tested using a modified F-statistic with a 5% significance level. The effect of SARS, A (H5N1), and the A (H1N1)2009 pandemic was tested using a meta-regression model. The model was adjusted for IV coverage in the general population and in the age groups.ResultsBetween 1998/99 and 2010/11 IV, coverage in the general population varied between 14.2% (CI 95%: 11.6%–16.8%) and 17.5% (CI 95%: 17.6%–21.6%). There was no trend in coverage (p = 0.097). In the younger age group (<15 years) a declining trend was identified until 2008/09 (p = 0.005). This trend reversed in 2009/10. There was also a gradual and significant increase in seasonal IV coverage in the elderly (p for trend < 0.001). After 2006/07, IV coverage remained near 50%. Adjusting for baseline trends, there was significantly higher coverage in the general population in 2003/04 (p = 0.032) and 2005/06 (p = 0.018). The high coverage observed in the <15-year age group in season 2009/10 was also significant (p = 0.015).ConclusionsIV coverage in the elderly population displayed an increasing trend, but the 75% WHO 2010 target was not met. This result indicates that influenza vaccination strategy should be improved to meet the ambitious WHO coverage goals. The major pandemic threats of the past decade had a modest but significant effect on seasonal influenza vaccination. There was an increase in vaccine uptake proportion in the general population in 2003/04 and in 2005/06, and in individuals <15 years old in 2009/10.

A nualmente o vírus da gripe é responsável por epidemias que afetam as populações humanas, originando infeções respiratórias normalmente benignas mas que podem ter repercussões elevadas na saúde dos indivíduos. Em termos de impacto, estima-se que as epidemias de gripe sejam responsáveis por excessos de consultas em cuidados primários, que podem variar entre 0,4% (Portugal) 1 e 1,4% 2 (Holanda) da população geral. Igualmen-estudosoriginais