The first Portuguese National Health Examination Survey (2015): design, planning and implementation

Nunes, Bruno Pereira; Barreto, Marta; Gil, AP; Kislaya, Irina; Namorado, Sónia; Antunes, Liliana; Gaio, Vânia; Santos, AJ; Rodrigues, AP; Santos, James Richard Silva; Alves-Alves, Clara; Castilho, Eduardo Madeira; Cordeiro, Eugénio; Dinis, Ana; Prokopenko, Tamara; Silva, AC; Vargas, Patrícia; Lyshol, Heidi; Dias, CM

doi:10.1093/eurpub/ckw175.104

Cited by 5 publications

(23 citation statements)

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“…The recommendations include informing national and local health authorities and health professionals in advance, enclosing an information lea et with the survey invitation, having a mass media strategy, having a web page, being exible about appointment times and re-invitations, as well as a speci c method of record-keeping on eligibility and participation status for each individual invited to participate in the survey. All these recommendations were described in the Scienti c Protocol [11] and followed during the project period [2,5,8]. Other important strategies implemented to increase participation were regular reminders [12], strict eldwork monitoring [13], and feedback on examination and blood analysis results as an incentive [14].…”

Section: Introductionmentioning

confidence: 99%

“…The INSEF sample was selected using a multi-stage probability sampling design in order to be representative at national level and for each of the 7 health administrative regions of Portugal. in order To estimate an expected prevalence of 50% with an absolute precision of 5% for a 95% con dence interval considering a design effect of 1.5 [5], the minimum target sample size for each region was set at 600 individuals resulting in a total of 4200 persons at the national level.…”

Section: Introductionmentioning

confidence: 99%

“…The eldwork was carried out between February and December 2015 at the 49 primary sampling units by local teams trained by the central team from INSA. Each eldwork team consisted of two nurses, one laboratory technician (occasionally another nurse with special training) and a technical assistant, a total of 117 professionals [2,5].…”

Section: Introductionmentioning

confidence: 99%

“…This is unfortunate, as this may decrease representativeness of survey results [21]. The Portuguese Health Examination Survey achieved a participation rate of 43.9% [5]. In the EHES pilot study, participation rates varied substantially between the countries (25-63%), but for most countries, rates were below 50% [7].…”

Section: Introductionmentioning

confidence: 99%

“…The Portuguese branch of the EHES pilot study was carried out in Algarve in 2010 [22]. Since INSEF was the rst Portuguese national health examination survey [5], carried out by teams that had no experience of this kind, in a population with the highest illiteracy rates in Europe [23] and at least one fth of the population presently not living in Portugal [24,25] this may be considered quite good.…”

Section: Introductionmentioning

confidence: 99%

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Creating a scientific solution: local problem solving in the Portuguese Health Examination Survey: a mixed method study

Lyshol

Gil

Tolonen

et al. 2021

Preprint

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Background Participation rates in health surveys, recognized as an important quality dimension, have been declining over the years, which may affect representativeness and confidence in results. The Portuguese national health examination survey INSEF (2015) achieved a participation rate of 43.9%, which is in line with participation rates from other similar health examination surveys. The objective of this article is to describe strategies used by the local teams to increase participation rates and to solve practical survey problems.Methods After a literature search, informal interviews were conducted with 14 public health officials from local health examination teams, regional and central authorities. 41 of the local staff members also filled in a short questionnaire anonymously. The interviews and self-administered questionnaires were analysed using mixed methods, informed by thematic analysis.Results The local teams believed that the detailed manual, described as a "cookbook for making a health examination survey", made it possible to maintain high scientific standards while allowing for improvising solutions to problems in the local context. The quality of the manual, supported by a series of training workshops with the central research and support team, gave the teams the confidence and knowledge to implement local solutions. Motivation and cohesion within the local teams were among the goals of the training process. Local teams felt empowered by being given large responsibilities and worked hard to incite people to attend the examination through a close and persuasive approach.Local teams praised their INSA contacts for being available for assistance throughout the survey, and said they were inspired to try harder to reach participants to please their contacts for interpersonal reasons.Conclusions The theory of organizational improvisation or bricolage, which means using limited resources to solve problems, was useful to discuss and understand what took place during INSEF.A detailed manual covering standard procedures and face-to-face workshops, including role-play, were vital to assure high scientific standards and high participation rates in this health examination survey. Close contacts between the central team and local focal points in all regions and all survey sites were key to accommodating unexpected challenges and innovative solutions.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Creating a scientific solution: local problem solving in the Portuguese Health Examination Survey: a mixed method study

Lyshol

Gil

Tolonen

et al. 2021

Preprint

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PM10 exposure interacts with abdominal obesity to increase blood triglycerides: a cross-sectional linkage study

Gaio

Roquette

Monteiro

et al. 2021

European Journal of Public Health

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Background Blood lipids and glucose levels dysregulation represent potential mechanisms intermediating the adverse cardiovascular effects of ambient particulate matter (PM) exposure. This study aims to estimate the effect of long-term PM10 exposure on blood lipids and glucose levels and to assess the potential mediation and/or modification action of abdominal obesity (AO) (waist-to-height ratio). Methods Our study was based on 2,390 participants of the first Portuguese Health Examination Survey (INSEF, 2015) with available data on blood lipids and glucose parameters and living within a 30-km radius of an air quality monitoring station with available PM10 measurements. PM10 concentrations were acquired from the air quality monitoring network of the Portuguese Environment Agency. Generalized linear models were used to assess the effect of 1-year PM10 exposure on blood lipids and glucose levels. An interaction term was introduced in the models to test the modification action of AO. Results We found an association between PM10 and non-fasting blood triglycerides (TG) after adjustment for age, sex, education, occupation, lifestyles-related variables and temperature but only in participants with AO. Per each 1 µg/m3 PM10 increment, there was a 1.84% (95% confidence interval: 0.02–3.69) increase in TG. For the remaining blood lipid and glucose parameters, no associations were found. Conclusions Our study demonstrates that even at low levels of exposure, long-term PM10 exposure interacts with AO to increase blood TG. Our findings suggest that reducing both AO prevalence and PM10 below current standards would result in additional health benefits for the population.

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Health impact assessment of salt reduction in bread in Portugal: a pilot study

Baptista

Alves

Braz

et al. 2021

Preprint

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Hypertension is a risk factor for cardiovascular diseases, which can be caused by excessive salt intake. In Portugal, one of the main foods to contribute to ingestion of salt is bread. Thus, a voluntary Protocol was signed between stakeholders with the aim to reduce salt content in bread by 2021. Herein, a retrospective HIA was carried out to assess the impact in blood pressure (BP) after this agreement. In order to find average values of salt intake and BP in Portuguese population, national surveys were used. Also, estimates of BP reduction and its size effects were calculated based upon meta-analysis data. It is expected that salt intake will be reduced mostly in individuals with low educational level, men, aged between 65-74 years old and residents in South region of Portugal. Results in hypertensive patients indicate that a higher effect on BP will occur in the same profile of individuals, except age (between 55 and 64 years old). However, the estimated effect is very low for all groups, suggesting that the Protocol will contribute to modest health gains. Complementary measures supported by HIA studies need to be adopted to actively promote salt intake reduction and effectively prevent hypertension.

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The first Portuguese National Health Examination Survey (2015): design, planning and implementation

Cited by 5 publications

References 0 publications

Creating a scientific solution: local problem solving in the Portuguese Health Examination Survey: a mixed method study

Creating a scientific solution: local problem solving in the Portuguese Health Examination Survey: a mixed method study

PM10 exposure interacts with abdominal obesity to increase blood triglycerides: a cross-sectional linkage study

Health impact assessment of salt reduction in bread in Portugal: a pilot study

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