ESSa - Artigos em Revistas Indexados à WoS/Scopus
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Browsing ESSa - Artigos em Revistas Indexados à WoS/Scopus by Author "Afonso, Andrea Luísa Fernandes"
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- Time trends and geographic patterns of mortality due to tracheal, bronchus, and lung cancer in PortugalPublication . Teixeira, Cristina; Fialho, Cristiana; Cunha, Joana; Oliveira, Ana; Afonso, Andrea Luísa Fernandes; Nogueira, António José M.Tracheal, bronchus, and lung cancer (TBLC) remains a major public health concern. Knowledge about geographic patterns and time trends in TBLC could give insights to better address this problem. This study aimed to evaluate the geographic patterns and time trends in mortality due to TBLC observed in Portugal. TBLC-related deaths and population estimates (2011–2021) were derived from the Instituto Nacional de Estatística. Age-standardized mortality rates for people aged 50 or more (ASMR_50+) per 100,000 were obtained. Analyses were stratified by gender, geographic region, and level of urbanization. The time trends in ASMR_50+ were evaluated using joinpoint regression models, and the values for the annual percentage change (APC) and the respective 95% confidence interval (95% CI) were obtained. Differences in mortality due to TBLC between regions and levels of urbanization (2017–2021) were assessed through a standardized mortality ratio (SMR) and the respective 95% CI. In 2021, the ASMR_50+ per 100,000 inhabitants observed in mainland Portugal was 158.0 and 40.4 among men and women, respectively. According to the time-trend analysis, ASMR_50+ due to TBLC remained stable or described a downward trend among men, but there was an upward trend among women in suburban and urban regions. Observed deaths were significantly higher than the expected for men in urban areas (SMR = 125%; 95% CI: 121–128 and SMR = 118%; 95% CI: 115–122 in Norte and Lisboa, respectively), and women in Urban Norte (SMR = 125%; 95%CI: 119–131). Lower mortality than expected was observed among men living in Rural Norte and Rural Centro, as well as, among women living in all the rural areas. In suburban areas, the observed deaths were lower, higher, or as expected depending on the geographic region and gender. A notable upward trend in mortality due to TBLC among women was observed. The geographic patterns observed suggest the effects of deleterious environmental factors and smoking habits, deserving attention from policymakers.
- Tuberculin skin testing versus interferon-gamma release assay among users of a public health unit in Northeast PortugalPublication . Afonso, Andrea Luísa Fernandes; Pires, Bruno; Teixeira, Cristina; Nogueira, António José M.he screening of groups with a high risk for developing tuberculosis (TB) is a priority in order to control this disease. Since there is no gold standard for the diagnosis of latent TB infection (LTBI), both the tuberculin skin test (TST) and the interferon-gamma release assays (IGRA) have been used for this purpose. The aim of this study was to determine the proportion of LTBI by using the TST and the IGRA tests, and to assess the risk factors related with discordant results between tests across several risk groups advised for screening in Northeast Portugal. Data were collected from the database of patients with suspected LTBI and advised for the screening in a public health unit (January 2014 to December 2015). The proportion of LTBI was computed using both tests. Logistic regression models assessed risk factors for a positive test and for discordant results between tests. The adjusted odds ratio (OR) and respective 95% confidence interval (95% CI) were obtained. Out of 367 patients included in the analysis, 79.8% had a positive TST and 46.0% of them had a positive IGRA. In comparison with contacts of active TB cases, healthcare workers and inmates presented higher odds of TST positivity (OR 4.38, 95% CI 1.59–12.09 and OR 4.74, 95% CI 1.45–15.49, respectively), but immunocompromised people presented lower odds of TST positivity (OR 0.14; 95% CI 0.06–0.31). Instead, healthcare workers (OR 0.44, 95% CI 0.24–0.80) and immunocompromised people (OR 0.24, 95% CI 0.10–0.56) presented lower odds of a positive IGRA. There were 42.0% concordant positive results, 16.1% concordant negative results, and 41.9% discordant results, with healthcare workers presenting higher odds of discordant results (OR 3.34, 95% CI 1.84–6.05). The proportion of LTBI estimated by TST and IGRA among people advised for screening in our setting is high, highlighting the need of preventive strategies. Among healthcare workers, TST results should be read with caution as the higher proportion of discordant results with a positive TST suggests the impact of the booster reaction in this group.