COVID-19 vaccine effectiveness among healthcare workers in Portugal: results from a hospital-based cohort study, December 2020 to November 2021

Introduction: Healthcare workers (HCW) were amongst the first prioritized for COVID-19 vaccination but data on COVID–19 vaccine effectiveness among HCW is still limited. This study aims to estimate the COVID–19 vaccine effectiveness (VE) against SARS–CoV–2 symptomatic infection among HCW from Portuguese hospitals. Methods: In this prospective cohort study, we analysed data from HCW (all professional categories) from two central hospitals in the Lisbon and Tagus Valley and Centre regions of mainland Portugal between December 2020 and November 2021. VE against symptomatic SARS–CoV–2 infection was estimated as one minus the confounder adjusted hazard ratios by Cox models considering age group, sex, presence of chronic disease and occupational exposure to patients diagnosed with COVID–19 as adjustment variables. Results: During the 11 months of follow up, the 2213 HCW contributed a total of 1950 person-years at risk and 171 SARS–CoV–2 events occurred. The COVID–19 incidence rate for unvaccinated HCW was 348.7 per 1000 person-years while for fully vaccinated HCW was 43.0 per 1000 person-years. We observed a VE against symptomatic SARS–CoV–2 infection of 73.9% (95% CI: 26.2–90.8%) for complete vaccination status. Conclusion: This cohort study found a high COVID-19 VE against symptomatic SARS–CoV–2 infection in Portuguese HCW, which is in concordance with previous studies from other countries. Monitoring of VE in this HCW cohort continues during the winter 2021/2022 to evaluate potential VE decay and booster vaccine effect. Keywords: Vaccine effectiveness, SARS–CoV–2 , COVID–19, symptomatic infection, healthcare workers.

Health Literacy And Health-Related Quality of Life Among Patients With Cardiovascular Disease in Tagus Valley Regional Health Hospital, Portugal: A Cross-Sectional Study

Purpose The aims of this study were to examine the association between health literacy (HL) and health-related quality of life (HRQoL) and to investigate the possible determinants of both variables among patients with cardiovascular diseases in Tagus Valley Regional Health Hospital, Portugal.Methods A descriptive cross-sectional study was conducted among 28 patients with CVD. A convenient sampling technique was used to enrol the study participants. Data were collected using a validated Portuguese version of Short Assessment of Health Literacy (SAHPLA-23) and a validated Portuguese version of Short Form Health Survey (SF-36v2). The multiple linear regression was used to investigate the possible associated variables and the association between HL and HRQoL by using SPSS version 25.Results The results showed the majority of patients with CVD had inadequate HL (89.3%). The majority of the participants had poor HRQoL with Physical Component Score (PCS) scored lower (38.77±9.9) than the Mental Component Score (MCS) (44.13±9.9). Educational level was found to be associated with HL. Level of education, employment status, family history of CVD and history of readmission because of CVD were the variables found to be associated with the PCS. However, no variable was found to be associated with the MCS of QoL. HL was shown to be the best predictor of the PCS (β=0.518, p=0.002) while the history of readmission because of CVD was identified as the second-best predictor of the PCS (β=-0.373, p=0.022). Conclusions Health literacy was significantly associated with the PCS of HRQoL.

Why the incidence in dialysis in the Lisbon and Tagus Valley Region (LVTR) is two to three times higher than in other regions of the country

The analysis of data from the Ministry of Health’s Integrated Chronic Kidney Disease Management Platform (PI -GID), reveals the existence of a striking regional difference in the incidence in dialysis. This difference is characterized by high levels of incidence in all regions, except the Alentejo, and extremely high levels in the Lisbon and Tagus Valley region. In this region, the incidence values are two to three times higher than in the others. The difference between regions is the result of a different number of patients starting hemodialysis, since the incidence in peritoneal dialysis is low and similar in all of them. It is difficult to find justification for such a discrepancy since the prevalence of factors usually responsible for the higher or lower level of incidence in dialysis does not differ significantly between them. A probable explanation may lie in the difference found in the concentration of public hemodialysis centers, a fact that may determine a difference in the criteria used for the entry of patients undergoing substitutive treatment of renal function. In fact, we found a close correlation between the number of public hemodialysis centers per million inhabitants and the level of incidence in dialysis. A more comprehensive analysis of the data from the Ministry of Health’s Integrated Chronic Kidney Disease Management Platform (PI -GID), if allowed, would be of enormous interest, not only to explain this discrepancy in the incidence of dialysis between regions, but because it could probably allow an explanation for Portugal having (one of) the highest levels of dialysis incidence in Europe

Satisfaction of General Practice Trainees with the Teaching Skills of Trainers: An Exploratory and Regional Study

Introduction: In Portugal, requirements for selection and training of General Practice trainers vary across the different regions of the country. The aim of our study was to assess the satisfaction of general practice trainees with their trainers of the Lisbon and Tagus Valley Regional Health Administration.Material and Methods: General Practice trainees were the target population for our cross-sectional, exploratory study. The authors developed a 16-item questionnaire based on the existing literature. The questions covered the following domains: patient safety, learning environment, trainer’s feedback, the trainee/trainer relationship, assessment of educational progress and continuous professional development of trainers. Items were scored on a 5-point Likert-type scale. Data was collected at a meeting in October 2018 attended by General Practice trainees.Results: A total of 384 questionnaires were distributed, with a response rate of 59.9%. The majority of respondents were female (79.9%) and all years of specialty training were represented. Our study shows that 60.4% of General Practice trainees from the Lisbon and Tagus Valley Regional Health Administration are very satisfied with the teaching skills of their trainers. However, there was lower satisfaction with trainer’s continuous professional development, trainer’s feedback, and monitoring of educational progress. The majority (57.4%) of respondents did not give feedback to their supervisors about their teaching performance, mostly because they do not feel comfortable doing so or because they have not considered this.Discussion: The findings show a high degree of satisfaction of the general practice trainees with their trainers of the Lisbon and Tagus Valley Regional Health Administration. The high response rate attained is one of the strengths of the study. The authors make some suggestions for improvement of domains with lower satisfaction levels. Unfortunately, it is difficult to extrapolate the findings nationwide due to the differences between the training programmes of the different regions.Conclusion: Although there is a high level of satisfaction, there is still potential for improvement, including the expansion of training programmes for trainers.

COVID-19 Transmission Dynamics: A Space-and-Time Approach

<b><i>Background:</i></b> At the end of January 2021, Portugal had over 700,000 confirmed COVID-19 cases. The burden of COVID-19 varies between and within countries due to differences in contextual and individual factors, transmission rates, and clinical and public health interventions. <b><i>Objectives:</i></b> To identify high-risk areas, between April and October, on a weekly basis and at the municipality level, and to assess the temporal evolution of COVID-19, considering municipalities classified by incidence levels. <b><i>Methods:</i></b> This is an ecological study following a 3-step approach, i.e., (1) calculation of the relative risk (RR) of the number of new confirmed COVID-19 cases, weekly, per municipality, using a spatial scan analysis; (2) classification of the municipalities according to the European Centre for Disease Control incidence categorization on November 19; and (3) characterization of RR temporal evolution by incidence groups. <b><i>Results:</i></b> Between April and October, the mean RR was 0.53, with a SD of 1.44, varying between 0 and 46.4. Globally, the north and Lisbon and Tagus Valley (LVT) area were the regions with the highest number of municipalities with a RR above 3.2. In April and beginning of May, most of the municipalities with an RR above 3.2 were from the north, while between May and August most municipalities with an RR above 3.2 were from LVT area. Comparing the incidence in November and retrospectively analyzing the RR showed the huge variation, with municipalities with an RR of 0 at a certain time classified as extremely high in November. <b><i>Conclusions:</i></b> Our results showed considerable variation in RR over time and space, with no consistent “better” or “worst” municipality. In addition to the several factors that influence COVID-19 transmission dynamics, there were some outbreaks over time and throughout the country and this may contribute to explaining the observed variation. Over time, on a weekly basis, it is important to identify critical areas allowing tailored and timely interventions in order to control outbreaks in early stages.

The Multiplier Effect of European Union Funds in the Alentejo Region, Portugal, Between 2014-2020

The Partnership Agreement established between the European Union and the Member States for the implementation of the European Structural and Investment Funds for the period 2014-2020 has come to an end. It is, therefore, important to understand what impact the Partnership Agreement had on public and private investments in the different Portuguese regions. Support for regional investment has allowed the construction or modernization of collective infrastructures, such as schools, promotion of cultural and natural heritage, investment in energy efficiency, investment in Information and Communication Technologies (ICT) for public services, develop research and development initiatives, as well as urban rehabilitation and mobility. This also includes investments of intermunicipal and business nature. This paper is part of an extended study that analyses the multiplier impact of the application of European Union funds in public and private investment in the 7 Portuguese regions: Porto and North of Portugal, Centro, Lisbon and Tagus Valley, Alentejo, Algarve, Azores and Madeira. In this article we analyse the multiplier impact of the investment of the European funds allocated to the Alentejo Region, in Portugal, under the H2020 Program until the month of March 2020.

Evidence of Surface Rupture Associated With Historical Earthquakes in the Lower Tagus Valley, Portugal. Implications for Seismic Hazard in the Greater Lisbon Area

The Lower Tagus Valley Fault, Portugal, has long been associated with the damaging earthquakes that affected the Greater Lisbon Area in historical times. These include a poorly documented earthquake that occurred in 1344, the relatively well-documented 1531 earthquake, and the most recent M6.0 1909 earthquake. In this work, we use a 0.5 m resolution LiDAR-based digital elevation model and a 0.5 cm resolution digital surface model based on UAV photogrammetry to accurately locate the fault scarps in the northernmost portion of the western fault strand and to select sites to perform paleoseimolological investigations. The paleoseismological and geochronological analysis performed in the Alviela trench site document the fault activity in the last 3000 years, including two earthquakes during historical times. We performed ground motion scenarios for 20 km, 40 km, and 60 km ruptures including the trench site. The ground motion fields obtained for the 40 km and 60 km ruptures are in agreement with most macroseismic intensity data available for the 1531 earthquake, implying a magnitude in the range M6.8–7.4. However, the degree of deformation preserved in the trench suggests a value closer to the lower magnitude bound. The intensity level observed in Lisbon in 1531 (IX) is lower than the modeled intensities for all considered scenarios and could be related to a particularly high level of vulnerability of the building stock.

Occurrence of Fusarium spp. in Maize Grain Harvested in Portugal and Accumulation of Related Mycotoxins during Storage

Maize is an important worldwide commodity susceptible to fungal contamination in the field, at harvest, and during storage. This work aimed to determine the occurrence of Fusarium spp. in maize grains produced in the Tagus Valley region of Portugal and the levels of related mycotoxins in the 2018 harvest and during their storage for six months in barrels, mimicking silos conditions. Continuous monitoring of temperature, CO2, and relative humidity levels were done, as well as the concentration of mycotoxins were evaluated and correlated with the presence of Fusarium spp. F. verticillioides was identified as the predominant Fusarium species. Zearalenone, deoxynivalenol and toxin T2 were not found at harvest and after storage. Maize grains showed some variability in the levels of fumonisins (Fum B1 and Fum B2). At the harvest, fumonisin B1 ranged from 1297 to 2037 µg/kg, and fumonisin B2 ranged from 411 to 618 µg/kg. Fumonisins showed a tendency to increase (20 to 40%) during six months of storage. Although a correlation between the levels of fumonisins and the monitoring parameters was not established, CO2 levels may be used to predict fungal activity during storage. The composition of the fungal population during storage may predict the incidence of mycotoxins.

A sanity check for earthquake recurrence models used in PSHA of slow deforming regions: the case of SW Iberia

Probabilistic Seismic Hazard Assessment (PSHA) is the most common tool used to decide on the acceptable seismic risk and corresponding mitigation measures. We propose two consistency tests to address the variability of earthquake generation models found in PSHA studies: i) one rule-of-thumb test where the seismic moment release from the model is converted to an average slip on a typical fault and compared with known plate kinematics or GNSS deformation field; ii) using a neotectonic model, the computed deformation is converted into seismic moment release and to a synthetic earthquake catalogue. We apply these tests to the W and SW Iberia slow deforming region, where two earthquake source areas are investigated: 1) the Lower Tagus Valley, one of the largest seismic risk zones of Portugal; and 2) the offshore SW Iberia area, considered to be the source for the 1st November 1755 event (M~8.7). Results show that some of the earthquake source models should be considered as suspicious, given their high/low moment release when compared to the expected values from GNSS observations or neotectonic modelling. In conclusion, PSHA studies in slow deforming regions should include a similar sanity check on their models' evaluation, downgrading the weight of poorly compliant models.