Mestrado em Saúde Pública / Master Degree Course in Public Health

Mestrado em Saúde Pública / Master Degree Course in Public Health

Mestrado em Saúde Pública / Master Degree Course in Public Health / Abstract Depression and cardiovascular disease: a pharmacoepidemiologic perspective by Germano Leonel Coelho Ferreira Supervisor: Professor Doutor Henrique de Barros Serviço de Higiene e Epidemiologia da Faculdade de Medicina da Universidade do Porto. Depressive disorder and cardiovascular disease comprise the two health conditions with higher burden in public health. It is known that individuals suffering from chronic illness are more likely to suffer psychological disturbances. In both cases treatment relies mostly on pharmacological interventions. Neuro-physiological and psychosocial links have been proposed to explain the interaction between depression and cardiovascular conditions. Our aim was to study the association between depression and cardiovascular disease from a pharmacoepidemiologic perspective, namely the likelihood for the treatment of depression to be associated with the treatment of cardiovascular disease, and the factors affecting this association. The study was comprised of two stages: a) a systematic review of available literature on the association of antidepressant drugs use with cardiovascular therapy; b) a crosssectional study where treatment with antidepressant drugs was considered the outcome of interest, evaluating the effect of selected determinants including concomitant use of cardiovascular treatment. The systematic literature review consisted of a search on MEDLINE, EMBASE and PsycINFO databases using pre-specified keywords. 4 publications were included in the review out of 1008 citations initially retrieved. The published evidence reveals a small number of studies and inconclusive results. Predominantly the authors suggest a strong influence by factors, such as gender and intensity of contact with the healthcare system. A cross-sectional study was conducted based on self-reported information on drug use, collected through interviews from a cohort of adults residents the city of Porto, Portugal. The data about the drugs used regularly in the year previous to the interview were then coded and classified according to the ATC classification system. Gender, age, marital status, educational attainment, employment situation and medical history were also collected. Of the 1852 individuals participating in the study, 1016 completed the Beck Depression Inventory and were asked the number of medical visits during the preceding 12 months. In the complete cohort, the prevalence of antidepressants use was 7.0% (95%CI: 5.8, 8.2) and depression was reported by 4.3% (95%CI: 3.4, 5.3) of the participants. Although antidepressant use was associated with female gender, some age strata, divorced/widowed marital status and cardiovascular drug use in the univariate analysis, after adjusting for demographic and social factors, using unconditional logistic regression, the association with cardiovascular drug use dissipated. The only factors remaining positive were female gender and self-reported depression. In a second analysis, those participants with a BDI 10 or had reported using at least one antidepressant drug, were classified as depressed and were included in the subanalysis to assess the likelihood of antidepressant use among depressed patients adjusting for age and gender together with number of medical visits and cardiovascular drug use. Female gender (OR=2.72; 95%CI: 1.20, 6.15) and a greater number of medical visits in the previous year [OR=3.88 (95%CI: 1.55, 9.75) for 2-5 visits, and OR=11.40 (95%CI: 3.92, 33.14) for 6-11 visits, compared to 0-1 visits] had a statistically significant association with antidepressant use in patients classified as depressed. The results of this study are in line with the results from previous research and allow us to conclude that the use of antidepressants is not likely to be associated with concomitant use of cardiovascular therapies. The apparent association may be the result of parallel chronic conditions and intense contact with the health care system

Mestrado em Saúde Pública / Master Degree Course in Public Health

Mestrado em Saúde Pública / Master Degree Course in Public Health

Mestrado em Saúde Pública / Master Degree Course in Public Health / O facto dos animais vadios constituírem um perigo para a Saúde Pública implica que estes sejam sistematicamente recolhidos da rua pelas Autarquias. Entregues aos milhares todos os anos nos seus centros de recolha oficial (antigos canis municipais), não existe posteriormente outra solução que não a sua eutanásia. Para mudar este cenário pensa-se ser necessário a implantação de um programa de controlo reprodutivo em canídeos a longo prazo através da sua esterilização, conjuntamente com uma política de educação e sensibilização sobre a actual situação de sobre-população animal. O objectivo deste estudo, até quanto sabemos único em Portugal, foi determinar a possibilidade de implantação de um programa de controlo reprodutivo em canídeos, avaliando a disponibilidade da população para a esterilização dos seus animais. Este trabalho permitirá decidir sobre a forma de intervenção na população de risco, fazendo um diagnóstico da situação actual da aceitação pelos proprietários da esterilização dos seus animais. Devido à diminuição de risco de aparecimento de tumor mamário conferida pela esterilização, foi paralelamente verificada a prevalência desta patologia nesta amostra. No âmbito deste estudo foram inquiridos 1219 proprietários de canídeos que tiveram acesso à campanha oficial de vacinação antirrábica de 2006 e 197 pelas clínicas veterinárias do Concelho, num total de 1416 questionários preenchidos. Foi feita a avaliação clínica para diagnosticar nódulos sugestivos de tumor mamário. Através dos inquéritos à população que frequentou a campanha oficial os resultados não foram animadores, verificando-se uma taxa baixa de animais esterilizados (4,9%), 1% nos machos e 10,5% nas fêmeas. A esterilização não é um acto recorrente entre a população visto que apenas 22,5% dos Munícipes a apoiam e reconhecem as suas vantagens. A maioria dos entrevistados (48,6%) desconhece as suas vantagens e 28,9% opõe-se à esterilização, principalmente por a considerar errada e antinatural. A taxa mais elevada de esterilização de animais está associada a um estrato social com rendimento médio-alto, com maior instrução e com profissões mais especializadas. Pelo contrário, a menor taxa de esterilização de animais e a maior percentagem de oposição à esterilização relaciona-se com estratos sociais de menores recursos financeiros e que habitam áreas rurais. Os factores de risco para a subsistência e aumento do número de animais abandonados tais como a alimentação de animais vadios e a falta do uso da trela pelos proprietários persistem na população detentora de animais com uma percentagem de 15,6% e 42,2%, respectivamente. A falha na recolha das fezes pelos proprietários dos animais quando os passeiam na rua atinge os 75,7%. Verificou-se que os proprietários de animais que atendem à campanha oficial de vacinação apresentam menos recursos económicos e menos instrução, assim como profissões menos especializadas do que aqueles que escolhem preferencialmente as clínicas veterinárias privadas. A prevalência de nódulos mamários foi estimada por palpação das cadeias mamárias em todos os animais avaliados, 2,6% (n=33), verificando-se estar estatisticamente associada aos factores sexo e idade do animal. Verificou-se a ausência de nódulos mamários nos animais esterilizados antes dos 3 anos de idade. Perante estes resultados, parece-nos imprescindível o investimento em campanhas educativas de promoção do controlo reprodutivo de forma a familiarizar a esterilização junto dos proprietários de animais. Um incentivo à esterilização poderá ser a diminuição do risco de desenvolver tumores mamários. O apoio económico às classes de menor rendimento, ao nível da comparticipação da esterilização, é igualmente necessário para possibilitar o acesso à mesma por todos e no futuro ser possível alcançar o patamar de outros países desenvolvidos ao nível do controlo da reprodução. / The fact that stray animals are a danger for the Public Health implies that these ones need to be systematically collected from the streets by the Autarchies. Every year thousand animals are delivered on their Official shelters (former municipal kennels) and therefore there is no other solution that its euthanasia. To change and manage this issue it is necessary to establish a program to control dog reproduction in a long term through its sterilization with an educational policy and awareness on the current situation about the animal over-population. Unique in Portugal, the purpose of this study was to determinate the possibility of a necessary program to establish the control of dog reproduction, evaluating and verifying the availability of the population for the sterilization of their animals. This work will allow to decide the best way to deal with the risky population, making a diagnosis of the current situation for the acceptance of the sterilization of their animals by the dog s owners. Due to the reduction of risk of the appearance of mammary tumor conferred by the sterilization, it was also found alongside this sample the prevalence of this disease. In this study were surveyed 1219 dog owners and all of them had access to the official campaign of anti-rabic vaccination in 2006 and 197 by the veterinary clinics of the municipality, a total of 1416 fulfilled inquiries. Their animals were evaluated to diagnose nodules and therefore analysed the possibility of mammary tumor. Through the inquiries maded to the population who attended the official campaign, the results were not encouraging, with a low level of sterilized animals (4.9%), 1% in males and 10.5% in females. The sterilization is not a recurrent act among the population because only 22.5% of the Munícipes are available to support and recognize the benefits. Most of the inquired people (48.6%) don t know the advantages of the sterilization and 28.9% are against the sterilization, mainly because they consider that a wrong option and also an anti-natural way to solve this issue. The higher rate of sterilization of animals is relied to a social stratum with medium-high incomes, with a higher educational level and with more specialized professions. In opposite, the lowest rate of sterilization of animals and the highest percentage of opposition to sterilization is related to lower social strata, with lower financial resource and who lives in rural areas. The factors of risk for the subsistence and increase of the number of abandoned animals such as the vagrant animal feeding and lack of the use of the lead by the dog s owners is a still a reality in the population that have animals, with a share of 15.6% and 42.2%, respectively . The lack of the excrement collection by the owners of the animals when they walk them in the street reached 75.7%. It was verifyied that the owners of animals that meet the official campaign of vaccination have less educational and lower economic resources, as well as less specialized professions than those who prefer to choose private veterinary clinics. The prevalence of mammary nodules was estimated by palpation of all animals evaluated, and 2.6% (n = 33) and have been statistically linked to the factors of gender and age of the animal. The lack of mammary nodules in animals sterilized before 3 years of age was verified and confirmed. These results show that it seems essential the investment in educational campaigns to promote reproduction control in order to familiarize the sterilization to the owners of the animals. The factor that may encourage the sterilization is the advantage that brings the level of prevention of mammary tumors. The economical support to the lower income classes in the matter of sharing the costs of sterelization is also necessary to enable access to all and in a near future also to make possible the abillity to reach the level of other developed countries in terms of the control of reproduction.

Mestrado em Saúde Pública / Master Degree Course in Public Health

Mestrado em Saúde Pública / Master Degree Course in Public Health

Mestrado em Saúde Pública / Master Degree Course in Public Health

Mestrado em Saúde Pública / Master Degree Course in Public Health