Tag Archive for: mortality

Cancer

Cancer is the main cause of premature death in Portugal

Malignant tumors are the second cause of death in the country – after cardiovascular diseases (including strokes and heart attacks) – killing every year nearly 30,000 people.
This number corresponds to one-third of the country’s annual births, at a time when the Portuguese population is shrinking.

At the opening of World Cancer Day Rui Portugal, the deputy director general of the General Directorate of Health (DGS) declared that roughly 60,000 new cases of cancer are discovered every year. Most common are lung, colon, and prostate cancer in men and breast and colon cancer in women.

Increased life expectancy (at present 80,7 years in Portugal), exposure to carcinogens (tobacco, alcohol, air pollution) and unhealthy lifestyles explain the progressive increase in the number of new cases.

He therefore emphasized that the main public health policies for controlling cancer should focus on risk factors such as tobacco and alcohol consumption at the same time urging the population to adopt a healthier lifestyle.

National screening programs for the prevention of cancer are little effective. Although the number of people screened for colon cancer has increased compared to the pre-Covid years, screening coverage in the country is heterogeneous and mainly concentrated in urban centers. There are rural areas where screening practically doesn’t exist.

‘Adherence strategies also need to be improved. People need to be convinced to join’, says JosĂ© Deniz, director of the National Program for Oncological Diseases.

The president of the Portuguese Society of Pneumology, AntĂłnio Morais, recalls that lung cancer is one of the main causes of death. And, although fewer people are smoking nowadays, 15% of the population still does.

‘Smoking cessation consultations were among the most lagging behind during the pandemic and continue to do so as a result of the lack of family doctors. It is necessary to take advantage of the window of opportunity when someone considers quitting smoking.’

Moreover, he emphasized, there is the problem of electronic cigarettes. ‘It is said to harm less because it doesn’t burn but the nicotine is still there, causing addiction. It is a hoax published to exhaustion, even knowing that tobacco advertising has been banned in Portugal.’

Prevention should start in school. ‘Children are also health agents’, says Maria de BelĂ©m Roseira, the former Minister of Health. ‘They must take home the advice their parents did not have or did not value’.


Enjoy the week            Aproveita a semana                (pic PĂșblico/Sapo)













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Womencare

‘A country that hesitates over the care of those giving birth is a country without direction’.

The crisis hitting Obstetric services in Portugal drags on this summer with limited services and even straightforward closures of State (National Health Service) Maternity Units during the weekends, including hospitals of reference in the Greater Lisbon area.

Pregnant women either make do on their own or have to go to private hospitals, where more than half of the doctors specializing in obstetrics are working.

The country’s tabloid Correio da Manhã commented that ‘something is wrong in a country with a shrinking population, that cannot guarantee the minimum conditions for its babies to be born safely and obliges pregnant women with obstetric emergencies to travel irresponsibly long distances because the closest maternity bloc is closed due to lack of doctors.

The reason for the public consternation was the recent loss of a baby whose 41-year-old mother in labor was forced to travel 100 km before reaching a functioning maternity hospital.

The Nurses’ Order and the NGO Observatory for Obstetric Violence are urging the Health Minister Martha Temido to put in place the European directive to give specialist nurses – who have the skills required to oversee low-risk pregnancies in primary care centers – the autonomy they are calling for, at the same time reducing the total dependence on hospital care.

There are currently 3,182 specialist nurses whose potential is being wasted in this regard.

The lack of medical specialists and obstetric care is not only affecting perinatal care but also maternal mortality, which has reached its highest level since 1982. Last year – with 85,000 live births – 17 pregnant women died due to complications of pregnancy ( 8 during pregnancy, 1 during childbirth, and 8 within six weeks after delivery). Thirteen occurred in hospital, a mere 3 were 40 years or older.

Moreover, instrumental vaginal birth (with help of a vacuum extractor or forceps) is three times (31%) higher in Portugal than the European average (11%). Episiotomies (incisions made in the perineum to enlarge the birth canal) are also more frequent and amount to 41%, twice the European average (20%).

These are the main conclusions of a European study including more than 21.000 women from 12 countries and published in the February issue of The Lancet Regional Health – Europe.
‘We have an exacerbated use of the these unnecessary practices similar to countries with a poor quality of care’, declared Raquel Costa, one of the researchers at the Institute of Public Health at the University of Porto.

Enjoy the week                                             Boa semana                          (pic PĂșblico/Sapo)















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Unsustainable

Portugal’s brittle healthcare system is under growing pressure due to an unprecedented rise in coronavirus infections as a result of a relaxation of the measures during Christmas.

Even after a stricter lockdown was put in place on the 15th of January, the number of new cases continued to rise to over 1000 per 100.000 inhabitants. Nearly double that in hard-hit Spain and three times as much as in the Netherlands. This week’s increase is even the biggest in the world!

The health system – which prior to the pandemic had the lowest number of critical care beds per 100.000 inhabitants in Europe – can accommodate a maximum number of 675 Covid patients in ICUs. Currently, more than 95% of the ICU beds are occupied and a further increase in the number of patients is expected over the coming weeks.

‘The impact in hospitals is huge because the number of beds doesn’t increase, the walls are not expandable and health workers are not multiplying’ declared Antonio Pais de Lacerda, a doctor at Lisbon’s biggest hospital Santa Maria.

It is predicted that as many people will die in the next two months as in the last ten and that daily case numbers will not drop before February. Media images of ambulances with patients queuing outside major hospitals in Lisbon waiting for beds, raise fears whether the National Health System (SNS) is on the verge of collapse.

At a recent Infarmed meeting – where government hears the opinion of experts – it was estimated that it will take at least two months for the country to return to pre-Christmas levels. The feeling also was that testing – currently around 47,000 tests a day with around 18% positive results – should be increased, especially in old people’s homes.

With a daily death toll reaching a record high of 218 – one death every seven minutes – and 10.455 new cases, the authorities desperately try to put a lid on the spread of infections. In a country just over 10 million already over 9000 people have died since the start of the pandemic.

In view of the unacceptable rise in the number of cases and deaths, Prime Minister AntĂłnio Costa issued – just 3 days after a stricter lockdown was put in place – even tougher restrictions, similar to the ones during the lockdown of March/April last year. Schools, however, will remain open, much to the dislike of the Ordem dos MĂ©dicos, that has called for an immediate closure to save lives.  

It will be clear that protection of the elderly has failed and that until a successful roll-out of the vaccination programme is in place, tension will prevail.

Stay healthy                          Fique saudĂĄvel             (pic PĂșblico/Expresso)


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Masks

With more than 3000 new Covid cases and 31 deaths registered in 24 hours – according to figures by Portugal’s DGS (Directorate General of Health) – Parliament decided last Friday that face masks are going to be mandatory in public spaces across the country.

The measure – valid for the next 70 days – obliges residents over the age of 10 to wear masks outside whenever physical distancing of 2 metres can’t be guaranteed. A face shield will not do.
Rule-breaking citizens risk a fine of between 100 and 500 euros.

The decision follows an earlier set of rules – in force since October 15 – in which the entire country returned to a State of Calamity including the prohibition of gatherings in public of more than five people, family events (weddings and baptisms) limited to a maximum of 50 people and fines up to 10,000 euros for anyone breaking rules over physical distancing or numbers of people allowed to meet.

Although with a population of 10 million people, Portugal recorded a comparatively low number of cases (116,000) and deaths (2,300) so far, it is – like most European nations – forced to increase restrictions in order to tackle the second wave of COVID-19. Out of 1455 people in hospital, 221 are currently in Intensive care.

People all over Europe are facing tougher restrictions. Big cities in Italy and France encounter curfews, Greek citizens have been told to stay off the street between 12.30 pm and 05.00 am and Spain declared the State of Emergency as from today.
The Czech Republic, Belgium, the Netherlands, and Spain are currently the worst-hit nations, according to recent figures by Johns Hopkins University.

Brussels – in need of a new approach to ‘free circulation’ of their citizens – proposed last week a ‘set of criteria’ comprising the number of new infections per 100.000 inhabitants over the previous 14 days, and the number/percentage of positive tests performed per 100.000 inhabitants in the last 7 days.

These criteria can be used to define red, yellow and green zones as well as consider restrictions on free circulation. They will also serve to determine areas where people have to stay in quarantine.

The day after Parliament decided on mandatory masks in public places, hundreds of people in Lisbon protested against the measures. They shouted ‘freedom’ and carried banners saying ‘masks create distrust’ and ‘fear is not a vaccine’.


Stay safe             Fique saudĂĄvel                       (pic PĂșblico/Sapo/Observ)





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Backstreet

Paula Rego, one of the most famous living artists has said the recent anti-abortion movement criminalizes women and believes recent legislation banning the procedure in some US states is dangerously regressive and will force women into finding potentially deadly ‘backstreet solutions’.

The painter – who was born in Portugal but lives in London – has spent her career focusing on women’s rights and abortion. ‘It seems unbelievable that these battles have to be fought all over again. It is grotesque’, she stated.

Back in 1998, the now 84-year-old artist created a series of paintings – The Abortion Pastels – in response to a referendum to legalize abortion in Portugal. At that time at least 2 women per year died as a result of secretive and often tortuous illegal abortions. The women who survived the severe bleeding and septicaemia risked 3 years in prison.

The referendum was defeated as a result of an intimidating lobby of the ultra-conservative Catholic church and a very low turnout among voters.

It lasted until 2007 before this mistake was corrected and abortion laws in Portugal were liberalized.
In a provocative interview from that time Rego is very clear about the hypocrisy and horror of the rusty abortion policy in her country. And she is proud that her paintings – highlighting the fear and danger of illegal abortion – were useful as propaganda material in the 2007 referendum. ‘It is imperative women have a choice’, she emphasizes.

Rego’s series depicts a theme uncomfortable in Western art – often only concerned with the idealisation of womanhood. Its cruel realism exposes a very real picture for many – especially poor – women in countries beneath the Equator, where every 9 minutes a woman still dies as a result of an illegal abortion. ‘If you are rich it is easier to have an abortion, usually by travelling to another country. Poor women are butchered.’

The exhibition Paula Rego: Obedience and Defiance’ will be the first major retrospective of her work since the 1960s. To support the exhibition – that opens on 15 June at MK Gallery in Milton Keynes, UK – the artist has offered a limited edition print from her celebrated series hoping the etching Untitled Abortion, 2000 will help draw attention to the dangers of making abortion illegal again.

Bom fim de semana          Have a nice weekend             (pics Womensart/Sapo)

 

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Health

A morte Ă© a curve na estrade ( death is a bend in the road ) – Fernando Pessoa

According to the 2019 edition of the Bloomberg Healthiest Country Index, which ranks 169 economies by factors contributing to health – overweight, lifestyle, tobacco & alcohol use and quality of health care – Portugal is in 22nd place.
Neighbouring Spain – that now has the highest life expectancy in Europe – tops the list of world’s healthiest nations.

In the past decade there has been a decline in deaths from cardiovascular diseases and cancer in Spain but not in Portugal, where more than half of all deaths are caused by cardiovascular diseases (30%) and cancer (25%).
The main single cause of mortality and morbidity in the country is a stroke (10%).

Portugal has, in fact, the highest prevalence of stroke in Europe. This is probably due to the high number of people with hypertension – one-third of the population has it but only half knows – and the excessive consumption of salt. Every hour three Portuguese suffer from a stroke, one dies and one remains disabled. In particular, women are more at risk as they grow older than men.

A consequence of the widespread existence of stroke and hypertension is the frequent occurrence of dementia.
Of 35 countries investigated, Portugal ranks 4th with respect to dementia as reported by the OECD (Organisation for Economic Cooperation and Development).

Alzheimer is the most common form of dementia in Western Europe. Interesting enough, this is not the case in Portugal. A recent epidemiological study from the University of Porto and published in the American Journal of Alzheimer Disease discovered that vascular dementia (57%) is more common in the Portuguese population than Alzheimer (36%).


The good news is that in Portugal nearly 2 in 3 cases of dementia can be averted by a change in lifestyle with a healthy diet and regular exercise, including a reduction of risk factors for cardiovascular diseases such as obesity, hypertension, smoking, alcohol abuse, high cholesterol, diabetes, excess of salt and stress.


Bom fim de semana      Have a healthy weekend       (pic Publico/Observador)

 

 

 

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Abortion

“Pedro, voor jou!” Hij staat op van zijn bureau, sloft naar de telefoon in gemeenschappelijke keuken en pakt de hoorn op. “Ja, met Pedro.”
Het blijft stil aan de andere kant van de lijn.

Pedro is net achttien en in zijn eerste studiejaar medische biologie aan de Universiteit van Lissabon als er in 1998 een referendum wordt gehouden over het legaliseren van abortus. In die tijd riskeerde een vrouw 3 jaar gevangenisstraf, als ze al niet doodbloedde door een clandestien uitgevoerde ingreep. Als gevolg van een draconische NEE-lobby van de ultraconservatieve katholieke kerk is de uitslag dramatisch en stemt – bij een opkomst van nipt 30% – iets meer dan de helft van de bevolking tegen legalisering.
Het zou nog tot 2007 duren voordat deze misstap via een nieuw referendum kon worden hersteld.

“Wie is daar?” Dan hoort hij zacht snikken en een piepstemmetje dat “ik” zegt. “Ana! Wat is er?” Pedro kent Ana vanaf de middelbare school en sinds anderhalf jaar hebben ze officieel verkering. Zij is dit jaar ook gaan studeren. Rechten, in Coimbra. “Ik ben al 7 weken over tijd”, fluistert ze. “Meu Deus, Ana!” Pedro’s hart slaat over en het klamme zweet breekt hem uit. Hoe kan dát nou? Ze waren nog zo voorzichtig geweest! Het kind laten weghalen? Hoe dan en wil Ana dat wel? “Pedro?” hoort hij nog in de verte. Dan wordt alles zwart voor zijn ogen.

Legalisering abortus vindt plaats in 2007

Hoewel in de jaren vóór legalisering gemiddeld twee vrouwen per jaar aan de gevolgen van een illegaal uitgevoerde abortus overleden, is dit sinds 2007 niet meer voorgekomen. Bovendien daalde het aantal abortussen met ruim 10% en kwam daarmee onder het Europese gemiddelde.

Maar er is nog minstens een – halve – wereld te winnen

Op het rijke Noordelijk halfrond is abortus niet langer een misdaad. Uitzonderingen zijn Ierland en Polen, waar de invloed van de katholieke kerk liberalisering belemmert.

Ten zuiden van de evenaar – en vooral in de armere landen – is abortus vaak nog strafbaar.

De hypocrisie is dat de elite van het Zuidelijk halfrond zich natuurlijk elke behandeling in het Noorden kan veroorloven – zoals bemiddelde Brazilianen, die voor een legale abortus naar Lissabon vliegen.

Degene die overlijdt of gevangenschap riskeert is dan ook arm in een wereld waar nog elke 9 minuten een vrouw sterft als gevolg van een clandestien uitgevoerde abortus.

 

Geniet van het weekend        Tenha um excelente fim de semana !

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