Lisbon Area Research Articles

Impact of sociodemographic and economic determinants of health on COVID-19 infection: incidence variation between reference periods

ObjectivesThe COVID-19 pandemic hit Portugal in March 2020, causing widespread disruption to various aspects of society. While extensive research has been conducted on the significance of socio-economic disparities in infection risk, this study aims to enhance our understanding of their evolving relationship over time by analysing four distinct periods in 2020. Study design and methodsThis retrospective observational ecological study included individuals residing in the Primary Healthcare Cluster areas of Almada-Seixal and Western Lisbon and Oeiras, who tested positive for SARS-CoV-2 through a polymerase chain reaction (PCR) test between the 2nd of March and the 8th of November of 2020. Using incidence rates for each specific neighbourhood (n = 29) and period, we explored the relationship between neighbourhood-level socio-economic variables and the risk of infection using negative-binomial regression models. ResultsIn the analysed period, a total of 8562 confirmed COVID-19 cases were identified. Overall incidence rates for each period were sequentially 2.74, 5.03, 3.99 and 14.29 COVID-19 cases per 100,000 person-days. Housing overcrowding, illiteracy rate and place of birth were associated with increased risk of infection, while age, congregate living, and employment in the secondary sector exhibited the opposite association. No association was consistent across all time periods. ConclusionsOur findings support the idea that the influence of socio-economic determinants of health is not immutable throughout time. In a pandemic context where information, knowledge, beliefs, and behaviours are ever-changing and evolving, a dynamic, inclusive, and adaptable approach to disease control can lead to a more equitable distribution of improved outcomes, benefiting all strata of society.

Promoting primary healthcare services resilience with chronic disease management digitalization: a foresight study in the Lisbon health region

Abstract Background Due to the pressure on health systems, the COVID-19 Pandemic forced administrators to rapidly harness and integrate existing technology to manage access of patients with chronic diseases to Primary Health Care (PHC) in Portugal. Studies show that one of the most important areas for improvement is the sustainability of artefacts after the implementation phase, which depends on the successful implementation of digital transformation. As such, this study aims to assess the impact and influence of digitalization of PHC to settle a set of actions to be taken so that implementation is carried out more effectively and to support evidence-based policy-making in a PHC Unit located in the peripheral area of Lisbon. Methods This study followed a collaborative foresight approach using a scenario development methodology proposed by Lapão and Thore, divided into three stages: understanding the context, developing scenarios, and their analysis. These steps were achieved by conducting focus groups using the thematic brainstorming approach to analyse strategic and operational scenarios within ten years (between 2022 and 2032). Results Considering the influence of digitalization of PHC in the next ten years, three relevant and plausible scenarios were developed: ‘Digital PHC and active patients’, ‘NHS transition’ and ‘Climate exigency’. Combining innovation skills to establish digital services with improved governance policies has shown significant benefits toward the goals of more patient-centred care. Conclusions The collaborative reflection process throughout the study made the different stakeholders identify and understand the impact of the essential measures to be taken in different scenarios, allowing the digitalization of PHCs to be implemented more effectively, enabling the sustainability of the National Health Service in the Lisbon region, which has only been discussed so far at a limited and theoretical level.

Governing the bairro clandestino of Cova da Moura (1974–2015): Decentred and collaborative governance in an informal neighbourhood in Lisbon’s metropolitan area

Cova da Moura was established in the municipality of Amadora in the mid-1970s as a bairro clandestino (‘informal’ or ‘illegal neighbourhood’). Since then, it has grown into a community of thousands of residents; having escaped the large rehousing operations of the 1990s, Cova da Moura is today one of the few surviving bairros clandestinos in the metropolitan area of Lisbon, as well as a ‘distressed urban area’. In the four decades of its life, Cova da Moura has passed through different eras of policymaking, and has been the object of a variety of public interventions. The article provides a critical assessment of the Iniciativa Bairros Críticos (Critical Neighbourhoods Initiative, 2005–2013), as an example of a policy initiative embodying a normative vision of collaborative governance. The case of the Iniciativa Bairros Críticos in Cova da Moura provides some lessons on how collaborative governance design can address key challenges that ‘distressed urban areas’ pose to public intervention – but at the same time shows us the unavoidable pitfalls of the process, as well as the limits of their reach vis-à-vis broad, structural issues.

Impact of the New Electricity Remuneration Scheme on the Waste-to-Energy Recovery Activity in Portugal

The remuneration scheme for the electricity produced by Waste-to-Energy (WtE) recovery plants has changed recently in Portugal according to 2020 legislation. The new model, linking the electricity remuneration from WtE plants to the spot electricity prices, is expected to bring greater uncertainty in the waste activity, which is a novelty for the sector. In Portugal, Valorsul is the municipal waste treatment entity responsible for the recovery and treatment of municipal solid waste (MSW) produced in 19 municipalities in the Lisbon area. This paper highlights the impact of the new Portuguese electricity remuneration scheme for electricity from waste on Valorsul’s WtE plant. For this purpose, the new remuneration scheme is modeled and simulated based on electricity spot market price scenarios, which are compared with the base case scenario of the former remuneration scheme. Considering different electricity prices for the electricity produced by the WtE plant, the present study anticipates the consequences of the gate-fee of such regulatory changes. Results show that any price changes in the electricity remuneration scheme are offset by equivalent changes in the waste gate-fee. Consequently, the change in the remuneration of the electricity from the WtE plant is, in fact, neutral for the Valorsul accounts and lower revenues from the electricity generation activity of the WtE will negatively impact the gate-fee prices paid by the waste users.

Validation of the energy resource assessment with experimental data for the site selection of a tidal turbine in the Tagus River estuary.

Lisbon, the capital of Portugal, is located on the mouth of the Tagus River, where the current speed and direction are mainly governed by the local tides. The narrowest part of the river is located between Lisbon downtown and the western side of the city. This narrowing accelerates the water flow and makes it a potential site for a tidal energy system. A preliminary study based on numerical simulations using the software MOHID was conducted to assess potential energy yields throughout the estuary using freely available hindcast data. This allowed the selection of three potential sites for a tidal turbine in the Lisbon area based on yearly tidal and current energy density: off the coasts of Cacilhas, Bel´em, and Pa¸co de Arcos. However, even if the current model has been previously validated with experimental data, it was only done at two locations in the estuary that are far from the potential sites. Due to the complexity of the phenomena driving the current speed at these locations, additional validation is necessary before committing to a specific site. This paper presents the numerical analysis, the experimental campaign and the validation of the results at those three locations. Drifters with sails of 3.4m and 4.5m depth were released at least 8 times at each location and retrieved after 15 minutes of free drift. Each drifter was tracked with a GPS and the current speed and direction were derived from the drifters’ trajectory. The analysis of the experimental data shows good agreement with the model, even though an error of 0.3m/s is consistent throughout the tests. This paper concludes with a discussion on the model temporal and spatial discretisation and the forces included in the analysis that could be the source of the differences between the numerical and experimental data.

A Stochastic Model of an Early Warning System for Detecting Anomalous Incidence Values of COVID-19

AbstractThe ability to identify and predict outbreaks during epidemic and pandemic events is critical to the development and implementation of effective mitigation measures by the relevant health and political authorities. However, the spatiotemporal prediction of such diseases is not straightforward due to the highly non-linear behaviour of its evolution in both space and time. The methodology proposed herein is the basis of an early warning system to predict short-term anomalous values (i.e., high and low values) of the incidence of COVID-19 at the municipality level for mainland Portugal. The proposed modelling tool combines stochastic sequential simulation and machine learning, namely symbolic regression, to model the spatiotemporal evolution of the disease. The machine learning component is used to model the 14-day incidence rate curves of COVID-19, as provided by the Portuguese Directorate-General for Health, while the geostatistical simulation component models the spatial distribution of these predictions, for a simulation grid comprising the metropolitan area of Lisbon, following a pre-defined spatial continuity pattern. The method is illustrated for a period of 5 months during 2021, and considering the entire set of 19 municipalities belonging to the metropolitan area of Lisbon, Portugal. The results show the ability of the early warning system to predict and detect anomalous high and low incidence rate values for different periods of the pandemic event during this period.

Public art and social media: street art tourism, sociocultural agency and cultural production in contemporary Lisbon

Abstract This essay engages with Guias do Mocho [Mocho’s Tourist Guides], a bottom-up cultural tourism initiative emerging in Quinta do Mocho, a ‘peripheral’ neighbourhood of Lisbon, as a way of problematizing the relationship between public and street art and social media aesthetics. Scholarship on digital creative industries and street art tourism tends to emphasize the complicities of this kind of cultural experience with neoliberal understandings of the urban space. By examining an example of bottom-up, localized guided tours that operates through social media in the context of peripheral areas of Lisbon, we argue that public art and social media should be seen as part of a more complicated correlation, one in which the affects and effects of creative, site-specific projects are actively developed and expanded in unforeseen ways. Our research demonstrates that public art and social media are mutually developing a renewed economy of attention and system of valorization. The critical examination of both elements is compulsory when measuring the impact of art-driven processes of community development.

Geographic patterns and hotspots of pediatric tuberculosis: the role of socioeconomic determinants.

Children are an important demographic group for understanding overall tuberculosis epidemiology, and monitoring of childhood tuberculosis is essential for appropriate prevention. The present study sought to characterize the spatial distribution of childhood tuberculosis notification rates in continental Portugal; identify high-risk areas; and evaluate the association between childhood tuberculosis notification rates and socioeconomic deprivation. Using hierarchical Bayesian spatial models, we analyzed the geographic distribution of pediatric tuberculosis notification rates across 278 municipalities between 2016 and 2020 and determined high-risk and low-risk areas. We used the Portuguese version of the European Deprivation Index to estimate the association between childhood tuberculosis and area-level socioeconomic deprivation. Notification rates ranged from 1.8 to 13.15 per 100,000 children under 5 years of age. We identified seven high-risk areas, the relative risk of which was significantly above the study area average. All seven high-risk areas were located in the metropolitan area of Porto or Lisbon. There was a significant relationship between socioeconomic deprivation and pediatric tuberculosis notification rates (relative risk = 1.16; Bayesian credible interval, 1.05-1.29). Identified high-risk and socioeconomically deprived areas should constitute target areas for tuberculosis control, and these data should be integrated with other risk factors to define more precise criteria for BCG vaccination.

Migration Background and hospital emergency department use by children : evidence from a cohort study in the Metropolitan Area of Lisbon, Portugal, in 2019 and 2020

Migration Background and hospital emergency department use by children : evidence from a cohort study in the Metropolitan Area of Lisbon, Portugal, in 2019 and 2020

Framework for Quantifying Energy Impacts of Rehabilitation of Derelict Buildings: Assessment in Lisbon, Portugal

Cities are currently responsible for an important part of energy consumption and greenhouse gas emissions, justifying the need to develop measures to help them become more sustainable. One of those measures can be to address under-utilized assets in cities, such as derelict buildings with high potential for rehabilitation, and the establishment of new residence hubs within cities. Consequently, this work establishes a novel framework for evaluating the impact of rehabilitating these buildings in an urban area in Lisbon, considering the energy consumption associated with the usage of the dwelling as well as the impact on mobility, since it was considered that these buildings will be occupied by people who currently work nearby but live in the outskirts of Lisbon, favouring an urban planning of proximity between home and work. To this extent, a methodology was developed for selecting the buildings to be analysed and the commuting movements to be replaced. Then, buildings were simulated in an urban building energy modelling (UBEM) tool, considering three rehabilitation scenarios, and the required primary energy, CO2 emissions, and costs were calculated. Regarding mobility, three new scenarios were compared with the current scenario. The results obtained confirm the high potential savings from the rehabilitation of derelict buildings and in the best-case scenario—corresponding to the rehabilitation considering envelope insulation, the installation of efficient windows, and the adoption of a heat pump together with a mobility standard targeting 15 min cities—reductions of 76% in primary energy and 84% in CO2 emissions were achieved.

The Representativeness of Outdoor Particulate Matter Concentrations for Estimating Personal Dose and Health Risk Assessment of School Children in Lisbon.

This study investigated the suitability of outdoor particulate matter data obtained from a fixed monitoring station in estimating the personal deposited dose. Outdoor data were retrieved from a station located within the urban area of Lisbon and simulations were performed involving school children. Two scenarios were applied: one where only outdoor data were used assuming an outdoor exposure scenario, and a second one where an actual exposure scenario was adopted using the actual microenvironment during typical school days. Personal PM10 and PM2.5 dose (actual exposure scenario) was 23.4% and 20.2% higher than the ambient (outdoor exposure scenario) PM10 and PM2.5 doses, respectively. The incorporation of the hygroscopic growth in the calculations increased the ambient dose of PM10 and PM2.5 by 8.8% and 21.7%, respectively. Regression analysis between the ambient and personal dose showed no linearity with R2 at 0.07 for PM10 and 0.22 for PM2.5. On the other hand, linear regression between the ambient and school indoor dose showed no linearity (R2 = 0.01) for PM10 but moderate (R2 = 0.48) for PM2.5. These results demonstrate that ambient data must be used with caution for the representativeness of a realistic personal dose of PM2.5 while for PM10 the ambient data cannot be used as a surrogate of a realistic personal dose of school children.

Upcoming drone delivery services: A perceptions-based clustering of citizens in Lisbon

Drones are an emerging technology that promises numerous benefits for delivery services. As e-commerce evolves and citizens become more familiar with parcel delivery services to their homes, drone services could become an alternative for last-mile logistics service providers. However, the potential diffusion of drone services will also be influenced by the public opinion. This study addresses the issue of citizens' perceptions of drone delivery services and uses the Metropolitan Area of Lisbon as a case study. Data was collected though a survey and analysed using a clustering approach. Six citizen clusters were identified: the drone-service supporters, the concerned about the package, the concerned with legal aspects, the drone-service neutrals, the likely supporters, and the non-supporters. The clusters vary according to socio-economic characteristics and members’ current satisfaction with the home delivery services. Logistics stakeholders can use the results of this study to successfully introduce drones into their logistics systems and benefit from the added value to the public.

Early evidence of the military roman conquest. The Atlantic coast of the ulterior province

The Roman conquest of Hispania, although well-known through written sources, still requires many clarifications at the archaeological level. Apparently, no trade contacts were made with the western Atlantic territories during the early stages of the Italic presence in the Iberian Peninsula. In this paper, we try to accomplish a transversal reading of the main data available on the older contexts that confirm the presence of the Roman Republic in this territory. Decimus Iunius Brutus undoubtedly played a decisive role as governor of Ulterior between 138 and 133 BCE, revitalising the Romanization of western Iberia. Archaeological data from the area of Lisbon and the Lower Tagus peninsula, as well as elements from the Mondego valley, seem to support this interpretation.

Sheathing and Pay Techniques in the Boa Vista 1 Ship (Lisbon, Portugal)

Between September 2012 and February 2013, archaeological excavations carried out in the riverside area of Lisbon (Portugal) revealed the remains of two wooden ships: Boa Vista 1 (BV1) and Boa Vista 2 (BV2), both dating from the late seventeenth or early eighteenth century. BV1 ship consists of scattered hull timbers which were damaged and out of their original positions. Some of the ship’s hull features are common in the Mediterranean like a composite keel with butt joints and hook scarfs in the connection between floors and futtocks, while others are well-known Iberian shipbuilding features like the transition between the keel and the sternpost being made through a single piece, the heel. A unique feature was a layer of animal hair between the sheathing and the hull planking. This paper focuses mainly on the study of wooden sheathing, including but not limited to the analysis of its conventional “architectural signatures”. The latest results concerning animal hair identification will also be presented and discussed, showing the added value of multidisciplinary approaches in archaeology.

Hydration patterns and beverage consumption among a sample of institutionalized senior adults in Portugal

Water plays an important role in different body functions, being fundamental for cells, tissues, and organs. It is also directly related to various processes, from maintaining body temperature to eliminating compounds. With age the feeling of thirst decreases, which can lead to inadequate consumption of water causing dehydration in the senior population. This dehydration can have consequences on the clinical status of this population, enhancing its clinical decline. The primary objective of the present study was to evaluate the daily consumption of liquid from beverages in institutionalized individuals in a senior adult residence in the Lisbon area. A cross-sectional observational quantitative study views. An adapted version of a specific fluid-validated questionnaire was used to assess the consumption of different beverages and total daily fluid intake. It was observed that institutionalized individuals did not consume enough total fluid intake to meet the European recommendations appropriate for their sex and age group. Nevertheless, individuals receiving artificial nutrition achieve a daily consumption of 1.5 liters of water.

The ‘Spirit’ of Schooling: The relevance of the sense of a calling on the school experiences of secondary-school Roma/Ciganos students

In The Protestant Ethic and the Spirit of Capitalism (PE), Max Weber examines the ecological domination of instrumental rationality to the detriment of value-oriented action. The concept of the calling (Beruf in German) becomes a key one for interpreting the process of value rationalization. One can find Weberian value-rationality among the Portuguese Roma/Ciganos, who seek alternative livelihood strategies via schooling, although they are still characterized by a high rate of early school dropouts, with a very low number of students attending secondary education. The EDUCIG (School performance among Ciganos/Roma: action research and co-design) project was launched in 2019 to grasp the multiple factors involved in this social problem. The project interview-based analysis entailed the participation of 31 Roma/Ciganos students from the metropolitan areas of Lisbon and Porto. Results suggest that despite the social, cultural and economic constraints affecting their school pathways, the academic success of young Roma/Ciganos is facilitated by the influence of religion, specifically the Pentecostal Evangelical Church and its respective values. Moreover, we can recognize the emergence of a new ‘spirit’ in these young Roma/Ciganos, a ‘spirit’ that does not aim at instant gratification but represents an investment in the future and, simultaneously, a desire for integration.

“You’re Better Being Poor Here”: Migration Decision-Making and Political and Lifestyle Considerations Among Qualified Brazilians in Portugal

This article looks at the migration of qualified Brazilians to Portugal, with reference to the impact of political developments in Brazil on migration decision-making processes and their lifestyle aspirations in the host society. Original fieldwork consists of twenty in-depth interviews conducted with qualified Brazilians in the Lisbon area during 2019. These interviews illustrate how political and economic instability in Brazil contributed to establishing a strong migration imperative. In this scenario, Portugal is chosen as a destination due to its perceived social stability and emergence as a fashionable destination for skilled workers, with the promise of a “cosmopolitan” life. In conclusion, we emphasise the need to consider how political conditions in a sending society and lifestyle considerations interact in the migration decision-making of skilled migrants. This approach confronts assumptions that serve to disguise the precariousness of many Brazilian migrants in Portugal due to their relatively high skill levels and raising long-term concerns regarding the sustainability of lifestyle-oriented migration.

Studying iodine intake of Portuguese children school meals

Iodine is an essential trace element, and its nutritional importance is well established. The iodine content of school meals of Portuguese children aged between 6 and 10 years (collected in the metropolitan area of Lisbon) was analyzed by ICP-MS. The samples were cooked with and without iodized salt and additionally some complementary foods were purchased as supplements to the main meals or to the other meal along the day. The results report six meals per day and they suggest that at least one main meals (lunch or dinner) prepared with iodized salt is enough to reach the recommended daily iodine intake (AI), 90 µg/day, not exceeding the tolerable upper intake (UL) level of 300 µg/day. When both main meals are cooked without iodized salt, 11 % of the hypotheses present an iodine content less than 90 µg/day. However, when lunch and dinner are prepared with iodized salt, 1 % exceeds the value of the UL. The food groups with the highest levels of iodine are daily products and fish. These results presuppose a balanced diet without any dietary restrictions. So, for ideological or medical reasons, special attention must be paid to diets with some limitations, such as vegetarian, lactose or high content of proteins free diets.

Feasibility and performance of a combined extracorporeal assisted cardiac resuscitation and an organ donation program after uncontrolled cardiocirculatory death (Maastricht II).

Approximately 500.000 people in Europe sustain cardiac arrest (CA) every year, being myocardial infarction the main etiology. Interest has been raised in a new approach to refractory cardiac arrest (rCA) using extra-corporeal oxygenation (ECMO). In settings where it can be rapidly implemented, ECMO assisted resuscitation (ECPR) may be considered. Additionally, donation after circulatory death, which seeks to obtain solid organs donation from patients suffering rCA, has increased its role effectively increasing the pool of donors. Combined programs with integration of ECPR and uncontrolled donation after circulatory determination of death (uDCDD) are worldwide limited and experience integrating these two techniques is lacking. We report a 24months experience of ECPR and uDCDD kidney transplantation based on a management protocol in a university teaching hospital in the urban area of Lisbon. Over a period of 24months, 58 patients were admitted to our ICU with rCA, 6 (10%) in the ECPR program and 52 (90%) in the uDCDD. Seventy-eight percent of patients were male, with an average age of 49year-old. CA was witnessed in 83% of cases and initial rhythm was ventricular fibrillation in 20 cases (35%). 13 (25%) patients were effective organ donors. Refusal for effective donation was mainly due to prior comorbidities. The development of an integrated program for ECPR and uDCDD is feasible and requires a well-established and efficient activation program. In an era of significant organ shortage, it provides a viable option for increasing the organ donation pool, with promising results.

Training the Armed Forces personnel in COVID-19 contact tracing: a Portuguese case study

Abstract Background Local contact tracing teams needed to be reinforced in preparation for a peak in Covid-19 cases. The Portuguese Armed Forces showed availability and their members initiated a formal training facilitated by the Public Health Unit (PHU) of Amadora. Health systems must be prepared to respond to all threats, as the COVID-19 pandemic showed us the need for quick task shifting and the training of non-experts’ workers. Objectives The aim of the project was to develop contact tracing skills by non-health professionals, in the context of the COVID-19 pandemic. The training program was held online, with a total duration of 48 hours, distributed by the topics described: introduction to health and epidemiology concepts, the national guidelines, and the information systems (13h). We privileged demonstrative and participatory training methods, followed by continuous supervision of each contact tracing survey and constant feedback (35h). Learning support materials were sent out to assist the trainees, including written and video support. Results More than 200 personnel - sailors, soldiers and airmen - were trained. Each Lisbon and Tagus Valley area PHU was reinforced with a team of military professionals in order to support the contact tracing process, with an increase in the number of surveys completed. We highlight as positive aspects: increased number of contact tracing surveys carried out; growth of inter-institutional partnerships; freeing up of specialized PHU resources to other important tasks. As for negative aspects we focus on the complexity in health communication, the limited time for training, and the lack of specific health knowledge of the trainees. Conclusions This pandemic revealed the Portuguese need for a transdisciplinary approach in the provision of care, specially at a Public Health level. Training programs like these highlight the vital role of reshaping and reorganizing the healthcare workforce answering Public Health necessities. Key messages • Training programs for non-health workers must be prepared to reinforce health systems when necessary. The reinforcement of contact tracing teams by the Portuguese Armed Forces was a great example. • A transdisciplinary approach in the provision of care was essential during the COVID-19 pandemic. Specific training of non-health workers can be planned in time to respond to health threats.