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Background Participation rates in health surveys, recognized as an important quality dimension, have been declining over the years, which may affect representativeness and confidence in results. The Portuguese national health examination survey INSEF (2015) achieved a participation rate of 43.9%, which is in line with participation rates from other similar health examination surveys. The objective of this article is to describe strategies used by the local teams to increase participation rates and to solve practical survey problems.Methods After a literature search, informal interviews were conducted with 14 public health officials from local health examination teams, regional and central authorities. 41 of the local staff members also filled in a short questionnaire anonymously. The interviews and self-administered questionnaires were analysed using mixed methods, informed by thematic analysis.Results The local teams believed that the detailed manual, described as a "cookbook for making a health examination survey", made it possible to maintain high scientific standards while allowing for improvising solutions to problems in the local context. The quality of the manual, supported by a series of training workshops with the central research and support team, gave the teams the confidence and knowledge to implement local solutions. Motivation and cohesion within the local teams were among the goals of the training process. Local teams felt empowered by being given large responsibilities and worked hard to incite people to attend the examination through a close and persuasive approach.Local teams praised their INSA contacts for being available for assistance throughout the survey, and said they were inspired to try harder to reach participants to please their contacts for interpersonal reasons.Conclusions The theory of organizational improvisation or bricolage, which means using limited resources to solve problems, was useful to discuss and understand what took place during INSEF.A detailed manual covering standard procedures and face-to-face workshops, including role-play, were vital to assure high scientific standards and high participation rates in this health examination survey. Close contacts between the central team and local focal points in all regions and all survey sites were key to accommodating unexpected challenges and innovative solutions.

publicado em: Environ Health Perspect. 2021;1. https://ehp.niehs.nih.gov/doi/abs/10.1289/isee.2021.P-457 BACKGROUND AND AIM: Methylmercury (MeHg) is a toxic compound that undergoes bioaccumulation in the aquatic food chain. Predatory fish species are an important human exposure source. Portugal has the highest consumption of fishery products in the European Union (EU), above the EU and world average. The main target of MeHg is the central nervous system and the prenatal period represents a period of greatest vulnerability regarding neurodevelopmental effects on the foetus. Human biomonitoring (HBM) allows direct exposure assessment of human exposure to chemical compounds. Total mercury (THg) concentration in blood is usually considered an appropriate biomarker for estimating short-term internal exposure to MeHg in individuals with regular fish consumption. The aim of the present study was to evaluate the exposure of Portuguese women of childbearing age to MeHg through HBM. METHODS: Three hundred Portuguese women of childbearing age (25 to 44 years) were randomly selected among the participants in a cross-sectional epidemiological study carried out in Portugal (INSEF) in 2015. THg content was determined in whole blood samples by thermal decomposition and amalgamation atomic absorption spectrophotometry (TDA/AAS). RESULTS:Two samples had THg levels below LOQ (0.5 µg/L), and in the remaining (n=298), THg levels ranged from 0.6 to 35.0 µg/L. About 52% of the samples had values below 5 µg/L, a HBM value below which no adverse health effects are expected. However, 48% of samples revealed levels above 5 µg/L and therefore presented risk of adverse health effects. Blood mercury concentration values were higher in older women, in higher education level and residents in the Autonomous Region of Madeira, with statistically significant differences compared to the other groups (p

publicado em: Environ Health Perspect. 2021;1. https://ehp.niehs.nih.gov/doi/abs/10.1289/isee.2021.P-062 BACKGROUND AND AIM:Although arsenic is an element naturally present in the environment, it is highly toxic in its inorganic forms. Exposure can occur through consumption of drinking water and contaminated food. Long-term exposure was shown to be associated with negative health outcomes. Nevertheless, data on the Portuguese population’s exposure to arsenic is scarce. As such, the aim of this work was to assess the exposure to Arsenic in the Portuguese population using samples collected in the study "Exposure of the Portuguese Population to Environmental Chemicals: a study nested in INSEF 2015" (INSEF-ExpoQuim), developed as an aligned study of the European Human Biomonitoring Initiative (HBM4EU). METHODS: INSEF-ExpoQuim was an epidemiologic study nested in INSEF 2015 including 270 participants aged 28-39 years,living in Portugal for more than 12 months and able to follow an interview in Portuguese. Fieldwork was developed between June 2019 and February 2020. First morning urine samples were collected along with data on socio-demographic characteristics, living conditions and residential history, habits/lifestyle, nutrition, health, occupation and substance specific information covering nearly all exposure pathways. Procedures followed the guidelines of the HBM4EU project. Total urinary arsenic is currently being determined by inductively coupled plasma mass spectrometry. RESULTS:Preliminary results for 38 samples yielded total urinary arsenic concentrations ranging from 11 to 462 μg/L with an average of 86 ± 94 μg/L. After completion of the determination of the urinary arsenic levels for all the samples a complete analysis of the data will be performed. CONCLUSIONS:Results from this study will contribute to the knowledge on the Portuguese population’s exposure to arsenic and may support the development and implementation of policy measures aimed at minimizing exposure to this chemical and improving the health of the population. HBM4EU is funded by the European Union’s Horizon 2020 research and innovation programme under grant agreement Nº 733032. info:eu-repo/semantics/publishedVersion

Background: Disability is not just a health problem. It is a wider phenomenon that reflects the gap between a person's capacities and their ability to fully perform the role demanded by society. Both personal and environmental factors are major contributors to disability. Objective: We aimed to estimate the prevalence of self-reported disability, overall and by sex, and associated factors in the Portuguese population in 2014. Methods: This was a cross sectional study based on data from the Portuguese National Health Interview Survey (2014) (n = 18,204). Long-term disability was evaluated based on the respondent reporting reasons for current disability lasting more than 6 months. Sex, age group, region, marital status, self-rated health, having or not health insurance, educational level, income, tobacco and alcohol consumption, physical activity and body mass index were considered as independent variables. A poisson model was performed to identify factors associated with disability. Results: Approximately 40% of the respondents reported having some long-term disability. Disability prevalence was higher in women than men (44.4% and 34.2%, respectively). Results showed age, region, education, self-rated health, physical activity and body mass index were associated with disability (p < 0.05). Conclusions: This study shows that along with personal factors, the context plays an important role in disability. We believe this piece of evidence emphasizes the factor context namely the region, when decision makers design disability related policies. info:eu-repo/semantics/publishedVersion

INTRODUCTION: Oral health is a determinant for quality of life and preventive behaviours such as regular tooth brushing can reduce the risk of a wide spectrum of oral diseases. Adopting preventive behaviours increases the likelihood of being healthy and can be conditioned by demographic and socio-economic factors. OBJECTIVE: This study aims to describe preventive oral hygiene behaviours in the Portuguese population and assess their association with sociodemographic and socioeconomic factors. MATERIAL AND METHODS: A cross-sectional epidemiologic study was developed using data from the first Portuguese National Health Examination Survey. The target population comprised Portuguese community-dwelling residents aged between 25 and 74 years old. The percentage of individuals who brushed their teeth at least twice a day, provided that once was before sleeping, was considered the indicator showing a preventive behaviour, as this is recommended by the General Directorate of Health in Portugal. Poisson regression was used to identify factors independently associated with this behaviour. RESULTS: Sixty-five per cent of the participants reported tooth brushing as recommended. The prevalence of adoption of this preventive behaviour was higher among those living in urban areas and those who have higher educational level. Results show an association between being male and having low educational level with lesser adoption of preventive oral health behaviours. CONCLUSION: These findings suggest a need for integrated approaches, from measures tackling social inequalities to actions focused on improving health literacy. It is also important to expand dental healthcare services and improve effective coverage to increase access for rural population. INSEF was developed as part of the Pre-defined project of the Public Health Initiatives Program, entitled ‘Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health and bilateral cooperation’, that benefited from a 1,500,000€ grant from Iceland, Liechtenstein and Norway through the EEA Grants. info:eu-repo/semantics/publishedVersion

Background: This study aimed to compare self-reported and examination-based prevalence of hypertension and hypercholesterolemia in Portugal in 2015 and to identify factors associated with the measurement error in self-reports. Methods: We used data from the Portuguese National Health Examination Survey (n = 4911), that combines personal interview, blood collection and, physical examination. Sensitivity and specificity of self-reported hypertension and hypercholesterolemia were calculated. Poisson regression was used to estimate prevalence ratios (PRs) of underreport of hypertension and hypercholesterolemia according to sex, age, socioeconomic status (education and income) and general practitioner (GP) consultation in the past year. Results: Sensitivity of self-reports was 69.8% for hypertension and 38.2% for hypercholesterolemia. Underreport of hypertension was associated with male gender (PR = 1.54), lack of GP consultation (PR = 1.70) and being 25–44 years old (PR = 2.45) or 45–54 years old (PR = 2.37). Underreport of hypercholesterolemia was associated with lack of GP consultation (PR = 1.15), younger age (PR = 1.83 for 25–44 age group and PR = 1.52 for 45–54 age group), secondary (PR = 1.30) and higher (PR = 1.27) education. Conclusion: Self-reported data underestimate prevalence of hypertension and hypercholesterolemia. Magnitude of measurement error in self-reports varies by health conditions and population characteristics. Adding objective measurements to self-reported questionnaires improve data accuracy allowing better understanding of socioeconomic inequalities in health. O primeiro Inquérito Nacional de Saúde com Exame Físico foi desenvolvido como parte integrante do projeto “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, que beneficiou de um apoio financeiro de 1.500.000€ concedido pela Islândia, Liechtenstein e Noruega, através do Programa Iniciativas em Saúde Pública (PT06) financiado pelas EEA Grants 2009-2014. info:eu-repo/semantics/publishedVersion

Introduction: Reduction of unfair differences in health between socioeconomic groups and countries constitutes an important public health challenge in the 21st century. To monitor progress on this goal, health inequalities are most frequently estimated based on self-reported data from population surveys. However, it has been shown that self-reported data on cardiovascular disease risk factors is prompt to reporting error. If errors occur more often in specific socioeconomic groups (due to under-diagnosis or lower literacy) they are likely to seriously bias health inequality estimates. This study aims at comparing measurement errors between socioeconomic categories in self-reported hypertension, and their consequences on health inequality estimates. Methods: We used data from the Portuguese National Health Examination Survey (INSEF), a cross-sectional nationwide study conducted in 2015 on a probabilistic sample (n=4911) of community-dwelling individuals aged between 25 and 74 years old. INSEF combines measured biochemical parameters and blood pressure with self-reported data. Self-reported hypertension was defined based on the question: “Do you have any of the following diseases or conditions: hypertension? (Yes/No)”. Examination-based hypertension was defined as having systolic blood pressure of at least 140 mmHg, or diastolic blood pressure of at least 90 mmHg, or using prescribed antihypertensive medication. Participants´ socioeconomic status was measured through the education level (no education/ 1st cycle of basic education, 2nd cycle of basic education, 3rd cycle of basic education, secondary education and higher education). Inequalities in hypertension between the highest and lowest socioeconomic status groups were measured using relative indexes of inequality (RII) and respective confidence intervals (CI 95%), estimated by Poisson regression. Estimates of inequalities were stratified by age and sex, using four population groups (male 25-49 years old, female 25-49 years old, male 50-75 years old, female 50-75 years old). Results: Hypertension was reported by 25.7% [CI 95%: 24.0 to 27.4] of participants, while 35.9% [CI 95%: 34.2 to 37.5] were considered to have hypertension according to examination-based data. The difference between examination-based and self-reported prevalence was 12.7pp for those with no education/ 1st cycle of basic education and 4.6pp for those with higher education. Similar educational gradients were observed for both self-reported (RII=1.87; CI 95%: 1.45 to 2.42) and examination-base (RII=1.91; CI 95%: 1.60 to 2.28) hypertension, with lowest prevalence of disease among the highly educated. Age- and sex-specific results showed considerable discrepancies in inequality indicators between self-reported and examination-based data. Namely, differences in estimated gradients were more pronounced among 25-49 years old males, with RII=0.67 (CI 95%: 0 .29 to 1.54) for self-reported and RII=1.90 (CI 95%: 1.22 to 2.96) for examination-based hypertension. In 25-49 years old females inequalities in self-reported hypertension were not statistically significant (RII=3.18; CI 95%: 0.94 to 10.73), while females with the lowest education were 4.35 (CI 95%: 2.60 to 7.27) times more likely to have examination-based hypertension then compared to the most educated. In 50-75 age group educational inequalities in self-reported hypertension were larger than in examination-based for both, male (RII=1.82 CI 95%: 1.25 to 2.69 vs. RII=1.40; CI 95%: 1.04 to 1.89) and female (RII=1.77; CI 95% 1.30 to 2.41 vs. RII=1.58; CI 95%: 1.22 to 2.04). Conclusions: Our results illustrated the significant effect of measurement error in self-reported hypertension on estimates of socioeconomic inequalities. Use of self-reported data led to underestimation of educational inequalities among young and middle-aged individuals and overestimation in older age groups. Inequality indicators derived from self-report should be interpreted with caution. EEA grants N/A

Background: In Health Examination Surveys interview information is complemented with objective information, providing more accurate indicators than self-reported data. We report the study design, planning and implementation of the first Portuguese Health Examination Survey (INSEF). Methods: INSEF was a cross-sectional population-based study representative at regional and national level. Individuals aged between 25 and 74 years old, residing in Portugal were selected from the national health users’ registry through multi-stage stratified probabilistic sampling. Sample size was set at 4200 individuals. Data was collected in primary care units and included blood pressure, height, weight, hip and waist measurements, blood collection for lipid profile, HbA1c and blood count and a general health questionnaire. European HES procedures were followed. Results: A total of 4911 individuals agreed to participate (43.9% participation rate). Participation rate varied by region, sex and age group, being lower in Lisbon and Tagus Valley (32.8%), for men (41.8%) and for those aged 25–34 years old (36%). Conclusions: INSEF has set up an experienced national and regional structure for HES implementation. Nationally representative quality epidemiological data is now available for public health monitoring, planning and research. The Portuguese National Health Examination Survey 2015 (INSEF) was developed as part of the Pre-defined project of the Public Health Initiatives Program (reference 000039_ PDP), ‘‘Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, that benefits from a 1.500.000€ Grant from Iceland, Liechtenstein and Norway through the European Economic Area Financial Mechanism (EEA Grants), 85%, and from the Portuguese Government, 15%. info:eu-repo/semantics/publishedVersion

© 2017 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved., Obesity is recognised as a serious public health issue, due to its associated morbidity and mortality. This study aimed at estimating the prevalence of overweight and obesity in the Portuguese population through direct measurements obtained by the 1st National Health Examination Survey (INSEF 2015) and to identify its associated sociodemographic factors. INSEF was a nationally representative cross-sectional prevalence study conducted on 4911 Portuguese adults aged 25-74 years, in 2015. Height and weight were measured according to the European Health Examination Survey procedures. Poisson regression was used to estimate the adjusted prevalence ratios of overweight and obesity according to age, marital status, occupational activity, education, urbanization of living area and smoking status. Overall prevalences of overweight and obesity were 39.1% and 28.6%, respectively. The prevalence of overweight was higher among men (45.5% vs 33.2%) while the prevalence of obesity was higher among women (32% vs 25%). The sociodemographic factors associated with overweight and obesity were age, marital status and education. Smoking status was associated with overweight and obesity but only in women. INSEF suggests that a high prevalences of overweight and obesity are found in older individuals, married, with lower education levels and non-smoking women. Public health interventions are urgently required for obesity prevention, namely throughout health literacy strategies., The authors are grateful to all the professionals involved in the INSEF fieldwork and to all the INSEF participants. INSEF was developed as part of the Pre-defined project of the Public Health Initiatives Program, ‘‘Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation’’, that benefits from a 1.500.000D Grant from Iceland, Liechtenstein and Norway through the EEA Grants.

Background: Obesity is recognized as a serious public health issue, both as a disease in itself and as an important risk factor for cardiovascular diseases and diabetes. The First Portuguese National Health Examination Survey (INSEF 2015) aimed at obtain in-depth knowledge about health status and determinants and contribute to the reduction of health inequalities. The goal of this analysis was to estimate the prevalence and to assess socioeconomic inequalities in obesity, through direct measurement of weight and height. Methods: INSEF is a nationally representative cross-sectional prevalence study conducted on 4911 adults aged 25-74 years old, in 2015. It included physical examination, blood collection and personal interview. INSEF participants’ height and weight were measured according to European Health Examination Survey procedures. Obesity was defined as body mass index ≥ 30 kg/m2. Poisson regression was applied to estimate prevalence ratios (aPR) of obesity according to sex, age group, education and employment status, adjusted for confounding. Results: Overall national prevalence of obesity was 28.7%, [95% CI 26.8; 30.6]. The prevalence of obesity was higher among females (32.1%, aPR =1.3, [1.2, 1.4]) than males (24.9%). Prevalence was higher in 65-74 years old age group (41.8% vs. 12.5%, aPR=2.4, [1.5, 3.6]). , compared to the 25-34 years old group. Individuals with no education or first grade basic education had double the prevalence of obesity than those with higher education (14.7% vs43.1%, aPR=2.1, [1.6, 2.8]). Conclusions: Obesity affects 287 per 1000 adults aged 25-74 years old in Portugal. INSEF provides evidence that a higher prevalence of obesity is found in older individuals, with lower education levels. Public health interventions that focus on specific population subgroups are required for obesity prevention, namely, throughout health literacy strategies. The Portuguese National Health Examination Survey is developed as a part of the project “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, that benefits from a 1.500.000€ Grant from Iceland, Liechtenstein and Norway through the EEA Grants. N/A

Background Health Examination Surveys (HES) were interview data is complemented with objective information from physical examination and laboratory analysis, provide more accurate health indicators than self-reported data. Here we report the study design, planning and implementation of the First Portuguese Health Examination Survey (INSEF) developed during 2014-2015. Methods INSEF was developed as a cross-sectional population-based study representative at regional and national level. Development …

publicado em: Eur J Public Health. 2015; 25(Suppl 3): 417. doi:10.1093/eurpub/ckv176.118. Disponível em: http://eurpub.oxfordjournals.org/content/eurpub/25/suppl_3/ckv176.118.full.pdf The participation of fieldwork teams is key to successful surveys implementation. Thus, the Portuguese National Health Examination Survey (INSEF) is involving fieldwork teams in survey quality control processes. The aim of this presentation is to report a midterm evaluation's results of the internal quality control concerning participants' recruitment strategies and how these influence participation rate. A focus group discussion was carried out with fieldwork teams (nurses, laboratory technicians and administrative staff) and regional coordinators in the North, Center and Algarve regions. Each focus group had between 8 to 14 participants with an average age of 47 years and a long professional experience with an average of 22 years. A slideshow presentation fostered the discussion of the survey process: strengths and weaknesses of training, recruitment, informed consent, physical exam, blood collection, interview and logistical issues. It also explored the teams' perceptions of local cultural attitudes and the strategies used within the fieldwork. A thematic content analysis was performed. According to fieldwork teams, higher participation rates depend on: invitation letter signed by personal General Practitioner; free clinical analysis; pride in being selected in a scientific study; study conducted by experienced health professionals; data collection in local health center, schedule flexibility, invitation and confirmatory telephone calls. Also important: population's size, cultural factors and fieldwork teams' years of experience. In two focus groups, opinions on invitation letters' legibility differed between socio-professional categories: nurses and administrative staff. Participation rate depends on fieldwork teams' credibility and local community. The use of qualitative methods such as focus group is important to improve survey processes and these can also give valuable input on fieldwork teams' engagement and motivation. The Portuguese National Health Examination Survey is developed as a part of the project “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, that benefits from a 1.500.000€ Grant from Iceland, Liechtenstein and Norway through the European Economic Area Grants (EEA Grants).

publicado em: Eur J Public Health. 2015; 25(Suppl 3): 386. doi:10.1093/eurpub/ckv176.035. Disponível em: http://eurpub.oxfordjournals.org/content/eurpub/25/suppl_3/ckv176.035.full.pdf Recruitment of participants in health surveys is recognised as the most challenging step of fieldwork. This work presents preliminary results of recruitment in the first Portuguese National Health Examination Survey (INSEF) comparing participants and non participants. INSEF is a cross-sectional prevalence study targeting 4200 individuals aged 25–74 years, living in Portugal for more than 12 months, non-institutionalized and able to follow an interview in Portuguese. Fieldwork started in February 2015 and to date 9/49 examination sites are completed. Selected individuals received an invitation letter and later were contacted by phone to schedule the appointment. Individuals were then classified in participants, refusals and of unknown eligibility. Participation rates were calculated according to European Health Examination Survey guidelines. Reasons for refusals were recorded and non participant’s characteristics analysed. Chi square and Fisher exact tests were used to compare participants and non participants regarding age, sex, education level, marital status, smoking, use of medication and of healthcare services. 1467 of the 2161 selected individuals were successfully contacted. Overall participation rate was 42%(n = 882), ranging between 27–54% by examination site. 49% of the 512 refusals accepted to respond to a short questionnaire for non participants. The main reasons for non participation were lack of time (27.6%) and professional reasons (22.4%). No significant differences were found for the majority of the analysed variables. Participants were found to be more frequently users of medication (p < 0.001) and to have between 45–54 years old (p = 0.023). To date the planed participation rate of 40% was successfully achieved at national level. Results obtained showed the need to implement strategies to engage in participation specific target groups. To mitigate selection bias adjustment of sampling weights for non response should be done. The Portuguese National Health Examination Survey is developed as a part of the project “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, that benefits from a 1.500.000€ Grant from Iceland, Liechtenstein and Norway through the European Economic Area Grants (EEA Grants).

Subtoxic blood lead levels (BLL) during pregnancy can be responsible for intrauterine delays in foetal development and thus increased risk of morbi-mortality of newborns. Since there is no protective transplacental barrier to lead, foetal exposure is due to maternal environmental exposure together with either increased absorption or bone demineralization with consequent release of lead, or both, that may occur during pregnancy. In non-occupationally exposed women, lead exposure may be increased due to residing near lead sources, consumption of polluted food products, and habits such as alcohol consumption and tobacco smoking. The main purpose of this study was to provide Portuguese data on the extent and pattern of foetal exposure to lead as determined through lead biomonitoring in the blood of pregnant women. Investigation on maternal BLL determinants and potential effects of subtoxic BLL on premature delivery and on newborn's characteristics was also objective of this study.

© 2014 Reis et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., Background: In 2008, the Portuguese smoke-free law came into effect including partial bans in the leisure-hospitality (LH) sector. The objective of the study is to assess the prevalence of smoking control policies (total ban, smoking permission and designated smoking areas) adopted by the LH sector in Portugal. The levels of noncompliance with each policy are investigated as well as the main factors associated with smoking permission and noncompliance with the law. Methods: Cross-sectional study conducted between January 2010 and May 2011. A random sample of venues was selected from the Portuguese LH sector database, proportionally stratified according to type, size and geographical area. All venues were assessed in loco by an observer. The independent effects of venues’ characteristics on smoking permission and the level of noncompliance with the law were explored using logistic regression. Results: Overall, 1.412 venues were included. Total ban policy was adopted by 75.9% of venues, while 8.4% had designated smoking areas. Smoking ban was more prevalent in restaurants (85.9%). Only 29.7% of discos/bars/pubs opted for complete ban. Full or partial smoking permission was higher in discos/bar/pubs (OR = 7.37; 95%CI 4.87 to 11.17). Noncompliance with the law was higher in venues allowing smoking and lower in places with complete ban (33.6% and 7.6% respectively, p, 0.001). Discos/bars/pubs with full smoking permission had the highest level of noncompliance (OR = 3.31; 95%CI 1.40 to 7.83). Conclusions: Our findings show a high adherence to smoking ban policy by the Portuguese LH sector. Nonetheless, one quarter of the venues is fully or partially permissive towards smoking, with the discos/bars/pubs considerably contributing to this situation. Venues with smoking permission policies were less compliant with the legislation. The implementation of a comprehensive smoke-free law, without any exceptions, is essential to effectively protect people from the second hand smoke., The work is part of a large Epidemiological Study on the Portuguese Tobacco Control Policy, developed by the Instituto de Medicina Preventiva da Faculdade de Medicina de Lisboa and supported, in its preliminary part, by the Direcção Geral da Saúde (DGS) and, in the second part, by the national funding institution Fundação para a Ciência e Tecnologia (FCT). The funders had no role in study design, data collection and analysis, decision to publish, or reparation of the manuscript.

publicado em: Eur J Public Health. 2015; 25(Suppl 3): 398. doi:10.1093/eurpub/ckv176.069. Disponível em: http://eurpub.oxfordjournals.org/content/eurpub/25/suppl_3/ckv176.069.full.pdf This work addresses practices related to quality assurance in the first Portuguese National Health Examination Survey (INSEF). INSEF is a cross-sectional population-based study that combines face-to-face interview, physical examination and blood collection and aims to obtain data on 4200 participants from all 7 regions of Portugal. To ensure accurate and high quality data, a monitoring system was implemented as part of internal quality assessment. It includes participant recruitment, physical examination, blood collection and interview and consists of: daily check of recruitment and participation; monitoring of blood pressure and anthropometric measurements by interviewer and collection site; monitoring blood draw, sample haemolyses and laboratory processing; evaluation of average time spent on each survey component by interviewer; daily validation of collected interview data to verify completeness and identify duplicates; regular contact with fieldwork teams to clarify issues raised in questionnaire administration. For each region we carried out survey quality assessment at the end of the second week of fieldwork (N=230 participants). Regional meetings took place to discuss assessment results and propose recommendations for improvement. Monitoring allowed identifying items in higher risk of missing data and challenging issues such as employing exclusion criteria. Proper registry of measurements and time spent were difficult for 3 out of 6 interviewers. We observed junior laboratory technicians to have higher rates of haemolysed samples, 11% compared to 2% from the most experienced. Monitoring of each fieldwork procedure allowed to provide on time feedback so fieldwork teams are able to implement correction actions aimed at reducing total survey error and improving survey quality. The Portuguese National Health Examination Survey is developed as a part of the project “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, that benefits from a 1.500.000€ Grant from Iceland, Liechtenstein and Norway through the European Economic Area Grants (EEA Grants).

Oral health is a state of being free from a range of diseases and disorders that affect oral cavity. Dental cavities and gum diseases are among the most prevalent diseases worldwide. However, they can be prevented as risk factors include poor diets and hygiene. Also, social determinants play a key role as it is well established that poor health is higher among the most disadvantaged. Thus this study aimed to describe oral preventive care of the Portuguese population and assess socioeconomic inequalities. The Portuguese National Health Examination Survey is developed as a part of the project “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, that benefits from a 1.500.000€ Grant from Iceland, Liechtenstein and Norway through the EEA Grants. N/A