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© 2022. The Author(s). 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 how local teams of survey personnel conducted the survey, describing strategies used to solve practical survey problems and to try to increase the participation rate. METHODS: After a literature search, informal interviews were conducted with 14 public health officials from local health examination teams, regional and central authorities. Forty-one of the local staff members (survey personnel) 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, continuous monitoring of the data collection 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. publishersversion published

Additional file 2: Questionnaire for local survey team members.

Additional file 5: Code list used in Thematic Analysis.

Additional file 4: Supplementary materials.

Additional file 1: Search terms.

Additional file 3: Informal interview guide.

info:eu-repo/semantics/publishedVersion

UIDB/04647/2020 UIDP/04647/2020 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. publishersversion published

Depression and depressive symptoms have been studied both as risk factors and consequences of elder abuse, even though the most common cross-sectional design of the studies does not allow inferring cause or consequence relationships. This study estimates the proportion of older adults who screened positive for depressive symptoms among those self-reporting elder abuse and examines whether individual characteristics and/or abusive experience aspects are associated with self-reported depressive symptoms. Participants were 510 older adults self-reporting experiences of abuse in family setting enrolled in the cross-sectional victims’ survey of the Aging and Violence Study. Depressive symptoms were assessed through the abbreviated version of the Geriatric Depression Scale (GDS-5). Poisson regression was used to determine the prevalence ratio (PR) of screening depressive symptoms according to individual and abusive experience covariates: sex, age group, cohabitation, perceived social support, chronic diseases, functional status, violence type, perpetrator, and number of conducts. Women (PR = 1.18, 95% confidence interval [CI] = [1.04, 1.35]) individuals perceiving low social support level (PR = 1.36, 95% CI = [1.16, 1.60]) and with long-term illness (PR = 1.17, 95% CI = [1.02, 1.33]) were found to be associated with increased risk for screening depressive symptoms. In regard to abusive experience, only the number of abusive conducts increased the PR (PR = 1.07, 95% CI = [1.05, 1.09]). Routine screening for elder abuse should include psychological well-being assessment. Interventions toward risk alleviation for both mental health problems and elder abuse should target women perceiving low social support level and with long-term illness. publishersversion published

UIDB/04647/2020 UIDP/04647/2020 O objetivo deste artigo é analisar de que forma as condições de trabalho dos auxiliares de ação direta interferem quotidianamente nos cuidados que são prestados em estruturas residenciais para pessoas idosas em Portugal e que soluções a implementar de modo a dignificar os cuidados e a profissão. Este artigo baseia-se num questionário autoadministrado a 150 auxiliares e em 40 entrevistas semiestruturadas, ambos aplicados em 16 estruturas residenciais para pessoas idosas na área metropolitana de Lisboa. Os resultados revelam que a sobrecarga laboral, as más condições de trabalho, associadas à falta de formação e à excessiva rotatividade dos recursos humanos têm consequências nefastas na qualidade dos cuidados que esses profissionais prestam, mas também na sua saúde física e mental, e no emprego. A necessidade crescente de cuidados de longa-duração devido ao envelhecimento da população exigirá a melhoria das condições de trabalho, a profissionalização e a dignificação do trabalho de cuidados. The aim of this article is to analyse how working conditions from care workers interfere daily in the care provided in older people homes, in Portugal, and what solutions should be implemented in order to dignify care and the care worker profession. This paper is based on 150 questionnaires and 40 semi-structured interviews with care workers, in 16 Portuguese care homes, in one council in the metropolitan area of Lisbon. Findings revealed that excessive workloads and poor working conditions, coupled with high staff turnover and poor training and pay have consequences not only the quality of the care that these care workers can offer, but also their physical and mental health, job satisfaction. The high demand for social care, due to the ageing of the Portuguese population, will require better working conditions, professionalisation and the dignification of care work. publishersversion published

The aim of this article is to analyse how working conditions from care workers interfere daily in the care provided in older people homes, in Portugal, and what solutions should be implemented in order to dignify care and the care worker profession. This paper is based on 150 questionnaires and 40 semi-structured interviews with care workers, in 16 Portuguese care homes, in one council in the metropolitan area of Lisbon. Findings revealed that excessive workloads and poor working conditions, coupled with high staff turnover and poor training and pay have consequences not only the quality of the care that these care workers can offer, but also their physical and mental health, job satisfaction. The high demand for social care, due to the ageing of the Portuguese population, will require better working conditions, professionalisation and the dignification of care work., O objetivo deste artigo é analisar de que forma as condições de trabalho dos auxiliares de ação direta interferem quotidianamente nos cuidados que são prestados em estruturas residenciais para pessoas idosas em Portugal e que soluções a implementar de modo a dignificar os cuidados e a profissão. Este artigo baseia-se num questionário autoadministrado a 150 auxiliares e em 40 entrevistas semiestruturadas, em 16 estruturas residenciais para pessoas idosas na área metropolitana de Lisboa. Os resultados revelam que a sobrecarga laboral, as más condições de trabalho, associadas à falta de formação e à excessiva rotatividade dos recursos humanos têm consequências nefastas na qualidade dos cuidados que esses profissionais prestam, mas também na sua saúde física e mental, no emprego e na satisfação face ao trabalho de cuidados. As necessidades crescentes de cuidados de longa-duração devido ao envelhecimento da população exigirá a melhoria das condições de trabalho, a profissionalização e a dignificação do trabalho de cuidados.

UIDB/04647/2020 UIDP/04647/2020 Increasing longevity implies «more life years» while not guaranteeing immunity from chronic illness, incapacity and dependence, inevitably creating greater need for care (formal and informal) from the state, society and the family.The state, social policy, family and intergenerational relationships seek to respond and find solutions to the challenge that incapacity and dependency set. Dependency and family care are two concepts that tend to emerge, however they are bound by the same etymology root, signifying relations of interdependence. In order to give greater visibility to the hidden world of family care, an empirical study was carried out involving fifty-two (semi-structured) interviews with families that looked after adults with severe incapacity in the Inner Lisbon area. How do you decide to care for someone? What does organising the care process mean? What are the dynamics that are created between the various family members? How is responsibility shared? How do you describe the experience? How does mutual family support work? These and other questions were possible thanks to the sense given to everyday family life by those involved in situations of dependence. From love to duty, from justice to aversion and violence, these are some of the justifications used, making family care a complex and ambivalent process, where solidarity and conflict can coexist. publishersversion published

UIDB/04647/2020 UIDP/04647/2020 Health surveys constitute a relevant information source to access the population's health status. Given that survey errors can significantly influence estimates and invalidate study findings, it is crucial that the fieldwork progress is closely monitored to ensure data quality. The objective of this study was to describe the fieldwork monitoring conducted during the first Portuguese National Health Examination Survey (INSEF) regarding protocol deviations and key performance indicators (KPI). Methods: Data derived from interviewer observation and from the statistical quality control of selected KPI were used to monitor the four components of the INSEF survey (recruitment, physical examination, blood collection and health questionnaire). Survey KPI included response rate, average time distribution for procedures, distribution of the last digit in a specific measure, proportion of haemolysed blood samples and missing values. Results: Interviewer observation identified deviations from the established protocols, which were promptly corrected. During fieldwork monitoring through KPI, upon implementation of corrective measures, the participation rate increased 2.5-fold, and a 4.4-fold decrease in non-adherence to standardized survey procedures was observed in the average time distribution for blood pressure measurement. The proportion of measurements with the terminal digit of 0 or 5 decreased to 19.6 and 16.5%, respectively, after the pilot study. The proportion of haemolysed samples was at baseline level, below 2.5%. Missing data issues were minimized by promptly communicating them to the interviewer, who could recontact the participant and fill in the missing information. Discussion/Conclusion: Although the majority of the deviations from the established protocol occurred during the first weeks of the fieldwork, our results emphasize the importance of continuous monitoring of survey KPI to ensure data quality throughout the survey. publishersversion published

© 2019 Sociedade Portuguesa de Cardiologia Introduction: Cardiovascular disease is an important cause of death and disability worldwide, and hypertension is responsible for at least 45% of all deaths due to heart disease and 51% of deaths due to stroke. This study aimed to estimate and describe the distribution of prevalence, awareness, treatment and control of hypertension in the Portuguese population in 2015. Methods: A national survey using a representative sample of 4911 individuals residing in Portugal and aged between 25 and 74 years was implemented. Trained nurses performed a health interview and a physical examination, including blood pressure measurement (right arm, three measurements at 1-min intervals). The prevalence of hypertension was stratified by gender, age group, marital status, education, occupation and type of residential area. Associations between hypertension prevalence and sociodemographic factors were assessed using bivariate and multivariate Poisson regression. Results: The overall hypertension prevalence was 36.0%. The highest rates were observed in males (39.6%), in individuals aged between 65 and 74 years (71.3%), and in those with low levels of education (62.6%) and with no formal occupation (64.5%). Among hypertensive individuals, 69.8% were aware of their condition and 69.4% were under treatment, of whom 71.3% were controlled. Rates of awareness and medical treatment were significantly higher among women and older individuals. Conclusions: A large majority of the adult Portuguese population are likely to reach blood pressure levels defined as hypertension in adulthood. Significant differences in hypertension prevalence were found according to gender, age and socioeconomic status, which highlights the importance of population strategies in public health policies. publishersversion published

Background: Research on elder abuse has defined it as a multidimensional construct that encompasses a set of different abusive behaviours, victims, perpetrators and settings. The array of possible elder abuse configurations is difficult to capture. This study sought to identify victimization patterns that represent distinct elder abuse configurations based on specific abusive behaviours and on the relationship with the perpetrator; it also sought to determine the association between these latent classes with victims' characteristics. Method: Data comes from two elder abuse surveys: a representative sample of community-dwelling adults and a convenience sample of older adults reporting elder abuse to four state and NGOs institutions. Latent Class Analysis (LCA) was used to categorize victimization in the population-based (N = 245) and in the victims' sample (N = 510) using 7 items measuring physical, psychological and financial abuse, and appointed perpetrators. Association tests were conducted to determine differences and similarities of victims' characteristics between the different obtained classes. Results: The LCA procedure identified six different latent classes of victimization experiences in each of the samples, which were statistically and plausibly distinct. In the population-based survey: verbal abuse by others (29%); psychological abuse from children/grandchildren (18%); overlooked by others (18%); stolen by others (15%); verbal Intimate Partner Violence (IPV) (14%) and physical and psychological IPV (6%). In the victims' survey: physical abuse by children/grandchildren (29%); physical IPV (26%); psychological abuse by children/grandchildren (18%); polyvictimization by others (16%); physical abuse by others (6%) and physical and psychological IPV (4%). In the victims survey the 6 groups significantly differ in age, gender, civil status, living arrangements, perceived social support and functional status. Conclusions: The results support the possibility of the multidimensionality of elder abuse not being accounted by the "classical" abuse typologies. Elder abuse victims seeking help may represent a distinct group from that included in population-based prevalence studies. The appointed perpetrators may be the most meaningful and relevant aspect in distinguishing victimization experiences. Further research is needed to develop tailored interventions to specific elder abuse cases and enhance successful outcomes. publishersversion published

© 2019 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, ˜ S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)., Introduction: Cardiovascular disease is an important cause of death and disability worldwide, and hypertension is responsible for at least 45% of all deaths due to heart disease and 51% of deaths due to stroke. This study aimed to estimate and describe the distribution of prevalence, awareness, treatment and control of hypertension in the Portuguese population in 2015. Methods: A national survey using a representative sample of 4911 individuals residing in Portugal and aged between 25 and 74 years was implemented. Trained nurses performed a health interview and a physical examination, including blood pressure measurement (right arm, three measurements at 1-min intervals). The prevalence of hypertension was stratified by gender, age group, marital status, education, occupation and type of residential area. Associations between hypertension prevalence and sociodemographic factors were assessed using bivariate and multivariate Poisson regression. Results: The overall hypertension prevalence was 36.0%. The highest rates were observed in males (39.6%), in individuals aged between 65 and 74 years (71.3%), and in those with low levels of education (62.6%) and with no formal occupation (64.5%). Among hypertensive individuals, 69.8% were aware of their condition and 69.4% were under treatment, of whom 71.3% were controlled. Rates of awareness and medical treatment were significantly higher among women and older individuals. Conclusions: A large majority of the adult Portuguese population are likely to reach blood pressure levels defined as hypertension in adulthood. Significant differences in hypertension prevalence were found according to gender, age and socioeconomic status, which highlights the importance of population strategies in public health policies., Introdução: As doenças cardiovasculares são uma importante causa de morte e incapacidade, sendo que a hipertensão arterial (HTA) é responsável por, pelo menos, 45% da mortalidade por doença cardíaca e 51% por acidente vascular cerebral. Este estudo pretende estimar e descrever a distribuição da prevalência, awareness, tratamento e controlo da HTA na população portuguesa em 2015. Métodos: Realizou-se um inquérito nacional com uma amostra representativa de 4911 indivíduos, dos 25 aos 74 anos, residentes em Portugal, e que compreendia a realização de uma entrevista de saúde e exame físico que incluía a medição da pressão arterial (braço direito, três medidas, intervalos de um minuto). A prevalência de HTA foi estratificada por sexo, grupo etário, estado civil, educação, ocupação e nível de urbanização. Estimou-se a associação entre a HTA e os fatores sociodemográficos usando regressão de Poisson bivariada e multivariada. Resultados: A prevalência de HTA foi de 36,0%, sendo mais elevada em indivíduos do sexo masculino (39,6%), entre os 65 e 74 anos (71,3%), com baixo nível de escolaridade (62,6%) e sem ocupac¸ão formal (64,5%). Dos indivíduos hipertensos, 69,8% tinham conhecimento da sua condição de saúde, 69,4% faziam medicação anti hipertensora e, destes, 71,3% estavam controlados. A prevalência do conhecimento e tratamento farmacológico da HTA foi mais elevada em mulheres e indivíduos mais velhos. Conclusões: A maioria da população adulta portuguesa poderá vir a ter HTA ao longo da vida. Foram encontradas diferenças importantes na prevalência de HTA de acordo com o sexo, a idade e o nível socioeconómico, o que enfatiza a importância de estratégias populacionais nas políticas de saúde pública.

UID/SOC/04647/2013 UID/SOC/04647/2019 SFRH/BPD/107722/2015 publishersversion published

UID/SOC/04647/2013 SFRH/BPD/107722/2015 The quality of care practices is still a central issue for long-term care policy. Following seven signs used to evaluate care practices, this article presents the initial results of ongoing research carried out in three Portuguese care homes in 2017. The article uses mixed methods (24 interviews and a data survey), based on the perspectives of care workers, professional staff and managers. The findings highlight the non-recognition of care work, difficult working conditions, poor training and a limited monitoring of the care system as factors that reduce the quality of care and increase the risk of an institutionalised culture of care omission. publishersversion published

Objectives: Recognized as an important public health issue, elder abuse has been associated with adverse health and social outcomes. However, findings are often complex and contradictory, which can be attributed to elder abuse being a multidimensional construct that encompasses a set of different abusive behaviours, victims, perpetrators and settings. The array of possible elder abuse configurations is difficult to capture. This study sought to identify victimization patterns that represent distinct elder abuse configurations based on specific abusive behaviours and on the relationship with the perpetrator; it also sought to determine the association between these latent classes with victims’ characteristics. Methods: Data comes from two elder abuse surveys: a representative sample of community-dwelling adults and a convenience sample of older adults reporting elder abuse to four state and NGOs institutions. Latent Class Analysis (LCA) was used to categorize victimization in the population-based (N=245) and in the victims’ sample (N=510) using 7 items measuring physical, psychological and financial abuse, and appointed perpetrators. Chi-square tests were used to compare victims’ characteristics between the different obtained classes. Results: The LCA procedure identified six different latent classes of victimization experiences in each of the samples, which were statistically and plausibly distinct. In the population-based survey: verbal abuse by others (29%); psychological abuse from children/grandchildren (18%); overlooked by others (18%); stolen by others (15%); verbal IPV (14%) and physical and psychological IPV (6%). In the victims’ survey: physical abuse by children/grandchildren (29%); physical IPV (26%); psychological abuse by children/grandchildren (18%); polyvictimization by others (16%); physical abuse by others (6%) and physical and psychological IPV (4%). In the victims survey the six groups significantly differ in age, gender, civil status, cohabitation, perceived social support and functional status. Conclusion: The results support the possibility of the multidimensionality of elder abuse not being accounted by the “classical” abuse typologies. Elder abuse victims seeking help may represent a distinct group from that included in population-based prevalence studies. The appointed perpetrators may be the most meaningful and relevant aspect in distinguishing victimization experiences. Further research is needed to develop tailored interventions to specific elder abuse cases and enhance successful outcomes. N/A

O distress psicológico é um constructo multifatorial que se relaciona com o mau funcionamento psicológico e pior qualidade de vida. Este estudo examina a associação entre o distress psicológico (avaliado através do instrumento Mental Health Inventory 5), sexo, idade, estado civil, escolaridade e ocupação. Utilizamos dados do 1º Inquérito Nacional de Saúde com Exame Físico (INSEF) realizado em Portugal em 2015, com uma amostra probabilística de 4911 indivíduos com idade compreendida entre os 25 e os 74 anos. A regressão de Poisson foi utilizada para estimar a razão de prevalência (RP) de distress psicológico de acordo com as diferentes variáveis. Todas as estimativas foram ponderadas para as diferentes probabilidades de seleção e distribuição da população por região geográfica, faixa etária e sexo. O distress psicológico foi reportado por 22,5% [IC 95%: 20,7-24,5] da população. A prevalência foi mais elevada nas mulheres (30,5%, RP=2,20 [1,74-2,80]), grupos etários mais velhos (28,4%, RP=1,80 [1,28-2,53]), nos viúvos (46,2%, RP=2,06 [1,71-2,46]) e nos desempregados (28,6%, RP=1,54[1,27-1,86]). O distress psicológico era menos prevalente nos indivíduos com níveis mais elevados de escolaridade. Os resultados sugerem que grupos populacionais específicos estão provavelmente mais em risco de desenvolver problemas de saúde mental: mulheres; viúvos; indivíduos entre os 45 e os 74 anos e desempregados. Psychological distress is a multi-factorial construct that relates to poor psychological function and worst quality of life. This study examines the association between psychological distress (evaluated using the Mental Health Inventory 5) and sex, age, civil status, education and professional activity. We used data from the first Portuguese Health Examination Survey (INSEF) conducted in Portugal in 2015, with a probabilistic sample of 4911 individuals aged 25-74 years old. Poisson regression was used to estimate prevalence ratios (PR) of psychological distress according to the different variables. All estimates were weighted to account for different selection probabilities and to match the population distribution in terms of geographic region, age group and sex. Psychological distress was reported by 22.5% [95%CI: 20.7-24.5] of the population. Women (30.5%, PR=2.20 [1.74-2.80]), older age groups (28.4%, PR=1.80 [1.28-2.53]), widows (46.2%, PR=2.06 [1.71-2.46]) and unemployed individuals (28.6%, PR=1.54 [1.27-1.86]) were more likely to report psychological distress. Prevalence of psychological distress was lower among individuals with higher levels of education. INSEF results suggest that specific population groups are probably more at-risk of developing mental health problems: women; widows and unemployed individuals between 45 and 74 years old. info:eu-repo/semantics/publishedVersion