João Vasco Santos

• MD MPH PhD
• Public Health resident at Ars Norte Administração Regional de Saúde do Norte

Background Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods. In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on...

Background The COVID-19 pandemic has led to disruptive changes worldwide, with different implications across countries. The evolution of citizens’ concerns and behaviours over time is a central piece to support public policies. Objective To unveil perceptions and behaviours of the Portuguese population regarding social and economic impacts of the...

Background: The Global Burden of Disease study has generated a wealth of data on death and disability in Europe. At a time of change for the European Union and European Region of WHO, with a new Health Commissioner and Regional Director, respectively, a review of health trends can contribute to identify outstanding needs and gaps. This paper repor...

Background: Health records are the basis of clinical coding. In Portugal, relevant diagnoses and procedures are abstracted and categorised using an internationally accepted classification system and the resulting codes, together with the administrative data, are then grouped into diagnosis-related groups (DRGs). Hospital reimbursement is partially...

Nowadays, evaluating the quality of health services, especially in primary health care (PHC), is increasingly important. In a historical perspective, the Department of Health (United Kingdom) developed and proposed a range of indicators in 1998, and lately several health, social and political organizations have defined and implemented different set...

This study analysed 88 944 hospitalizations for skin and soft tissue infections (SSTI) in Portugal from 2000 to 2016, using nationwide registry data. Results revealed an increasing burden of SSTI hospitalizations, with rates rising from 47.5 to 53.5 per 100 000 people. Although in-hospital mortality rose from 2.1% to 3.1%, adjustments for Charlson...

Purpose The main goal of this study is to identify the associated factors with avoidable admissions in ED, comparing pre-COVID and COVID periods. Methods This was retrospective study that took place in a Paediatric Emergency Department of a metropolitan, university-affiliated hospital in Portugal. All visits to paediatric emergency department betw...

Background The transferability of health policies in the European Union (EU) faces challenges due to economic, political, and healthcare system factors, including cross-country differences in health preferences. In order to aid policymaking, previous research has grouped EU countries based on geographical proximity or literature-based criteria, but...

Background The burden of disease (BoD) methodology is a valuable tool for evidence-based policymaking. However, there is currently no systematic analysis available regarding its use in the European Union (EU) legislation framework. This study aims to describe the implementation of BoD methodology in EU legislation. Methods A search was conducted o...

Background The shift of selected surgical procedures from inpatient to outpatient settings has been seen as a solution to improve health care provision. These shifts often occur under pay-for-performance schemes, pay-for-efficiency schemes, or other forms of financial incentives. For this study, we aimed to assess the effect of Decree 132/2009, imp...

Environmental stressors are an important source of burden of disease worldwide. The accurate economic evaluation of health hazards caused by environmental stressors guide the design of more effective and comprehensive public policies. However, guidelines on cost assessment, monetisation and discounting methodologies are scarce. Therefore, several d...

Objective To describe a protocol to achieve consensus on valid and important indicators to assess primary health care (PHC) quality regarding all clinical contexts of PHC in European health systems. Study design Qualitative study using the Delphi technique to gain consensus among European panels of experts comprising a heterogeneous professional b...

Health system performance assessment (HSPA) is essential for health planning and to improve population health. One of the HSPA domains is related to effectiveness, which can be represented considering different dimensions. Composite indicators can be used to summarize complex constructs involving several indicators. One example of such efforts is t...

All patient refined‐diagnosis related groups (APR‐DRGs) includes severity of illness (SOI) and risk of mortality (ROM) subclasses. For predictions, both subscales are used together or interchangeably. We aimed to compare SOI and ROM by evaluating the reliability and agreement between both. We performed a retrospective observational study using main...

Background The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010. Methods We used the Global Burden of Dise...

Background The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010. Methods We used the Global Burden of Dis...

This study has the aim of assessing the Brazilian perceptions, influencing factors and political positioning on the confidence concerning COVID-19 vaccination. To achieve the objective, the methods rely on a cross-sectional survey of Brazilian citizens, distributed through different social networks. The sample is composed of 1,670 valid responses,...

Introduction In Portugal, a reform to implement Long-term mental health care (LTMHC) started in 2017 allowing patients with severe mental illness receiving psychosocial rehabilitation to regain their autonomy and be reintegrated into their communities. Aim To describe the first steps of the Portuguese LTMHC implementation and to assess the relatio...

Health impact assessments (HIA) provide decision-makers with sound information about the health implications of policies or programmes and projects. Using an economic lens to perform HIA and to study policies to be implemented, can be a daunting task as there are many challenges can hamper its performance. Data scarcity and difficult access to it,...

Background This study aims to explore the relationship between health expenditure and social expenditure in their role in affecting health outcomes, such as death rates and disability-adjusted life years. Both types of spending may behave as complementary or supplementary goods, besides, they may interact with each other over time. Methods We used...

Background Life Expectancy (LE) at birth, the average number of years a person is expected to live from birth, supposing constant age-specific mortality, is an essential indicator of a country or region's well-being, reflecting policy options at the regional level and highlighting progress and gaps in societal health, including at the sub-national...

Background: In Portugal, trained physicians undertake the clinical coding process, which serves as the basis for hospital reimbursement systems. In 2017, the classification version used for coding of diagnoses and procedures for hospital morbidity changed from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-...

Objectives: Within the framework of the burden of disease (BoD) approach, disease and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature re...

Objectives: To describe and assess the risk of bias of the primary input studies that underpinned the Global Burden of Disease Study (GBD) 2019 modelled prevalence estimates of low back pain (LBP), neck pain (NP), and knee osteoarthritis (OA), from Australia, Brazil, Canada, Spain, and Switzerland. To evaluate the certainty of the GBD modelled prev...

Trust in institutions is a key driver to shape population attitudes and behavior, such as compliance of non-pharmaceutical interventions (NPI). During the COVID-19 pandemic, this was fundamental and its compliance was supported by governmental and non-governmental institutions. Nevertheless, the situation of political polarization in some countries...

Introduction Healthcare expenditure, a common input used in health systems efficiency analyses is affected by population age structure. However, while age structure is usually considered to adjust health system outputs, health expenditure and other inputs are seldom adjusted. We propose methods for adjusting Health Expenditure per Capita (HEpC) for...

With the increasing influx of patients and frequent overcrowding, the adoption of a valid triage system, capable of distinguishing patients who need urgent care, from those who can wait safely is paramount. Hence, the aim of this study is to evaluate the validity of the Paediatric Canadian Triage and Acuity Scale (PaedCTAS) in a Portuguese tertiary...

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026 Global Burden of Disease 2021 Health Financing Collaborator Network † Show footnotesOpen AccessPublished:January 24, 2023DOI:https://doi.org/10.1016/S2214-109X(23)00007-4 Summary Background The COVID-19 pandemic h...

This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and...

This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and...

The need to control the sanitary situation during the COVID-19 pandemic has led governments to implement several restrictions with substantial social and economic impacts. We explored people’s trade-offs in terms of their income, life restrictions, education, and poverty in the society, compared to their willingness to avoid deaths. We applied a we...

Background Unexpected variability across healthcare datasets may indicate data quality issues and thereby affect the credibility of these data for reutilization. No gold-standard reference dataset or methods for variability assessment are usually available for these datasets. In this study, we aim to describe the process of discovering data quality...

Issue/problem Contact tracing is an important and widely used method to control transmission of communicable diseases. The COVID-19 pandemic presented a new and big challenge with a high number of confirmed cases and contacts and subsequent high burden on contact tracing activities. Naturally, the effectiveness of such interventions needs to be ass...

Background Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods. In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on...

For establishing evidence-based or evidence-informed decision making in health systems, it is essential to determine which public health interventions and health policies are worth investing in, considering that public budgets are always limited. For that purpose, we can use well-established economic evaluation methods based on marginal analysis as...

Coding of medical data is a very important previous step for many activities in Health Care management, since it is the basis for several activities ranging from hospital reimbursement to clinical research. Literature identifies some issues related to coding clinical data, which derives in inadequate levels of quality leading to some in acceptable...

Objectives Information on the effectiveness of COVID-19 contact tracing is lacking. We proposed 2 measures for evaluating the effectiveness of contact tracing and applied them in a public health unit in northern Portugal. Methods This retrospective cohort study included the contacts of people with COVID-19 diagnosed July 1–September 15, 2020. We e...

Background Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD st...

The aims of this study were to assess All-Patient Refined Diagnosis-Related Groups’ (APR-DRG) Severity of Illness (SOI) and Risk of Mortality (ROM) as predictors of in-hospital mortality, comparing with Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) scores. We performed a retrospective observational study using mainland Por...

Objectives This study aimed to describe trends and patterns of cause-specific hospitalizations in mainland Portugal between 2000 and 2016. Study design This was a retrospective observational study based on hospital discharge data during the period 2000–2016 in mainland Portugal. Methods All inpatient hospital discharges among mainland Portuguese...

Introduction The global spread of COVID-19 has led to a wide range of pandemic response measures, with great heterogeneity between countries, varying mostly in time and duration of implementation. The stringency level of measures was based on different epidemiological and health services indicators. In this work, we aimed to assess the association...

Introduction Many different indicators can be used for health system effectiveness. Therefore, using composite indicators is a good way to summarize them all. One example of such efforts is the Healthcare Access and Quality Index (HAQI) from the Global Burden of Diseases study, for which different causes of mortality amenable to health care are sum...

Objectives To use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) to estimate mortality and disability trends for the population aged ≥70 and evaluate patterns in causes of death, disability, and risk factors. Design Systematic analysis. Setting Participants were aged ≥70 from 204 countries and terri...

Background: The use of non-pharmaceutical interventions (NPI) is one of the main tools used in the coronavirus disease 2019 (COVID-19) pandemic response, including physical distancing, frequent hand washing, face mask use, respiratory hygiene and use of contact tracing apps. Literature on compliance with NPI during the COVID-19 pandemic is limited...

Background Assessment of disability-adjusted life years (DALYs) resulting from non-communicable diseases (NCDs) requires specific calculation methods and input data. The aims of this study were to: (i) identify existing NCD burden of disease (BoD) activities in Europe; (ii) collate information on data sources for mortality and morbidity; and (iii)...

Objective There is still a lack of health indicators for monitoring and evaluating health planning at the local level. In Portugal, local health plans (LHP) include a prioritized set of health priorities, which should be monitored and evaluated. This study is an example of a low‐resource method to identify and reuse indicators for LHP monitoring an...

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to provide...

OBJECTIVE: To investigate how sociodemographic conditions, political factors, organizational confidence, and non-pharmaceutical interventions compliance affect the COVID-19 vaccine hesitancy in Brazil. METHODS: Data collection took place between November 25th, 2020 and January 11th, 2021 using a nationwide online survey. Subsequently, the research...

Background Non-communicable diseases (NCDs) remain the leading cause of disease burden in the European Union (EU). However, this burden varies across Member States, driven by the socioeconomic and demographic structure of the populations, as well as health care and social support systems in each country. This geographical gradient in the burden of...

Background The European Union (EU) faces many health-related challenges. Accurate and timely data on mortality and morbidity from diseases and injuries and their trends over time are essential for health planning and priority setting. Methods We use the GBD 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to eva...

The global spread of COVID-19 has led to a wide range of pandemic response measures, heterogeneous between countries, varying mostly in time and duration of implementation. Common measures include social distancing, travel restrictions, school closings, bans on public gatherings, investment in healthcare, contact tracing and other public health int...

Background In addition to information on mortality and morbidity from diseases and injuries, it is important to identify the attributable burden of risk factors to allow for health planning and prioritization. Methods For the whole EU and each country, using estimates and 95% uncertainty intervals from the GBD 2019 study, we report attributable (a...

The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development as...

A pandemia global Covid-19, denominada pela área de saúde pública como “Doença por Coronavírus”, foi declarada pela Organização Mundial da Saúde (OMS) no dia 12 de Março de 2020¹ devido à sua distribuição por todo o mundo, após a sua descoberta em Dezembro de 2019 na China. 1 ano e 3 meses, em Junho de 2021, o mundo atinge mais de 180 milhões de ca...

Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descripti...

Background: The Global Burden of Disease (GBD) study has generated a wealth of data on death and disability outcomes in Europe. It is important to identify the disease burden that is attributable to risk factors and, therefore, amenable to interventions. This paper reports the burden attributable to risk factors, in deaths and disability-adjusted...

Introduction Administrative hospital databases represent an important tool for hospital financing in many national health systems and are also an important data source for clinical, epidemiological and health services research. Therefore, the data quality of such databases is of utmost importance. This paper aims to present a systematic review of r...

Recent estimates have reiterated that non-fatal causes of disease, such as low back pain, headaches and depressive disorders, are amongst the leading causes of disability-adjusted life years (DALYs). For these causes, the contribution of years lived with disability (YLD) - put simply, ill-health - is what drives DALYs, not mortality. Being able to...

CD73 converts AMP to adenosine, an immunosuppressive metabolite that promotes tumorigenesis. This study presents a systematic evaluation of CD73 expression in benign, hyperplastic, and neoplastic thyroid. CD73 expression was assessed by immunohistochemistry in 142 thyroid samples. CD73 was expressed in normal thyroid (3/6) and goiter (5/6), with an...

Acute Myocardial Infarction (AMI) is frequently reported when coding hospital encounters, being commonly monitored through acute care outcomes. Variability in clinical coding within hospital administrative databases, however, may indicate data quality issues and thereby negatively affect quality assessment of care delivered to AMI patients, apart f...

Ambulatory care sensitive conditions (ACSCs) are conditions for which hospitalizations are thought to be avoidable if effective and accessible primary health care is available. However, to define which conditions are considered ACSCs, there is a considerable number of different lists. Our aim was to compare the impact of using different ACSC lists...

Summary Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a sta...

p>Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators...

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publ...

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardise...

Background Primary health care (PHC) is the cornerstone of several health systems. The Portuguese PHC is organized in five mainland regions (ARS), that oversee 55 local groups of primary healthcare centres (ACES). We assessed the efficiency of all 55 ACES in mainland Portugal, as well as organizational and socioeconomic determinants of the efficien...

Background In Portugal, there are different organizational models in primary health care (PHC), mainly regarding the payment scheme. USF-B is the only type with financial incentives to the professional (pay-for-performance). Our goal was to assess the relationship between groups of primary healthcare centres (ACES) with higher proportion of patient...

An amendment to this paper has been published and can be accessed via the original article.

Background: Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates o...

The Diagnosis Related Group-based administrative hospital database is an important tool for hospital financing in several health systems. It is also an important data source for clinical, epidemiological and health services research. Therefore, the data quality of these databases is of utmost importance for the exploitation of the data. To prevent...

Background: Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of...

Background: Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SD...

Objectives We aimed to study health status’ time trends in the European Union (EU) during 1990–2017 and its enlargements’ impact.Methods Using estimates from the Global Burden of Disease 2017 study and calculating age-sex-standardized rates, we have described time trends and analysed the differences between EU groups regarding the state of health....

Coded data are the basis of information systems in all countries that rely on Diagnosis Related Groups in order to reimburse/finance hospitals, including both administrative and clinical data. To identify the problems and barriers that affect the quality of the coded data is paramount to improve data quality as well as to enhance its usability and...

Background Primary care quality is one of the main dimensions of primary care performance and can be evaluated by several methods, e.g. studying hospitalizations for conditions that could be treated, or less severe, if appropriately managed in primary care. Accordingly, the Agency for Healthcare Research and Quality (AHRQ) developed prevention qual...

Abstract Objectives: To assess the proportion of positive screenings for latent tuberculosis infection (LTBI) before starting biological therapy and to analyse the effectiveness of screening and prophylaxis in preventing active tuberculosis (TB). Methods: Comprehensive and systematic literature search in four electronic databases (Pubmed, Cochrane...

SETTING: In Portugal, as in other countries, tuberculosis (TB) is considered a disease that should be managed on an ambulatory basis. However, hospitalisation remains important to manage some at-risk groups and complications. OBJECTIVE: To identify the possible risk factors associated with hospitalisations in TB patients in Portugal. DESIGN: Data e...

Introduction: Paediatric population still represents a high burden of hospitalisations among burns inpatients. Children under five years old have a distinct aetiology distribution comparing to other age groups, representing in Portugal a fifth of all hospitalisations with burns. We aimed to describe the demographic and clinical burden of burns req...

The quality of clinical data held in administrative databases is crucial for appropriate funding of health care services. As Diagnosis-Related Groups (DRGs) continue to play an important role in hospital payment mechanisms, proper coding of diagnoses and procedures is of most concern. This study used an administrative, nationwide Portuguese inpatie...

Evidence regarding quality indicators in primary health care is a major need for better mental health management, monitoring and decision-making. In this paper, we compared two methods of retrieving quality indicators for mental health in primary care by means of an umbrella review, that included eight systematic reviews, and of grey literature. Fr...

Background: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, c...

Summary Background Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide i...

Background: The All Patient-Refined Diagnosis-Related Groups (APR-DRGs) system has adjusted the basic DRG structure by incorporating four severity of illness (SOI) levels, which are used for determining hospital payment. A comprehensive report of all relevant diagnoses, namely the patient's underlying co-morbidities, is a key factor for ensuring t...

Background: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development,...

Background. Clinical coding is the process of transforming the information about diseases or procedures recorded in the health records, into numeric or alphanumeric codes, using an international classification system. Recently, a new version of the classification system (ICD-10-CM/PCS) started being used in Portugal.