R&D Institutions

Resultado da avaliação 2007 na área de Ciências da Saúde

Unidade de I&D

Instituto de Medicina Preventiva [HESC-LVT-Lisboa-4104] visitada em 24/04/2008

Classificação: Good

Comentários do painel de avaliação
Sobre a unidade
The IMP is a structural unit of Lisbon’s Medical Faculty, with the mission of teaching, doing research, and providing services in the fields of Preventive Medicine for individuals, families, groups and communities.
The general coordinator is professor J. Pereira Miguel, with the support of dr. Armando Pereirinha
The IMP comprises only one research group (Lisboa-4104-3090) on Health Determinants, the coordinator of which is Fátima Reis. The main objectives of the Group is to carry out research on health-impacting factors (health determinants), focussing on the underlying causes of the main illnesses related to the increasingly relevant environmental factors, lifestyle choices, psychosocial factors, the performance of the health services themselves. The Unit and the group consist of a number of Functional units as listed below.
The Unit consists of staff members from the Faculty and has currently 6 PhD students. The Unit organizes two postgraduate master courses on
- epidemiology
- health communication
In addition to the research activities the staff members of the Unit have a number of functions in Health Organizations in Portugal and abroad (WHO EB, EU Commission) and participate in NGO’s (antismoking org, medical doctors of the World)

Self-appraisal as presented by the Director
- clear scientific domain;
- quality of members;
- good logistics;
- few members with full time research work;
- lack of financial support;
- teaching overload;
- PhD students;
- collaborations: Ministry of Health, WHO, EU, FCT;
- country needs;
- attitude of the medical establishment towards the field;
- competition;
- imbalance at FML;

The activities of the IMP have been presented by several staff members.

We review the research activities according to the functional units as presented during the site-visit.

Preventive Cardiology: Armando Pereirinha is active in the field of the prevention of Cardiovascular Diseases. In particular, he has presented the Calcium score by EBT as a new risk marker (paper published in Atherosclerosis 2006; 187: 378-84). Differences in atherosclerosis burden in different nations and continents were assessed by coronary artery calcium. They reviewed CACS from 17,563 individuals collected in the USA (74%), Brazil (15%) and Portugal (11%). Significant differences in CACS were detected among the three nations. The CACS differences paralleled the respective cardiovascular mortality rates.
Finally, Dr Pereirinha participates on the “Health Knowledge on the Web for Citizens” project led by Harvard University, and he will be in charge of the Portugal branch. The research plan includes a platform of knowledge on the use of health services, and also:
– Measurement and analysis of content usage by the public, in terms of different target groups;
– Surveys among the users regarding the value of each component of the platform.
The overall aim is to increase the population’s “health literacy”.

Environmental Health: Fatima Reis, coordinator of the research group on Health Determinants, explained the structure of the group and its main activities. She stressed the relatively low proportion of researchers with a PhD degree and of personnel fully integrated into the group. Research is done on environmental determinants of health, involving an array of different topics such as ETS, waste incinerators, lead and health perception. The group participates in European networks such as ESBIO on biomonitoring, and they have developed new methods for environmental research. Future plans include better exposure assessment for main pollutants produced by incinerators, and the assessment of their health effects with the help of biomarkers.

Health inequalities and migrant health: Mario Carreira is leading research mainly in the fields of health inequalities and migrant health. The latter addresses issues such as current health status, access to health care of the immigrant community, chronic diseases care, and dental health status among the immigrant community. His research themes include the development of state-of-art epidemiological sampling methods aiming to capture highly mobile, unregistered individuals. The main research programs are:
Health Status and Access to Health Care of the African and Brazilian Immigrant Communities (in collaboration with the National Institute of Health).;
Health Status, Believes, Practices and Attitudes of Diabetics in African Immigrant Communities (in collaboration with the International Centre for Migration and Health and the Portuguese Diabetic Association and the General-Directorate of Health);
African and Brazilian immigrants communities dental health status and dental care access (in collaboration with Faculty of Dental Medicine);
Iron, zinc and vitamin A deficiency in children from African immigrant community in Portugal FCT: IME/ESP/49879/2003 (in collaboration with Garcia d’Orta Association).
Another field of research is on Health Information Systems in Europe, funded by European Union and coordinated by Veneto Region, Italia, 2003.

Future plans include the extension of research on migrants to other communities and other topics:
Health status and health care access in Islamic immigrant from Pakistan, India and Bangladesh. With the social support of Lisbon Mosque. Grant in negotiation with High-commissariat for Health;
Metabolic control in diabetic's African immigrants. In collaboration with Portuguese Association of Diabetics.
Hypertension prevalence, knowledge, control and validation of the hypertension self-referred in the African and Brazilian immigrant communities in Portugal. Grant in negotiation with pharmaceutical industry;
Attitudes and representations of health and illness and access to health care in immigrants: towards friendly health services. Measuring the immigration phenomenon into emergency medical. Coordinated by WHO (Barcelona office).

Epidemiology: Paulo Nicola presented a detailed research plan in Epidemiology encompassing the following three streams:
- Prevalence and Determinants of Chronic Diseases;
- Information Systems for Epidemiologic/Clinical Research;
- Additional horizontal actions.
The main objective of the first stream is to build a multidisciplinary research group with expertise in chronic diseases determinants including physicians, pharmacists, nurses, statisticians, sociologists and informaticians. These resources are to develop a research program around heart disease in Rheumatic arthritis, the prevalence and determinants of hypertension control and medication adherence, and the prevalence of asthma and asthma control. Among the most remarkable achievements to date are the description of heart failure as a major contributor of excess mortality in rheumatoid arthritis; the description of rheumatoid arthritis as a risk factor for heart failure; a methodological contribution to the calculation of attributable risk in longitudinal studies, and a comparison of methods for the identification of hypertensive patients in Primary Care.
Strong collaboration with the Mayo Clinic (US) and European groups has been developed. The group led by Dr Nicola has a strong record of publications in high impact journals.
Future goals include the provision of access to high quality and validated data for clinical research through the building of new information systems for prospective data collection, including a National Registry for Rheumatic Patients, that involves international collaborations, and the USF’s Electronic Medical Record for the Normalization and Classification of Clinical Data.

Research in Family Medicine: Cristina Ribeiro has presented her activities around Research in Family Medicine. The main goals of this stream of research are: to study the natural history of common problems and major diseases and how to prevent them; to understand how patients, families, communities, and systems deal with health and illness; to improve doctor- patient communication, decision making, and partnership; to test systems to improve patient satisfaction, safety, and outcomes. This field is still under development and strengths and weaknesses, including local difficulties, of the program have been discussed.

Sexual and Reproductive Health: Miguel Oliveira da Silva is a gynaecologist who has coordinated the EU-sponsored REPROSTAT 2 (2004-2007) whose goal was to assess the usefulness of a comprehensive set of reproductive health indicators designed for the enlarged European Union, with a particular emphasis on the reproductive health of adolescents and young adults. The study has examined issues such as the use of emergency contraceptives in Europe, including Portugal, and the determinants of early pregnancy (below the age of 20). This research has certainly considerable Public Health relevance in general and for Portugal in particular. It is not totally clear which is the degree of integration between Dr Oliveira da Silva’s work and the Unit of Public Health.

General comments:
The panel considers that the Institute has to be praised for the considerable amount of work in very relevant fields of Public Health. We have identified strengths and weaknesses, of which the Unit members are clearly aware.
Overall the Unit’s members have good sources of funding, but they still depend substantially on funding from the industry, a situation that needs to be redressed. On addition there is serious problem of fragmentation and heterogeneity, with too many apparently unrelated activities, some of which conducted by a single person. We strongly recommend strengthening internal cooperation with a more effective organization of activities clustered according to themes.
In general, the Institute lacks structural, well-funded personnel, and its activities are mainly supported by physicians who sometimes do research in their spare time. This is also reflected by the small number of PhDs in the Institute.
Minor comments: the design and power of several studies are unclear and should be worked out in a more comprehensive way: for example, that on prevalence of asthma, cancer mortality, mental health, frequency of reproductive alterations and auto-perception of health status in relation to solid waste incineration processes.

In general the Panel recommends that the Unit develops a well structured PhD program around the theme Epidemiology and Health Determinants. The Unit should also attempt to publish in journals with higher impact. The Unit has the potential of achieving a very good level if it takes strategic decisions in order to concentrate its research activities in the most promising programs such as the “Prevalence and Determinants of Chronic Diseases”, and the development of “Information Systems for Epidemiologic and Public Health Research”.
Sobre os grupos de investigação
Centro de Investigação sobre Determinantes da Saúde [RG-HESC-LVT-Lisboa-4104-3090]