General Directorate Of Health Research Articles

Planning matters: a document analysis of 23 Portuguese national health programs

Abstract Background Health planning is crucial for effective public health interventions and optimal use of resources. Portugal has a long history of developing health plans and programs, with the General-Directorate of Health (GDH) publishing programs for communicable and noncommunicable diseases. Yet, these programs’ evaluation is rare, not only in terms of results but also in their design and content. This study aimed to analyze all available GDH programs to assess their structure and content. Methods We performed a document analysis of the 23 national health programs, analyzing the items well-established by the literature as fundamental to be present in these plans and programs. Each program was analyzed independently by two independent researchers, and discrepancies were resolved within the authors’ group. Besides assessing items as present or absent, comments were added. Results Programs largely varied: of the 23 programs, 17 were outdated, and four were dispersed among multiple documents. Sixteen complied with at least 75% of the predefined items, with priority programs having a higher compliance rate compared to non-priority ones (83% vs 33%). The definition of goals was the most commonly fulfilled criterion, present in 91.7% of the analyzed documents. Though, the time scope of the programs was updated only in 20.8% of the programs, accounting for the criterion least commonly met. Discussion/Conclusions Despite being published by the same institution, the programs analyzed were heterogeneous, and most were not updated. Establishing a standardized structure for the design of these health programs would ensure that fundamental items are present, accelerate the update of the programs, and facilitate communication and collaboration with partners and stakeholders in public health Key messages • This study analyzed 23 national health programs published by the Portuguese General-Directorate of Health (GDH) and found great heterogeneity in their structure and availability. • Establishing a common standardized structure for health planning is essential to ensure all fundamental aspects are taken into consideration and improve communication and stakeholders partnership.

Seroprevalence of anti-SARS-CoV-2 antibodies and cross-variant neutralization capacity after the Omicron BA.2 wave in Geneva, Switzerland: a population-based study.

More than two years into the COVID-19 pandemic, most of the population has developed anti-SARS-CoV-2 antibodies from infection and/or vaccination. However, public health decision-making is hindered by the lack of up-to-date and precise characterization of the immune landscape in the population. Here, we estimated anti-SARS-CoV-2 antibodies seroprevalence and cross-variant neutralization capacity after Omicron became dominant in Geneva, Switzerland. We conducted a population-based serosurvey between April 29 and June 9, 2022, recruiting children and adults of all ages from age-stratified random samples of the general population of Geneva, Switzerland. We tested for anti-SARS-CoV-2 antibodies using commercial immunoassays targeting either the spike (S) or nucleocapsid (N) protein, and for antibody neutralization capacity against different SARS-CoV-2 variants using a cell-free Spike trimer-ACE2 binding-based surrogate neutralization assay. We estimated seroprevalence and neutralization capacity using a Bayesian modeling framework accounting for the demographics, vaccination, and infection statuses of the Geneva population. Among the 2521 individuals included in the analysis, the estimated total antibodies seroprevalence was 93.8% (95% CrI 93.1-94.5), including 72.4% (70.0-74.7) for infection-induced antibodies. Estimates of neutralizing antibodies in a representative subsample (N=1160) ranged from 79.5% (77.1-81.8) against the Alpha variant to 46.7% (43.0-50.4) against the Omicron BA.4/BA.5 subvariants. Despite having high seroprevalence of infection-induced antibodies (76.7% [69.7-83.0] for ages 0-5 years, 90.5% [86.5-94.1] for ages 6-11 years), children aged <12 years had substantially lower neutralizing activity than older participants, particularly against Omicron subvariants. Overall, vaccination was associated with higher neutralizing activity against pre-Omicron variants. Vaccine booster alongside recent infection was associated with higher neutralizing activity against Omicron subvariants. While most of the Geneva population has developed anti-SARS-CoV-2 antibodies through vaccination and/or infection, less than half has neutralizing activity against the currently circulating Omicron BA.5 subvariant. Hybrid immunity obtained through booster vaccination and infection confers the greatest neutralization capacity, including against Omicron. General Directorate of Health in Geneva canton, Private Foundation of the Geneva University Hospitals, European Commission ("CoVICIS" grant), and a private foundation advised by CARIGEST SA.

Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (ASR-MH-COVID19) - Development and validation

IntroductionThe COVID-19 crisis has generated an increasing stress throughout the population.ObjectivesTo develop and validate the Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (GDH) (ASR-MH-COVID19).MethodsThe items content was based on the GDH guides for the prevention of mental health and psychosocial well-being of the general population during the COVID-19 outbreak. After content and facial validity analysis, the preliminary version of the ASR-MH-COVID19 (8 items to be answered on a Likert scale) was completed by 413 individuals (69.2% female; mean age=31.02±14,272), in September-December 2020 (Sample1) and then by 967 (70.9% female; mean age=34.02±14,272), in February-May 2021 (Sample2). Sample1 was randomly divided in two sub-samples. Sample1A was used for exploratory factor analysis/EFA and Sample1B for confirmatory factor analysis/CFA; CFA was then replicated with Sample2. The online surveys also included the Adherence Scale to the Recommendations of Portuguese GDH to minimize the impact of COVID-19 (ASR-COVID-19; Pereira et al. 2020).ResultsCFAs were informed by EFA and showed that the unidimensional model presented acceptable-good fit indexes (Sample1B: χ2/df=2.747; RMSEA=.0980, p&lt;.001; CFI=.973; TLI=.918, GFI=.972; Sample2: χ2/df=3.327; RMSEA=.0490, p&lt;.001; CFI=.993; TLI=.983, GFI=.990). Cronbach’s alfas were α&lt;.850. Pearson correlations between ASR-MH-COVID19 and ASR-COVID19 were significant (p&lt;.01) and moderate-high for the total (r=.753) and dimensional scores (Distance and respiratory hygiene, r=.739; House and personal hygiene, r=.584; Use of remote services and isolation r=.425).ConclusionsThe new ASR-MH-COVID19 has shown validity and reliability, allowing the investigation of this (mental) health behaviour.DisclosureNo significant relationships.

Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (ASR-MH-COVID19) - Development and validation

IntroductionThe COVID-19 crisis has generated an increasing stress throughout the population.ObjectivesTo develop and validate the Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (GDH) (ASR-MH-COVID19).MethodsThe items content was based on the GDH guides for the prevention of mental health and psychosocial well-being of the general population during the COVID-19 outbreak. After content and facial validity analysis, the preliminary version of the ASR-MH-COVID19 (8 items to be answered on a Likert scale) was completed by 413 individuals (69.2% female; mean age=31.02±14,272), in September-December 2020 (Sample1) and then by 967 (70.9% female; mean age=34.02±14,272), in February-May 2021 (Sample2). Sample1 was randomly divided in two sub-samples. Sample1A was used for exploratory factor analysis/EFA and Sample1B for confirmatory factor analysis/CFA; CFA was then replicated with Sample2. The online surveys also included the Adherence Scale to the Recommendations of Portuguese GDH to minimize the impact of COVID-19 (ASR-COVID-19; Pereira et al. 2020).ResultsCFAs were informed by EFA and showed that the unidimensional model presented acceptable-good fit indexes (Sample1B: χ2/df=2.747; RMSEA=.0980, p&lt;.001; CFI=.973; TLI=.918, GFI=.972; Sample2: χ2/df=3.327; RMSEA=.0490, p&lt;.001; CFI=.993; TLI=.983, GFI=.990). Cronbach’s alfas were α&lt;.850. Pearson correlations between ASR-MH-COVID19 and ASR-COVID19 were significant (p&lt;.01) and moderate-high for the total (r=.753) and dimensional scores (Distance and respiratory hygiene, r=.739; House and personal hygiene, r=.584; Use of remote services and isolation r=.425).ConclusionsThe new ASR-MH-COVID19 has shown validity and reliability, allowing the investigation of this (mental) health behaviour.DisclosureNo significant relationships.

Adherence to the Recommendations from the Portuguese General Directorate of Health (GDH) during the COVID-19 pandemic: fear or prosocial behaviour?

IntroductionDuring a public health crisis, preventive measures are essential. However, to make them effective, all citizens must be engaged.ObjectivesTo analyse the differential role of individual and contextual variables in the adherence to public health recommendations.Methods1376 adults (70.5% female; mean age=35.55±14.27) completed a survey between September/2020 and May/2021 with: Adherence Scale to the Recommendations during COVID-19 (ASR-COVID19; evaluates three dimensions of adherence), Fear of Covid-19 Scale (FC19S) and Toronto and Coimbra Prosocial Behaviour Questionnaire (ProBeQ; assesses empathy and altruism).ResultsAdherence did not differ between individuals with or without personal or family history of COVID-19 infection. ASR-COVID19 and all dimensions were positively correlated to ProBeQ’s altruism and empathy (from r=.32 to r=.54); FCV19S correlated positively to total adherence score and house sanitation (from r=.18 to r=.26; all p&lt;.01). Linear regressions revealed that altruism and empathy (first model), as well as fear of Covid-19 (second model), were significant predictors of adherence; however, while the first model explained ≅28% of its variance, the second (FCV19S as independent variable) only explained ≅3%. Regression models performed in a subsample of participants with personal or family history of COVID-19 revealed that only empathy, but not altruism, was a significant predictor of adherence; in this subsample, fear was no longer a significant predictor of adherence, except for lockdown and use of teleservices.ConclusionsBased on our results, we suggest health care providers and public health campaigns should take into consideration social solidarity and altruism, as well as previous experiences, when appealing to public’s engagement in health behaviour.DisclosureNo significant relationships.

"The Importance of Just in Time (JIT) Methodology and its Advantages in Health Care Quality Management Business – A Scoping Review"

Ahsan Siddiqui, M.D, M.S.P.H (UK)* Author Affiliations Consultant Preventive Medicine and Epidemiologist, Department of Quality, Management & Patient Safety, General Directorate of Health, Saudi Arabia Received: February 11, 2022 | Published: February 23, 2022 Corresponding author: Ahsan Ali Siddiqui, Consultant Preventive Medicine and Epidemiologist, Department of Quality, Management & Patient Safety, General Directorate of Health, Riyadh, Saudi Arabia DOI: 10.26717/BJSTR.2022.42.006701

"Kaizen Concept or Methodology to Improve the Performance in the Health Care and Patient Safety Business and its Advantages"

Ahsan Siddiqui* Author Affiliations Quality Management & Patient Safety Department, General Directorate of Health, Riyadh, Saudi Arabia Received: November 25, 2021 | Published: December 03, 2021 Corresponding author: Ahsan Siddiqui, Quality Management & Patient Safety Department, General Directorate of Health, Riyadh, Saudi Arabia DOI: 10.26717/BJSTR.2021.40.006439

"Comparing the Workplace Organization Method 5s with the 7 Wastes (Muda) in Waste and Failure Management Tool, in the Health Care Quality Management"

Ahsan Siddiqui* Author Affiliations Quality Management & Patient Safety Department, General Directorate of Health, Riyadh, Saudi Arabia Received: November 08, 2021 | Published: November 15, 2021 Corresponding author: Ahsan Siddiqui, Quality Management & Patient Safety Department, General Directorate of Health, Riyadh, Saudi Arabia DOI: 10.26717/BJSTR.2021.40.006387

Vaccine refusal/hesitancy—the ethical point of view

BackgroundIn 2019, WHO classified vaccine hesitancy as one of the top 10 threats to global health. Vaccination is an area of excellence in nursing that has gained a new focus and has become a challenge in the provision of care and in the management field. Vaccine hesitation raises questions about mandatory vaccination, individual versus collective freedom that are highlighted in the current context due to the emergence of new vaccines. In this paper, we want to analyze and update knowledge about vaccines hesitancy from an ethical and bioethical perspective.MethodsA combination of literature reviews on vaccine refusal/hesitancy, ethics and COVID-19 vaccine confidence, accessed on SciELO and PubMed databases and analysis of documents from General Directorate of Health and Ordem dos Enfermeiros (National Nurses Association).ResultsVaccination programs aim is a collective protection. The desirable effects at individual level do not have the same ethical value at collective level, leading to cost-benefit imbalances. Moral conflicts between the individual and the collective, cost-benefit imbalances and the insufficiency of bioethics principles, lead us to the use of other moral values and principles, such as responsibility, solidarity and social justice, as a tool for ethical reflection problems related to COVID-19 vaccines.ConclusionsThere are no perfect solutions to ethical dilemmas and some optimal solutions could depend the context. In a pandemic situation, one of the most relevant ethical issues is the herd immunity since it leaves public health at risk. Equity and the principle of justice in vaccination campaign are shown daily in the nursing profession.

Podemos falar de segurança do paciente durante uma pandemia? Uma experiência portuguesa

Objetivo: enumerar medidas governativas e de saúde pública implementadas em Portugal decorrentes da pandemia pelo vírus SARS-CoV-2 e descrever a atuação do Gabinete de Segurança do Paciente do Centro Hospitalar Universitário de Lisboa Central (CHULC), referência nacional na resposta à situação de emergência de saúde pública. Métodos: utilizou-se como método a análise normativa, documental, além de relato de caso por pesquisa-ação. Resultados: em Portugal, documentaram-se os primeiros casos de infeção por SARS-CoV-2 a 2 de março de 2020. Os processos assistenciais são geridos pelo Ministério da Saúde e Direção Geral da Saúde, abrangendo o Sistema Nacional de Saúde (universal) e o sector privado. O Gabinete de Segurança do Doente do CHULC, participou na redefinição dos processos, criação de vias alternativas de informação entre as várias estruturas, implementação de inovações no uso de tecnologias e vigilância clínica, gestão dos equipamentos de proteção, motivação e suporte emocional dos profissionais e na consolidação das principais metas de segurança do doente (ex. identificação do doente, medicação e cirurgia segura). A aprendizagem feita com os erros contribui para a melhoria contínua dos processos. Conclusão: em Portugal e no mundo a pandemia por COVID-19 não terminou. Compreendemos que é tempo de refletir e voltar aos princípios básicos da segurança, como a higiene das mãos, a etiqueta respiratória e o controlo ambiental. Na gestão do risco e segurança do paciente em situação de crise, é necessário, mais do que nunca, inovar e aprender com os erros.

The importance of medical devices in preventing and combating SARS-CoV-2 and cooperation between national regulators, academy and industry - Perspectives from the Portuguese reality

In view of the scarcity of medical devices necessary to combat the outbreak crisis caused by the new SARS-CoV-2 coronavirus pandemic, an exceptional regime regarding applicable device conformity assessment procedures and market surveillance was established through Recommendation (EU) 2020/403 of the European Commission of 13 March. This was adopted by Portugal through the publication of Decree-Law no. 14-E / 2020 of 13 April. Many guidelines were issued during the pandemic by INFARMED and with the cooperation of other national entities (Ministry of Economy, Ministry of Science, Technology and Higher Education, national Industry and General Directorate of Health) to support medical device manufacturers and importers. It is important that these guidelines are reflected in the development of the Portuguese medical device industry in order to promote its international recognition and to ease access to other medical markets. A detailed analysis of all variables here included in this opinion article, together with some proposals, aims to promote a national strategic vision in the area of the development and production of medical devices, in order to enhance ideas and gains that resulted from these responses to the crisis, serving for future analysis to be published in due course.

Advancement in Medical Sciences to Treat Medical and Surgical Diseases including Prevention, Treatment and Vaccine Development of COVID-19 in Pandemic

Ahsan Siddiqui, M.D, M.S.P.H (UK)* Author Affiliations Department of Quality Management & Patient Safety, General Directorate of Health, Riyadh Saudi Arabia Received: June 25, 2020 | Published: July 08, 2020 Corresponding author: Ahsan Ali Siddiqui, Consultant Epidemiologist, Quality Management & Patient Safety, Department, General Directorate of Health, Riyadh Saudi Arabia DOI: 10.26717/BJSTR.2020.28.004695

Covid-19 Proposed Treatment and other Medical Diseases Prevention and Treatment as Modern Medical Sciences is Beneficial for All of Us

Ahsan Siddiqui, M.D, M.S.P.H (UK)* Author Affiliations Department of Quality Management & Patient Safety, General Directorate of Health, Saudi Arabia Received: June 25, 2020 | Published: July 08, 2020 Corresponding author: Ahsan Ali Siddiqui, Consultant Epidemiologist, Quality Management & Patient Safety, Department, General Directorate of Health, Riyadh Saudi Arabia DOI: 10.26717/BJSTR.2020.28.004696

Educación alimentaria y nutricional para reducir la obesidad en escolares de Panamá: protocolo de estudio

El sobrepeso en escolares representa un creciente problema de salud pública en Panamá. El objetivo es desarrollar y validar un programa de intervención en educación alimentaria y nutricional (EAN) contra el sobrepeso y la obesidad en escolares de Panamá bajo la perspectiva de una política pública intersectorial de salud y educación. La intervención se basa en el cambio de conducta bajo el modelo socio-ecológico que favorezca la adopción de comportamientos alimentarios y de estilos de vida más saludables. Se trata de un estudio en 768 escolares de diseño cuasi experimental, pre-post intervención, prospectivo y sin grupo control, de tipo observacional explicativo en instituciones de educación básica general del sector público en tres Distritos de Panamá Oeste: La Chorrera, Capira y Chame. Se seleccionaron 5 escuelas, la escuela Victoria DˈSpinay y La Herradura en el Distrito de La Chorrera, la escuela Hernando Bárcenas en el Distrito de Capira y las escuelas El Espavé y Berta Elida Fernández en el Distrito de Chame. El protocolo fue registrado en la plataforma internacional de ensayos Nº ISRCTN28920505. Se obtendrán datos sociodemográficos, antropométricos, nutricionales y alimentarios; de seguridad alimentaria; y de conocimiento, actitud, percepción y comportamiento sobre alimentación y estilos de vida saludables de marzo a diciembre de 2019 durante la implementación del programa intersectorial denominado “Escuelas Saludables” del Ministerio de Salud y del Ministerio de Educación de Panamá. Se describirán y compararán los datos utilizando estadística paramétrica y no paramétrica. El protocolo de estudio fue revisado y aprobado por el Comité de Bioética de la Universidad de Panamá (Ref. CBUP/Nº075/2019), registrado en la Dirección General de Salud (DIGESA) del MINSA (Nº 881). Se solicitará consentimiento informado firmado por parte de los acudientes y asentimiento por cada niño participante. Los resultados del estudio serán difundidos ampliamente en revistas indexadas de revisión de pares y en congresos de salud y nutrición.Número de registro de protocolo: ISRCTN28920505.

The Urgent Need of Reliable and Approved Vaccination for COVID-19 Novel Corona Virus in Current Pandemic

Ahsan Siddiqui, M.D, M.S.P.H (UK)* Author Affiliations Department of Quality Management & Patient Safety, General Directorate of Health, Saudi Arabia Received:June 01, 2020 | Published: June 12, 2020 Corresponding author:Ahsan Ali Siddiqui, Consultant Epidemiologist, Quality Management & Patient Safety, Department, General Directorate of Health, Riyadh Saudi Arabia DOI: 10.26717/BJSTR.2020.28.004623

Role of Convalescent Plasma Therapy in Successful Prevention and Treatment of Covid-19 Novel Corona Virus Critical Patients, In 2020 Global Pandemic

Ahsan Siddiqui, M.D, M.S.P.H (UK)* Author Affiliations Department of Quality Management & Patient Safety, General Directorate of Health, Saudi Arabia Received: March 14, 2020 | Published: June 11, 2020 Corresponding author: Ahsan Ali Siddiqui, Consultant Epidemiologist, Quality Management & Patient Safety, Department, General Directorate of Health, Riyadh Saudi Arabia DOI: 10.26717/BJSTR.2020.28.004618

Covid-19 Novel Corona Virus Control and preventions In China and Discussing Their National Success to Back to Normal Life, While World Is Combatting the Deadly Viral Pandemic

Dr Ahsan Siddiqui, M.D, M.S.P.H (UK)* Author Affiliations Quality Management & Patient Safety Department, General Directorate of Health, Riyadh Saudi Arabia Received: May 05, 2020 | Published: May 18, 2020 Corresponding author: Dr Ahsan Ali Siddiqui, Consultant Epidemiologist, Quality Management & Patient Safety Department, General Directorate of Health, Riyadh Saudi Arabia DOI: 10.26717/BJSTR.2020.27.004544

To Device Three Research Questions that Could be Examined, and Tested by Applying the Techniques Chosen from the Data Which is Provided by University Statistics Department

Dr Ahsan Siddiqui, M.D, M.S.P.H (UK)* Author Affiliations Department of Quality Management & Patient Safety, Saudi Arabia Received: February 25, 2019 | Published: March 12, 2019 Corresponding author: Dr Ahsan Ali Siddiqui, Consultant Epidemiologist, Department of Quality Management & Patient Safety, General Directorate of Health, Riyadh Saudi Arabia DOI: 10.26717/BJSTR.2019.15.002767 Also View In:

Posters Presentation on Breast Feeding, Mother Cancer Awareness, Mother and Child Health, Mother Healthy Food and Mother Mental Health

Dr Ahsan Ali Siddiqui MD, MSPH (UK)* Author Affiliations Quality Management & Patient Safety Department, General Directorate of Health, Riyadh Saudi Arabia Received: February 25, 2019 | Published: March 06, 2019 Corresponding author: Dr Ahsan Ali Siddiqui, Consultant Epidemiologist, Quality Management and Patient Safety Department MOH Riyadh Saudi Arabia DOI: 10.26717/BJSTR.2019.15.002717 Also View In:

Oral hygiene habits in Portugal: results from the first Health Examination Survey (INSEF 2015)

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.