Health In Portugal Research Articles

Advanced practice nursing in Portugal – Where do we stand?

Background: Portugal's health workforce has been described as an inefficient mix of resources, impacting productivity and access to health services. To address these issues, stakeholders have advocated for Advanced Practice Nursing (APN) to strengthen the nursing role and improve service delivery. Aim: To analyze the relevance, pertinence, feasibility, and main barriers and facilitators of APN implementation in Portugal. Methods: A scoping review was conducted in the CINAHL, MEDLINE Complete, PubMed, and ScienceDirect databases for peer-reviewed articles in English and Portuguese, published after 2000, on human resource configurations in health and nursing role expansion in Portugal. A review of grey literature further complemented the research. Results: A total of 59 studies (43 international, 16 national), 31 technical reports (17 international, 14 national), seven press articles, and two theses were screened. Findings were grouped into themes of APN conceptualization, regulation, barriers and facilitators, and funding. APN implementation depends on a consensus regarding APN conceptualization, regulation, and scope of practice. Key barriers include medical opposition, limited political commitment, and lack of comprehensive data on APNs' social and financial impact in Portugal. Conclusions: The implementation of Advanced Practice Nursing in Portugal is relevant and necessary, though its feasibility depends on strong leadership, political commitment, and consensus among stakeholders. Further research is essential to assess APNs' social and economic impacts within the Portuguese healthcare system.

Advancing urban health in Portugal: exploring liveability and its association with mental morbidity

Abstract Background As cities face challenges posed by urbanisation, it becomes essential to understand how city planning can contribute to protecting public health. In this study, we aimed to assess the liveability of different areas in Lisbon, Portugal, by developing a liveability index at the parish level. Secondly, we aimed to explore its association with hospitalisation due to mental disorders. Methods The liveability index was built based on the World Health Organisation’s Urban Health Index methodology. We obtained data on liveability related to housing, socio-economic conditions and access to services (e.g. healthcare) from the 2011 census and other open data sources for Lisbon’s parishes (n = 22). Data on hospital admissions due to mental disorders was sourced at the parish level from the national database for hospital morbidity for the period 2013-2016 and sex-age-standardised. Binomial negative regression was employed to estimate the association between the liveability index tertiles and observed hospital admissions. We used the expected number of hospitalisations as the offset variable and tested for spatial autocorrelation among the regression residuals. Results Our analysis showed that living in the most liveable parishes is associated with a significant decrease in the standardised admission ratio due to mental disorders, compared to living in the least liveable areas (Incidence Relative Ratio=0.643; 95% CI: 0.427, 0.967). We did not observe any geographical pattern in the regression residuals (Moran’s I= -0.035, p = 0.427). Conclusions Our findings show disparities in liveability among Lisbon’s parishes and identify a protective association between living in higher liveability areas and hospital admissions due to mental disorders. This work should prompt further studies concerning this subject to inform urban planning policies to improve liveability and equally reduce the risk of mental health-related harm within cities. Key messages • A spatial index to assess liveability in urban areas was developed. The association between the liveability of Lisbon’s parishes and hospital admissions due to mental disorders was explored. • We found a significant protective association between higher liveability and hospital admissions due to mental disorders. This work is relevant to inform the implementation of urban planning policies.

Insights from the EQUALS4COVID19 study on migrant mental health in Portugal: a cross-sectional mixed-methods approach

BackgroundThe COVID-19 pandemic and related disruptive consequences in the economic, health, and educational sectors have impacted people’s lives, contributing to a context of increased economic and social vulnerability. The pandemic has revealed and accentuated social inequalities and discrimination based on racial or ethnic origin. This study aimed to contribute to the promotion of the mental health and well-being of migrant populations living in Portugal via the definition of an analytical framework and recommendations emerging from the EQUALS4COVID19 project.MethodsTo gather information on the impact of the COVID-19 pandemic and resilience determinants among immigrants, a mixed-methods approach was implemented in 2022, combining a cross-sectional survey targeting immigrant adults in Portugal, focus groups with immigrants, focus groups with healthcare professionals, and in-depth individual interviews with stakeholders involved in the implementation of measures related to mental health and well-being during the pandemic. The analysis followed an integrated framework; quantitative data informed the script of qualitative data collection methods, and qualitative analysis informed the reinterpretation of quantitative data.ResultsThe survey with 604 Brazilian and Cape Verdean immigrants revealed that gender (being a woman) was associated with both psychological distress and depression-related symptomatology and that the perception of discrimination was a major risk factor for psychological suffering, while perceived social support and individuals’ resilience characteristics were protective factors. Qualitative data provided deeper insights into these findings, revealing the ways mental health is affected by social structures, such as gender and ethnic hierarchies. Migrants tend to work in precarious jobs requiring physical presence, which, together with dense housing conditions, puts them at higher risk of infection. The deterioration of the economic conditions of the general population has also increased the perception of ethnic-racial discrimination, which was found to be related to the increase in insecurity and anxiety-related symptomatology among the migrant population. Newly arrived migrants, with reduced support networks, experienced a greater sense of insecurity as well as concern and anguish regarding relatives who live far away, in their home country. Migrant women reported greater family-related distress, including work-life balance problems.ConclusionsProposals to address mental health inequalities should be considered in the context of the necessary global changes both at the societal level and in the delivery of mental health services. Additionally, they should be considered with the active involvement of migrants, families, and communities in the design and delivery of mental health promotion and care processes.

Assessing Portuguese health risks: Anisakiks parasite in Atlantic chub mackerel (Scomber colias) sold in Portuguese markets.

Anisakiosis is a significant zoonotic disease caused by parasitic nematodes of the Anisakis genus. It can be contracted by humans through the consumption of raw or undercooked fish contaminated with the parasite, leading to gastrointestinal and allergic symptoms. While anisakiosis is not frequently documented in Portugal, the presence of allergic reactions to Anisakis in Spain suggests ongoing exposure in the Iberian Peninsula. To address this concern, the Interdisciplinary Centre of Marine and Environmental Research in Porto, Portugal, in collaboration with the Biology Centre of Czech Academy of Sciences in Ceske Budejovice, Czech Republic, has proposed a project entitled 'Assessing Portuguese Health Risks: Anisakis Parasite in Atlantic Chub Mackerel (Scomber colias) Sold in Portuguese Markets' under the European Food Risk Assessment Fellowship Programme. The primary objective of the project is to gather valuable epidemiological data on the host, Atlantic chub mackerel (S. colias) and the parasitic nematode (Anisakis spp.) with the focus on assessing contamination levels and evaluating potential health risks associated with anisakiosis in the Portuguese population. By conducting this research, the project aims to contribute to the understanding of anisakiosis and its impact on public health in Portugal. Investigation of the presence of the Anisakis parasite in Atlantic chub mackerel sold in Portuguese markets will provide crucial insights into the risks associated with consuming raw or undercooked fish. Ultimately, our findings will aid in the development of preventive measures and guidelines to ensure the well-being of the Portuguese population.

Beyond medication: Exploring social prescribing for mental ill health in Portugal

Abstract Mental ill health represents a priority challenge in public health due to its considerable burden on people's health and well-being, as well as economic consequences. Individuals with mental health problems have been presented with limited alternatives for improving their mental well-being, with medication being the most widely adopted solution. It is imperative that the focus shifts to prevention and the promotion of positive mental health. This can be achieved through non-medical alternatives, such as social prescribing (SP), a person-centered and intersectoral intervention. Some studies reveal that mental ill health is one of the most common reasons for referral to a SP service, with encouraging results about SP's benefits in mental health. SP has been implemented in Portugal since 2018, a country that had one of the highest prevalence of mental health disorders in the European Union. The aim of this study was to establish the prevalence of mental health-related referrals in Portugal and to describe the type of community services patients were referred to. Sociodemographic, health, and referral-related data was collected for 714 patients at primary healthcare units in Lisbon between 2018-2021. Results show that 53.6% of participants were aged between 26-65 and 66.9% were female. Approximately 20% were referred for mental health reasons and 65.5% had been diagnosed with a mental health disorder. Patients were referred to a range of third-sector organizations (associations, ONGs, municipalities) and activities (swimming, music classes, volunteering, pregnancy club), but no specific mental health services were identified among them. This could suggest that there is a lack of available mental health responses in the community or that they are not yet accessible to SP team. Further efforts are needed to map out these resources and reinforce the intersectoral work to create and promote mental well-being responses, to ensure access to mental health support for all. Key messages • There is a need to shift the focus towards prevention and promoting positive mental health through non-medical alternatives, such as social prescribing. • In SP in Portugal, there is a lack of available mental health resources in the community, suggesting the need for further efforts to create and promote mental well-being responses for all individuals.

Workers needed: a needed assessment of the workforce in local public health services in Portugal

Abstract Background Portugal is planning to reform its public health services, which have been struggling with a shortage of professionals, even after hiring more staff during the COVID-19 pandemic. Meanwhile, in 2023, new local health units will be created to reorganize the local public health services (LPHS). Therefore, it is essential to examine and discuss how many and where the professionals in LPHS are in Portugal. Methods A cross-sectional descriptive analysis was conducted using hiring data, in the second trimester of 2023. The number of professionals in LPHS in mainland Portugal was described and compared between the 55 LPHS and the 5 health regions. They were classified into categories, with a special attention given to medical specialists, nurses, and environmental health technicians, who have specific regulations. Results More than 20 different professions can be found in the different LPHS. The total number of professionals in public health services in mainland Portugal was 1720, of which 380 (22.1%) were medical specialists, 304 (17.7%) were nurses, 443 (25.8%) were environmental health technicians. The highest number of professionals was found in ACES Baixo Vouga with 70. The health region with the highest number of professionals was ARS Norte with 635. When considering full-time equivalents, only 18 (32,7%) LPHS have the legally recommended ratio of one medical specialist per 25 000 inhabitants, the ratio of one nurse per 30 000 inhabitants is attained in 18 (32,7%) LPHS, and only 12 (21,8%) have the indicated one environmental health technician per 15 000 inhabitants. Conclusions This study provides a comprehensive overview of the number and distribution of professionals in LPHS in mainland Portugal, at a time of change, with concerning results. These can be useful to plan and evaluate policies and interventions regarding public health personnel recruitment and organization, considering impending the reforms. Key messages • There is a lack of professionals in local public health services in Portugal, with few meeting the legally recommended ratios of medical specialists, nurses, and environmental health technicians. • The incoming changes in public health services organizations are a good opportunity to reorganize and invest in their workforce, which is essential to improve public health in Portugal.

Does the media (also) keep the score? Media-based exposure to the Russian-Ukrainian war and mental health in Portugal.

The Russian-Ukrainian war (RUW) is responsible for extensive individual suffering and a socio-economic impact on the world and is reshaping global affairs. Many studies have focused on direct exposure to conflict and several public health policies have been devised. Nonetheless, indirect exposure through media has received minimal attention and there is limited evidence that mental health symptoms and disorders may arise as a result. We explored the role of voluntary or involuntary media-based exposure to the RUW on individuals' mental health including stress symptoms, coping strategies, daily functioning, and worries across demographic variables. In our sample, subjects with involuntary and higher amount of exposure seem to have higher stress symptoms. Also, those who had previous ruminations on war issues could be at risk of developing more post-traumatic stress symptoms. Therefore, media appears to be a conduit that spreads negative consequences of community trauma beyond directly affected communities.

The first Portuguese Open Dialogue pilot project intervention.

In 2020, the Directorate General of Health (DGS), a central service of the Ministry of Health in Portugal, approved and co-financed the first Open Dialogue program in the country. The present report aims to demonstrate the preliminary results of the first year of the project, implemented in the northern interior region of Alentejo. Seven people at the Center of Concern (PCC) and 21 family members/social networks received care through Open Dialogue; four external social workers and psychologists were also involved in the project as members of the support network. A total of 160 network meetings were undertaken, reaching as many as 27 per month in the busiest periods. Based on a previous Italian Research Protocol, developed by Pocobello et al. (non-published manuscript), quantitative and qualitative data were collected in and after the clinical meetings involving PCC and their family/social network, through a multi-method approach: clinical history interview (e.g., generic research on sociodemographic data, duration of untreated symptoms, reasons for requesting help, possible hospitalizations, and/or treatments/therapies) and the following scales applied every five sessions (e.g., CORE-OM, BSI, GAF, and LSNS-6). The preliminary results indicate an improvement in global functioning and the enlargement of social network size/support, a decrease in symptoms, and a negative correlation between the number of sessions and the LSNS6. Medication use remained largely unchanged at the end of the project. In general, even with a small sample, the results are considered satisfactory and seem to be aligned with the vast majority of Open Dialogue studies, which for several decades have consistently pointed toward better recovery rates than treatment as usual as well as increased client satisfaction. We expect that the results presented can boost further research and help strengthen the OD approach.

COVID-19 or threat of a nuclear war in Europe? A cross-sectional study of anxiety levels in adults living in Portugal.

Since 2019, Europe has experienced ongoing stressors with the emergence of the COVID-19 pandemic and the Russian-Ukrainian War, which have had social, financial, physical, and psychological impacts. Studies suggest that anxiety, fear, post-traumatic stress disorder, depression, and other psychological disorders are common in such situations, and there is a need for more research on the impact of the war on mental health in Portugal. The main goal of the present study was to assess the impact of the fear of COVID-19 and anxiety related to nuclear war on the general anxiety levels of adult individuals living in Portugal. A cross-sectional study was conducted from May to July 2022 using an online questionnaire built on the Google Forms platform. Portuguese-speaking male and female individuals aged 18 years or older, who provided informed consent and agreed to participate, were included. The outcome variable was defined using the Portuguese version of the GAD-7 scale, while the main predictors were the FCV-19S and the NWA Scale in Portuguese. Linear and logistic regression models were used to test associations between predictors and outcome variable. The study included 1,182 participants, with a mean age of 46.5 (±11.7) years, mostly women (80.6%). The global mean GAD-7 score was 5.8 (±4.5) points, and 17.9% of the participants scored above the 10-point cutoff. Higher scores were found in both the FCV-19S and the NWA scale among participants with anxiety, as measured by both a 10-point cutoff (p < 0.001), and GAD-7 scale mean scores (p < 0.001). The study showed that fear of COVID-19 [OR of 1.133 (95%CI: 1.097-1.170)] and, at a lesser extent, nuclear war anxiety [OR of 1.020 (95%CI, 1.009-1.031)] contribute to anxiety in the general population. This is also true for those with a personal history of anxiety, revealed by multiple regression. This study contributes to the research on COVID-19's impact on anxiety and provides the first comprehensive assessment of nuclear war anxiety in Portugal. Results highlight the need for long-term care for anxiety, as prevalence is expected to increase due to the pandemic and war, even in non-conflict areas like Portugal.

Experience and Expectation - Digital health implementation in Portugal as present-making via futures imaginations

Traditionally, anthropological analysis has placed emphasis on traditions, customs, and cultural heritage, often overlooking the connection between present actions and future aspirations. Acknowledging the reciprocal influence of present actions in shaping the future and the impact of future visions on shaping present actions, this article aims to redress the neglect of future implications on present social practices within anthropological studies. Through an investigation of the implementation of digital health in Portugal, utilizing discourse analysis, qualitative examination, and critical reflection, this study delves into the impact of digitization on sociotechnical systems within healthcare. It also introduces concepts pertinent to the anthropology of the future and methodological propositions for studying the future within the present context. This inquiry explores the sociotechnical imaginaries stemming from the conceptualization of digital health ideals and their realization in present contexts. Aligned with Koselleck's philosophy of historical time, this examination reveals an essential interplay between present actions and future consequences, advocating for an anticipatory approach in anthropology. This method seamlessly integrates future considerations into present realities, augmenting our understanding of social dynamics and fostering a forward-thinking perspective. This perspective is particularly valuable for scrutinizing the intricate political economies of techno-scientific promises fostered within innovation-oriented endeavours. The analysis, conducted across three dimensions—the utilization, reconfiguration, and evolution of the healthcare system through digitalization—highlights the intricate relationship between current healthcare practices, future aspirations, and the transformative impact of digitalization.

Association of lifestyle and sociodemographic factors on multimorbidity: a cross-sectional study in Portugal

BackgroundLifestyle factors are widely recognized as modifiers and major risk factors for non-communicable diseases. Previous studies on the prevalence of multimorbidity in Portugal predict an unfavourable reality. The aim of the present study was to analyse 1) the prevalence of multimorbidity in Portugal and 2) the association of individuals’ lifestyles and sociodemographic factors with multimorbidity.MethodsA cross-sectional, population-wide study was conducted on a representative sample of the general population of Portuguese adults aged ≥ 20 years. Categorical variables were described by their respective absolute and relative frequencies (n (%)). All variables with a p-value < 20% were included in the multiple logistic regression model. The variables were removed one by one in descending order of p-value (p) until the model contained only significant variables. The results are presented using the odds ratio and 95% confidence intervals. P-values ​​ < 5% were considered significant.ResultsThe prevalence of multimorbidity was 48.9% (n = 436), and the odds of multimorbidity increased 4% (p < 0.001) for each year of increase in age. Participants with reasonable general health status had higher odds of multimorbidity (Odds ratio (OR) = 3.04; p < 0.001), and those with poor or very poor general health status had even higher odds (OR = 9.14; p < 0.001). Compared to those who never smoked, participants who quit smoking ≥ 1 year presented an increase of 91% (p = 0.005) in the odds of multimorbidity. Individuals with no good-quality sleep, non-moderate screen time, or non-moderate stress level had higher odds of multimorbidity (OR = 1.98; OR = 1.88; OR = 2.22, respectively. p < 0.001).ConclusionsThis study presented a new approach to multimorbidity in Portugal. Population-based, multidimensional lifestyle interventions are needed. It seems necessary to optimize and adjust measures to prevent non-communicable diseases to improve health in Portugal. In the future, longitudinal studies will be an asset to reinforce and clarify these conclusions.

Gauging Public Health Literacy needs through Google Trends: the COVID-19 vaccination example

Abstract Background The rollout of the COVID-19 vaccination program in Portugal was one of the most successful in the world. However, there was still a challenge for Public Health services to determine the health literacy needs of the population in the context of a new vaccine and the uncertainty of the pandemic. The goal of this study was to evaluate the usefulness of Google Trends data to gauge the health literacy needs of the general population during the pandemic. Methods A Google Trends search was performed for Portugal including 5 topics related to health literacy needs of the population (“vaccination”, “scheduling”, “isolation”, “booster dose” and “vaccination certificate” ) between the 28th of december 2019 and the 10th of march 2022. The variation shows the relative popularity of each term referring to the total number of Google searches during that period in a normalized scale of 0-100. The variation was compared to the number of doses administered daily in Portugal and key moments of the vaccination campaign as defined by the Directorate-General for Health in Portugal. Results The terms “vaccination” and “isolation” had a steady rise in popularity from December 2019 to January 2021. The term “vaccination” was the most popular search term with peak popularity in July 2021 and a downward trend followed by an ascent to a lower peak in popularity in January 2022. The terms “scheduling” and “vaccination certificate” both followed a similar pattern, though at lower popularity levels. The term “isolation” was low on popularity since February 2021, with a significant rise and peak in January 2022. This variation relates to key dates during the Portuguese vaccination campaign. Conclusions Google Trends data seems to correlate with key events during the Portuguese COVID-19 vaccination campaign. That data might be incorporated in the planning framework of health literacy activities for national and local Public Health services. Key messages • Google Trends might be an important source of information for public health teams. • There is a need for further research into how Google Trends data can be incorporated with other sources of information to inform health literacy activities.

Promoting health literacy during Covid-19 pandemic–valuable partnership with Portuguese pharmacists

Abstract Issue/Problem COVID-19 pandemic has amplified the amount of health information available; however, hard-to-reach populations remain and much of the information available is not accurate. Therefore, the use of new proximity approaches in the promotion of health literacy is essential because people face challenges and barriers when trying to find information relevant to them. Description of the problem From the beginning of the COVID-19 pandemic in 2020, the Division of Literacy, Health and Wellbeing of the Directorate-General of Health in Portugal developed Social Mobilization and Community Engagement training sessions-which included a presentation and a toolkit of flyers/posters/videos. These sessions had the goal of disseminating public health measures through good practices in health literacy and communication methods/skills to promote efficient communication among people who play an active role (as microinfluencers) in prevention and mitigation of risks associated with COVID-19, as is the case of pharmacists. Results A total of 200 Portuguese pharmacists enrolled on the Social mobilization training session in November 2021. More than 150 initiatives were implemented thereafter by those microinfluencers (pharmacists) in the local communities-31% directed to children or young people, 31% to older adults, and 13.8% to migrants or tourists. 70% of the participants considered the materials of the toolkit as adequate and sufficient, and 62.1% answered that people in the community showed interest for those materials available in the pharmacies. Lessons This Social mobilization project was important because it assembled and preserved trust- basing the information of the training on reliable sources about COVID-19 virus. It also trained the microinfluencers (pharmacists) in communication strategies. All these approaches were important to prevent and mitigate the impact of COVID-19 via adoption of non-pharmacological measures and promotion of vaccination. Key messages • Portugal was pioneer in promoting Social mobilization and community engagement training sessions, maintaining a proximity communication, tailoring the information, and maximizing its impact. • Within the group of health professionals, pharmacists are a privileged group to promote these communication strategies and social mobilization due to their proximity with the local community.

The impact of Covid-19 on the Mental Health of the Portuguese Population

IntroductionCovid-19 does not only have repercussions on the physical level, representing a new way of life, both individually and in society. The pandemic results in invisible consequences for the population’s mental health.ObjectivesThis study aimed to explore the consequences of Covid-19 on mental health in Portugal with a view to understanding and promoting the well-being and happiness of the Portuguese.MethodsThe study included 111 young people and adults, aged between 18 and 58 years (M= 21.81, SD= 5.34), with 43.7% males and 52.7% females. A sociodemographic questionnaire was applied to all participants, as well as the Échelle de Mesure des Manifestations du Bien-Être Psychologique (ÈMMBEP; Massé et al., 1998 - Portuguese translation by Monteiro, Tavares &amp; Pereira, 2012) which translates into a response scale 5-point Likert type, with five subscales, including happiness. In addition, a semistructured interview with data collection instruments was administered.ResultsThe results obtained demonstrate the negative impact of Covid-19 on the level of well-being, regardless of the participant’s gender or age.ConclusionsThe data presented point to the need to sensitize individuals to the risk of the pandemic in terms of mental health, thus increasing society’s awareness of the psychological effects of this new global disease. Therefore, coping mechanisms are essential to promote well-being and successfully overcome the pandemic.DisclosureNo significant relationships.

Applying optimization models in the scheduling of medical exams

The management of waiting lists in hospitals is a topic with relevance given its direct implication in the quality of healthcare services provided to the patients in the good management of human, material and financial resources. Ministry of Health in Portugal stipulates a guaranteed maximum response time for the execution of Complementary Means of Diagnosis and Therapeutics (CMDT), surgeries and outpatient appointments. This paper addresses an investigation conducted at the Centro Hospitalar e Universitário do Porto (CHUP) with the goal of optimizing decisions in the management of waiting lists for CMDT. This objective will be achieved through the development of hill climbing and simulated annealing models. With this study, it was possible to optimize the way these exams can be scheduled, reducing waiting lists, associated costs and waste, improving the quality of service provided to patients.

A Tale of Two Pandemics in Three Countries

Abstract Issue Italy, Spain, and Portugal's health systems are financed through general taxation, are generally free at the point of care, and provide universal health coverage. The three national health systems emerged in the late 1970s, in Italy as the result of the collapse of the previous social health insurance system and in Spain and Portugal as part of their democratization. They share some standard organizational and performance features that constitute potential strengths and vulnerabilities when facing a pandemic event. Description One of the most salient of these features is the impact of a decade of fiscal austerity. During the Great Recession and the Eurozone crisis, the governments of Italy, Spain, and Portugal decreased the budget available for health care, leading to cuts in long-term infrastructure investments and making it even more difficult to deal with the problem of workforce. Results Compared with northern European countries, these countries have very efficient healthcare systems. In other words, the return in terms of population health is very good for every Euro invested. Lessons However, in what is only apparently a paradox, efficiency is not an advantage during a pandemic. If all the resources are fully optimized, any significant surges in demand, such as those experienced during early March 2020 in Italy and Spain, this favors a collapse of the health system. Portugal seemed especially vulnerable, as it had the lowest number of intensive care unit beds per inhabitant in Europe and one of the lowest levels of investment in public health services in Europe. Main messages In 2015, on average, the countries of the Organization for Economic Co-operation and Development (OECD) allocated 2.8 percent of their total healthcare budget to health promotion and disease prevention. More investment in health promotion is a need strategy to drive countries over critical conditions.

Does waiting times decrease or increase operational costs in short and long-term? Evidence from Portuguese public hospitals.

The Portuguese National Health System is composed of all public entities offering health services. There has been a successive increase in expenditure in recent years due to various factors that have contributed to a high degree of uncertainty about the evolution of operating costs in Public Business Hospitals. This research's main objective is to study the relationship between operational costs and waiting times as well as costs with healthcare professionals and waiting times in both external consultations and hospital surgeries. Furthermore, we will empirically assess the presence of U-shaped behaviour in both of these two relationships. We have included a sample of 38 hospitals considered in the Portuguese National Health System. We also included, in our analysis, five groups of public business hospitals, according to the Administrative Central Agency of Portugal's Health Service, considering the period between January 2015 and December 2019. To validate the two relationships proposed, the Autoregressive Distributed Lag panel model was used. This study highlights that longer waiting times for external consultation and surgery significantly affect hospital costs and suggest that longer waiting times do not merely increase absence rates. The study also proves that there are long-term effects that last beyond the short-term waiting period.

The Impact of the COVID-19 Pandemic on Children's Health in Portugal: The Parental Perspective.

The COVID-19 pandemic poses unprecedented challenges for healthcare services and has led to changes in the usagepattern of the pediatric population. We aimed to describe the impact of COVID-19 on children's health, wellbeing, and access to medical care in Portugal. We conducted a cross-sectional study through an anonymous online survey via social media. The collected data refers to a period between the 16th of March and the 17th of May 2020. We obtained responses to the survey on 19 745 children. Of the previously scheduled outpatient consultations, 54.2% werepostponed by healthcare institutions and 21.6% of planned vaccinations were missed. Parents expressed concerns regarding psychological, social, and physical consequences for their children due to the pandemic. The observed reduction of pediatric emergency department visits and the postponement of outpatient consultations andvaccine administrations are potentially harmful for non-COVID patients. The current pandemic and the imposed social distance mighthave an important negative impact on the mental health of children. Further studies are necessary to fully comprehend the outcomes of the decreased access to medical care, as well as thecollateral damage for children beyond the clinical aspects of the pandemic. Defining strategies regarding the urge to vaccinate children and not postpone urgent evaluations should be a public health priority.

Professional competences of the physiotherapists in the field of mental health in Portugal: a questionnaire based survey

Introduction In 2001 the World Health Organisation made the following statement: "the Mental Health – neglected for far too long – is crucial to the overall well-being of individuals, societies and countries" [1]. In Portugal, the focus on this issue arose in 2017 when a national program for Mental Health was created stating that "people are living more years, but with disabilities on the area of Mental Health, which implies an overload for society" [2]. Currently, the importance of the role that Physiotherapy has in this field is demonstrated by the World Physiotherapy Day 2018 campaign held by World Confederation of Physical Therapy, which was centred on the theme "Physiotherapy and Mental Health" [3]. The role of the Physiotherapist in Mental Health aims to promote the welfare and autonomy of people with physical dysfunctions associated with mental diseases and use physical stimuli to influence Mental Health [4]. The purpose of this study is to characterise the professional profile of the Physiotherapists working in Portugal in the field of Mental Health. Materials and methods This is questionnaire online-based survey. An online questionnaire was sent to institutions, hospitals, centres where official records showed physiotherapists working in the field of Mental Health. The questionnaire was divided in 2 parts: socio-demographic information and questions related to Mental Health practice and training. The questionnaire was answered by 18 physiotherapists, which had an average age of 38 years (±10.4) and 94% were female (n = 17). All the participants gave their informed consent. Results All the respondents have at least 3 years of continuous work in Mental Health field and 50% (n = 9) of them have experience for more than 5 years. Physiotherapists intervene daily with a minimum of 3 patients and 56% (n = 10) of them work within a multi-professional team. Concerning education, 78% (n = 14) of the physiotherapists stated that the theme of Mental Health was insufficiently addresses during the bachelor degree. More than 70% (n = 12) of the physiotherapists declared that have none or a little support to their clinical practice concerning training, guidelines. Discussion and conclusions Training in mental health during bachelor is insufficient and coincident with the information provided by the coordinators of the 19 physiotherapy degrees in Portugal. The recommendations collected in the questionnaire, highlight the main aspects that should be addressed within the mental health theme in the basic training of physiotherapists. Moreover, the physiotherapists working in the field report urgent needs of formation.

The Gut Microbiota of the Egyptian Mongoose as an Early Warning Indicator of Ecosystem Health in Portugal.

The Egyptian mongoose is a carnivore mammal species that in the last decades experienced a tremendous expansion in Iberia, particularly in Portugal, mainly due to its remarkable ecological plasticity in response to land-use changes. However, this species may have a disruptive role on native communities in areas where it has recently arrived due to predation and the potential introduction of novel pathogens. We report reference information on the cultivable gut microbial landscape of widely distributed Egyptian mongoose populations (Herpestes ichneumon, n = 53) and related antimicrobial tolerance across environmental gradients. The panel of isolated species is consistent with the typical protein-based diet of a carnivore: Firmicutes predominate (89% of individuals), while Clostridiales, Enterobacteriales, and Lactobacillales are the major classes. Forty-one individuals (77.4%) harbour Clostridium spp. A spatial influence on mongooses’ microbiota is confirmed by nonmetric multidimensional scaling analysis, with a significant contribution of municipality to their microbiota composition. Antimicrobial susceptibility testing of mongoose commensal bacteria to 28 compounds evidences xenobiotic tolerance of Escherichia coli (E. coli), enterococci, Salmonella Spartel and Mbandaka serotypes and Pseudomonas bacteria, among others. The common isolation of antimicrobial tolerant microbiota from the mongoose’s gut suggests this species is exposed to anthropogenic influence and is affected by forestry and agricultural-related practices, reflecting its easy adaptation to ecological gradients across agroecosystems. We thus propose regular microbial and phenotypic resistance profiling of widely distributed mongooses as a sentinel tool for xenobiotics’ lifecycle and ecosystem health in Portugal.