[Hospitals in Portugal from the nineteenth to the mid-twentieth centuries]. / Os hospitais em Portugal no século XIX e na primeira metade do século XX.

Since the modern era, healthcare in Portugal has been provided primarily by hospitals, many of which were founded by the Sisters of Mercy and known as Misericordias. However, the creation of new hospitals in the nineteenth century and first half of the twentieth century did not necessarily yield improved patient care, since these institutions tended to be small, poorly equipped, and lacking in human and material resources. This study presents a reflection on developments in Portuguese hospitals from 1834 through to the first decades of the twentieth century, drawing on data on several institutions to identify changes and continuities in the healthcare offered.

Desde a época moderna, em Portugal, a assistência à doença foi prestada, sobretudo, pelos hospitais, muitos deles criados pelas Misericórdias. No entanto, a criação de novos hospitais no século XIX e nas primeiras décadas do século XX não trouxe, necessariamente, uma melhoria no tratamento dos doentes, visto que, salvo raras exceções, eram espaços pequenos, mal equipados e carentes de recursos humanos e materiais. O objetivo deste texto é apresentar uma reflexão sobre a resposta hospitalar em Portugal entre 1834 e as primeiras décadas do século XX. Pretendemos apontar as mudanças e continuidades que, nesse período, ocorreram no campo da assistência à doença, fazendo referência à criação de diversas instituições.

Advancing insights in critical COVID-19: unraveling lymphopenia through propensity score matching - Findings from the Multicenter LYMPH-COVID Study.

OBJECTIVE: To elucidate the impact of lymphopenia on critical COVID-19 patient outcomes. METHODS: We conducted a multicenter prospective cohort study across five hospitals in Portugal and Brazil from 2020 to 2021. The study included adult patients admitted to the intensive care unit with SARS-CoV-2 pneumonia. Patients were categorized into two groups based on their lymphocyte counts within 48 hours of intensive care unit admission: the Lymphopenia Group (lymphocyte serum count < 1 × 109/L) and the Nonlymphopenia Group. Multivariate logistic regression, propensity score matching, Kaplan‒Meier survival curve analysis and Cox proportional hazards regression analysis were used. RESULTS: A total of 912 patients were enrolled, with 191 (20.9%) in the Nonlymphopenia Group and 721 (79.1%) in the Lymphopenia Group. Lymphopenia patients displayed significantly elevated disease severity indices, including Sequential Organ Failure Assessment and Simplified Acute Physiology Score 3 scores, at intensive care unit admission (p = 0.001 and p < 0.001, respectively). Additionally, they presented heightened requirements for vasopressor support (p = 0.045) and prolonged intensive care unit and in-hospital stays (both p < 0.001). Multivariate logistic regression analysis after propensity score matching revealed a significant contribution of lymphopenia to mortality, with an odds ratio of 1,621 (95%CI: 1,275 - 2,048; p < 0.001). Interaction models revealed an increase of 8% in mortality for each decade of longevity in patients with concomitant lymphopenia. In the subanalysis utilizing three-group stratification, the Severe Lymphopenia Group had the highest mortality rate, not only in direct comparisons but also in Kaplan‒Meier survival analysis (log-rank test p = 0.0048). CONCLUSION: Lymphopenia in COVID-19 patients is associated with increased disease severity and an increased risk of mortality, underscoring the need for prompt support for critically ill high-risk patients. These findings offer important insights into improving patient care strategies for COVID-19 patients.

[Food and nutrition surveillance actions in Brazil and Portugal: a comparative documentary analysis]. / Ações de vigilância alimentar e nutricional no Brasil e em Portugal: uma análise documental comparativa.

Food and nutrition surveillance is fundamental to the formulation, implementation, monitoring, and evaluation of public policies on food and nutrition. The comparative analysis of the evolution of food and nutrition surveillance actions between countries makes it possible to learn about advances, challenges and innovations for the planning of interventions. This study aimed to describe and compare food and nutrition surveillance actions in Brazil and Portugal, countries with different geographical dimensions and socio-economic profiles, but with the common characteristic of having a universal healthcare system. We manually searched for documents describing food and nutrition surveillance actions and for potential data sources on the institutional websites of the Brazilian and Portuguese governments. The recommendations of the READ approach were used (59 documents were identified for Brazil and 29 for Portugal). In Brazil, food and nutrition surveillance actions are included in health policies and in the constraints of conditional cash transfer programs. The Brazilian Households Budget Surveys and health surveys are used simultaneously with the Brazilian National Food and Nutrition Surveillance System (SISVAN). In Portugal, food and nutrition surveillance actions are part of health policies, via the National Program and the Integrated Strategy for the Promotion of Healthy Eating. Among the data sources identified are the Portuguese Food Balance Sheet and household budget, health and food surveys, as well as initiatives to monitor the nutritional status of children and adolescents. In both countries, strategies need to be improved in terms of the regularity of data recording, the harmonization of food consumption indicators and the dissemination of information.

A vigilância alimentar e nutricional é fundamental para a formulação, a implementação, o monitoramento e a avaliação de políticas públicas de alimentação e nutrição. A análise comparativa da evolução das ações de vigilância alimentar e nutricional entre países permite o conhecimento de avanços, desafios e inovações para o planejamento de intervenções. O objetivo foi descrever e comparar as ações de vigilância alimentar e nutricional no Brasil e em Portugal, países com dimensões geográficas e perfis socioeconômicos distintos, mas com sistema de saúde universal em comum. Nós buscamos por documentos que descrevessem as ações de vigilância alimentar e nutricional e por potenciais fontes de dados de maneira manual em websites institucionais dos governos brasileiro e português. O estudo utilizou as recomendações da abordagem READ (59 documentos foram identificados para o Brasil e 29 para Portugal). No Brasil, as ações de vigilância alimentar e nutricional estão inseridas em políticas de saúde e nas condicionalidades dos programas de transferência condicionada de renda. As Pesquisas de Orçamentos Familiares e os inquéritos de saúde são utilizados simultaneamente no Sistema de Vigilância Alimentar e Nutricional (SISVAN). Em Portugal, as ações de vigilância alimentar e nutricional estão inseridas nas políticas de saúde, por meio do Programa Nacional e da Estratégia Integrada para a Promoção da Alimentação Saudável. Entre as fontes de dados identificadas estão a Balança Alimentar Portuguesa, os inquéritos de orçamentos familiares, de saúde e alimentares, além de iniciativas para o monitoramento do estado nutricional de crianças e adolescentes. Em ambos os países, as estratégias precisam ser aprimoradas em relação à regularidade do registro de dados, à harmonização dos indicadores do consumo alimentar e à disseminação das informações.

La vigilancia alimentaria y nutricional es fundamental para la formulación, implementación, monitoreo y evaluación de las políticas públicas de alimentación y nutrición. El análisis comparativo de la evolución de las acciones de vigilancia alimentaria y nutricional entre países permite el conocimiento de los avances, desafíos e innovaciones para la planificación de intervenciones. El objetivo fue describir y comparar las acciones de vigilancia alimentaria y nutricional en Brasil y en Portugal, países con diferentes dimensiones geográficas y perfiles socioeconómicos, pero con un sistema de salud universal en común. Buscamos documentos que describieran las acciones de vigilancia alimentaria y nutricional y posibles fuentes de datos manualmente en sitios web institucionales de los gobiernos de Brasil y Portugal. El estudio utilizó las recomendaciones del enfoque READ (se identificaron 59 documentos para Brasil y 29 para Portugal). En Brasil, las acciones de vigilancia alimentaria y nutricional están incluidas en políticas de salud y en las condicionalidades de los programas de transferencia condicionada de ingresos. Las Encuestas de Presupuestos Familiares y los estudios de salud se utilizan simultáneamente con el Sistema de Vigilancia Alimentaria y Nutricional (SISVAN). En Portugal, las acciones de vigilancia alimentaria y nutricional están incluidas en las políticas de salud, por medio del Programa Nacional y de la Estrategia Integrada para la Promoción de una Alimentación Saludable. Entre las fuentes de datos identificadas, se encuentran la Balanza Alimentaria Portuguesa, las encuestas de presupuestos familiares, de salud y alimentarias. Además de iniciativas para el monitoreo del estado nutricional de niños y adolescentes. En ambos países, es necesario mejorar las estrategias con relación a la regularidad del registro de datos, a la armonización de los indicadores de consumo de alimentos y a la difusión de la información.

Analyzing innovative policies and practices for palliative care in Portugal: a qualitative study.

BACKGROUND: Countries with formal policies for palliative care, and advanced and integrated practices in this field, such as Portugal, face challenges in achieving excellence in care, particularly in home-based assistance. Issues include care coordination among providers, confusion regarding the roles of each health care professional in the network, and a lack of monitoring and evaluation of actions. Our objective was to analyze the implementation of palliative care in primary health care in Portugal. METHODS: We conducted a qualitative, descriptive, and exploratory study in Portugal involving health care professionals with experience in palliative care. The data were collected through semistructured interviews and focus groups between March and October 2023. Eighteen health care professionals participated. We used the Alceste software for lexicographic analysis. The research was authorized by an Ethics Committee. RESULTS: Four classes were identified; classes 1 and 2, comprising 77% of the corpus, addressed the study objectives. Participants highlighted inequitable access, strategic development plans with unattainable short-term goals; and low literacy. They emphasized the importance of legislation, professional training initiatives for generalist palliative care at home, and early referral. Home-based challenges included professionals' lack of exclusive dedication, absence of 24/7 coverage, and unavailability of capable family caregivers. The networks' response to hospital admissions and patient transitions from hospital to home, with access to the specialized team, was also inadequate. CONCLUSIONS: Health care professionals aim to increase patients' time spent at home, reduce emergency department visits, and minimize hospitalizations by leveraging the resources of the national palliative care network. In addition to investments to sustain network implementation and legally guaranteed palliative care rights, the country must focus on measurable indicators for evaluating and monitoring actions, providing better guidance in the short, medium, and long term.

MULT: An allometric body mass index (ABMI) reference to assess nutritional status of multiethnic children and adolescents.

OBJECTIVES: To develop an allometric body mass index (ABMI) reference that adjusts the weight in relation to height, taking into account the changes during development (MULT ABMI reference), and to compare it with international BMI references. METHODS: The MULT ABMI reference was constructed through the LMS method, calculated with 65 644 ABMI observations of 17 447 subjects aged 5-22 years, from the United Kingdom, Ethiopia, India, Peru, Vietnam, Portugal, and Brazil. The M, S, and L curves of the MULT ABMI reference were compared with the curves of the MULT, World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF), and Dutch Growth Study (DUTCH). RESULTS: The greater differences in the M curve between MULT ABMI and WHO, CDC, IOTF, DUTCH, and MULT BMI references were around puberty (138 to 150 months for boys; 114 to 132 for girls). MULT ABMI presented S values similar to IOTF and DUTCH BMI references for boys 60 to 114 months and then became higher, approaching the MULT BMI S values from 198 to 240 months. For girls the MULT ABMI S values were close to the IOTF, CDC, and DUTCH from 60 to 110 months, and then became higher, approaching the MULT BMI S values until 240 months. CONCLUSION: MULT ABMI presented an advantage in comparison to the existing BMI references because it takes into account the growth changes during puberty and is a new option to assess the nutritional status of multiethnic populations.

Construction and enhancement of a prototype for a medical-hospital equipment for hypodermoclysis: a qualitative study.

OBJECTIVES: to construct a Subcutaneous Hydration Device semi-functional prototype and gather initial information to improve this prototype design and realize its acceptance potential. METHODS: a qualitative, descriptive and exploratory study, which used focus group, following the Technology Acceptance Model. The group was held at the Escola Superior de Enfermagem de Coimbra, Portugal, in December 2022, composed of nine participants from six different disciplinary areas, and followed thematic analysis. RESULTS: four topics emerged associated with the device components: elastomeric infusion pump; needle/access device; clamp; administration set. From these topics, topics were triggered that highlighted: characteristics about the target population; ease of use and accessories; patient comfort and safety; and device application context. FINAL CONSIDERATIONS: the Subcutaneous Hydration Device semi-functional prototype is viable and interesting for the clinic. The results support its improvement and direct future investments for experimental studies.

Initial outcomes and safety of MR guided focused ultrasound (MRgFUS) thalamotomy for essential tremor of the first FUS Medical Unit in Portugal.

BACKGROUND: The magnetic resonance imaging-guided focused ultrasound (MRgFUS) has emerged as an innovative treatment for patients with medically refractory essential tremor (ET). OBJECTIVE: This retrospective observational study aims to present the results of the first five patients with medically refractory ET who underwent MRgFUS treatment at this pioneering medical unit in Portugal. METHODS: We conducted a retrospective chart review for the first five patients who underwent unilateral MRgFUS thalamotomy of the ventral intermediate (Vim) nucleus to treat medically refractory ET at our medical unit. RESULTS: The mean patient age was 65.4 (26-84) years, and 60% were male. All patients had a family history of ET. The mean duration of disease was 17.4 years (range 10-24 years), and their dominant hand was the right. According to personal preference, the thalamotomy was performed on the left side in four patients, and on the right side in one. The MRgFUS thalamotomy led to significant improvements in both the clinical rating scale for tremor (CRST) score, by 62%, and the CRST composite score for the treated hand, by 73%. All patients experienced improvements in functionality and quality of life, by 52%. No severe adverse events were observed, and those that did occur during and following the procedure were mild and transient. CONCLUSION: The initial results from Portugal's first MRgFUS medical unit indicate promising outcomes, with improvement in quality of life, as well as mild and temporary adverse events These findings contribute to the growing body of literature supporting the efficacy and safety of MRgFUS as a viable treatment option for patients with medication-resistant ET.

ANTECEDENTES: A talomotomia por ultrassons focados - guiada por imagem de ressonância magnética (MRgFUS) surgiu recentemente como um tratamento inovador para pacientes com tremor essencial (TE) refratário ao tratamento médico. OBJETIVO: Este estudo observacional retrospectivo tem como objetivo apresentar os resultados dos primeiros cinco pacientes com TE refratário à medicação submetidos ao tratamento com MRgFUS numa unidade médica pioneira em Portugal. MéTODOS: Realizamos uma revisão retrospectiva dos dados clínicos dos cinco primeiros pacientes submetidos a talamotomia MRgFUS unilateral do núcleo ventral intermédio (Vim) para tratamento do TE medicamente refratário em nossa unidade médica. RESULTADOS: A idade média dos pacientes era de 65,4 (26­84) anos, e 60% eram do sexo masculino. Todos os pacientes tinham história familiar de TE. A duração média da doença foi de 17,4 anos, e todos eram destros. De acordo com a preferência individual, em 4 pacientes, a talamotomia foi realizada no lado esquerdo, e em um, no lado direito. A talamotomia por MRgFUS levou a melhorias significativas tanto na pontuação da escala de classificação clínica para tremor (CRST), de 62%, e na pontuação composta da CRST para a mão tratada, de 73%. Todos os pacientes apresentaram melhorias na funcionalidade e na qualidade de vida, de 52%. Não foram observados efeitos adversos graves e os que ocorreram durante e após o procedimento foram ligeiros e transitórios. CONCLUSãO: Os resultados iniciais da primeira unidade médica MRgFUS de Portugal indicam melhorias na qualidade de vida dos pacientes, com efeitos adversos ligeiros e transitórios. Estes dados reforçam a evidência crescente sobre a eficácia e segurança da talamotomia por MRgFUS como opção viável para pacientes com TE resistente à medicação.

Exploring the factors driving higher interactions in false amber necklace posts on Facebook.

The consumption and sharing of information on social media contribute to the circulation of false health content. In this sense, popular belief-driven posts recommending the use of amber necklaces to prevent symptoms of teething can be easily found on social media, even when they offer health risks for children. Accordingly, this study aimed to characterize posts in Portuguese by identifying message-based factors associated with higher user interactions of Facebook. A total of 500 Facebook posts published in Portuguese between August 2016 and August 2021 were retrieved by CrowdTangle, and analyzed quantitatively according to time of publication, total user interaction, and post overperforming score, and then qualitatively by two independent investigators, according to motivation, authors' profiles, and sentiment. The data were evaluated by descriptive analysis, Mann-Whitney U test, chi-square test, and multiple logistic regression models regarding interaction metrics. The posts were published predominantly by commercial profiles, with social, psychological, and financial motivations, and expressed positive sentiment. Furthermore, time of publication (OR=2.65), regular user profiles (OR=3.30), and neutral/negative sentiment (OR=2.76) were associated positively with total interactions, whereas only time of publication was associated with post overperforming scores (OR=1.65). In conclusion, Facebook posts promoting efficacy of amber necklaces in managing teething symptoms are primarily created by commercial profiles with vested interests in marketing the product. The key factors that contribute to the success of posts containing false information about amber necklaces on Facebook can be identified by considering the author's profile, sentiment, and time of publication.

Emoções e estratégias adotadas por brasileiros e portugueses durante a pandemia da covid-19 / Emotions and strategies adopted by brazilians and portuguese during the covid-19 pandemic / Emociones y estrategias adoptadas por brasileños y portugueses durante lapandemia de covid-19

Introdução:No final de 2019 um novo coronavírus com alta taxa de transmissibilidade foi identificado na China. Em março de 2020a Organização Mundial da Saúde declarou apandemia de Covid-19. Apandemiateve impacto na vida dos indivíduos, das famílias e da sociedade em geral. As pessoas tiveram dese adaptar à nova realidadee manifestaram diferentes emoçõese sentimentosdevido à situação pandêmica. As emoções vividas eo isolamento social necessário motivarama adoção de estratégias por parte das pessoas para se sentirem mais adaptadas e equilibradas anível físico e mental no seu dia a dia.Objetivo:O presente artigo tem como objetivo descrever e analisar as emoções, sentimentose estratégias adotadas por brasileiros e portugueses durante a pandemia da Covid-19. Metodologia:Este estudo faz parte de uma pesquisa mais ampla, realizada através de um questionário sociodemográfico com perguntas abertas e fechadas, efetuadono Google Forms, aplicado onlineem maio de 2020. Noquestionário foram abordadas as emoções e estratégias desenvolvidas e adotadas pelos 438 entrevistados (257 brasileiros;181 portugueses) durante a pandemia.A análise dosdados foi realizada através deestatística descritiva e análise de conteúdo temática.Resultados:Verificou-se que nos dois países, as emoções mais manifestadas foram medo e tristeza e as principais estratégias adotadas foram a criação de horários com rotinas diárias eexercício físicomas também algumas estratégias diferentes entre brasileiros e portugueses.Conclusões:Em momentos de crise pessoas de diferentes culturas experienciam emoções semelhantes tais como medo e tristeza e ajustam as suas rotinas diárias criando diferentes estratégias para enfrentar a adversidade de acordo com o seu contexto sociocultural (AU).

Introduction:At the end of 2019, a new coronavirus with a high transmissibility rate was identified in China. In March 2020, the World Health Organization declared the Covid-19 pandemic. The pandemic situation has had an impact on people's lives, families, and society.People had to adapt to the new reality and expressed different emotions and feelings due to the pandemic situation. The emotions experienced and the necessary social isolation motivated people to adopt strategies to feel more adapted and balanced on a physical and mental level in their daily lives. Objective: This article aims to describe and analyze the emotions, feelings and strategies adopted by Brazilians and Portuguese during the Covid-19 pandemic. Methodology:This study is part of a broader research, carriedout using a sociodemographic questionnaire with open and closed questions, carried out on Google Forms, applied online in May 2020. The questionnaire addressed the emotions and strategies developed and adopted by the 438 interviewees (257 Brazilians and 181 Portuguese) during the pandemic. Data analysis was carried out using descriptive statistics and thematic content analysis. Results: It was found that in both countries, the most expressed emotions were fear and sadness and the main strategies adopted were the creation of schedules with daily routines and physical exercise but also some different strategies between Brazilians and Portuguese. Conclusions: In times of crisis, people from different cultures experience similar emotions such as fear and sadness and adjust their daily routines, creating different strategies to face adversity according to their sociocultural context (AU).

Introducción: A finales de 2019, se identificó en China un nuevo coronavirus con una alta tasa de transmisibilidad. En marzo de 2020, la Organización Mundial de la Salud declaró la pandemia de Covid-19. La situación de pandemia ha repercutido en la vida de las personas, las familias y la sociedad. Las personas han tenido que adaptarse a la nueva realidad. En este contexto pandémico, las personas han expresado diferentes emociones y sentimientos debido a la nueva realidad social que han experimentado, y han creado estrategias para sentirse más adaptadas y equilibradas a nivel físico y mental en su vida diaria.Objetivo: Identificar y describir las principales emociones y sentimientos experimentados por brasileños y portugueses, así como crear estrategias para adaptarse a la situación durante el periodo de bloqueo de la pandemia Covid-19.Metodología:Este estudio forma parte de una encuesta más amplia, llevada a cabo mediante un cuestionario sociodemográfico con preguntas abiertas y cerradas, realizado en Google Forms, aplicado onlineen mayo de 2020, que indagaba sobre las emociones y los sentimientos experimentados en relación con la situación de pandemia y las estrategias creadas. La muestra fue de 438 participantes, 181 portugueses y 257 brasileños. Los datos se analizaron mediante estadística descriptiva y análisis del discurso.Resultados: En ambos países, el miedo y la tristeza fueron las emociones más expresadas. La mayoría de las estrategias utilizadas fueron el establecimiento de un horario y el ejercicio físico, pero también hubo algunas estrategias diferentes entre brasileños y portugueses.Conclusiones: En momentos de crisis, personas de diferentes culturas experimentan emociones similares como el miedo y la tristeza y ajustan sus rutinas diarias creando diferentes estrategias para enfrentar la adversidad de acuerdo con su contexto sociocultural (AU).

Nurses' perspectives on nurses' work methods.

OBJECTIVES: To analyze nurses' perspectives on nurses' work methods in the hospital context. METHODS: A descriptive study with a qualitative approach was conducted in a hospital in northern Portugal, involving 17 nurses. Semi-structured interviews were used for data collection. Data collected between May and June 2023 underwent content analysis, supported by Atlas.ti software. RESULTS: Three thematic areas emerged: "Nurses' work methods in a hospital context," highlighting the conception and components of work methods and the methods in use; "Implementation of nurses' work methods," emphasizing influencing factors and challenges to implementation; and "Impact of nurses' work methods on patients, nurses, and institutions." FINAL CONSIDERATIONS: Nurses' work methods constitute the structure of nursing care. Some factors influence and some challenges arise in the implementation of these methods, producing impacts on patients, nurses, and institutions.

[National health systems, legislation, and social determinants: a comparative study of Brazil, Spain, Portugal, and Italy]. / Sistemas nacionais de saúde, legislação e seus determinantes sociais: um estudo comparativo entre Brasil, Espanha, Portugal e Itália.

This is a documentary, exploratory, descriptive study, which is part of a multicenter international study assessing the national health systems with a care model based on primary health care of Brazil, Spain, Italy, and Portugal, funded by the Brazilian National Research Council (CNPq, acronym in Portuguese). It aims to identify the basic health legislation, the right to health, and the doctrinal and organizational principles of each country with a focus on the impact of social determinants of health on the national health systems. The results showed these countries have similar legislation and doctrinal principles, with a constitutional right to health, based on primary health care, and with a care model of the family health type. The challenges identified were low birth rate and high life expectancy at birth in European countries and criteria for access to medication and care financing. Based on our findings, the countries with higher investment in a structural basis, ensuring more dignified, solid, and vigilant socioeconomic and sanitary conditions, provide an important differentiation in responsiveness and sustainability of the national health system and direct impact on the quality of life.

Trata-se de uma pesquisa documental, exploratória, descritiva, partindo de um estudo multicêntrico e internacional entre Brasil, Espanha, Itália e Portugal sobre sistemas nacionais de saúde com modelo de atenção baseado na atenção primária à saúde e financiado pelo Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) do Brasil. Tem como objetivo identificar as legislações de base da saúde, o direito à saúde e os princípios doutrinários e organizativos de cada país selecionado com ênfase no impacto dos determinantes sociais de saúde sobre os sistemas nacionais de saúde. Os resultados revelaram países com legislações e princípios doutrinários semelhantes, com direito à saúde constitucional, ancorados na atenção primária à saúde, e com modelo assistencial de acesso do tipo saúde da família. Os desafios encontrados foram a baixa natalidade e elevada expectativa de vida ao nascer em países europeus e critérios para acesso a medicamentos e financiamento assistencial. Com base nos nossos achados, os países que tiveram maior investimento em base estrutural, perpassando por assegurar condições socioeconômicas e sanitárias mais dignas, sólidas e vigilantes, garantiram importante diferenciação na capacidade de resposta e sustentabilidade do sistema nacional de saúde e no impacto direto na qualidade de vida das pessoas.

Se trata de una investigación documental, exploratoria, descriptiva, parte de un estudio multicéntrico, internacional entre Brasil, España, Italia y Portugal sobre los Sistemas Nacionales de Salud con un modelo de atención basado en la atención primaria de salud y financiado por el Consejo Nacional de Desarrollo Científico y Tecnológico (CNPq) de Brasil. Tiene como objetivo identificar la legislación de base de la salud, el derecho a la salud y los principios doctrinales y organizativos de cada país seleccionado con énfasis en el impacto de los determinantes sociales de la salud sobre los sistemas nacionales de salud. Los resultados revelaron países con legislaciones y principios doctrinales similares, con derecho a salud constitucional, anclados en la atención primaria de salud y con un modelo asistencial de acceso del tipo salud de la familia. Los desafíos encontrados fueron la baja tasa de natalidad y la alta esperanza de vida al nacer en países europeos y criterios para el acceso a medicamentos y financiación asistencial. Con base en nuestros hallazgos, los países que tuvieron mayor inversión en base estructural, asegurando condiciones socioeconómicas y sanitarias más dignas, sólidas y vigilantes, garantizan una diferenciación importante en la capacidad de respuesta y sostenibilidad del sistema nacional de salud y en el impacto directo en la calidad de vida de las personas.

Brazilian-Portuguese Version of My Strengths My Health System: A Methodological Study.

My Strengths My Health (MSMH) is a simplified version of the Omaha System developed for the use of patients and their caregivers. Its main objective is to enable a whole-person assessment with the participation of the patients in understanding the concepts that comprise their care plan. Since 2021, we joined a worldwide initiative to translate MSMH to other languages and this paper reports the Brazilian experience in 3 stages, developed from January 2022 to December 2023: translation and back translation of terms, its validation by freshman nursing students and its adoption by patients at an outpatient facility. Among the results, we highlight the patients' comments on the perceived ease of use of the system. MSMH adoption by caregivers and populations of different cultures and languages can amplify the comprehension of biological, psychological, social, spiritual and environmental determinants of health worldwide specially if issues on digital health literacy are considered.

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

BACKGROUND: The 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. METHODS: To 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. RESULTS: The 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. CONCLUSIONS: Proposals 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.

Hyperbaric Medicine in Pediatrics - reality of a Portuguese reference center.

OBJECTIVE: To identify and characterize the population of Pediatric patients referred to our hyperbaric oxygen therapy center. METHODS: Retrospective and observational study, including pediatric patients treated with hyperbaric oxygen therapy, from 2006 to 2021, at the hyperbaric medicine reference center in the north of Portugal. Variables of interest were extracted from electronic medical records. RESULTS: Our study included 134 patients. The most frequent reasons for referral were carbon monoxide poisoning (n=59) and sudden sensorineural hearing loss (n=41). In 75 cases (56%), treatment was initiated in an urgent context. Symptom presentation at Emergency Department varied among patients, the most frequent being headache and nausea/vomiting. Concerning carbon monoxide poisoning, the most common sources were water heater, fireplace/brazier, and boiler. Regarding adverse effects, it was identified one case of intoxication by oxygen and four cases of middle ear barotrauma. CONCLUSIONS: The most frequent cause for referral was carbon monoxide poisoning. All patients evolved favorably, with few side effects being reported, emphasizing the safety of this therapy. While most pediatricians may not be aware of the potential benefits arising with hyperbaric oxygen therapy, it is of upmost importance to promote them, so that this technique is increasingly implemented.

Measurement invariance of the Coparenting Relationship Scale (CRS) across 10 countries.

The purpose of this study was to assess the factor structure and the measurement invariance of the Coparenting Relationship Scale (CRS) across 10 countries based on the seven-factor coparenting model (i.e., Coparenting Agreement, Coparenting Closeness, Exposure to Conflict, Coparenting Support, Endorsement of Partner's Parenting; Division of Labor) proposed by Feinberg (2003). The results of research on coparenting from numerous countries have documented its foundational importance for parent mental health, family relationship quality, child development, and psychopathology. Yet, a cross-country perspective is still lacking. Such a perspective can provide insight into which dimensions of coparenting are universally recognized and which are especially prone to variation. A unique multinational data set, comprised of 15 individual studies collected across 10 countries (Belgium, Brazil, China, Israel, Italy, Japan, Portugal, Switzerland, Turkey, USA) in nine languages was established (N = 9,292; 51.1% mothers). Measurement invariance analyses were conducted. A six-factor structure (original seven factors minus Division of Labor) of the measure was consistent across the different contexts and measurement invariance was achieved at the configural level. There was no support for metric or scalar invariance. These findings provide a basis for the CRS to be used across countries and should inspire future quantitative and qualitative research in cross-country coparenting research to understand what aspects are universal and what aspects of coparenting are linked to specific material, relational, or ideational conditions that underlie high-quality coparenting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

What Should Personalised Mental Health Support Involve? Views of Young People with Lived Experience and Professionals from Eight Countries.

Research demonstrates that young people value mental health support that is tailored to their needs and preferences, rather than a "one size fits all" offer, which is often not equitably accessible (National Children's Bureau, 2021). Understanding young people's lived experiences across different sociocultural contexts is important. The aim of this research was to conduct an international qualitative study on the views of young people with lived experience and professionals, on proposed aspects of personalised support for anxiety and/or depression. Participatory action focus groups were conducted with N = 120 young people with lived experience of anxiety and/or depression (14-24 years) and with N = 63 professionals in Brazil, India, Kenya, Pakistan, Portugal, South Africa, Turkey, and the United Kingdom. Data were analysed using the rigorous and accelerated data reduction (RADaR) technique. Overall, although some country-specific differences were found in terms of what aspects of support young people found to be most important, individual preferences were considered stronger, furthering the view that support should be personalised to the needs of the individual young person. Young people experiencing anxiety and/or depression should be able to choose for themselves which aspects of support they would prefer in their own care and support plans, with families and mental health professionals providing guidance where appropriate, rather than removing the young person from the decision-making process altogether. It should also be ensured that the aspects of personalised support can be understood by young people and professionals from different contexts, including marginalised and minoritised groups and communities.

Cardiovascular Risk and Lifestyle: comparison between teaching workers in Portugal and Brazil.

OBJECTIVE: Compare Cardiovascular Risk between workers in Brazil and Portugal who work in the teaching context and its relationship with Lifestyle and Common Mental Disorder. METHODS: Cross-sectional study that compared the cardiovascular health conditions of teaching workers in Manaus (Brazil) and Coimbra (Portugal). The odds ratio between groups was estimated. RESULTS: The differences were: Smoking and hypercholesterolemia in participants from Portugal. Hypertension, chronic disease, increased abdominal perimeter, common mental disorder, and absence from work in Brazil. The variables with the greatest effect for high cardiovascular risk were: Country-Portugal [17.273 (95%CI1.538-193.951)], sex-male [61.577 (95%CI5.398-702.469)] and smoking [593.398 (95%CI57.330-6.142.020)]. CONCLUSION: The differences in risk between groups showed that participants from Portugal, men, with high blood pressure and/or smokers are the most vulnerable to having a cardiovascular event. There is a need for interventions to promote cardiovascular health in the workplace in both countries.

Cognitive maturity of Portuguese nursing students to intervene in disasters: initial training contribution.

OBJECTIVE: To understand whether, from the perspective of coordinators/directors of nursing courses and nurses with skills in the field of disasters, nursing students have the necessary cognitive maturity to articulate the various dimensions inherent to the area of disasters, allowing efficient performance. METHOD: A study with a qualitative methodological approach, based on inductive reasoning and rigorous phenomenon description, based on exploratory research. RESULTS: Given the specificity and complexity of these phenomena, the inclusion of the disaster domain in the teaching-learning process, supporting valid knowledge construction and allowing the development and maturity of nursing students' cognitive processes, is crucial. CONCLUSION: Currently, reduced technical-scientific training in the field of disasters in Portugal constitutes a barrier in the development of nursing students' cognitive maturity, impeding their ability to respond when faced with phenomena of this complexity.

Decentralization of the health system - experiences from Pakistan, Portugal and Brazil.

BACKGROUND: Decentralization of a health system is a complex and multidimensional phenomenon that demands thorough investigation of its process logistics, predisposing factors and implementation mechanisms, within the broader socio-political environment of each nation. Despite its wide adoption across both high-income countries (HICs) and low-and-middle-income countries (LMICs), empirical evidence of whether decentralization actually translates into improved health system performance remains inconclusive and controversial. This paper aims to provide a comprehensive description of the decentralization processes in three countries at different stages of their decentralization strategies - Pakistan, Brazil and Portugal. MAIN BODY: This study employed a systematic analysis of peer-reviewed academic journals, official government reports, policy documents and publications from international organizations related to health system decentralization. A comprehensive search was conducted using reputable databases such as PubMed, Google Scholar, the WHO repository and other relevant databases, covering the period up to the knowledge cutoff date in June 2023. Information was systematically extracted and organized into the determinants, process mechanics and challenges encountered during the planning, implementation and post-decentralization phases. Although decentralization reforms have achieved some success, challenges persist in their implementation. Comparing all three countries, it was evident that all three have prioritized health in their decentralization reforms and aimed to enhance local decision-making power. Brazil has made significant progress in implementing decentralization reforms, while Portugal and Pakistan are still in the process. Pakistan has faced significant implementation challenges, including capacity-building, resource allocation, resistance to change and inequity in access to care. Brazil and Portugal have also faced challenges, but to a lesser extent. The extent, progress and challenges in the decentralization processes vary among the three countries, each requiring ongoing evaluation and improvement to achieve the desired outcomes. CONCLUSION: Notable differences exist in the extent of decentralization, the challenges faced during implementation and inequality in access to care between the three countries. It is important for Portugal, Brazil and Pakistan to address these through reinforcing implementation strategies, tackling inequalities in access to care and enhancing monitoring and evaluation mechanism. Additionally, fostering knowledge sharing among these different countries will be instrumental in facilitating mutual learning.

Are sun exposure time, dietary patterns, and vitamin D intake related to the socioeconomic status of Portuguese children?

OBJECTIVES: To investigate the association among sun exposure time, vitamin D intake, dietary patterns, and socioeconomic status in Portuguese children. METHODS: Participants aged 3-11 years (50.1% females) were recruited from public and private schools (n = 118) in the districts of Coimbra (n = 2980), Lisbon (n = 3066), and Porto (n = 2426). Parents reported their children's daily sun exposure time during the summer season and reported children's food consumption, including vitamin D food sources, using standardized questionnaires. Parents' education level was used as a proxy measure to the socioeconomic status (SES). The principal component factor analysis (PCA) method was used to identify dietary patterns. The eight dietary patterns identified were labeled in: "fast food", "rich in vitamin D", "sugary drinks", "vitamin D", "candies", "supplements", "rich in calcium" and "vegetables/healthy". Linear regression analyses were performed to investigate the association between sun exposure time and dietary patterns according to SES. RESULTS: A total of 4755 children were included. Children from high SES had significantly longer sun exposure time (p < .001) and more frequently consumed vitamin D supplements (p < .001). "Fast food" pattern showed a negative association with sun exposure time in medium and high SES (p = .014 and p < .001, respectively). CONCLUSION: Children with lower SES spend less time exposed to the sun, consume fewer dietary sources of vitamin D, and consume more foods rich in fat and sugar.