Problemas de saúde nos países desenvolvidos e planeamento estratégico: evolução das políticas e estratégias de prevenção e combate à pré-obesidade e obesidade infantil e dos jovens em Portugal

A obesidade é uma doença crónica e constitui um factor de risco para outras patologias, como a diabetes ou as doenças cardiovasculares, contribuindo para a diminuição da qualidade de vida de adultos, crianças e jovens, e para o aumento dos custos directos e ndirectos com a saúde. Entre as suas múltiplas causas, destacam-se as mudanças comportamentais, nomeadamente as alterações ao padrão alimentar e a diminuição da actividade física, que resultam num balanço energético positivo. A pré-obesidade e obesidade são um grave problema de saúde nos países desenvolvidos e em desenvolvimento, sendo consideradas como epidemia global e um dos maiores desafios da saúde pública do início do século XXI. Verifica-se que a obesidade tem efeitos negativos imediatos na saúde individual dos mais jovens, aumentando-lhes também o risco de obesidade e suas co-morbilidades na idade adulta. O crescimento do problema entre crianças e jovens, bem como uma maior facilidade na introdução de mudança aos seus comportamentos, está na base de recomendações para que seja dada prioridade à prevenção e combate à pré-obesidade e obesidade nestas faixas etárias. Em Portugal, diversos estudos indicam o agravar do problema entre a população, sendo a prevalência entre crianças e jovens uma das mais ao nível europeu. Este facto, associado aos custos individuais, sociais e económicos da doença, constitui um foco de interesse para quem estuda a evolução dos sistemas de saúde. Com esta investigação procurou-se compreender a evolução das políticas e estratégias de prevenção e combate à pré-obesidade e obesidade infantil e dos jovens e como ela se projecta no futuro. Para tal, fez-se uso de uma metodologia qualitativa, através da análise da semântica e conteúdos de um Corpus documental que incluiu, entre outros, a Estratégia de Saúde para o Virar do Século (1998-2002), o Plano Nacional de Saúde 2004-2010 e a versão preliminar do Plano Nacional de Saúde 2011-2016. Os resultados mostram que o aumento de prevalência de excesso de peso na população portuguesa levou a que o problema ganhasse importância nas preocupações das autoridades de saúde. Verifica-se no entanto que a preocupação com o aumento da prevalência nas crianças e jovens se reflectiu mais tardiamente nos documentos estratégicos. Conclui-se ainda que a centralidade política da prevenção e combate ao problema, em particular, nas idades infanto-juvenis, surge após a aprovação da Carta Europeia de Luta Contra a Obesidade (WHO-Europe, 2006), de que Portugal é signatário. É possível estabelecer uma correspondência entre os princípios da Carta e as orientações estratégicas do PNS 2011-2016, recomendando-se o reforço deste alinhamento. PALAVRAS-CHAVE: Pré-obesidade, Obesidade, Portugal, Infantil, Crianças, Adolescentes, Jovens, Excesso de Peso, Plano Nacional de Saúde, Sistemas de Saúde, Planeamento em Saúde, Carta Europeia de Luta contra a Obesidade, Planeamento Estratégico.Obesity is a chronic disease and a contributing risk factor for other conditions, such as diabetes or cardiovascular diseases, associated with the decrease of life quality of adults, children and youth, and with the increase of direct and indirect health costs. Its most common causes are behavioural changes, like dietary changes and decrease of physical activity, that lead to a positive energy balance and gain of weight. Overweight and obesity are becoming a major problem in developed and developing countries, being considered as a global epidemic and as one of the greatest public health challenges of the twenty-first century. Obesity has immediate negative effects on individual health of young people, increasing the risk of obesity and its co-morbidities in their adult age. The fact of being a growing problem among children and youth, coupled with a relatively high permeability of members of this age group to behavioral changes is at the basis of recommendations to prioritize these groups for the prevention and combat against overweight and obesity. In Portugal, several studies show that the problem is growing among the population, being the prevalence among children and youth one of the highest in Europe. This fact, together with the individual, social and economic burden of the disease, is of interest to those who study the evolution of health systems. With this investigation, we analyzed the evolution of policies and strategies for preventing and combating overweight and obesity among children and young people and how they are projected in the future. For this, we used a qualitative methodology to analyze the semantic and content analysis of a set of documents, including the Health Strategy (1998-2002), the National Health Plan 2004-2010 and the draft of the National Health Plan 2011-2016. Our results show the increasing concern of Portuguese health authorities with the growing impact of obesity in the population. However the concern with its increase among children and young people risen later in the strategic document. We established that prevention and combat obesity, particularly within children and adolescents, became a political priority after the approval of the European Charter on Counteracting Obesity (WHO-Europe, 2006) of which Portugal is a signatory member. It is possible to establish a correspondence between the principles of the European Charter and the strategic guidelines of the National Health Plan 2011-2016, and we recommend the strengthening of this alignment

Prevention and battle against obesity in children and youngsters at a strategic planning level and their evolution in Portugal

SCIELO:S0870-90252014000100003Introduction Considered by WHO as a global epidemic and one of the greatest public health challenges of the twentyfirst century, Obesity is a chronic disease with multiple causes, especially behavioural changes like dietary changes and sedentary lifestyle. It is a risk factor for other conditions, such as diabetes or cardiovascular diseases, associated with the decrease of life quality of individual and the increase of health costs. Overweight has immediate negative effects on individual health of young people, increasing the risk of Obesity and its comorbidities in their adult age. The fact of being a growing problem among children and youth, coupled with a relatively high permeability of members of these age groups to behavioral changes is at the basis of recommendations to a priority intervention with these groups. Several studies show that the problem is growing among the Portuguese population, being the prevalence among children and youth one of the highest in Europe. This fact, together with the individual, social and economic burden of the disease, is of interest to those who study the evolution of health systems. With this investigation, we tried to understand the evolution of policies and strategies for preventing and combating Obesity among children and young people at strategic management level in Portugal. Method With a qualitative methodology, we analyzed the semantic and content of a set of documents, including the Health Strategy (19982002), the National Health Plan 20042010 and the draft of the National Health Plan 20122016, complementing it with ad hoc query with key informants. Results and discussion Our results permit one overview of strategic planning in Portugal and show that the increasing concern of Portuguese health authorities with the growing impact of Obesity in the population. However the concern with its increase among children and young people risen later in the strategic documents. We established that the problem became a political priority after the approval of the European Charter on Counteracting Obesity, of which Portugal is a signatory member, and it's possible to find a correspondence between the principles of the European Charter and the strategic guidelines of the National Health Plan 20122016.publishersversionpublishe

Planeamento sustentável em saúde: percepções sobre termos, conceitos e características processuais e metodológicas

Introdução: Nas últimas décadas, o reconhecimento do papel central da saúde para o alcance do desenvolvimento sustentável tem provocado desafios específicos ao processo de planeamento do desenvolvimento, em geral, e do planeamento em saúde, em particular. Integrado num projeto de investigação mais vasto, com a finalidade de contribuir para o desenvolvimento de um modelo de planeamento em saúde no quadro dos Objetivos de Desenvolvimento Sustentável (ODS), este estudo, de carácter exploratório, tem por objetivo contribuir para a compreensão de conceitos e características processuais e metodológicas do planeamento sustentável em saúde, com base nas principais mensagens recolhidas num painel de discussão realizado durante o 5º Congresso Nacional de Medicina Tropical em abril de 2019. Material e Métodos: As apresentações dos oradores convidados para o painel e as transcrições das intervenções no debate foram submetidas a análise de conteúdo. Adicionalmente, foi conduzida uma análise documental de fontes documentais resultantes de uma revisão da literatura de tipo narrativa, que permitiu uma recolha de elementos para complementar e enquadrar os achados da análise de conteúdo e a discussão da temática. Resultados e discussão: Emergiram 4 temas principais: i) perceções do planeamento sustentável, II) planeamento sustentável e participação dos cidadãos, III) planeamento sustentável e articulação intersectorial, e IV) planeamento sustentável e condições de implementação. As perceções do planeamento sustentável foram das mais diversas, por exemplo, o planeamento que garante a implementação ou a continuidade do ciclo de planeamento, e só uma minoria dos participantes enquadrou o planeamento sustentável como sendo aquele que contribui para a consecução dos ODS. As abordagens participativas do planeamento em saúde, que integram a participação dos cidadãos e a articulação intersectorial, com particular enfoque na redução das iniquidades em saúde e no alcance da cobertura universal, foram consideradas entre as mais efetivas para o alcance de objetivos de saúde e de bem-estar alinhados com os princípios do desenvolvimento sustentável. Conclusão: A mobilização social e das comunidades no processo de planeamento em saúde parece ser facilitador da seleção e implementação de estratégias de saúde no contexto do desenvolvimento sustentável.N/

The Covid-19 pandemic reinforces the need for sustainable health planning

Funding Information: Not applicable. Publisher Copyright: © 2021 John Wiley & Sons Ltd.The 2030 Agenda for Sustainable Development highlighted the growing attention to the adequacy of health planning models to sustainable development. A re-reading of the results of a round table debate on “sustainable planning”, which took place at the 5th National Congress of Tropical Medicine (Portugal, 2019) under a participant observation strategy, framed by the findings of a “synthesis of better evidence” literature review and cross–referenced with the reflections of different authors and experts about the momentum created by the COVID–19 pandemic, underlined the challenges to sustainable health planning that have emerged and are projected beyond the current pandemic context. Variable perceptions of the term “sustainable health development”, leading to the potential loss of their relevance in guiding the elaboration of policies and strategic plans, and the potential higher effectiveness of the participatory approaches of health planning in achieving sustainable health were highlighted in the debate and literature, in general and in public health emergency contexts. Those results gained new relevance during the current COVID–19 pandemic, bringing back to the forefront a reflection of the inadequate planning framework that has usually been used to understand and respond to global health challenges, despite the already existing experience, evidence and support instruments.publishersversionpublishe

Sampling effects on the identification of roadkill hotspots: Implications for survey design

Although locating wildlife roadkill hotspots is essential to mitigate road impacts, the influence of study design on hotspot identification remains uncertain. We evaluated how sampling frequency affects the accuracy of hotspot identification, using a dataset of vertebrate roadkills (n = 4427) recorded over a year of daily surveys along 37 km of roads. “True” hotspots were identified using this baseline dataset, as the 500-m segments where the number of road-killed vertebrates exceeded the upper 95% confidence limit of the mean, assuming a Poisson distribution of roadkills per segment. “Estimated” hotspots were identified likewise, using datasets representing progressively lower sampling frequencies, which were produced by extracting data from the baseline dataset at appropriate time intervals (1e30 days). Overall,24.3% of segments were “true” hotspots, concentrating 40.4% of roadkills. For different groups, “true” hotspots accounted from 6.8% (bats) to 29.7% (small birds) of road segments, concentrating from 60% (lizards, lagomorphs, carnivores) of roadkills. Spatial congruence between “true” and “estimated” hotspots declined rapidly with increasing time interval between surveys, due primarily to increasing false negatives (i.e., missing “true” hotspots). There were also false positives (i.e., wrong “estimated” hotspots), particularly at low sampling frequencies. Spatial accuracy decay with increasing time interval between surveys was higher for smaller-bodied (amphibians, reptiles, small birds, small mammals) than for larger-bodied species (birds of prey, hedgehogs, lagomorphs, carnivores). Results suggest that widely used surveys at weekly or longer intervals may produce poor estimates of roadkill hotspots, particularly for small-bodied species. Surveying daily or at two-day intervals may be required to achieve high accuracy in hotspot identification for multiple species

evolução do perfil, atividade e formação no setor público entre 1971 e 2019

Auxiliares de saúde são trabalhadores com funções de suporte a profissionais mais qualificados na prestação de cuidados. Constituem parte considerável e desconhe-cida dos recursos humanos da saúde em Portugal.Publicados em 2010, o perfil profissional e o referencial de formação de técnico auxiliar de saúde introduziram mudanças ainda por estudar. Integrado numa investigação sobre qualificação da força de trabalho da saúde numa perspetiva de análise de políticas, este estudo visa contribuir para a compreensão dos contextos nacional e internacional de definição e implementação destas medidas. Através de entrevistas e análise documental, procedeu-se à análise da evolução do perfil, atividade e formação dos auxiliares de saúde do setor público entre 1971 até 2019, um percurso de três etapas pontuadas por alterações na sua categoria profissional, designação e funções.Alinhado com as estratégias nacionais e europeias de qualificação, o perfil de técnico auxiliar de saúde, além de um descritivo de atividade claro, impulsionou uma oferta formativa de base até aí inexistente. Contrariamente ao verificado noutros países, não deu origem a mecanismos legais para regulação da atividade ou acesso ao mercado de trabalho, nem teve reflexos diretos no estatuto dos auxiliares do setor público. Healthcare assistants have a supporting role of more qualified professionals. They are a considerable and unknow part of the Portuguese health workforce. The professional profile and the Technical Healthcare Assistant course, published in 2010, brought changes that have not yet been studied. part of an investigation that analyses these policies, this study aims to contribute to the understanding of the national and international contexts of definition and implementation of these measures. Through interviews and documentary analysis, a description and analysis of the evolution of the profile, activity and training of Health Assistants in the public sector from 1971 to 2019 was carried out, a three-stage course punctuated by changes in their professional categories, designation and functions. Aligned with national and European qualification strategies, the profile of Health Assistant Technician, in addition to a clear activity description, boosted a basic training offer that did not exist until then. Contrary to what was seen in other countries, it did not give rise to legal mechanisms to regulate activity or access the labor market, nor did it have a direct impact on the status of healthcare assistants in the public sector.publishersversionpublishe

os casos de Cabo Verde, Moçambique e Guiné-Bissau

Introdução: As Tecnologias de Informação e Comunicação (TIC) podem contribuir para desenvolvimento e consolidação dos sistemas de saúde. A partir da análise de três casos, este artigo procura contribuir para o conhecimento sobre as oportunidades que as TIC representam no espaço lusófono, descrevendo e identificando boas práticas, dificuldades e oportunidades para reforçar uma agenda comum. Material e métodos: A partir das apresentações de peritos numa mesa redonda sobre o contributo das TIC para Serviços de Saúde em países de baixos recursos e de uma revisão narrativa de literatura, são analisadas e discutidas intervenções em Cabo Verde, Moçambique e na Guiné-Bissau. Resultados e discussão: Os exemplos analisados, pese as diferenças de maturidade identificadas, mostram fatores de sucesso (capacitação de profissionais, respaldo político) e dificuldades comuns (investimento elevado, resistência dos profissionais), bem como benefícios gerados (poupanças, melhoria de acesso), desafios e oportunidades para futuro (sustentabilidade e parcerias). Conclusão: O uso de TIC nestes sistemas de saúde mostra diferentes maturidades, tão mais elevada quanto maior a aposta na capacitação de profissionais, no acesso a recursos e financiamento, a na priorização políticas promotoras de centros nacionais de teles saúde. O reforço de parcerias na CPLP para partilhar soluções e conhecimento é garante de maior crescimento e sustentabilidade. Introduction: Information and Communication Technologies (ICT) can contribute to the development and consolidation of health systems. From the analysis of three cases, this article seeks to contribute to the knowledge about the opportunities that ICT represents in the lusophone space, describing and identifying good practices, difficulties and opportunities to reinforce a common agenda. Material and methods: From expert presentations at a round table on the ICT Contribution to Health Services in low-income countries and a narrative literature review, interventions in Cape Verde, Mozambique and Guinea-Bissau are analyzed and discussed. Results and discussion: The examples analyzed, despite differences in maturity, show common factors of success (professional qualification, political support) and difficulties (high investment, resistance of professionals), as well as benefits introduced in health systems (savings, higher access), challenges and opportunities for the future (sustainability and partnerships). Conclusion: The ICT use in these health systems shows different maturities, as higher the greater the bet in the training of professionals, in access to resources and financing, in the prioritization policies to promote national telehealth centers. The reinforcement of partner-ships in the CPLP to share solutions and knowledge are guarantees of higher growth and sustainability.publishersversionpublishe

The silent extinction of freshwater mussels in Portugal

Freshwater mussels are one of the most threatened animal groups in the world. In the European Union, threatened and protected mussel species are not adequately monitored, while species considered to be common and widespread receive even less attention. This is particularly worrying in the Mediterranean region, where species endemism is high and freshwater habitats are severely affected by water scarcity. In the absence of hard data on population trends, we report here a long-term comparison of freshwater mussel assemblages at 132 sites covering 15 different hydrological basins in Portugal. This study reveals a widespread decline of 60 % in the number of sites and 67 % in the overall abundance of freshwater mussels across Portugal over the last 20 years, indicating that all species are rapidly declining and threatened with extinction. These results show that current legislation and conservation measures are largely ineffective and highlight the importance of updating the Habitats Directive to enforce standard monitoring protocols for threatened species in the European Union and to extend monitoring to other freshwater species thought to be common and widespread. Efficient water management, restrictions on irrigation expansion in important biodiversity areas, mitigation of hydrological changes and loss of aquatic habitat connectivity caused by physical alterations are urgently needed to reverse these declining population trends. For the severely endangered species Margaritifera margaritifera, Potomida littoralis, and Unio tumidiformis, where populations are now critically low, more urgent action is needed, such as ex-situ conservation, protection of remaining populations and large-scale habitat restoration.We would like to thank Jake Dimon, José Tourais, Filipe Rolo, and Elza Fonseca for their help in the surveys. This research was developed under the project EdgeOmics - Freshwater Bivalves at the edge: Adaptation genomics under climate-change scenarios (PTDC/CTA-AMB/3065/2020) funded by the Portuguese Foundation for Science and Technology (FCT) through national funds. FCT also funded MLL under contract 2020.03608.CEECIND, EF under contract CEECINST/00027/2021/CP2789/CT0003, AGS under the grants SFRH/BD/137935/2018 and COVID/DB/152933/2022, and JGN under the grant 2020.04637. BD. The baseline survey was funded by the project “Documentos Estruturantes” (POA 1.100021) of the Instituto da Conservaçã da Natureza

contributos do 5º Congresso Nacional de Medicina Tropical para um reflexão sobre termos, conceitos e características processuais e metodológicos

Introdução: Nas últimas décadas, países e sistemas de saúde têm vindo a dedicar atenção crescente a práticas de planeamento que promovam o desenvolvimento sustentável. Reconhecendo os desafios específicos que se colocam ao planeamento em saúde, este artigo tem por objetivo contribuir para a reflexão sobre o conceito e características processuais e metodológicas do planeamento sustentável em saúde, com base nas principais mensagens recolhidas num painel de discussão do 5º Congresso Nacional de Medicina Tropical. .Material e métodos: Foram utilizadas as apresentações dos oradores convidados para o painel e as intervenções do debate. Complementar-mente, foram utilizadas fontes documentais resultantes de uma revisão narrativa da literatura. Todo o material foi sujeito a análise documental. Resultados e discussão: As abordagens participativas do planeamento em saúde, que integram a participação dos cidadãos e a articulação intersectorial, com particular enfoque na redução das iniquidades em saúde e no alcance da cobertura universal, foram consideradas entre as mais efetivas para o alcance de objetivos de saúde e de bem-estar alinhados com os princípios do desenvolvimento sustentável. Conclusão: A mobilização social e das comunidades no processo de planeamento em saúde parece ser facilitador da seleção e implementação de estratégias de saúde no contexto do desenvolvimento sustentável. Introduction: In recent decades, countries and health systems have been paying increasing attention to planning practice for sustainable development. Recognizing the specific challenges facing health planning, this article aims to contribute to the reflection on the concept and procedural and methodological characteristics of sustainable health planning, based on the main messages gathered in a panel discussion of the 5th National Congress of Tropical Medicine. Material and methods: We used the panel presentations and discussion interventions, in addition with documentary sources resulting from a narrative literature review. All material was subject to documentary analysis. Results and discussion: Participatory approaches to health planning, integrating community participation and intersectoral action, with a particular focus on reducing health inequities and achieving universal coverage, were considered to be among the most effective to achieve health and well-being goals aligned with the principles of sustainable development. Conclusion: Social and community mobilization in the health planning process seems to contribute to the selection and implementation of health strategies in the context of sustainable development.publishersversionpublishe

The PREDICTS database: a global database of how local terrestrial biodiversity responds to human impacts

Biodiversity continues to decline in the face of increasing anthropogenic pressures such as habitat destruction, exploitation, pollution and introduction of alien species. Existing global databases of species’ threat status or population time series are dominated by charismatic species. The collation of datasets with broad taxonomic and biogeographic extents, and that support computation of a range of biodiversity indicators, is necessary to enable better understanding of historical declines and to project – and avert – future declines. We describe and assess a new database of more than 1.6 million samples from 78 countries representing over 28,000 species, collated from existing spatial comparisons of local-scale biodiversity exposed to different intensities and types of anthropogenic pressures, from terrestrial sites around the world. The database contains measurements taken in 208 (of 814) ecoregions, 13 (of 14) biomes, 25 (of 35) biodiversity hotspots and 16 (of 17) megadiverse countries. The database contains more than 1% of the total number of all species described, and more than 1% of the described species within many taxonomic groups – including flowering plants, gymnosperms, birds, mammals, reptiles, amphibians, beetles, lepidopterans and hymenopterans. The dataset, which is still being added to, is therefore already considerably larger and more representative than those used by previous quantitative models of biodiversity trends and responses. The database is being assembled as part of the PREDICTS project (Projecting Responses of Ecological Diversity In Changing Terrestrial Systems – www.predicts.org.uk). We make site-level summary data available alongside this article. The full database will be publicly available in 2015