Editorial: Dietary intake, eating behavior and health outcomes

[Excerpt] Dietary intake and eating behaviors are important determinants of non-communicable diseases (NCDs) and have been widely investigated (1). The association between dietary intakes (e.g., fruits, vegetables, processed meat, and trans-fat) and NCDs (e.g., obesity, cardiovascular diseases (CVD), diabetes, and cancer) have been described. The associations varied by socioeconomic and the burden differed by demographic conditions (2, 3). Nevertheless, due to the complexity of measuring exposures related to dietary intake, the evidence base is mainly observational and lacking experimental designs. Additionally, there is scant evidence on the effectiveness of health promotion strategies focusing dietary consumption and behavior, on health outcomes. Bring in mind the complexity of studying dietary intake and its effects in health, the Frontiers in Nutrition dedicated a specific topic to Dietary intake, eating behavior and health outcomes. A total of 105 studies were submitted with 35 being selected for publication after peer-review. [...]- (undefined

Enfermeiros em funções avançadas: uma análise da aceitação em Portugal

OBJECTIVE: This paper focuses on the policy context for the deployment of nurses in advanced roles, with particular reference to Portugal. The health sector in Portugal, as in all countries, is labour intensive, and the scope to utilise nurses in more advanced roles is currently being debated. METHODS: Mixed methods were used: an analysis of international data on the nursing workforce; an analysis of documents and media articles; interviews with key-informants; an online survey of managers, and a technical workshop with key-informants. CONCLUSIONS: The limited evidence base on nurses in advanced roles in Portugal is a constraint on progress, but it is not an excuse for inaction. Further research in Portugal on health professionals in innovative roles would assist in informing policy direction. There is the need to move forward with a fully informed policy dialogue, taking account of the current political, economic and health service realities of Portugal.OBJETIVO: Este estudio se focaliza en el contexto político del desarrollo de competencias avanzadas de enfermería, con énfasis en el caso portugués. El sector de la salud en Portugal, como en todos los países, es intensivo en mano de obra, y la posibilidad de utilizar enfermeros en funciones más avanzadas está actualmente en debate. MÉTODOS: Fue utilizado una aproximación mixta: análisis de datos internacionales sobre la fuerza de trabajo de enfermería; análisis de documentos y noticias; entrevistas con informadores clave; un cuestionario online y una oficina técnica con informadores clave. CONCLUSIONES: La limitada base de evidencia sobre la extensión de competencias de los enfermeros en Portugal es un obstáculo para el progreso pero no es una excusa para la inacción. Investigación adicional sobre profesionales de la salud en papeles innovadores podría ayudar a informar y direccionar la decisión política. Es necesario avanzar con un diálogo político plenamente informado, considerando la realidad político económica actual y el sistema de servicios de salud en Portugal.OBJETIVO: este artigo foca o contexto político da implementação de competências avançadas em enfermagem, com ênfase no caso português. O setor da saúde em Portugal, assim como em outros países, usa mão de obra intensa, e a prática de enfermeiros com competências avançadas está atualmente em debate. MÉTODOS: abordagem de métodos mistos com análise de dados internacionais sobre a mão de obra em enfermagem, documentos e notícias na mídia, entrevistas com informantes-chave, questionário online e um workshop técnico com informantes-chave. CONCLUSÕES: existe base de evidência limitada sobre enfermeiros com funções avançadas em Portugal, o que é um entrave ao progresso, mas não uma desculpa para a inércia. Mais estudos conduzidos em Portugal, abordando funções inovadoras para profissionais da saúde, ajudariam a informar e direcionar políticas na área. É necessário avançar para informar, de forma plena, o diálogo político, levando em consideração a realidade atual em termos políticos, econômicos e do sistema de saúde em Portugal

Are immigrants more vulnerable to the socioeconomic impact of COVID-19? A cross-sectional study in Amadora Municipality, Lisbon metropolitan area

Funding Information: The project was funded by a grant from the Portuguese Science and Technology Foundation (FCT), RESEARCH4COVID19, reference 065, co-financed by FAMI funds reference PT/2018/FAMI/350, and by Saúde Global e Medicina Tropical, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Portugal, ref. UID/04413/2020. Publisher Copyright: Copyright © 2022 O. Martins, Shaaban, Abecasis, Muggli, Amado, Vaz, Dias, Silva and Fronteira.Introduction: Immigrants carry an extra burden of morbidities and mortalities since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Pre-existing inequalities among immigrants may threaten their economic wellbeing during the pandemic. This study analyzed the socioeconomic impact of COVID-19 on immigrants and natives living in Amadora, Metropolitan Region of Lisbon and the extent to which preexisting inequalities had been exacerbated during the pandemic. Materials and methods: This cross-sectional study was conducted in Amadora Municipality, Lisbon Region, through phone interviews and using a structured questionnaire. Data collected in July 2020, included information on a cohort of 420 households, of which 51% were immigrants. To evaluate the socioeconomic position and economic wellbeing changes occurring during the pandemic we estimate crude and adjusted odds ratio (OR) and 95% CI, using Portuguese natives as the reference group. Results: Overall, 287 (70%) participants responded to the questionnaire, of which 47% are immigrants. Preexisting socioeconomic inequalities were exacerbated during the pandemic. Compared with natives, immigrants were more likely to experience job loss, temporary lay-off, and income loss during the COVID-19 pandemic. Immigrants were also more likely to face several kinds of financial hardship during the pandemic, such as difficulties in buying food, hygiene products, and paying bills. Conclusion: To the best of our knowledge, this study is the first to capture the direct socioeconomic impact of COVID-19 among immigrants and natives in Portugal. It highlights the bidirectional relation between inequalities deeply rooted among immigrants and COVID-19. Socioeconomic inequalities affect local patterns of COVID-19 burden, as confirmed in previous studies, but COVID-19 also has an impact on the economic wellbeing of Amadora immigrants during the pandemic. Urgent policies must be implemented to mitigate the economic burden of COVID-19 among immigrants, namely in Amadora, Lisbon Region.publishersversionpublishe

protocol for a living systematic review

Funding Information: This study was funded by the Solidarity Fund, through a grant administered by the World Health Organization. Publisher Copyright: ©Ana Paula Cavalcante de Oliveira, Mariana Lopes Galante, Leila Senna Maia, Isabel Craveiro, Alessandra Pereira da Silva, Ines Fronteira, Raphael Chança, Paulo Ferrinho, Mario Dal Poz.Background: Countries and health systems have had to make challenging resource allocation and capacity-building decisions to promote proper patient care and ensure health and care workers’ safety and well-being, so that they can effectively address the present COVID-19 pandemic as well as upcoming public health problems and natural catastrophes. As innovations are already in place and updated evidence is published daily, more information is required to inform the development and implementation of policies and interventions to improve health and care workforce capacity to address the COVID-19 pandemic response. Objective: The objective of this protocol review is to identify countries’ range of experiences with policies and management interventions that can improve health and care workers’ capacity to address the COVID-19 pandemic response and synthesize evidence on the effectiveness of the interventions. Methods: We will conduct a living systematic review of quantitative, qualitative, and mixed methods studies and gray literature (technical and political documents) published in English, French, Hindi, Portuguese, Italian, and Spanish between January 1, 2000, and March 1, 2022. The databases to be searched are MEDLINE (PubMed), Embase, SCOPUS, and Latin American and Caribbean Health Sciences Literature. In addition, the World Health Organization’s COVID-19 Research Database and the websites of international organizations (International Labour Organization, Economic Co-operation and Development, and The Health System Response Monitor) will be searched for unpublished studies and gray literature. Data will be extracted from the selected documents using an electronic form adapted from the Joanna Briggs Institute quantitative and qualitative tools for data extraction. A convergent integrated approach to synthesis and integration will be used. The risk of bias will be assessed with Joanna Briggs Institute critical appraisal tools, and the certainty of the evidence in the presented outcomes will be assessed with the Grading of Recommendations, Assessment, Development and Evaluation. Results: The database and gray literature search retrieved 3378 documents. Data are being analyzed by 2 independent reviewers. The study is expected to be published by the end of 2023 in a peer-reviewed journal. Conclusions: This review will allow us to identify and describe the policies and strategies implemented by countries and their effectiveness, as well as identify gaps in the evidence.publishersversionpublishe

Continuity and change in human resources policies for health: lessons from Brazil

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A Structural Equations Modeling Approach

COVID-19 vaccine hesitancy (VH) has caused concerns due to the possible fluctuations that may occur directly impacting the control of the pandemic. In this study, we aimed to estimate the prevalence and factors associated with COVID-19 VH in Portuguese-speaking countries. We developed a web survey (N:6,843) using an online, structured, and validated questionnaire. We used Measurement Models, Exploratory Factor Analysis, Exploratory Structural Equation Models, and Confirmatory Factor Analysis for the data analysis. The overall prevalence of COVID-19 VH in Portuguese-speaking countries was 21.1%. showed a statistically significant direct effect for VH: vaccine-related conspiracy beliefs (VB) (β = 0.886), perceived stress (PS) (β = 0.313), COVID-19 Misinformation (MIS) (β = 0.259) and individual responses to COVID-19 (CIR) (β = −0.122). The effect of MIS and CIR for VH was greater among men and of PS and VB among women; the effect of PS was greater among the youngest and of VB and CIR among the oldest. No discrepant differences were identified in the analyzed education strata. In conclusion, we found that conspiracy beliefs related to the vaccine strongly influence the decision to hesitate (not to take or to delay the vaccine). Specific characteristics related to gender, age group, social and cognitive vulnerabilities, added to the knowledge acquired, poorly substantiated and/or misrepresented about the COVID-19 vaccine, need to be considered in the planning of vaccination campaigns. It is necessary to respond in a timely, fast, and accurate manner to the challenges posed by vaccine hesitancy.publishersversionpublishe

Nonspecific Effects of the Bacillus Calmette-Guérin Vaccine in Portuguese Children Under 5 Years of Age: Protocol for a Population-Based Historical Birth Cohort Study

BackgroundThe Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis (TB) shows beneficial nonspecific effects, which are likely related to innate immune training. Until 2016, a single BCG dose was administered to all newborns in Portugal. In July 2016, a clinical guideline established that only children under 6 years belonging to high-risk groups should receive BCG. This might have prevented nonvaccinated children from developing trained immunological responses as effectively as BCG-vaccinated children. ObjectiveThis study aims to investigate if there is variation in TB-related and all-cause mortality, and severe, moderate, or mild morbidity in children under 5 years of age, and whether such variation might be explained by the BCG vaccination policy change in 2016. MethodsThis population-based historical birth cohort study includes children under 5 years of age born in Portugal between July 1, 2010, and June 30, 2021. Newborns with low birth weight, premature status, or known or suspected HIV infection are excluded. The follow-up period is until the completion of 5 years of age or the end of follow-up (June 30, 2021). The study will use secondary data from the National Health Service user registry, death certificate database, vaccination registry, communicable diseases surveillance system, TB surveillance system, diagnosis-related group information system for hospital admissions and emergency department visits, and primary health care information system. The data will be linked. Primary outcomes include person-time incidence rates of death (all causes and TB), TB diagnosis, and all causes and some specific causes of severe, moderate, or mild morbidity, and the incidence rate ratio of nonvaccinated to BCG-vaccinated children. We will compare the probability of surviving the first and fifth years of life or of not having severe, moderate, or mild morbidity during the follow-up period according to exposure (BCG vaccinated or nonvaccinated, number of doses, and time from birth until the first dose), using the log-rank test for assessing differences in survival rates between exposed and nonexposed children and hazard ratios for quantifying the differences. Moreover, we will perform a proportional hazards regression analysis. ResultsEthics approval has been obtained. In March 2022, database owners were contacted to present the project and discuss the request for data. A unique identifier will be used. In July 2023, a process of redefinition of the variables per database was initiated. Data were received in October and November 2023. In November 2023, further work was conducted. By April 2024, we expect to start analyzing the full data set. ConclusionsThe results will contribute to the accumulating body of knowledge and might have relevance to guide global BCG vaccination policy. Data linkage can contribute to a swifter mechanism to use available health data to conduct population-based studies and inform policy decision-making. Trial RegistrationClinicalTrials.gov NCT05471167; https://clinicaltrials.gov/study/NCT05471167 International Registered Report Identifier (IRRID)DERR1-10.2196/5533

Nurses in advanced roles: a review of acceptability in Portugal Las enfermeras de competencias avanzadas: una revisión de aceptación en Portugal Enfermeiros em funções avançadas: uma análise da aceitação em Portugal

OBJECTIVE: This paper focuses on the policy context for the deployment of nurses in advanced roles, with particular reference to Portugal. The health sector in Portugal, as in all countries, is labour intensive, and the scope to utilise nurses in more advanced roles is currently being debated. METHODS: Mixed methods were used: an analysis of international data on the nursing workforce; an analysis of documents and media articles; interviews with key-informants; an online survey of managers, and a technical workshop with key-informants. CONCLUSIONS: The limited evidence base on nurses in advanced roles in Portugal is a constraint on progress, but it is not an excuse for inaction. Further research in Portugal on health professionals in innovative roles would assist in informing policy direction. There is the need to move forward with a fully informed policy dialogue, taking account of the current political, economic and health service realities of Portugal.OBJETIVO: Este estudio se focaliza en el contexto político del desarrollo de competencias avanzadas de enfermería, con énfasis en el caso portugués. El sector de la salud en Portugal, como en todos los países, es intensivo en mano de obra, y la posibilidad de utilizar enfermeros en funciones más avanzadas está actualmente en debate. MÉTODOS: Fue utilizado una aproximación mixta: análisis de datos internacionales sobre la fuerza de trabajo de enfermería; análisis de documentos y noticias; entrevistas con informadores clave; un cuestionario online y una oficina técnica con informadores clave. CONCLUSIONES: La limitada base de evidencia sobre la extensión de competencias de los enfermeros en Portugal es un obstáculo para el progreso pero no es una excusa para la inacción. Investigación adicional sobre profesionales de la salud en papeles innovadores podría ayudar a informar y direccionar la decisión política. Es necesario avanzar con un diálogo político plenamente informado, considerando la realidad político económica actual y el sistema de servicios de salud en Portugal.OBJETIVO: este artigo foca o contexto político da implementação de competências avançadas em enfermagem, com ênfase no caso português. O setor da saúde em Portugal, assim como em outros países, usa mão de obra intensa, e a prática de enfermeiros com competências avançadas está atualmente em debate. MÉTODOS: abordagem de métodos mistos com análise de dados internacionais sobre a mão de obra em enfermagem, documentos e notícias na mídia, entrevistas com informantes-chave, questionário online e um workshop técnico com informantes-chave. CONCLUSÕES: existe base de evidência limitada sobre enfermeiros com funções avançadas em Portugal, o que é um entrave ao progresso, mas não uma desculpa para a inércia. Mais estudos conduzidos em Portugal, abordando funções inovadoras para profissionais da saúde, ajudariam a informar e direcionar políticas na área. É necessário avançar para informar, de forma plena, o diálogo político, levando em consideração a realidade atual em termos políticos, econômicos e do sistema de saúde em Portugal

Health System review, 2017

This analysis of the Portuguese health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Overall health indicators such as life expectancy at birth and at age 65 years have shown a notable improvement over the last decades. However, these improvements have not been followed at the same pace by other important dimensions of health: child poverty and its consequences, mental health and quality of life after 65. Health inequalities remain a general problem in the country. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Out-of-pocket payments have been increasing over time, not only co-payments, but particularly direct payments for private outpatient consultations, examinations and pharmaceuticals. The level of cost-sharing is highest for pharmaceutical products. Between one-fifth and one-quarter of the population has a second (or more) layer of health insurance coverage through health subsystems (for specific sectors or occupations) and voluntary health insurance (VHI). VHI coverage varies between schemes, with basic schemes covering a basic package of services, whereas more expensive schemes cover a broader set of services, including higher ceilings of health care expenses. Health care delivery is by both public and private providers. Public provision is predominant in primary care and hospital care, with a gate-keeping system in place for access to hospital care. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. In May 2011, the economic crisis led Portugal to sign a Memorandum of Understanding with the International Monetary Fund, the European Commission and the European Central Bank, in exchange for a loan of 78 billion euros. The agreed Economic and Financial Adjustment Programme included 34 measures aimed at increasing cost-containment, improving efficiency and increasing regulation in the health sector. Reforms implemented since 2011 by the Ministry of Health include: improving regulation and governance, health promotion (launch of priority health programmes such as for diabetes and mental health), rebalancing the pharmaceutical market (new rules for price setting, reduction in the prices of pharmaceuticals, increasing use of generic drugs), expanding and coordinating long-term and palliative care, and strengthening primary and hospital care.publishersversionpublishe