A obesidade como um importante problema de saúde pública em Portugal: conquistas e desafios: editorial

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Design, implementation and evaluation of a new eHealth pharmaceutical service for cooperative disease management using an interactive platform: opportunities to improve health systems performance

RESUMO Introdução: As doenças crónicas são a principal causa de mortalidade em toda a Europa. O aumento da prevalência de doenças crónicas está a gerar a necessidade de reformas nos sistemas de saúde. Estas reformas abordam a gestão de doenças crónicas com base em equipas multidisciplinares, com novos papéis atribuídos a profissionais não-médicos, como enfermeiros e farmacêuticos comunitários (CP). A comunicação entre profissionais e cidadãos é fundamental em todos os modelos multidisciplinares, o que torna o uso de Sistemas e Tecnologias de Informação (IST) cada vez mais indispensável. É de extrema importância para a ciência e a sociedade entender como serviços suportados por IST - eHealth - podem ser desenvolvidos e utilizados para enfrentar os constrangimentos e desafios dos futuros sistemas de saúde. Objetivo: O objetivo principal deste projeto foi o de desenvolver, implementar e avaliar um serviço farmacêutico de gestão de doença suportado por IST, no contexto da farmácia comunitária, utilizando a metodologia Design Science Research (DSRM) como metodologia de investigação. Métodos: A aplicação de DSRM decorre em seis fases, desde a definição e caracterização do problema até à avaliação da solução (ou artefacto). A primeira fase foi constituída por um exercício de cenarização, um estudo observacional de tempo e movimento e um questionário de preenchimento online, para avaliar as futuras possibilidades para os farmacêuticos comunitários no sistema de saúde, e a atual prestação de serviços farmacêuticos suportados por IST em farmácia comunitária. Na segunda fase, foram realizadas entrevistas qualitativas com utentes de serviços de saúde. Estas duas fases informaram o desenho da plataforma web de suporte ao serviço, que foi o objetivo da terceira fase. De seguida, nas duas etapas seguintes, a plataforma web foi testada e a usabilidade avaliada através de um estudo de caso com utentes selecionados numa universidade sénior. Resultados: A partir do exercício de cenarização, foi possível identificar as incertezas críticas que serão os “motores da mudança” para os farmacêuticos comunitários. Estas são a “capacidade de inovar e desenvolver serviços” e o “ambiente legislativo”. Tanto no estudo observacional como no inquérito, verificou-se que todas as farmácias utilizam os IST para a dispensa de medicamentos e tarefas administrativas; apenas 15% das farmácias respondentes usam os IST para responder a questões de saúde dos utentes; 50% do tempo diário do farmacêutico é despendido em interação com os utentes da farmácia e 38% em tarefas administrativas. Em média, os farmacêuticos observados têm 54 minutos de tempo livre por dia, maioritariamente em micropausas distribuídas pelo dia de trabalho. Os custos calculados para os serviços farmacêuticos observados foram muito semelhantes nas três farmácias. O custo médio do serviço de dispensa de medicamentos foi de €3,66 e do serviço de aconselhamento €1,34. Dos utentes entrevistados, 46% admitiram que procuraram o farmacêutico para informações sobre questões de saúde ligeiras antes de ir a um médico, enquanto a entrega de medicamentos ao domicílio foi o novo serviço mais solicitado. Na fase de demonstração da plataforma, verificou-se que o registo, monitorização e armazenamento de dados bioquímicos e fisiológicos, tanto pelo utente como pelo farmacêutico, contribuiu para aumentar o interesse comum na gestão da doença, o que poderá permitir uma melhoria nos resultados da saúde. Na avaliação de usabilidade, verificou-se a necessidade de melhorar o acesso rápido à informação, bem como a vi necessidade de melhorar a legibilidade da informação para melhorar a experiência de utilização dos utentes seniores. Conclusão: Atualmente, o uso de IST nas farmácias comunitárias portuguesas está principalmente focado na dispensa de medicamentos. Parece existir uma necessidade de reorganização interna das farmácias de forma a permitir aumentar a eficiência da prestação de serviços farmacêuticos e permitir a prestação de serviços farmacêuticos de eHealth. Para os serviços farmacêuticos de eHealth estarem mais integrados no modelo de negócio atual, é necessário melhorar o marketing do serviço, de forma a aumentar o recrutamento de utentes e demonstrar o valor do serviço para os doentes crónicos e médicos. A qualidade e usabilidade da plataforma eHealth é fundamental. No entanto, também o acompanhamento por um profissional de saúde e a integração dos serviços farmacêuticos com os cuidados de saúde primários são importantes para uma melhor gestão da doença. A DSRM demonstrou ser útil no desenvolvimento e implementação de serviços de eHealth, proporcionando um maior envolvimento dos utilizadores, aumentando a utilidade percebida do serviço. No próximo ciclo de DSRM, vão ser necessários os inputs de médicos de cuidados primários e outros profissionais de saúde, de modo a desenvolver um novo artefacto, para testar e avaliar o valor clínico e económico dos serviços farmacêuticos eHealth.Background: Chronic diseases are the main cause of mortality throughout Europe. The increasing prevalence of chronic diseases is leading to the necessity of health system reforms. These reforms address chronic-disease management based on multidisciplinary teams, with major roles for non-physicians, such as nurses and community pharmacists (CP). A cornerstone on every multidisciplinary model is the communication between stakeholders, for which the use of Information Systems and Technologies (IST) is increasingly indispensable. It is of importance to science and society to understand how IST supported services – eHealth - could be developed and used to address the challenges and constrains of future health systems. Aim: The main goal of this project was to design, implement and evaluate a disease management web-based interactive pharmaceutical service, within a community pharmacy setting, using Design Science Research Methodologies (DSRM). Methods: The application of DSRM six stages’ is described, from the definition and characterization of the problem to the evaluation of the artefact. The first stage consisted of a scenario exercise, a time and motion observational study and an online survey, to assess future roles for community pharmacists and current pharmaceutical services provision supported by IST in community pharmacy. In the second stage, qualitative interviews with health services’ users were performed. These two stages helped to inform the design of the web-platform, which was the goal in the third stage. After this, the web-platform was tested and the usability evaluated in the two following stages, through a case study with selected patients from the participant pharmacies and from a senior university. Results: The scenario exercise allowed to identify the critical uncertainties that will be the drivers of change for the Community Pharmacists. These were found to be the “Ability to develop Services”, and the “Legislative Environment”. From both the survey and observational study, it was found that pharmacies’ IST is mainly used for dispensing medicines and administrative tasks with only 15% of the respondent pharmacies using IST to answer patients’ queries; 50% of pharmacists daily time is spent with patients, 38% on administrative tasks, while still having an average of 54 minutes of idle time spread through the day, mainly in micro-pauses. The overall costs of Pharmaceutical services across three pharmacies were found to be very similar, with the average dispensing service cost at €3.66 and €1.34 for the counselling service; 46% of the interviewed users admitted that they sought healthcare provision with the CP for minor issues before going to a physician, while home delivery was the most requested new service. In the demonstration stage, we found that the registration, monitoring and storage of biochemical and physiological data, recorded by the CP and the patients in the platform, contributed to a common interest that may allow an improvement in patients’ health outcomes. From the usability evaluation, concerns about the quick access to information were perceived as well as the need to improve legibility, addressing senior users’ difficulties. Conclusion: The current state of IST usage in Portuguese community pharmacies is mainly focused on medicine dispensing. There seems to exist a need for internal reorganization of pharmacies allowing for more efficient pharmaceutical services provision and to enable eHealth pharmaceutical services provision. To make eHealthpharmaceutical services more integrated in the current pharmacy daily business, marketing efforts need to be done, to recruit and demonstrate value to the chronic patients and physicians. The quality and usability of the web-based platform is critical, as is the close professional follow-up and integration of pharmacy and primary care services focused in disease management. DSRM helps in developing and implementing eHealth services through a higher involvement of the stakeholders, increasing the perceived usefulness of the service. The next DSRM cycle will need to use the input of primary care physicians and other health professionals in order to develop an artifact to test and evaluate the clinical and economic value of eHealth pharmaceutical services

Orsa Rural Hotel: business plan

Serves the present report as a tool to financially evaluate the possibility of building a new, luxury, sustainable and differentiated Rural 5-Star Hotel in Guia, Albufeira. The conclusions taken from this business plan are elaborated and supported in accordance with a pertinent existent literature review about the related issues, based in an intense market and industry research as well as the assessment of the consumers’ preferences and perceptions towards the construction of a rural hotel of this type. The marketing plan designed gathers all the vital resources required for a project like this. Furthermore, it contains a detailed description with all the steps and processes to follow, the development of the adequate strategy and the legal information framework that clarifies the questions and documents to be addressed in the report. Financially, the edification of the Orsa Rural Hotel is classified as viable, with a Net Present Value of 470 438.28 €, an Internal Return Rate of 17.1% and a Payback Period inferior to 8 years. Subsequently, the familiar company José António Catuna & Filhos Lda should advance with the project.Serve o presente business plan como ferramenta para analisar a possibilidade de construção de um novo, luxuoso, sustentável e diferenciado hotel rural de 5 estrelas na região da Guia, Albufeira. As conclusões que advêm deste relatório são devidamente fundamentadas e elaboradas de acordo com a revisão da literatura existente sobre os tópicos relacionados com esta temática, baseadas ainda numa pesquisa de Mercado, da indústria e das preferências e percepções dos consumidores relativamente a uma unidade hoteleira rural deste género. O plano de marketing delineado inclui todas as componentes necessárias para a realização de um projeto desta envergadura e contém, para lá de uma detalhada descrição de todos os processos e passos a seguir, da formulação de uma estratégia adequada assim como ínumeras informações relativas ao enquadramento legal do negócio. Financeiramente, a construção do "Orsa Rural Hotel" é considerada como viável, tendo como Valor Atualizado líquido de 470 438.28 €, uma Taxa Interna de Rentabilidade de 17.1% e um Payback Period inferior a 8 anos. Assim sendo, a empresa José António Catuna & Filhos Lda deve avançar com o projeto

Social and environmental determinants, household food insecurity

Food security is defined as a situation that exists when “all people, at all times, have physical and economic access to sufficient, safe and nutritious food to maintain a healthy and active life. It is a multilevel concept, which includes four main dimensions: availability related to food supply; accessibility in order to ensure the physical and economic access to food; adequacy to meet nutritional needs in quantity and quality while respecting individual food preferences and cultural issues (utilization); and, lastly, stability of the guarantee of food security over time. According to the food security definition, it is abroad concept where all these dimensions are largely affected by a considerable number of factors related to: public policies of different sectors, food production/industry/distribution food systems, marketing and advertising of food, social support networks and individual determinants related to food choice behaviour

Ultrathin electronic tattoos (e-tattoo) for on-skin sensing

Wearable devices, specifically noninvasive attached on skin, provide a very versatile mean of acquiring physiological information about the human body, such as humidity, pH, heartbeat (electrocardiograms) and temperature, as well as are capable of transdermal stimulation and therapeutics. A key challenge in wearable devices, consist in a mismatch between the soft, curvilinear and dynamic skin, and the rigid and fragile silicon wafer-based electronics. Nor- mally, the interfaces between skin and devices are insecure and can severally limit the func- tionality of the wearable devices, as well as increase the amount of motion artifacts and signal to noise ratio. Temporary electronic tattoos (e-tattoos) are an attractive platform for fabricating skin worn and body compliant wearable devices. These e-tattoos allow wearable sensors to mimic the structure of the skin, and conform very well when attached, due to its elasticity properties, while maintaining good sensing performances. In this project, we explore the versatility and advantages of using different polymeric membranes, such as polyimides and parylene for the fabrication of temporary e-tattoos with sensing devices. Additionally, as a proof of concept, we fabricated a wearable and skin confor- mal e-tattoo for temperature sensing. The produced polyimide with aluminum sensors pre- sented resistances of 49.5 Ω and 114.4 Ω and TCR values of 0.0017 ºC-1 for both sensors. The polyimide with gold sensors achieved resistance values of 61.4 Ω and 142.3 Ω with TCR values of 0.0015 ºC-1 and 0.0017 ºC-1. The parylene with gold sensor presented a resistance of 26.4 Ω and TCR of 0.0015 ºC-1.Dispositivos vestíveis, especificamente não-invasivos em contacto com a pele, apresen- tam um método bastante versátil para adquirir informação fisiológica sobre o corpo humano, tal como, humidade, pH, ritmo cardíaco e temperatura, e são também capazes de estimulação e terapia através da pele. Um dos maiores desafios destes dispositivos está na diferença entre a pele, suave e curvilínea, e a eletrónica baseada em bolachas, rígida e frágil. Normalmente, as interfaces entre pele e dispositivo são inseguras e podem limitar seriamente a funcionalidade do dispositivo, bem como podem aumentar os artefactos de movimento e o ratio sinal-ruído. Tatuagens eletrónicas temporárias são uma plataforma atrativa para o fabrico de dis- positivos vestíveis conformáveis à pele. Estas "e-tattoos" permitem ao sensor imitar a estrutura da pele, e conformam-se muito bem quando coladas à pele, devido às suas propriedades elás- ticas, mantendo boas performances sensoriais. Neste projeto, exploramos a versatilidade e vantagens do uso de diferentes membranas poliméricas, nomeadamente poliamida e parileno, para o fabrico de e-tattoos. Adicionalmente, com o uso destas membranas, provámos que é possível fabricar uma tatuagem vestível e con- formal, especificamente para sensor de temperatura. Os sensores de poliamida com aluminio apresentam resistências de 49,5 Ω e 114,4 Ω e valores de TCR de 0,0017 ºC-1 para ambos. OS sensores de poliamida com ouro apresentam resistências de 61,4 e 142,3 Ω com valores de TCR de 0,0015 ºC-1 e 0,0017 ºC-1. O sensor de parileno com ouro apresentou uma resistência de 26,41 Ω e TCR de 0,0015 ºC-1

Physicians and nurses professional relationship with criminal investigation in dealing with survivors of sexual abuse: a scoping review

Survivors of sexual abuse and their families seek help from criminal law enforcement agencies and health professionals to obtain justice and health care. Many communities have implemented multi-professional collaborative models so that the victim’s well-being is assured and the truth is established. However, there is a general lack of evidence on how to best articulate these teams with the healthcare professionals caring for the survivors. Therefore, this Scoping Review was conducted in order to analyze and to map the barriers and facilitators of the relationship between health professionals and the criminal investigation team in the care of survivors of sexual abuse. The methodology proposed by the Joanna Briggs Institute for Scoping Reviews was used, and the Bronstein five dimension model of interprofessional collaboration served as the basis for the analysis of barriers and facilitators. Quantitative, qualitative and mixed studies, primary and secondary sources, text and opinion documents were included. Content analysis was performed on the main findings of the collected studies. Twelve articles were identified and analyzed. Collaboration, communication, hierarchy, skills, confidentiality, and leadership emerged as key themes. Multidisciplinary Sexual Assault Nurse Examiner (SANE) and Sexual Assault Response Teams (SARTs) were implemented to coordinate care, but conflicting goals and values among professionals posed challenges. Communication failures and inadequate information sharing hindered collaboration. Neutral leaders who coordinate teams, minimize groupthink, and improve decision-making were found to be valuable. Engaging across disciplinary boundaries and addressing power dynamics were challenging but could be addressed through facilitation and conflict resolution. This review highlights the importance of effective collaboration and interaction within teams and with other professionals in the care of sexual abuse survivors.info:eu-repo/semantics/publishedVersio

The complex profiles of household food insecurity risk by BMI class: results from Portuguese family surveys (2011-2013)

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Collaborative learning experiences within the nutrition policy discipline in the nutritional sciences undergraduate students of Porto University

This paper describe and analyse the impact of an educational approach based on collaborative learning regarding a critical analyse of the new Portuguese Food and Nutrition Action Plan (PFNAP), into the students enrolled at Nutrition Policy (NP) course unit of Nutritional Sciences Undergraduate of University of Porto (UP). In our opinion this new educational approach ensure that students developed the necessary competencies to effectively meet the challenges of the public health nutrition practic

Atividade física e Saúde Pública : políticas e estratégias de ação intersectorial na promoção de health-enhancing physical activity (HEPA) em Portugal

RESUMO - INTRODUÇÃO: A promoção de health-enhancing physical activity (HEPA), entendida como atividade física para a saúde, revela-se um dos aspectos fulcrais do trabalho de ação intersectorial da saúde pública e um dos principais desafios atuais no combate a esta pandemia da inatividade física de consequências na saúde, económicas, ambientais e sociais. A inatividade física está identificada como sendo um dos fatores de risco que contribui largamente para a mortalidade global. Análises às abordagens políticas de promoção da atividade física para a saúde são importantes instrumentos de sistematização da informação relacionada com o estudo deste problema. OBJETIVOS: É objetivo deste estudo analisar políticas e estratégias de ação intersectorial na promoção da atividade física para a saúde em Portugal. Em específico, elencar e analisar: 1) principais políticas e estratégias atuais dos diferentes sectores; 2) consideração de qual é o papel do sector da saúde no assunto; 3) fatores-chave e critérios de sucesso para a implementação de políticas de promoção de HEPA. METODOLOGIA: Estudo qualitativo, descritivo e transversal, por meio de entrevistas semiestruturadas e abertas pelos sectores da saúde, educação, desporto, transportes/planeamento urbano e ação social; análise documental, relativamente aos últimos 3 anos, com análise de conteúdo quanto aos critérios de sucesso presentes. RESULTADOS: Foram encontradas várias categorias nas dimensões macroambiente, microambiente e individual dos determinantes da atividade física no trabalho dos diferentes sectores; o sector da saúde não foi habitualmente considerado como devendo proporcionar administração para a ação intersectorial neste domínio; foram identificados os critérios: com menor expressão no material analisado, aos quais é atribuída maior importância e aqueles com menor aplicabilidade nos documentos analisados. CONCLUSÕES: Não podemos afirmar que exista uma abordagem política/estratégica integrada de abrangência nacional, operacional, no que respeita à promoção da atividade física para a saúde. São limitadas as conclusões pelas características inerentes ao tipo de estudo desenhado, no entanto, pensamos ter contribuído para descrever as principais políticas e estratégias de ação intersectorial na promoção de HEPA em Portugal. Estudos mais abrangentes em termos de níveis de governação, sectores envolvidos e período temporal deverão ser desenvolvidos de forma a potenciar o desenvolvimento da atividade física e saúde pública.ABSTRACT - INTRODUCTION: Health-enhancing physical activity (HEPA) promotion appears to be one of the core businesses for public health intersectoral action work and one of the main current challenges in combating the physical inactivity pandemic which has health, economic, environmental and social consequences. Physical inactivity is identified as being a risk factor that contributes greatly to global mortality. Policy approaches’ content analysis to promote health-enhancing physical activity have been important information systematization tools for the study of this problem. AIM/OBJECTIVES: The aim of this study is to analyse policies and strategies for intersectoral action on health-enhancing physical activity promotion in Portugal. Specifically, to identify and analyse: 1) major current policies and strategies of the different sectors, 2) consideration of what is the role of the health sector in this issue; 3) key factors and success criteria for HEPA promotion policies implementation. METHODS: Qualitative descriptive and transversal study designed through semi-structured open interviews on health, education, sports, transportation / urban planning and social action sectors; the document analysis focused on the last three years, involving content analysis of the success criteria. RESULTS: Several categories of macroenvironment, microenvironment and individual dimensions of physical activity determinants were identified on different sectors work; the health sector was not usually considered to provide stewardship for intersectoral action in this area; success criteria were identified: with lower expression in the analyzed material; greater importance attribution and; those with less applicability in the documents analyzed. CONCLUSIONS: It is not possible to affirm that there is an operational national policy approach / integrated strategy, regarding health-enhancing physical activity promotion. Conclusions are limited by inherent study characteristics; however, we believe to have contributed to policies and strategies description for intersectoral action on national HEPA promotion. A governmental level comprehensive and extended period of time studies should be developed in order to improve physical activity and public health development

A Decade of Food and Nutrition Policy in Portugal (2010-2020)

For the first time, in 2012, the Portuguese Government, through the National Program for the Promotion of Healthy Eating of the Directorate-General for Health, implemented a set of concerted measures for improving the dietary habits, nutritional status and health of the population. Prior to, and since 2007, several epidemiological, social and political circumstances converged, for later enabling the development of a national strategy throughout the decade 2010-2020. This was also supported by specific international guidelines, namely from the World Health Organization and the European Commission. The national strategy objectives have been: (a) To increase the knowledge about the population's food consumption, its determinants and consequences; (b) to modify the access to certain food items specially in schools, workplaces and public spaces; (c) To inform and empower individuals regarding shopping, preparation and storage of healthy foods, especially amongst those most vulnerable or with a lower income; (d) to identify and promote actions capable of encouraging a healthier diet through the integration of other societal sectors, namely agriculture, sports, environment, education, social security and local authorities; and (e) to better capacitate different professionals who, owing to their roles, may influence nutritional knowledge, attitudes and behaviors. Several actions are described, including the creation of legislation to address these objectives. It is worth noting that one of the biggest challenges to this public policy has been the interventions within the environments where people live. By knowingly being central to food choice determinants, these environmental modifications were also where the stakeholders felt the greatest tensions and difficulties, but also where there are the greatest gains to be made. Solutions to overcome these problems and other perceived difficulties have been proposed here and are considered to be some of the main lessons and achievements throughout this process. (c) 2020 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health