Cebus flavius is a recently rediscovered species and a candidate for the 25 most endangered primate species list. It was hypothesized that the distribution of C. flavius was limited to the Atlantic Forest, while the occurrence of C. libidinosus in the Rio Grande do Norte (RN) Caatinga was inferred, given its occurrence in neighboring states. As a result of a survey in ten areas of the RN Caatinga, this paper reports on four Cebus populations, including the first occurrence of C. flavius in the Caatinga, and an expansion of the northwestern limits of distribution for the species. This C. flavius population may be a rare example of a process of geographic distribution retraction, and is probably the most endangered population of this species. New areas of occurrence of C. libidinosus are also described. Tool use sites were observed in association with reports of the presence of both capuchin species.

During the COVID-19 pandemic, the temporary closure of physical activity and sports facilities, and the generalized cancellation or postponement of sports events have a massive impact on social and economic development. In this study, we explored the feasibility of using tracking data from a football match to assess interpersonal contact between individuals by calculating two measures of respiratory exposure. The dynamic tracking positioning of all players and referees during one international football match was analyzed. For each individual, two measures of respiratory exposure were calculated, based on the 2 m interpersonal distance recommendations for contact tracing for COVID-19 control. Overall, individuals spent a median of 0.12 mm:ss (IQR = 0.45 mm:ss) exposed to interpersonal contact of fewer than 2 m from others. The highest value of exposure was observed between two players of opposing teams (6.35 mm:ss). The results suggest that tracking data can be used to assess respiratory exposure to interpersonal contact in team sports, such as football. The measures of exposure calculated can be used to the prompt identification of high-risk contacts of COVID-19 cases during a match or a training session, but also the risk stratification of different sports and physical activities.

Portugal has faced an economic and financial crisis that began circa FY2009 and whose effects are still ongoing. In FY2011, the Portuguese state and the European triumvirate – composed of the European Commission, the International Monetary Fund, and the European Central Bank – signed the Memoranda of Understanding. This troika agreement aimed to improve the operational efficiency of public services. This crisis had a considerable impact on the Portuguese citizens’ life and productivity, as well as on the public health care system. Cuts over public expenditures have been made to reduce the risk of noncompliance with budgetary targets, despite their potential impact on quality and access to health care services. We analyzed the main policies and measures undertaken by the Portuguese Ministry of Health with respect to the bailout program associated with the troika agreement. Then, we focused on the budgetary cuts–related risks over the social performance of the care system. Evidence suggests that structural reforms in the health care sector in the troika period had positive effects in terms of drugs administration and consumption, on the one hand, and secondary care expenditures reduction, on the other hand. Nonetheless, we observed some divestitures on infrastructures and the worsening of access to health care services.

The drivers of high prevalence of non-communicable diseases (NCD) among migrants are well-documented. Health literacy is regarded as a potential tool to reduce health inequalities and improve migrant's access to and quality of health care. Yet, little is known about the health literacy needs among these groups and how to address them. This paper outlines the protocol for a migrant community-based co-design project that seeks to optimize health literacy, health promotion, and social cohesion in support of prevention of NCDs among migrants in Lisbon using the OPtismizing HEalth LIteracy and Access (Ophelia) process. This participatory implementation research project starts with a mixed-methods needs assessment covering health literacy strengths, weaknesses and needs of migrants, and local data about determinants of health behaviors, service engagement, and organizational responsiveness. Diverse migrant groups will be engaged and surveyed using the Health Literacy Questionnaire and questions on sociodemographic and economic characteristics, health status, use of health services, and perceived impact of the COVID-19 pandemic. Semi-structured interviews with migrants will also be conducted. Based on data collected, vignettes will be developed representing typical persons with diverse health literacy profiles. Migrants and stakeholders will participate in ideas generation workshops for depth co-creation discussions in simulated real-world situations based on the vignettes, to design health literacy-based multisectoral interventions. Selected interventions will be piloted through quality improvement cycles to ensure ongoing local refinements and ownership development. Through a genuine engagement, the project will evaluate the uptake, effectiveness and sustainability of the interventions. This protocol takes a grounded approach to produce evidence on real health literacy needs from the perspective of key stakeholders, especially migrants, and embodies strong potential for effective knowledge translation into innovative, locally relevant, culturally and context congruent solutions for prevention of NCDs among migrants. Given the diverse communities engaged, this protocol will likely be adaptable to other migrant groups in a wide range of contexts, particularly in European countries. The scale-up of interventions to similar contexts and populations will provide much needed evidence on how health literacy interventions can be developed and applied to reduce health inequality and improve health in diverse communities.

Background: The role of demographic and socio-economic determinants of COVID-19 transmission is still unclear and is expected to vary in different contexts and epidemic periods. Exploring such determinants may generate a hypothesis about transmission and aid the definition of prevention strategies. Objectives: To identify municipality-level demographic and socio-economic determinants of COVID-19 in Portugal. Methods: We assessed determinants of COVID-19 daily cases at 4 moments of the first COVID-19 epidemic wave in Portugal, related with lockdown and post-lockdown measures. We selected 60 potential determinants from 5 dimensions: population and settlement, disease, economy, social context, and mobility. We conducted a multiple linear regression (MLR) stepwise analysis (p < 0.05) and an artificial neural network (ANN) analysis with the variables to identify predictors of the number of daily cases. Results: For MLR, some of the identified variables were: resident population and population density, exports, overnight stays in touristic facilities, the location quotient of employment in accommodation, catering and similar activities, education, restaurants and lodging, some industries and building construction, the share of the population working outside the municipality, the net migration rate, income, and renting. In ANN, some of the identified variables were: population density and resident population, urbanization, students in higher education, income, exports, social housing buildings, production services employment, and the share of the population working outside the municipality of residence. Conclusions: Several factors were identified as possible determinants of COVID-19 transmission at the municipality level. Despite limitations to the study, we believe that this information should be considered to promote communication and prevention approaches. Further research should be conducted.

Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. ABSTRACT Aims:The excess demand for pediatric emergency services has caused much concern among health professionals and hospital administrators. The aim of this study was to assess the utilization of a pediatric emergency department and to determine whether its use was injudicious. Methods: Retrospective cross-sectional analysis of all emergency cases treated throughout 2012 in a general hospital located in the metropolitan area of Lisbon, Portugal. The data were obtained from the hospital's computer information system. Each patient was submitted at admission to the Manchester triage system adapted for Portugal, and the episodes were categorized into immediate, very urgent, urgent, standard, nonurgent, and not classified. All those episodes classified as standard and non-urgent were denoted as unjustified urgent episodes. The data were collected anonymously and analyzed by the IBM SPSS Statistics software using the chi-square test and one-way ANOVA at a 5% significance level (p<0.05). Results: We analyzed 37,099 pediatric emergency department episodes, of which 19,478 patients were male (53%), the median age was 4 years (interquartile range of 1-9 years), and 78.4% were up to 10 years old. Of all the episodes, 21,177 (57.1%) were classified as standard and 15,470 (41.6%) as urgent or very urgent. Of these patients, 27,294 (73.6%) used the emergency department during the week and 28,679 (77.3%) between 10 a.m. and 12 a.m. It was found that in 90.8% of very urgent, 97.1% of urgent, and 99.4% of standard episodes, patients were discharged without the need for hospitalization. Conclusions: More than half of the children who used the pediatric emergency department had standard or non-urgent needs, and almost all of them were discharged with follow-up recommendations by the attending physician. Most of the episodes occurred during opening hours of primary healthcare centers.

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RESUMOO sistema de saúde português tem sido caraterizado pela existência de uma permanente relação entre o setor público e o setor privado tanto na prestação como no financiamento dos cuidados de saúde. Nas últimas décadas, ao nível da prestação de cuidados o setor privado aumentou significativamente a sua capacidade de resposta ampliando o seu nível de envolvimento na relação com o setor público. Esta relação decorre do enquadramento jurídico definido na Lei de Bases da Saúde desenvolvendo-se sob a forma de acordos, convenções e contratos bem como, mais recentemente, através do modelo de parcerias-público privadas. No que se refere ao caso específico da rede hospitalar esta nova dinâmica de relação contribuiu, nas últimas duas décadas, para acentuar a natureza mista do sistema através de um evidente reforço da componente privada na rede hospitalar particularmente através do investimento em unidades de âmbito generalista. Palavras-chave: Hospitais; Serviço Nacional de Saúde; Parcerias Público-Privadas;Portugal; Sector Privado; Sector Público. ABSTRACTThe Portuguese health system has been characterized by the existence of a constant relationship between public and private sector, both in providing and financing health care. In recent decades, the private sector increased their responsiveness of care, extending the engagement in the relationship with the public sector. This relationship stems from the legal framework set out in the law, developing agreements, conventions and more recently through the model of public-private partnerships. In hospital network, this new dynamic relationship contributed, in the last two decades, to accentuate the mixed characteristics of the system, through a clear strengthening of the private component in the hospital network, particularly by investing in differentiated units. Keywords: Hospitals; National Health Service Portugal; Private Sector; Public Health; Public-Private Sector Partnerships. INTRODUÇÃOO sistema de saúde, em Portugal carateriza-se por uma cobertura universal (em termos da população servida) e geral (em termos das especialidades oferecidas), de matriz predominante pública, integrando financiamento e prestação repartida por três segmentos fundamentais -cuidados hospitalares, cuidados de saúde primários e cuidados continuados integrados. Apesar da presença dominante, ao ní-vel do financiamento e da prestação, mantida desde a criação do Serviço Nacional de Saúde (SNS), a participação do setor privado, nos últimos anos, tem vindo a ser crescente nos diferentes níveis do financiamento e da prestação de cuidados. 1No âmbito da combinação público-privada têm sido múl-tiplos os mecanismos de cooperação entre os dois setores. No essencial podem ser distinguidos dois tipos de relação: um de natureza complementar -em que os cidadãos recorrem a prestadores privados mediante acordo estabelecido com os serviços públicos -e outro de substituição, em que há lugar à utilização dos serviços privados por iniciativa própria. Em qualquer das situações o objetivo é garantir o acesso ao...