It is critical to develop tailored strategies to increase acceptability of the COVID-19 vaccine and decrease hesitancy. Hence, this study aims to assess and identify factors associated with COVID-19 vaccine hesitancy in Portugal. We used data from a community-based survey, “COVID-19 Barometer: Social Opinion”, which includes data regarding intention to take COVID-19 vaccines, health status, and risk perception in Portugal from September 2020 to January 2021. We used multinomial regression to identify factors associated with intention to delay or refuse to take COVID-19 vaccines. COVID-19 vaccine hesitancy in Portugal was high: 56% would wait and 9% refuse. Several factors were associated with both refusal and delay: being younger, loss of income during the pandemic, no intention of taking the flu vaccine, low confidence in the COVID-19 vaccine and the health service response during the pandemic, worse perception of government measures, perception of the information provided as inconsistent and contradictory, and answering the questionnaire before the release of information regarding the safety and efficacy of COVID-19 vaccines. It is crucial to build confidence in the COVID-19 vaccine as its perceived safety and efficacy were strongly associated with intention to take the vaccine. Governments and health authorities should improve communication and increase trust.

Non-adherence to antibiotics is common in the community setting. Factors related to the antibiotic, the patient, and the patient-physician relationship should be addressed to promote adherence. Pharmacists should provide information to patients about correct use of antibiotics and address barriers to adherence.

BackgroundEstimates of the burden of maternal morbidity are patchy.ObjectiveTo conduct a systematic review of systematic reviews of maternal conditions to: (1) make available the most up‐to‐date frequency estimates; (2) identify which conditions do not have reliable estimates; and (3) scrutinize the quality of the available reviews.Search strategyWe searched Embase, MEDLINE, and CINAHL, combining terms for pregnancy, frequency (e.g. prevalence, incidence), publication type, and specific terms for each of 121 conditions.Selection criteriaWe included peer‐reviewed systematic reviews aiming to estimate the frequency of at least one of the conditions in WHO's list of maternal morbidities, with estimates from at least two countries.Data collection and analysisWe present the frequency estimates with their uncertainty bounds by condition, region, and pregnancy/postpartum period. We also assess and present information on the quality of the systematic reviews.Main resultsOut of 11 930 found, 48 reviews were selected and one more was added. From 49 reviews we extracted 34 direct and 60 indirect frequency estimates covering 35 conditions. No review was available for 71% of the conditions on the WHO list. The extracted estimates show substantial maternal morbidity, spanning the time before and beyond childbirth. There were several gaps in the quality of the reviews. Notably, one‐third of the estimates were based only on facility‐based studies.ConclusionsGood‐quality systematic reviews are needed for several conditions, as a research priority.

PurposePre‐licensure studies have limited ability to detect rare adverse events (AEs) to vaccines, requiring timely post‐licensure studies. With the increasing availability of electronic health records (EHR) near real‐time vaccine safety surveillance using these data has emerged as an option. We reviewed methods currently used to inform development of similar systems for countries considering their introduction.MethodsMedline, EMBASE and Web of Science were searched, with additional searches of conference abstract books. Questionnaires were sent to organizations worldwide to ascertain unpublished studies. Eligible studies used EHR and regularly assessed pre‐specified AE to vaccine(s). Key features of studies were compared descriptively.ResultsFrom 2779 studies, 31 were included from the USA (23), UK (6), and Taiwan and New Zealand (1 each). These were published/conducted between May 2005 and April 2015. Thirty‐eight different vaccines were studied, focusing mainly on influenza (47.4%), especially 2009 H1N1 vaccines. Forty‐six analytic approaches were used, reflecting frequency of EHR updates and the AE studied. Poisson‐based maximized sequential probability ratio test was the most common (43.5%), followed by its binomial (23.9%) and conditional versions (10.9%). Thirty‐seven of 49 analyses (75.5%) mentioned control for confounding, using an adjusted expected rate (51.4% of those adjusting), stratification (16.2%) or a combination of a self‐controlled design and stratification (13.5%). Guillain‐Barré syndrome (11.9%), meningitis/encephalitis/myelitis (11.9%) and seizures (10.8%) were studied most often.ConclusionsNear real‐time vaccine safety surveillance using EHR has developed over the past decade but is not yet widely used. As more countries have access to EHR, it will be important that appropriate methods are selected, considering the data available and AE of interest. © 2016 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd.

Background: Knowledge on the settings and activities associated with a higher risk of SARS-CoV-2 transmission is essential to inform decision-making. We thus designed a case-control study to identify relevant settings for community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Portugal.Methods: We evaluated 1,088 cases, identified through the national surveillance system, and 787 community controls, recruited using random digit dialing. Sociodemographic characteristics, individual protective measures, and activities or visited settings were obtained through telephone interview. We report sex-, age-, education-, and citizenship-adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).Results: Household overcrowding (aOR = 1.47; 95% CI 1.14–1.91) and work in senior care (4.99; 1.30–33.08) increased while working remotely decreased the risk of infection (0.30; 0.22–0.42). Going to restaurants/other dining spaces (0.73; 0.59–0.91), grocery stores (0.44; 0.34–0.57) or hair salons (0.51; 0.39–0.66), or the use of public transportation did not present a higher risk of infection (0.98; 0.75–1.29), under existing mitigation strategies. Lower education ( ≤ 4 years vs. tertiary education: 1.79; 1.33–2.42) and no Portuguese citizenship (5.47; 3.43–9.22) were important risk factors.Conclusions: The utilization of public transportation, restaurants, and commercial spaces was not associated with increased risk of infection, under capacity restrictions, physical distancing, use of masks, and hygiene measures. Overcrowding, foreign citizenship, low education and working on-site were positively associated with SARS-CoV-2 infection.

An aero-structural design and analysis study of a telescopic wing with a conformal camber morphing capability is presented. An aerodynamic analysis of a telescoping wing, first with a high speed airfoil followed by an analysis with a low speed airfoil is performed. The data obtained from these analyses is used to determine the optimum polar curves for drag reduction at different speeds. This information in turn provided the background for devising an optimal morphing strategy for drag reduction assuming that the telescoping wing airfoil has the capability to step morph between the high and low speed airfoils. Next, a conformal camber morphing concept is introduced. The concept is based on a non-uniform thickness distribution along the chord of a wing shell section that deforms from a symmetrical airfoil shape into a cambered airfoil shape under actuation. Structural optimization based on finite element models is used to obtain the shell thickness distribution for minimum shell section weight and best airfoil shape adjustment. Finally, a comparison study between the performance of an aircraft equipped with a morphing wing (telescopic wing combined with conformal camber morphing) and the performance of the same aircraft equipped with an optimized fixed wing for 30 m/s cruise speed and 100 N weight is presented. Aerodynamic optimization based on computational fluid dynamics models is used for the optimum fixed wing geometric parameters calculations. The optimal wing configurations for various performance parameters are calculated. The morphing wing generally outperforms the optimum fixed wing with the exception of a 10% reduction in rate of climb and 4% drag penalty at 30 m/s cruise speed.

Context To assess the real impact of human-made structures on bird and bat communities, a significant number of carcass-removal trials has been performed worldwide in recent decades. Recently, researchers have started to use camera traps to record carcasses exact removal time and better understand the factors that influence this event. Aims In our study, we endeavoured to identify the factors that significantly affect carcass-persistence time, such as (1) season, (2) scavenger guild, (3) type of carcass, (4) habitat and (5) weather conditions. Additionally, we aimed to assess the performance of camera-trapping technology in comparison to the conventional method typically used in carcass-removal trials. Methods We conducted two trials in two wind farms during early spring and during summer season. In each trial, we used 30 bird carcasses and 30 mice carcasses as surrogates for bats. Digital infrared camera traps were used to monitor each carcass. Chi-squared test was used to investigate differences between wind farms regarding the scavenger guild. A log-rank test was used to compare carcass-persistence times for both wind farms. Carcass-persistence times were analysed using both non-parametric and parametric survival models. Finally, we evaluated the percentage of carcasses removed during the day time and night time. Key results In our study area, carcass-persistence times were influenced by the scavenger guild present and by the exposure to rain. Camera traps allowed to record the exact removal time for the majority of the carcasses, reducing the number of visits to the study site about five times. However, there were also cases wherein loss of data occurred as a result of equipment flaws or camera theft. Conclusions Results demonstrated the importance of undertaking site-specific carcass-removal trials. Use of camera-trap methodology is a valid option, reducing displacement costs. Costs related to equipment purchase and the risk of camera theft should be taken into consideration. Implications When choosing camera-trapping, the main aspect to evaluate is the balance between the investment in equipment purchase and the cost savings through reduced displacement costs. Further studies are required concerning the real effects of the data collected on the accuracy of carcass-removal correction factor obtained.

The COVID-19 pandemic has resulted in changes in healthcare use. This study aimed to identify factors associated with a patient’s decision to avoid and/or delay healthcare during the COVID-19 pandemic. We used data from a community-based survey in Portugal from July 2020 to August 2021, “COVID-19 Barometer: Social Opinion”, which included data regarding health services use, risk perception and confidence in health services. We framed our analysis under Andersen’s Behavioural Model of Health Services Use and utilised Poisson regression to identify healthcare avoidance associated factors. Healthcare avoidance was high (44%). Higher prevalence of healthcare avoidance was found among women; participants who reported lower confidence in the healthcare system response to COVID-19 and non-COVID-19; lost income during the pandemic; experienced negative emotions due to physical distancing measures; answered the questionnaire before middle June 2021; and perceived having worse health, the measures implemented by the Government as inadequate, the information conveyed as unclear and confusing, a higher risk of getting COVID-19, a higher risk of complications and a higher risk of getting infected in a health institution. It is crucial to reassure the population that health services are safe. Health services should plan their recovery since delays in healthcare delivery can lead to increased or worsening morbidity, yielding economic and societal costs.