Health literacy, a more complex concept than knowledge, is a required capacity to obtain, understand, integrate and act on health information [1], in order to enhance individual and community health, which is defined by different levels, according to the autonomy and personal capacitation in decision making [2]. Medium levels of Health literacy in an adolescent population were found in a study conducted in 2013/2014, being higher in sexual and reproductive health and lower in substance use. It was also noticed that the higher levels of health literacy were in the area adolescents refer to have receipt more health information. The health literacy competence with higher scores was communication skills, and the lower scores were in the capacity to analyze factors that influence health. Higher levels were also found in younger teenagers, but in a higher school level, confirming the importance of health education in these age and development stage. Adolescents seek more information in health professionals and parents, being friends more valued as a source information in older adolescents, which enhance the importance of peer education mainly in older adolescents [3]. As a set of competences based on knowledge, health literacy should be developed through education interventions, encompassing the cultural and social context of individuals, since the society, culture and education system where the individual is inserted can define the way the development and enforcement of the health literacy competences [4]. The valued sources of information should be taken into account, as well as needs of information in some topics referred by adolescents in an efficient health education. Schizophrenia is a serious and chronic mental illness which has a profound effect on the health and well-being related with the well-known nature of psychotic symptoms. The exercise has the potential to improve the life of people with schizophrenia improving physical health and alleviating psychiatric symptoms. However, most people with schizophrenia remains sedentary and lack of access to exercise programs are barriers to achieve health benefits. The aim of this study is to evaluate the effect of exercise on I) the type of intervention in mental health, II) in salivary levels of alpha-amylase and cortisol and serum levels of S100B and BDNF, and on III) the quality of life and selfperception of the physical domain of people with schizophrenia. The sample consisted of 31 females in long-term institutions in the Casa de Saúde Rainha Santa Isabel, with age between 25 and 63, and with diagnosis of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Physical fitness was assessed by the six-minute walk distance test (6MWD). Biological variables were determined by ELISA (Enzyme-Linked Immunosorbent Assay). Psychological variables were assessed using SF-36, PSPP-SCV, RSES and SWLS tests. Walking exercise has a positive impact on physical fitness (6MWD -p = 0.001) and physical components of the psychological test...

The COVID-19 pandemic has forced policy makers to decree urgent confinements to stop a rapid and massive contagion. However, after that stage, societies are being forced to find an equilibrium between the need to reduce contagion rates and the need to reopen their economies. The experience hitherto lived has provided data on the evolution of the pandemic, in particular the population dynamics as a result of the public health measures enacted. This allows the formulation of forecasting mathematical models to anticipate the consequences of political decisions. Here we propose a model to do so and apply it to the case of Portugal. With a mathematical deterministic model, described by a system of ordinary differential equations, we fit the real evolution of COVID-19 in this country. After identification of the population readiness to follow social restrictions, by analyzing the social media, we incorporate this effect in a version of the model that allow us to check different scenarios. This is realized by considering a Monte Carlo discrete version of the previous model coupled via a complex network. Then, we apply optimal control theory to maximize the number of people returning to “normal life” and minimizing the number of active infected individuals with minimal economical costs while warranting a low level of hospitalizations. This work allows testing various scenarios of pandemic management (closure of sectors of the economy, partial/total compliance with protection measures by citizens, number of beds in intensive care units, etc.), ensuring the responsiveness of the health system, thus being a public health decision support tool.

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Introduction:The urinary tract infections, after respiratory infections, are the most common in the community. The knowledge about the prevalence of microbial strains and their antibiotic susceptibility is crucial to establish an effective empirical therapy. The aim of this study was to determine the antibiotic susceptibility patterns of bacterial strains isolated from positive urine cultures performed in patients from the central region of Portugal. Material and Methods:We carried out a documental analysis of 6008 urine bacteriological exams, to be made available to physicians, most of which run through the automated system VITEK 2, bioMérieux. The majority (80%) of the urine bacteriological exams were from female. Escherichia coli was the most prevalent bacterial pathogen (65.9%), followed by Klebsiella spp (12%). Results: Nitrofurantoin showed high levels of activity (96%) for Escherichia coli, as well as Fosfomycin (96.6%). Amoxicillin-clavulanic acid presents an activity level of only 81.1% for the same germ. Quinolones exhibit efficacy to only 78% of the strains of Escherichia coli, below the Fosfomycin and Nitrofurantoin. Nitrofurantoin showed high levels of activity (96%) for E. coli as well as Fosfomycin (96.6%). Amoxicillin-Clavulanic Acid presents a level of activity of only 81.1% for the same germ. The quinolones have a efficacy for only 78% of strains of E. coli, lower than Fosfomycin. Discussion: Escherichia Coli was the most prevalent uropathogen (65.9%). High efficacy against this pathogenic agent was found for Fosfomycin (96.6%) and Nitrofurantoin (96%). Conclusion:Further antimicrobial surveillance studies should be developed, in order to formulate local empirical therapy recommendations for optimized therapeutical choices.

ResumoEnquadramento: A utilização dos serviços de urgência (SU) por situações não urgentes constitui uma preocupação a nível nacional e mundial. Objetivos: Avaliar as características sociodemográficas e o acesso ao SU por utentes não urgentes e identificar os fatores que motivam a sua procura. Metodologia: Neste estudo transversal recorreu-se a uma entrevista e à consulta dos processos clínicos eletrónicos de 357 doentes triados como não urgentes num SU de um hospital português seguindo-se uma amostragem acidental. Resultados: Os utentes da amostra são maioritariamente do sexo feminino, de meia-idade, com reduzidas habilitações literárias, que recorrem ao SU, sobretudo no período diurno e por iniciativa própria. Os motivos mais referenciados foram: A minha doença justifica a ida à urgência (91,7%) e Posso realizar os exames todos no mesmo dia (65,6%). A maioria dos utentes (87,9%) teve alta clínica, sendo que 84,9% dos utentes tem acesso ao médico de família. Conclusão: Foram identificados múltiplos determinantes do acesso ao SU, permitindo apontar sugestões que visam uma utilização racional dos cuidados de saúde.Palavras-chave: serviços médicos de emergência; serviços de saúde; assistência ao paciente; adulto AbstractBackground: The use of the emergency department (ED) for non-urgent situations is a source of concern, both at the national and international levels. Objectives: To assess the sociodemographic characteristics and ED use of non-urgent patients and to identify the reasons for non-urgent ED use. Methodology: This cross-sectional study used patient interviews and the electronic medical records of 357 patients triaged as non-urgent at a Portuguese hospital ED, using an accidental sampling technique. Results: The majority of patients were women, middle-aged, and had a low education level; most of them used the ED during the day and on their own initiative. The most common reasons were: My disease justifies ED use (91.7%) and I can undergo all medical examinations on the same day (65.6%). The majority of patients (87.9%) were discharged, and 84.9% had access to a family doctor. Conclusion: Multiple determinants of non-urgent ED use were identified. Some recommendations were put forward to improve the rational use of healthcare services.

RESUMO -Introdução:As feridas são um problema de saúde pública, com forte impacto na qualidade de vida. Consideram--se crónicas as que evoluem durante mais de seis semanas. As feridas crónicas mais frequentes são as de pressão, as vasculares e as de origem diabética, sendo as venosas cerca de 80% das vasculares. O presente estudo tem como objetivo caracterizar as feridas crónicas dos doentes da área de influência do Agrupamento de Centros de Saúde do Pinhal Litoral (ACeS PL). Material e Métodos: Trata-se de um estudo descritivo, com uma componente analítica, e transversal, com uma amostra de conveniência constituída pelos doentes com ferida crónica, identificados pelos profissionais de enfermagem, quer no domicílio, quer nas salas de tratamento dos centros de saúde. Resultados: A prevalência de feridas crónicas na população estudada é 0,84/1000, sendo 1,01/1000 no sexo masculino e 0,69/1000 no feminino (p < 0,05). Os doentes com mais de 80 anos apresentam uma prevalên-cia de 5,68/1000, que é mais elevada relativamente aos mais novos (p < 0,05). Em relação ao tipo de feridas, as de causa vascular são as mais frequentes (36%) e, destas, 77,7% são de origem venosa. Discussão e Conclusão: A taxa de prevalência de ferida crónica é ligeiramente inferior à encontrada noutros estudos que utilizam a mesma metodologia, sendo mais elevada nos homens e nas idades mais avançadas. Considera-se excessiva a proporção de úlceras de pressão das categorias III e IV, verificando-se algumas inconformidades no diagnóstico e tratamento das mesmas. Por isso, foi sugerida a criação de um grupo multidisciplinar de consultadoria e formação em feridas no serviço de saúde. PALAVRAS-CHAVE -Doença Crónica; Ferimentos e Lesões, Portugal; Prevalência. Characteristics and Prevalence of Chronic Wounds in

We recommend systematic evaluation of job satisfaction in contracting regimens, similarly to user satisfaction.

(1) Background: Evidence shows that facilitated advance decisions can increase the number of meaningful and valid Advance Care Directives (ACDs) and improve the quality of care when End-Of-Life (EOL) is near. Little is known about the awareness and attitudes of Portuguese adults towards ACDs. The present study aims to assess the knowledge, attitudes, and preferences of a sample of Portuguese adults regarding EOL care decisions and ACDs. (2) Methods: A total of 1024 adults were assessed with an online cross-sectional survey collecting information on sociodemographic factors, knowledge, attitudes and preferences regarding advance decisions and EOL care. (3) Results: Participants had a mean age of 40.28 ± 11.41 years. Most were female and had a professional background related to healthcare. While 76.37% of participants had heard of ACDs, only a small percentage (2.34%) had actually ever made an ACD. Knowledge levels were weakly correlated with attitudes regarding ACDs (r = −0.344; p < 0.01). (4) Conclusions: Participants lacked a comprehensive understanding about ACDs, but revealed positive attitudes towards their use and usefulness. Further research can inform efforts to improve ACD engagement in this population. The discussion about ACDs should be part of health promotion education with a focus on planning for a comfortable and peaceful death.