Introduction: Since December 2019, more than 925,000 cases of COVID-19 have been reported worldwide, 8,251 cases in Portugal by the end of March. Previous studies related to the SARS pandemic showed a decrease up to 80% in the emergency care episodes. Hence, the objective of this study is to analyze the use of emergency services during the first pandemic month, compared to historical records. Methods: Data from emergency episodes in mainland Portugal, from January 2014 to March 2020, were downloaded from the National Health Service (NHS) Transparency Portal and the NHS monitoring website. The evolution of emergency services from March to September 2020 was forecasted based on historical data from January 2014 to February 2020. Information for March 2020 was forecasted globally, by the Regional Health Administration (RHA) and Manchester Triage System (MTS). Results: Compared with forecasted values, there was a 48% reduction in the number of emergency episodes in March 2020. In the analysis by the RHA, Alentejo had the smallest decrease in the number of episodes; interestingly, Alentejo is also the area with fewer CO-VID-19 cases in mainland Portugal. In the analysis by the MTS, the episodes classified as yellow showed the highest reduction (50%). For episodes classified as urgent, there is a difference of about 144,000 episodes during March 2020. Discussion: The results of this preliminary study are aligned with the evidence produced for previous pandemics. Data about the use of emergency services, demographic and clinical characteristics of the episodes would be relevant to analyze this reduction. Conclusion: There was a significant drop in the number of emergency service use in March 2020, and although the causes of this reduction are not determined, the association between the beginning of the pandemic and the reduction of demand is evident. Understanding this phenomenon is crucial to plan interventions to avoid unnecessary morbidities or deaths, caused by a delayed visit to the emergency department.

Background Despite the significant body of evidence on the efficacy and cost-effectiveness of internet interventions, the implementation of such programs in Portugal is virtually non-existent. In addition, Portuguese psychologists’ use and their attitudes towards such interventions is largely unknown. Objective The aim of this study was to explore Portuguese psychologists’ knowledge, training, use and attitudes towards internet interventions; to investigate perceived advantages and limitations of such interventions; identify potential drivers and barriers impacting implementation; and study potential factors associated to previous use and attitudes towards internet interventions. Methods An online cross-sectional survey was developed by the authors and disseminated by the Portuguese Psychologists Association to its members. Results A total of 1077 members of the Portuguese Psychologists Association responded to the questionnaire between November 2018 and February 2019. Of these, 37.2% (N=363) were familiar with internet interventions and 19.2% (N=188) considered having the necessary training to work within the field. 29.6% (N=319) of participants reported to have used some form of digital technology to deliver care in the past. Telephone (23.8%; N=256), e-mail (16.2%; N=175) and SMS (16.1%; N=173) services were among the most adopted forms of digital technology, while guided (1.3%; N=14) and unguided (1.5%; N=16) internet interventions were rarely used. Accessibility (79.9%; N=860), convenience (45.7%; N=492) and cost-effectiveness (45.5%; N=490) were considered the most important advantages of internet interventions. Conversely, ethical concerns (40.7%; N=438), client’s ICT illiteracy (43.2%; N=465) and negative attitudes towards internet interventions (37%; N=398) were identified as the main limitations. An assessment of participants attitudes towards internet interventions revealed a slightly negative/neutral stance (Median=46.21; SD=15.06) and revealed greater acceptability towards blended treatment interventions (62.9%; N=615) when compared to standalone internet interventions (18.6%; N=181). Significant associations were found between knowledge (χ24=90.4; P<.001), training (χ24=94.6; P<.001), attitudes (χ23=38.4; P<.001) and previous use of internet interventions and between knowledge (χ212=109.7; P<.001), training (χ212=64.7; P<.001) and attitudes towards such interventions, with psychologists reporting to be ignorant and not having adequate training in the field, being more likely to present more negative attitudes towards these interventions and not having prior experience in its implementation. Conclusions This study revealed that most Portuguese psychologists are not familiar with and have no training or prior experience using internet interventions and had a slightly negative/neutral attitude towards such interventions. There was greater acceptability towards blended treatment interventions compared to standalone internet interventions. Lack of knowledge and training were identified as the main barriers to overcome, underlining the need of promoting awareness and training initiatives to ensure internet interventions successful implementation.

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BackgroundInternet-delivered interventions can provide remarkable opportunities in addressing breast cancer survivors' unmet support care needs, as they present an effective strategy to improve care coordination and provide access to efficacious, cost-efficient and convenient survivorship care. Nevertheless, research focusing on improving survivors' psychosocial needs using internet-based tools is scarce and its practical implementation is limited.ObjectivesTo study the acceptability, feasibility, efficacy and cost-effectiveness of iNNOVBC, a 10 weeks guided internet-delivered individually-tailored Acceptance and Commitment Therapy (ACT)-influenced cognitive behavioural (CBT) intervention developed to improve mild to moderate anxiety and depression in Breast cancer survivors when compared to treatment as usual (TAU) in a waiting list control group (WLC).MethodsA two-arm, parallel, open label, multicentre, waiting list randomized controlled trial will be conducted to investigate the efficacy and cost-effectiveness of INNOVBC. The primary outcomes in this research will be anxiety and depression. Secondary outcomes will include psychological flexibility, fatigue, insomnia, sexual dysfunction and Health Related Quality of Life (HRQoL).Ethical approvalThis study has been reviewed and approved by Comissão Nacional de Proteção de Dados; Instituto Português de Oncologia do Porto Francisco Gentil; Unidade Local de Saúde de Matosinhos, EPE; Centro Hospitalar de São João and Ordem dos Psicólogos ethical committees.Expected resultsIt is anticipated that iNNOVBC will show to be an efficacious and cost-effective program in improving the outcomes of interest in this study, as opposed to a WLC under TAU. The results of this research will be published in accordance with CONSORT-EHEALTH guidelines.ConclusionsThis study will inform on the acceptability, feasibility, efficacy and cost-effectiveness of iNNOVBC, in improving psychosocial outcomes in breast cancer survivors when compared to TAU in a WLC. Its conclusions will contribute to understand the idiosyncrasies of designing and implementing internet-delivered interventions in breast cancer survivors.Trial Registration code: INNOVBC (NCT03275727).

PurposeGeneric instruments to assess health utilities can be used to express the burden of health problems in widely used indexes. That is in contrast with what can be obtained with condition-specific instruments, outcomes are very specific and difficult to compare across conditions. The purpose of this study was to assess health and visual outcomes and its determinants in patients with visual impairment (VI) using the EQ-5D-3L and the Activity-inventory (AI). MethodsParticipants were recruited in different hospitals during the PCVIP-study. A total of 134 patients with acuity 0.30 logMAR or less in the better eye were interviewed. The AI includes 46 goals split between three objectives: social functioning, recreation and daily living, was used to measure visual ability. The EQ-5D consists of five questions covering one domain each and was used to provide a measure of health states. Responses to each domain were combined to produce a single individual index.ResultsThe AI and the EQ-5D-3L showed enough discriminatory power between VI levels (p<.001) and their results were strongly correlated r(134)=.825, (p<.001). Explanatory factors for visual ability were level of VI in better eye, age and gender, R 2 =.43, (p<.001). Explanatory factors for the EQ-5D-3L were level of VI in the better eye, comorbidities and gender, R 2 =.36, (p<.001). ConclusionsOur results showed that the EQ-5D-3L is useful when characterizing the burden of VI and to compute, when necessary, quality-adjusted-life-years (QALY) changes due to VI. However, is important to consider that the EQ-5D-3L uses a coarse response scale, assesses a limited spectrum of domains and is influenced by comorbidities. This might limit its responsiveness to small changes in visual ability.