Portuguese Journal of Public Health最新文献

After many years of being portrayed as a major achievement of the health service, child health in Portugal has recently come under scrutiny after an increase in infant deaths. Commentators have pointed to unequal access to healthcare and poorly monitored pregnancies of migrant mothers as possible causes. In this context, we revisit the socioeconomic determinants of children's health, reflecting on how various factors such as parental income and education, immigration, ethnicity, and social policies exert their influence on child health. Socioeconomic determinants have long been recognised, but their importance is often overlooked in the field of child health. The authors discuss theoretical approaches such as the worlds of influence framework proposed by UNICEF and consider various pathways through which socioeconomic determinants shape children's health, namely, the so-called material, psychological, behavioural, and structural pathways. The authors then move on to consider the empirical literature, drawing attention to factors such as life course, socioeconomic disadvantage, deprived neighbourhoods, poverty and income, household and family characteristics, parental education, ethnic diversity, and immigration. Finally, policy implications are considered, with the authors arguing that a multisectoral and coordinated approach, embracing both social and public health interventions, is required. Guaranteeing universal access to services that promote healthy early child development - including early childcare and education and efforts to reduce childhood poverty - is central to promoting equity. Classic public health policies, such as health surveillance and prevention programs, especially targeted at the preconception period, gestation, and childhood, are also important. In geographical areas with a strong immigrant presence, specific programs designed to facilitate integration should be available. If we are to improve child health and make sure that none are left behind, we need to focus attention on a broad range of socioeconomic determinants.

Background: The COVID-19 pandemic led to measures that conditioned the response of health services. More research is needed on what measures may be undertaken to promote the stability of general practitioners (GPs).

Objectives: The objective of this study was to describe a project taking place in a primary health care (PHC) unit in Lisbon at the beginning of 2022, aiming to monitor vulnerable populations, including children and pregnant women.

Method: A descriptive study design based on a case report was conducted.

Results: A rich internship field presented an opportunity to the training of future doctors specializing in Family Medicine and providing health services at the PHC level, which are considered essential in the Portuguese health system. Additionally, the problem of inequality in access to PHC is ameliorated, especially in a context with a high number of patients without an assigned GP.

Conclusions: Training of future doctors specializing in Family Medicine can be improved, and, at the same time, the problem of inequality in access to PHC is ameliorated. In order to lead a successful PHC, reform topics should be considered, such as the promotion of policies to retain professionals in the National Health Service.

Introduction: The World Health Organization's Well-Being Index (WHO-5) is a five-item scale designed to measure psychological well-being and is considered effective in detecting depressive symptoms. This scale was translated and validated in more than 30 languages and is used in clinical practice and research worldwide. In Portugal, validation of this scale has yet to be done. This study aimed to analyse the psychometric performance of the WHO-5 scale in the setting of a Portuguese adolescent population.

Methods: An observational cross-sectional survey-based study was carried out to assess the emotional state of adolescents resorting to the WHO-5 scale. A sample of 1,916 elementary and secondary school students from grades 7-12 was used.

Results: The WHO-5 median score was 17 [14-20], and the best scores were found in males (p < 0.001), in those with no health issues (p < 0.001), those who slept well (p < 0.001), those who practiced sports (p < 0.001), and those who had no difficulties making friends (p < 0.001). Results from the answers to the WHO-5 questionnaire showed good internal consistency with a Cronbach alpha value of 0.80, and a confirmatory factor analysis supported the unidimensional structure of the questionnaire, which was consistent with a valid scale for the study sample.

Conclusion: This study showed that the Portuguese version of the WHO-5 can assess psychological well-being in adolescents. The WHO-5 is a simple and readily useable scale that can be applied in routine consultations for screening the emotional state of adolescents and early detection of signs of mental health problems.

Introduction: Cancer is the second leading cause of death worldwide and its incidence has been increasing. It is estimated that almost half of all cancer cases could be prevented by lifestyles changes. Cancer knowledge may be key to addressing this growing trend. This study focused on health students and its primary objective was to evaluate students' knowledge and perceptions about cancer.

Methods: In this study, the tool "Students Knowledge and Perceptions about Cancer" was used to retrieve quantitative data about students' knowledge. Their perceptions were evaluated using a Likert scale that ranged from "Don't know" to "Know almost everything." This tool was shared on LinkedIn and Facebook, making the sampling method non-probabilistic.

Results and discussion: From a sample of 170 health students, 72.4% (123) got more than half of the questions right. Lung cancer is the topic with lower knowledge. Overall, there seems to be a positive statistically significant correlation between students' knowledge and their perceptions about their knowledge (p ≤ 0.05). Despite the satisfactory levels of general knowledge about cancer, there should be more campaigns that are appealing to students that emphasise prevention as a mean to reduce cancer incidence. There is still work to be done to have more awareness among health students, especially regarding risk behaviours and screenings related to cancer. New studies with more representative samples should be conducted.

Introduction: Digitalisation has made technologies an important vehicle for development and learning, especially for children and young people. However, multiple risks of excessive or inappropriate use have been described. This study aimed to characterise the use of screens in young Portuguese students and the association with perceived health problems in the Aveiro municipality.

Methods: A cross-sectional study was conducted between September 2019 and April 2020 on students enrolled in schools in the Aveiro municipality of Portugal through a questionnaire applied to 4th, 6th, and 8th graders. A descriptive analysis characterised the screen use, while logistic regressions were utilised to assess association with perceived health outcomes.

Results: Four of the 989 students who responded to the questionnaire (0.4%) reported not using any screen device. Around 57% of students reported not taking any device to school. Screen time spent during weekdays was associated with higher reduction in physical activity (adjOR = 2.54, p = 0.019). Receiving a device between 0 and 5 years old showed positive association with body pain (adjOR = 1.62, p = 0.034), and using screens at school was associated with more problems at home (adjOR = 2.04, p = 0.01). Screen use during meals and having screens in the bedroom during sleep were consistently associated with a more negative perception of health outcomes.

Discussion: Literature points to a multitude of possible health consequences regarding inadequate or excessive screen use, but most data are based on small samples and a limited number of observations. This is one of the first studies describing screen use among young schoolgoers in Portugal and the first using a big representative sample of Aveiro students. Our study gives some insight on the screen habits of young people in Portugal and demonstrates that some habits can have impact on important aspects such as physical activity, body pain, and family dynamics.

Conclusion: Screen use and screen habits have important consequences in multiple aspects of health. Systematic data collection on screen use and its impact on health, including mental health, among schoolgoers is essential, particularly to understand long-term effects and allow effective prevention strategies.

Background: Cost-effectiveness analyses of preventive screening strategies are paramount for public health to ensure effective resource use, especially for sexually transmitted infections such as Chlamydia, which lead to significant quality-adjusted life years (QALY) loss.

Summary: This study systematically reviewed EMBASE, PubMed, and SCOPUS databases, from inception to October 2022, Chlamydia infection screening strategies' cost-effectiveness studies analyzing Incremental Cost Effectiveness Ratio (ICER) of QALYs versus no screening. Out of 487 studies, six were included, each employing distinct screening approaches, assumptions, and prevalence and incidence rates. The ICERs varied from USD 2,350/QALY gained with annual screening of women aged 15-24 years to EUR 117,529/QALY gained with women and men screening (age 16-29).

Key messages: The results underscore the impact of the different assumptions on ICERs and highlight the importance of precise epidemiology on Chlamydia infections. Studies characterizing the local population are crucial for accurate cost-effectiveness analysis and public health policy formulation.

Introduction: Food insecurity, defined as limited or uncertain access to adequate food, is recognized as a public health problem linked to poor eating habits, chronic diseases, and social inequalities. This study aims to characterize and compare food insecurity status among immigrant and Portuguese populations receiving primary healthcare in Amadora.

Methods: A cross-sectional study was conducted based on interviews with individuals aged 18 and above, living in Amadora for at least 1 year. Sociodemographic and health status variables were collected, and food insecurity was assessed using a Portuguese-adapted version of the US Department of Agriculture Household Food Security Survey Module. Data analysis included binary logistic regression to explore the predictive capacity of variables, with food insecurity as the outcome.

Results: The estimated prevalence of household food insecurity was 29.7%, with 10.5% classified as severely food insecure. Single individuals (OR: 3.090; CI: 1.353-7.059), those with basic education (OR: 3.296; CI: 1.175-9.247); immigrants (OR: 4.358; CI: 2.206-8.611), households with three or more members (OR: 2.686; CI: 1.019-7.079), and incomes below EUR 1,100 (OR: 7.359; CI: 2.613-20.726) were more likely to belong to food insecure households. When Portuguese households were analyzed, low income (OR: 8.730; CI: 2.607-29.232) and smoking habits (OR: 3.375; CI: 1.345-8.469) were found to be potential determinants of food insecurity. As for immigrant households, being single (OR: 6.002; CI: 1.404-25.659), having a household with three or more members (OR: 13.953; CI: 2.119-91.887), and low income (OR: 7.110; CI: 1.257-40.226) increased the risk of food insecurity.

Conclusion: The results of this study show that food insecurity is significantly associated with sociodemographic and health factors, with differences between Portuguese and immigrant populations. Awareness of this problem and the need for monitoring should therefore be raised to prioritize community interventions.

Introduction: Recently, university counseling services have been faced with an increasing number of students seeking psychological support. However, human resources and time constraints limit the services to respond adequately. Recently, national guidelines for Mental Health Services in Higher Education recommended the stepped care approach to increase efficiency. The present study aimed to explore the implementation of a stepped care model in a Portuguese public university, analyzing students' sociodemographic and clinical characteristics, and presenting the flow of the stepped care approach and the students' waiting periods in each step.

Methods: An observational study was conducted in the University of Coimbra's health services between May 2019 and June 2021. Descriptive statistics were performed to describe the sociodemographic and clinical characteristics of the sample, the flow of the stepped care approach, and students' waiting periods.

Results: We enrolled 295 students in the present study. The findings of this study revealed that over 40% had a clinical diagnosis of anxiety or depressive disorders. In terms of students' flow within the stepped care model, 82% of students sought psychological help through self-referral. Concerning the implementation of the stepped care model, results have shown that most students wait less than a month to access each step.

Discussion/conclusions: Although preliminary, our results suggest that the stepped care model might be a useful service organization, mainly in a community in which accessibility to services and speed of response are particularly important. Most students being self-referred highlight the importance of direct contact between the university community and the health services. Additionally, anxiety and mood disorders were the most prevalent diagnoses in our sample, which also points to the relevance of a stepped care approach, since other studies have highlighted its advantages for this kind of clinical population.