National Policies and Territorial Cohesion

Since March 2020, the European Union has launched a wide range of initiatives to tackle the COVID‐19 pandemic, mainly through two complementary channels "through creating a new set of initiatives aimed specifically at resolving and or mitigating the effects of the pandemic in terms of public health, but also the resulting economic and social effects [and] by mobilizing a set of policies and public policy instruments to combat the effects of the pandemic, with the purpose of allocating resources to the new needs of the European economy and society” (Neto in Europa XXI J Regional Sci Territorial Policies 38:33–50, 2020). The main objectives of this chapter are: (i) to analyse the extent to which the new European rationale of policies to respond to the economic and social impacts of the pandemic, and in particular the European Recovery and Resilience Facility, enabled the emergence of a new generation of strategies and national public policies, which, within the framework of the great principles of the European Union that guide recovery, seek to provide specific answers to the way in which each member state was affected by the pandemic and how it conceives its recovery process;(ii) Carry out a comparative analysis of the intervention rationales of the Recovery and Resilience Plans (RRP) of a set of Member States;(iii) Evaluate how each of these RRPs establishes and/or foresees, or not, some model of articulation with the respective Partnership Agreements 2014–2020 and 2021–2027 of the Cohesion Policy;(iv) Analyse to what extent each RRP assumes or determines, or not, a territorialisation of its intervention. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Mental health impact of coronavirus disease 2019 pandemic on children with psychiatric disorder

Introduction: The first full lockdown due to the coronavirus pandemic in Portugal started in March 2020 and sent home every child, only to return to school in September the same year. Children are thought to cope harder with this pandemic, but little is known about those already struggling with psychiatric conditions. Methods: We interviewed parents of 196 children in psychiatric follow-up in Clínica da Encarnação, a child psychiatry unit, Centro Hospitalar Universitário Lisboa Central, and reported their perception of the impact of the lockdown on the mental health of their children, as well as on their families. Results: The parents reported a slight deterioration of their children condition and symptomatology, particularly irritability and anxiety. We identified several important fragility factors such as female gender, lower school grade, higher daily screen time, lower housing quality, parental precarious job situation, parental psychiatric disorder, pharmacologic treatment, and shorter follow-up time. We also found some resilience factors such as coronavirus disease 2019 cases in the family and school failure, as well as male gender and shorter daily screen time. The parents who reported a deterioration of familial conflicts also reported a worse lockdown impact on their children psychiatric condition. Discussion: Our findings suggest a heterogeneous impact on these children’s psychiatric symptomatology. Efforts should be made towards prevention along with interventions. The fragility and resilience factors identified should help direct these interventions. © 2022, Portuguese Society of Paediatrics. All rights reserved.

Anti-spike antibody responses in hemodialyzed patients vaccinated with anti-COVID-19 BNT162B2 mRNA vaccine

Background: Patients under hemodialysis are at higher risk of developing severe complications upon SARS-CoV-2 infection and were prioritized in the Portuguese vaccination campaign. Methods: We performed a longitudinal analysis of antibody responses upon vaccination with BNT162b2 mRNA (Pfizer/BioNTech, Comirnaty) in a cohort of 156 hemodialyzed patients. Direct ELISA was used to quantify IgG, IgM and IgA anti-fulllength Spike antibody levels against calibrated sera from naturally infected patients at three points: day of the first vaccine dose (t0);3 weeks later (day of the second dose, t1), and 3 weeks after the second inoculation (t2) for 143/156 patients. Anti-n was also measured in t0 and patients anti-n positive were excluded. Results: We observed that 90.9% of the patients developed anti-spike IgG antibodies after the second vaccine dose (t2). Seroconversion was remarkably low at t1 after the first vaccine dose with only 29.4% of patients developing anti-spike IgG antibodies. In addition to positivity, the second vaccine dose markedly increased IgG antibody levels. IgA levels were also higher at t2 with 83.9% of the patients achieving positivity while IgM positivity only reached 29.4%. Age showed a significant negative effect on the humoral response at t2 for anti-Spike IgG and for IgM, particularly over 60 years. Further analysis revealed that nine patients under immunosuppression therapies showed significantly lower humoral response along the vaccine schedule (p=0.005 at t1;p=0.008 at t2). Interestingly, the inability to develop anti-HBs antibodies upon hepatitis B vaccination frequently found in hemodialyzed patients was not correlated with lack of responsiveness to SARS-CoV-2 vaccination. Conclusions: The large majority hemodialyzed patients showed a significant humoral response to BNT162b2 mRNA vaccination, but a sizable proportion of patients showed low antibody levels when compared to responses in the general population (medRxiv 2021.03.19.21253680).

Use of personal protective equipment when providing vaginal delivery care in times of COVID-19

Introduction. In December 2019, in Wuhan, China, there was an outbreak of atypical pneumonia caused by the SARS-CoV-2 virus, which is a type of coronavirus causative of COVID-19, which overtime became a pandemic. In this context, the use of personal protective equipment is of special interest, especially when providing care in vaginal delivery, due to the confusion in obstetric circles regarding the best way to protect healthcare personnel in these cases. The objective of this review article is to identify which are the personal protective elements indicated for providing care in vaginal birth and their correct use during COVID-19. Division of Covered Topics. A narrative review of the literature was carried out, accessing the following databases: PubMed, Medline, Elsevier, Google Scholar, and websites such as the World Health Organization (WHO), Center for the Control and Prevention of Diseases (CDC), and the American College of Obstetricians and Gynecologists, among others. Keywords such as "Coronavirus Infections", "Normal Birth", Personal Protective Elements", "Healthcare Personnel", "Respiratory Protective Devices", and "Eye Protection Devices" were used. The literature allowed us to identify introductory aspects on the matter, epidemiology, general characteristics of personal protective elements, and the specific elements for correct use when providing care in vaginal birth. Conclusions. Labor is considered an aerosol-generating procedure. Therefore, the main recommendation is the use of an N95 mask or a respirator which allows for greater protection for healthcare personnel when assisting vaginal birth, in order to avoid infection due to SARS-CoV-2. However, there must be an adequate and complete use of personal protective equipment, such as surgical gowns, hats, eye protection and gloves, regardless of the patient's symptomatology.