The Portuguese NHS 2024 reform: transformation through vertical integration.

Vertical integration models aim for the integration of services from different levels of care (e.g., primary, and secondary care) with the objective of increasing coordination and continuity of care as well as improving efficiency, quality, and access outcomes. This paper provides a view of the Portuguese National Health Service (NHS) healthcare providers' vertical integration, operationalized by the Portuguese NHS Executive Board during 2023 and 2024. This paper also aims to contribute to the discussion regarding the opportunities and constraints posed by public healthcare organizations vertical integration reforms. The Portuguese NHS operationalized the development and generalization of Local Health Units management model throughout the country. The same institutions are now responsible for both the primary care and the hospital care provided by public services in each geographic area, in an integrated manner. This 2024 reform also changed the NHS organic and organizational structures, opening paths to streamline the continuum of care. However, it will be important to ensure adequate monitoring and support, with the participation of healthcare services as well as community structures and other stakeholders, to promote an effective integration of care.

Influenza A virus propagation requires the activation of the unfolded protein response and the accumulation of insoluble protein aggregates.

Influenza A virus (IAV) employs multiple strategies to manipulate cellular mechanisms and support proper virion formation and propagation. In this study, we performed a detailed analysis of the interplay between IAV and the host cells' proteostasis throughout the entire infectious cycle. We reveal that IAV infection activates the inositol requiring enzyme 1 (IRE1) branch of the unfolded protein response, and that this activation is important for an efficient infection. We further observed the accumulation of virus-induced insoluble protein aggregates, containing both viral and host proteins, associated with a dysregulation of the host cell RNA metabolism. Our data indicate that this accumulation is important for IAV propagation and favors the final steps of the infection cycle, more specifically the virion assembly. These findings reveal additional mechanisms by which IAV disrupts host proteostasis and uncovers new cellular targets that can be explored for the development of host-directed antiviral strategies.

The hidden RNA code: implications of the RNA epitranscriptome in the context of viral infections.

Emerging evidence highlights the multifaceted roles of the RNA epitranscriptome during viral infections. By modulating the modification landscape of viral and host RNAs, viruses enhance their propagation and elude host surveillance mechanisms. Here, we discuss how specific RNA modifications, in either host or viral RNA molecules, impact the virus-life cycle and host antiviral responses, highlighting the potential of targeting the RNA epitranscriptome for novel antiviral therapies.

Association between Musculoskeletal Injuries and Depressive Symptoms among Athletes: A Systematic Review.

Musculoskeletal (MSK) injuries have a significant physical and psychological influence on an athlete's life. A systematic review of prospective cohort, cross-sectional, and case-control studies was undertaken in this study to analyze the association between MSK injuries with depressive symptoms in athletes. We searched on PubMed, Web of Science, and Scopus, with data inception to 15 February 2023. The methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Of the 3677 potential studies only nine were included. These studies showed a bidirectional association between MSK injuries and depressive symptoms. Athletes with MSK injuries had higher levels of depressive symptoms, which raises the likelihood of experiencing depression in the future. Women athletes had higher levels of depressive symptoms compared with men. The presence of depressive symptoms is a significant predictor of disability in athletes. Our findings suggest that coaches should be more aware of depressive symptoms, in order to prevent MSK injuries, and to monitor athletes following an MSK injury.

Consumo de antibióticos em regime ambulatório: panorama português 2015-2018

A resistência a antibióticos torna-se cada vez mais um problema preocupante em matéria de saúde pública. O elevado consumo de antibióticos para fins terapêuticos e profiláticos, nomeadamente quando usados inadequadamente, é um dos fatores que mais promove a resistência a agentes antimicrobianos. O presente trabalho tem por objetivo analisar a evolução do consumo de antibióticos em Portugal continental estimado a partir da prescrição médica e é expresso em DDD, forma agrupada por região, com destaque para alguns distritos, entre 2015 e 2018. Trata-se de um estudo observacional e descritivo que tem por base dados da Autoridade Nacional do Medicamento e Produtos de Saúde, I.P (Infarmed). Como principais resultados se verificou que o consumo total de antibióticos no período 2015-2018 variou entre 71.613.882,21 DDD e 73.143.461,37 DDD, o que representa um crescimento de a 2,1%, crescendo assim o uso de beta-lactâmicos (J01C), sulfonamidas (J01E), macrólidos (J01F), aminoglicosídeos (J01G) e outras antibactérias (J01X). Destaca-se ainda uma grande redução do uso de quinolonas (J01M) com -18% e uma redução mais discreta das tetraciclinas (J01A) em 3,1%. Como principais conclusões verificou-se um aumento do uso de antibióticos no ambulatório em Portugal com um pico de consumo que alcançou 75.660.771,43 DDD em 2017. No ano seguinte registou-se uma redução do consumo em 3,3%, dando sinais de uma trajetória descendente. Contudo, o valor em 2018 apesar da redução é ainda elevado, sendo por isso necessário reforçar a promoção do uso racional dos antibióticos junto dos utentes e de cada médico prescritor.

A Critical Analysis of Decentralizing the Portuguese Public Healthcare Provision Services.

The Portuguese health system has a universal, public, general National Health Service (NHS), tending towards free healthcare access. Created in 1979, this delivery model developed from the integration and complementarity between the different response levels (primary, hospital, continuing, and palliative care). However, over the last 40 years, the initially centralized system underwent a decentralization process with the creation of Regional Health Administrations in the five mainland administrative regions. Since then, the entire NHS has settled around this new organization. The most recent step started in 2018 with the decentralization of primary healthcare skills to 190 municipalities. This paper presents the various critical issues involved in the latest gradual decentralization process in health, intending to bring services closer to the citizens, and to be more focused on their needs. The article identifies and discusses the implications of this experience based on the steps foreseen in the already-published legal texts.

Modeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation study.

Background: Excessive salt consumption-associated with a range of adverse health outcomes-is very high in Portugal, and bread is the second largest source. Current Portuguese legislation sets a maximum limit of 1.4 g salt per 100 g bread, but imported and traditional breads are exempted. In 2017 the Ministry of Health proposed reducing the salt threshold to 1.0/100 g by 2022, however the legislation was vetoed by the European Commission on free-trade grounds. Aims: To estimate the health impact of subjecting imported and traditional breads to the current 1.4 g threshold, and to model the potential health impact of implementing the proposed 1.0 g threshold. Methods: We gathered bread sales, salt consumption, and epidemiological data from robust publicly available data sources. We used the open source WHO PRIME modeling tool to estimate the number of salt-related deaths that would have been averted in 2016 (the latest year for which all data were available) from; (1) Extending the 1.4 g threshold to all types of bread, and (2) Applying the 1.0 g threshold to all bread sold in Portugal. We used Monte Carlo simulations to generate confidence intervals. Results: Applying the current 1.4 g threshold to imported and traditional bread would have averted 107 deaths in 2016 (95% CI: 43-172). Lowering the current threshold from 1.4 to 1.0 g and applying it to all bread products would reduce daily salt consumption by 3.6 tons per day, saving an estimated 286 lives a year (95% CI: 123-454). Conclusions: Salt is an important risk factor in Portugal and bread is a major source. Lowering maximum permissible levels and removing exemptions would save lives. The European Commission should revisit its decision on the basis of this new evidence.

Surgical sterilization of free-ranging capybaras (Hydrochoerus hydrochaeris): "Passos Nunes" uterine horn ligature.

Capybaras are the primary hosts of Amblyomma sculptum tick, vectors of Rickettsia rickettsia bacteria, and the zoonotic agent of Brazilian Spotted Fever (BSF). In this context, contraceptive methods have been suggested for population control in order to reduce the number of free-ranging capybaras cohabiting with humans in urban and rural areas and acting as disease amplifiers. To maintain the group's expected behavior and social hierarchy, sterilization techniques that preserve the gonads are recommended. On 126 female capybaras in the Brazilian state of São Paulo, a new surgical technique named "Passos Nunes" uterine horn ligature was performed after adequate general anesthesia. It achieved effective surgical sterilization, with an incision length of about 3 cm in the periumbilical linea alba, cranial to the pubis. After entering the abdominal cavity, the urinary bladder is pulled laterally to access the uterine horns and the cervix. The uterine horn is folded up, forming a strap; the distal portion of the strap is ligated and its distal end sectioned. The exact process is performed on the opposite horn. After the surgical procedure, the musculature is sutured in a sultan pattern and the subcutaneous tissue with a horizontal mattress pattern. The skin is sutured in a separate simple format, using nylon 2.0 for all steps. The wide exposure of the uterine horns facilitates the confirmation of pregnancy, allowing the surgeon to choose between salpingo hysterectomy or ligature of the uterine horns. The present study presents a new technique of surgical sterilization that can be used in female free-ranging mammals in which maintenance of the gonads is recommended, and births of offspring should not occur.

Medicamentos genéricos em Portugal: estudo de avaliação do conhecimento dos utentes / Generic drugs in Portugal: a study to evaluate users' knowledge

O início da comercialização de medicamentos genéricos em Portugal ocorreu em 1990 (Decreto-Lei 81/90) e tinha por objetivo reduzir custos, mantendo a eficácia terapêutica. O presente estudo tem por objetivo avaliar o grau de conhecimento dos portugueses relativamente ao medicamento genérico e sua utilização. Trata-se de um estudo analítico com recolha de dados baseada na aplicação de um questionário aplicado a 300 utentes do SNS residentes nas cinco regiões de Portugal. A informação foi tratada com recurso ao Software: Excel® e SPSS®. Como principais resultados, a grande maioria (95%) dos inquiridos consumiu medicamentos genéricos (MG). No entanto, apenas 45% os define corretamente e os restantes apresentam dúvidas relativas à sua eficácia quando comparada com medicamentos de marca. Quanto à distribuição geográfica os utentes residentes na região Norte e do Alentejo estão mais familiarizados com o conceito e consumo, ao contrário dos utentes residentes na região Centro e no Algarve. Relativamente à prescrição, 52% referem que os seus médicos promovem a prescrição de MG, 35% referem que na farmácia já substituíram medicamentos de marca por genéricos e 22% referem que substituíram um genérico por outro. Quanto ao preço, todos reconhecem que os medicamentos genéricos têm menor custo, sendo para 70% dos inquiridos um importante fator que prevalece no momento da dispensa. Por fim, concluiu-se que o conhecimento dos utentes sobre o medicamento genérico é positivo, mas ainda restam dúvidas na população quanto à eficácia do mesmo, sendo necessárias mais ações de sensibilização junto da população.

Utilização de medicamentos genéricos em Portugal: conhecimento de doentes, médicos e farmacêuticos / Use of generic drugs in Portugal: perceptions and attitudes by patients, physicians and pharmaceuticals

O medicamente genérico tem uma maior importância na promoção da sustentabilidade dos sistemas de saúde. O presente estudo pretende analisar o conhecimento relativo à dispensa de medicamento genérico e sua substituição na perspectiva do utente (consumidor), médico (prescritos) e farmacêuticos (agentes que dispensam e recomendam da substituição). Como método foram aplicados três questionários foram elaborados (um para utentes, outro para médicos e outro para farmacêuticos). Os resultados foram analisados por modelos de análise estatística realizadas com recurso ao SPSS versão 26.0. Assim se verificou que todos os 300 utentes entrevistados conheciam ou já tinham ouvido falar em medicamentos genéricos apresentando um entendimento correto associado ao seu nível de escolaridade e influenciado pelo médico e farmacêutico. Por seu lado, 85% médicos entrevistados confirmam que têm promovido o medicamento genérico juntos dos seus utentes e 90% dos farmacêuticos referiram que recomendam a substituição de medicamentos de marca por genéricos. Concluiu-se assim que embora a quota de medicamentos genéricos tenha crescido em período de austeridade, é ainda necessário divulgar mais a informação incentivando a opção e a adesão terapêutica dos utentes aos medicamentos genéricos.

Vertical integration in healthcare: What does literature say about improvements on quality, access, efficiency, and costs containment?

INTRODUCTION: Vertical integration models involve integrating services from different levels of care (e.g., primary care, acute care, post-acute care). Therefore, one of their main objectives is to increase continuity of care, potentially improving outcomes like efficiency, quality, and access or even enabling cost containment. OBJECTIVES: This study conducts a literature review and aims at contributing to the contentious discussion regarding the effects of vertical integration reforms in terms of efficiency, costs containment, quality, and access. METHODS: We performed a systematic search of the literature published until February 2020. The articles respecting the conceptual framework were included in an exhaustive analysis to study the impact of vertical integration on costs, prices of care, efficiency, quality, and access. RESULTS: A sample of 64 papers resulted from the screening process. The impact of vertical integration on costs and prices of care appears to be negative. Decreases in technical efficiency upon vertical integration are practically out of the question. Nevertheless, there is no substantial inclination to visualise a positive influence. The same happens with the quality of care. Regarding access, the lack of available articles on this outcome limits conjectures. CONCLUSIONS: In summary, it is not clear yet whether vertically integrated healthcare providers positively impact the overall delivery care system. Nevertheless, the recent growing trend in the number of studies suggests a promising future on the analysis of this topic.

Nutri-Score: The Most Efficient Front-of-Pack Nutrition Label to Inform Portuguese Consumers on the Nutritional Quality of Foods and Help Them Identify Healthier Options in Purchasing Situations.

Several studies have identified Front-of-Pack Nutrition Labels (FoPLs) as a promising strategy to improve the nutritional quality of consumers' food choices and encourage manufacturers to offer healthier products. This study aims to fill the evidence gap regarding the most effective FoPL among the Portuguese population. In total, 1059 Portuguese participants were recruited through a web panel provider and asked to declare their intended food choices and to rank three sets of products (pizza, cakes and breakfast cereals) according to their nutritional quality, first in the absence of any labelling, and then with a FoPL displayed on-pack (five FoPLs tested). Finally, participants were asked to answer nine statements related to perceptions of FoPLs. Results showed that participants improved their food choices, depending on the FoPL and the food category. All FoPLs led to a higher percentage of correct responses on the ranking task compared to the no label condition. The Nutri-Score was among the FoPLs producing the greatest improvement across all food categories compared to the reference intakes (OR = 6.45 [4.43-9.39], p-value < 0.0001) and facilitating the highest percentage to correctly rank products according to nutritional quality. This study suggests that, among the available options, Nutri-Score is the most efficient FoPL to inform Portuguese consumers of the nutritional quality of foods and help them identify healthier options in mock purchasing situations.

Bedside clinical tests to assess sensitization in office workers with chronic neck pain.

OBJECTIVE: This study aimed to assess pain sensitization in individual office workers with chronic neck pain through simple bedside quantitative sensory tests (QST) and to associate the findings with pain intensity and pain catastrophizing. METHODS: One hundred-and-four office workers with chronic neck pain were assessed using pressure pain threshold (PPT) considering pain sensitive if PPTs were lower than 155 kPa in the upper trapezius and 245 kPa in the tibialis anterior. Pain sensitive to temporal summation of pain (TSP) was considered if there was a difference of two points in the visual analogue scale (VAS) comparing the first and last stimulus. Pain sensitive was considered to conditioned pain modulation (CPM) if the CPM-effect was less than -7.5%. Pain intensity and catastrophizing were measured using VAS and with the Pain Catastrophizing Scale. RESULTS: There was at least one pain sensitive QST finding in 66 office workers (63.5%). TSP findings were the most common (48.1%), followed by PPT's (31.7%) and CPM (20.2%). Based on the QST findings, office workers were divided based on the number of individual QST findings, and higher pain intensity and pain catastrophizing scores were found in office workers with one (N = 38, P < 0.05) or two (N = 28, P < 0.05) compared with office workers with no QST findings (N = 38). CONCLUSION: This study demonstrated that most office workers with chronic neck pain exhibit either widespread pressure hyperalgesia, facilitated TSP or impaired CPM, indicating pain sensitization within the central nervous system. This was associated with increased clinical pain and pain catastrophizing rumination scores.

Pressure pain thresholds in office workers with chronic neck pain: A systematic review and meta-analysis.

OBJECTIVES: The purpose of this study was to (a) compare pressure pain threshold (PPT) values between office workers with chronic neck pain and asymptomatic controls; (b) establish reference PPT values in chronic neck pain; and (c) evaluate associations between PPTs and pain intensity, and disability. METHODS: Seven English/Portuguese databases were searched for relevant literature. Studies investigating adult office workers (age >18 years) with chronic neck pain were included if PPTs were an outcome. The risk of bias was assessed using the Downs and Black checklist. Meta-analysis was conducted if a cluster contained at least two studies reporting the same PPTs. RESULTS: Ten high quality, two low quality, and one poor quality studies were included. The meta-analysis revealed decreased PPT values in the upper trapezius, extensor carpi ulnaris, and tibialis anterior in office workers with chronic neck pain when compared with healthy workers, without a statistical difference (p > 0.05). The PPT reference value in the upper trapezius was 263 kPa (95% confidence interval [CI] = 236.35 to 289.70), and 365 kPa (95% CI = 316.66 to 415.12) for the tibialis anterior in office workers with chronic neck pain. No correlations were found between the upper trapezius PPT and pain intensity and disability. CONCLUSION: This meta-analysis found that all the PPT measurements were not significantly reduced in office workers with chronic neck pain compared with healthy workers. These assumptions were based on a small sample of existing studies, and therefore further studies are necessary to quantify the differences in PPTs. Hypersensitivity PPT reference values are proposed for localized and extrasegmental sites in office workers with chronic neck pain.

Sensitization in office workers with chronic neck pain in different pain conditions and intensities.

OBJECTIVES: Office workers with chronic neck pain demonstrates signs of widespread hyperalgesia, less efficient descending pain modulation, which could indicate sensitization of central pain pathways. No studies have assessed a wide variety of office workers with different chronic neck pain disorders and assessed the impact of pain intensity on assessments of central pain pathways. This study aimed to assessed pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM) and to associate these with pain intensity and disability in subgroups of office workers. METHODS: One hundred-and-seventy-one office workers were distributed into groups of asymptomatic and chronic neck pain subjects. Chronic neck pain was categorized as chronic trapezius myalgia and chronic non-specific neck pain and as 'mild-pain' (Visual Analog Scale [VAS]≤3) and 'moderate-pain' (VAS>3) groups. PPTs, TSP, CPM, and Copenhagen Psychosocial Questionnaire II were assessed in all subjects. Neck Disability Index and Pain Catastrophizing Scale were assessed in all the symptomatic office workers. RESULTS: PPTs were lower in moderate pain (n=49) and chronic trapezius myalgia (n=56) compared with asymptomatic subjects (n=62, p<0.05). TSP was facilitated in moderate pain group compared with mild pain (n=60, p<0.0001) group and asymptomatic subjects (p<0.0001). No differences were found in CPM comparing the different groups (p<0.05). Multiple regression analysis identified Neck Disability Index and TSP as independent factors for prediction of pain intensity in chronic trapezius myalgia (R2=0.319) and chronic non-specific neck pain (R2=0.208). Somatic stress, stress and sleep as independent factors in chronic non-specific neck pain (R2=0.525), and stress in moderate pain group (R2=0.494) for the prediction of disability. CONCLUSIONS: Office workers with chronic trapezius myalgia and moderate pain intensity showed significant signs of widespread pressure hyperalgesia. Moreover, the moderate pain group demonstrated facilitated TSP indicating sensitization of central pain pathways. Neck Disability Index and TSP were independent predictors for pain intensity in pain groups. Sleep and stress were independent predictors for disability.

Effectiveness of lip repositioning surgeries in the treatment of excessive gingival display: A systematic review and meta-analysis.

To synthesize the available evidence regarding lip repositioning surgery (LRS) and quantify the short- and long-term reduction in excessive gingival display (EGD) with the procedure. Additionally, evaluate the effect of myotomy on the results. Seven electronic databases were searched up to May 2020 by two independent reviewers. Studies evaluating the exclusive use of LRS to treat EGD were included. After risk of bias assessment, the data were quantitatively evaluated with random-effects meta-analysis. The initial database search yielded 368 studies, of which 16 were selected for full-text review. Finally, eight studies were included. The random effects model exhibited an EGD reduction of 2.87 mm (95% CI: 1.91-3.82) after 3 months of LRS. These results decreased after 6 months (2.71 mm; 95% CI: 1.95-3.47) and 12 months (2.10 mm; 95% CI: 1.48-2.72). Meta-analysis comparing the performance of myotomy showed greater EGD reduction at 6 months than without myotomy (P < 0.02). LRS is an effective approach for treating EGD, and it has satisfactory results up to 6 months. After this period, the effectiveness appears to progressively decrease over time indicating substantial relapse at 12 months. Myotomy seems a suitable alternative to increase the stability of LRS. Lip repositioning surgery is an effective procedure to improve smile esthetics in the short-term (up to 6 months). After this period, the efficacy of LRS seems to decrease progressively, and an approximately 25% relapse may be expected after 12 months. Clinicians should combine the procedure with other approaches, such as plastic periodontal surgeries, restorative procedures, or botulin toxin injections for more predictable and stable outcomes.

Avaliação do grau de integração da atenção primária à saúde com atendimento especializado no modelo de unidade local de saúde experimentado em Portugal / Evaluation of the degree of integration of primary health care with specialized care in the model of local health unit experienced in Portugal

Resumo A integração da atenção primária à saúde com a atenção especializada em hospitais foi um importante desafio colocado ao sistema de saúde português. Iniciado em 1999, por intermédio de uma experiência-piloto, essa integração ocorreu com a criação de Unidades Locais de Saúde. Toda a assistência (atenção primária e especializada) na mesma região passou a depender de uma só equipe de gestão, com as mesmas regras e modelos de funcionamento. Embora o modelo tenha já vários anos e atualmente existam oito Unidades Locais de Saúde, não há pesquisas que avaliem essa transformação. Diante desse objetivo, foi encontrado um artigo publicado na revista Saúde e Sociedade que avaliou o grau de integração da atenção primária à saúde de município de pequeno porte na Rede de Atenção à Saúde, cuja metodologia de avaliação se enquadra perfeitamente no propósito do presente estudo. Assim, foi adotado esse método de avaliação, por meio de uma matriz com 25 indicadores com parâmetros de avaliação pontuados em escala de zero a três. Seguidamente, com o objetivo de mensurar o grau de integração, foram aplicados questionários aos profissionais de saúde. A pontuação final (grau de integração) foi calculada pela relação entre a soma dos pontos recebidos e esperados, multiplicado por 10. Os resultados mostram um escore nacional de integração de 7,03, o que indica a boa integração entre atenção primária e especializada.

Abstract The integration of primary health care with the specialized care provided in hospitals was an important challenge to the Portuguese health system. Initiated in 1999 via a pilot experience, this integration took place with the creation of Local Health Units. All assistance (primary and hospital care) in the same region came to depend on a single management team, with equal rules and operating models. Although the model has several years and there are currently eight Local Health Units, the truth is that this model has not been objectively evaluated. Considering this objective, a study was published in the journal Health and Society that evaluated the degree of integration of Primary Health Care in a small city in the Health Care Network, whose evaluation methodology fits perfectly in the objective of this study. Thus, this method of evaluation was adopted by means of a matrix with 25 indicators accompanied by evaluation parameters and scored from 0 to 3. Questionnaires were applied to health professionals of the Local Health Units in Portugal to measure the degree of integration. The final score (degree of integration) was estimated by the ratio between the sum of the points received and expected, multiplied by 10. The results show a national integration score of 7.03, which indicates the good integration between primary and specialized care.

Organização do trabalho na atenção primária à saúde: a experiência em uma região do interior de Portugal / Organization of work in primary health care: the experience in a region of the interior of Portugal

A atenção primária e a resposta em saúde pública, em Portugal, dada a limitação de recursos, encontra ­ se muito dependente do modelo de organização de trabalho das equipes de saúde. No presente estudo, foi realizada uma pesquisa avaliativa, de abordagem qualitativa, com um desenho de estudo de caso para analisar a organização do trabalho numa região do interior de Portugal. A coleta de dados realizou - se com recurso à análise documental, à observação directa e à realização de entrevistas semiestruturadas aplicadas a 96 participantes (gestores, profissionais e usuários) da Unidade Local de Saúde de Castelo Branco, localizada no interior de Portugal. Para interpretação dos dados coletados pelas entrevistas, recorreu ­ se à técnica de análise de conteúdo. Como principais resultados, os usuários relataram dificuldades de comunicação com os funcionários e segundo os profissionais ficou claro as necessárias mudanças na organização, reforço de recursos e definição de metas a atingir para cumprimento de um plano de ação. Em conclusão, a prestação de cuidados na atenção primária à saúde tem uma elevada cobertura de acesso. Porém, mesmo com uma avaliada global positiva por parte dos profissionais, gestores e usuários existem muitas melhorias a implementar, desde a organização do trabalho interno e a articulação com o hospital.

Primary care and public health response in Portugal, given the limited resources, is very dependent on the work organization model of the health teams. In the present study, an evaluation study was carried out, with a qualitative approach, with a case study design to analyze the organization of work in a region of the interior of Portugal. Data collection was carried out using documentary analysis, direct observation and semi- structured interviews applied to 96 participants (managers, professionals and users) of the Local Health Unit of Castelo Branco, located in the interior of Portugal. To interpret the data collected by the interviews, we used the technique of content analysis. As main results, users reported difficulties communicating with employees and according to professionals it was clear the necessary changes in the organization, reinforcement of resources and definition of goals to be reached to fulfill a plan of action. In conclusion, the provision of care in primary health care has high access coverage. However, even with a positive overall assessment by professionals, managers and users there are many improvements to be implemented, from the organization of internal work and articulation with the hospital.

Gestão hospitalar em Portugal: a busca de um modelo ajustado aos hospitais públicos / Hospital management in Portugal: search the best model to public hospitals

A busca de um modelo de gestão hospitalar adequado à prestação de cuidados de saúde no setor público é já procurado em Portugal há várias décadas. Foram implementados vários modelos e realizadas avaliações quantitativas, ouvindo poucas vezes os intervenientes nos processos. Objetivo: o presente estudo objetivou analisar as percepções dos grupos de interesse (stakeholders) relativamente às medidas aplicadas que mais contribuíram para a consecução dos objetivos da reforma para a melhoria do acesso, qualidade e eficiência. Método: estudo exploratório-descritivo, de abordagem qualitativa, realizado com recurso a 50 entrevistas semiestruturadas gravadas e transcritas, optando-se pela análise de conteúdo. Resultados: as falas indicam que os diferentes grupos têm diferentes interpretações, dependendo da sua atividade ou função no sistema de saúde. Todos referem que a gestão melhorou com a implementação de práticas de gestão empresarial e com a prestação regular de contas. No entanto, exigem mais transparência, incentivos e acesso. Conclusões: A inovação nas práticas de gestão hospitalar contribuiu para a melhoria do acesso, da qualidade e eficiência.

The search for a model of hospital health for public health care has been sought in Portugal for decades. Several models were implemented and met the quantitative needs, and sometimes they were implemented in the processes. Objective: This study aimed to analyze the perceptions of the stakeholders on the measures that contributed most to the achievement of the objectives of the reform in order to improve access, quality and efficiency. Method: na exploratory­descriptive study, with a qualitative approach, performed with a 50 semi­structured interviews recorded and transcribed, opting for content analysis. Results: the speeches indicate that the different groups have different interpretations, depending on their activity or function in the health system. All said that it is beer to implement business and financial management practices. However, call for more transparency, incentives and access. Conclusions: Innovation in hospital management practices built to improve access, quality and efficacy.

Emerging Roles of tRNAs in RNA Virus Infections.

Viruses rely on the host cell translation machinery for efficient synthesis of their own proteins. Emerging evidence highlights different roles for host transfer RNAs (tRNAs) in the process of virus replication. For instance, different RNA viruses manipulate host tRNA pools to favor viral protein translation. Interestingly, specific host tRNAs are used as reverse transcription primers and are packaged into retroviral virions. Recent data also demonstrate the formation of tRNA-derived fragments (tRFs) upon infection to facilitate viral replication. Here, we comprehensively discuss how RNA viruses exploit distinct aspects of the host tRNA biology for their benefit. In light of the recent advances in the field, we propose that host tRNA-related pathways and mechanisms represent promising cellular targets for the development of novel antiviral strategies.