[Prevention Harmful Consumption of Alcohol and Drugs in Sao Tome and Principe Through Public Health Communication: The Scientific Protocol]. / Comunicação em Saúde Pública na Prevenção do Consumo Excessivo de Álcool e Drogas na População Escolar de São Tomé e Príncipe: Protocolo Científico.

INTRODUCTION: Sao Tome and Principe is an African low-and-middle-income country, where extreme poverty causes major health inequalities. No systematic research has been done on the consumption of alcohol and drugs in Sao Tome and Principe, and only overall statistics are available based on the importation of alcoholic drinks and their distribution among the population. There are also no studies on consumption of alcohol and illicit substances in children and youth and no preventive measures being undertaken. Besides that, manual databases present significant limitations, considering the lack of causes associated with mortality rates (0 - 5 years and > 5), and the difficulty to establish a cause/effect relation between diseases, deaths and life expectancy. No relevant data with burden of life was found in the reports of Centro Nacional de Endemias or the non-governmental, organization Instituto Marques de Valle Flor, a facilitator on healthcare clinical specialties selected on a voluntary basis by doctors from Portuguese hospitals. So, we proposed to provide a first overview of family and housing conditions, and above all, the consumption of alcohol and illegal drugs in young people. Thus, a project, the National Survey on Harmful Consumption of Alcohol and Drugs in Schools of Sao Tome and Principe, will be realized in order to better characterize the situation among children and young students and test public health communication strategies and preventive interventions aimed at this target-population. Interventions were designed taking into consideration local sociocultural realities of target audiences. We considered dialect language, single-parent families (matriarchal structure) and polygamy (mostly) in men and a country and governments led by men (patriarchal structure) and, in which the woman's role, as Food and Agriculture Organization of the United Nations reports, remains overlooked. Subsequently, we will collect traditional alcohols samples from the two main islands for analysis (at Laboratório de Estudos Farmacêuticos and Laboratório Nacional de Engenharia Civil - Portugal) and to determine heavy metals in the production process and impact on burden of life. MATERIAL AND METHODS: In order to characterise the country's situation in terms of alcohol and illicit substances consumption a literature review was carried out through a search in several international electronic databases, such as those of the World Health Organization, World Health Organization Africa, United Nation, The Lancet and Lancet Global Health, etc. Available data of the following institutions of Sao Tome and Príncipe was also analyzed: National Institute of Statistics, Ministry of Education, Culture and Training and Ministry of Health and Social Affairs. Several interviews with community and church leaders as well as with members of catholic missions were carried out to better understand the local situation. Following this, a nationwide cross-sectional survey of a sample of 2064 students will be carried out. This will include a questionnaire on socio-demographic characteristics, lifestyles, health behaviors/attitudes, alcohol and illicit substances consumption. Finally, based on the overall diagnosis obtained, some edutainment health communication preventive interventions will be tested in the primary schools of three districts (EDUCA_TURTLE) and on the radio journalists (EDUCA_PRESS). These were evaluated by primary school teachers and by radio journalists.

Introdução: São Tomé e Príncipe é um País Africano de Língua Oficial Portuguesa, de rendimento baixo-médio, onde a extrema pobreza potencia grandes desigualdades em saúde. Pouco se sabe sobre o consumo de álcool e substâncias ilícitas, além dos indicadores de importação e distribuição pela população. Não existem estudos realizados sobre este tema em crianças e adolescentes e são desconhecidas quaisquer medidas preventivas. Além disso, as bases de dados manuais apresentam limitações significativas, perante a inexistência de causas associadas às taxas de mortalidade (0 - 5 anos e > 5), e incapacidade de estabelecer uma relação causa-efeito entre doenças e morte e esperança média de vida. Inexistência de dados relativo às causas de mortalidade nos relatórios do Centro Nacional de Endemias ou nos relatórios da organização não-governamental Instituto Marquês de Valle Flor, entidade facilitadora de cuidados de saúde em especialidades clínicas selecionadas em regime de voluntariado de médicos de hospitais Portugueses. Propusemos assim realizar o primeiro diagnóstico de situação familiar e condições de habitação, e sobretudo, sobre o consumo de álcool e de substâncias ilícitas nos jovens. Neste sentido, foi desenvolvido o Inquérito Nacional sobre o Consumo de Álcool e Drogas em Meio Escolar em São Tomé e Príncipe para melhor caraterização da situação na população escolar, e para testar estratégias de comunicação em saúde e intervenções preventivas adaptadas às realidades socioculturais das populações-alvo. Foram considerados o dialeto, as famílias monoparentais, (estrutura matriarcal) a poligamia (sobretudo nos homens) num país e com governos liderados por homens (estrutura patriarcal), onde o papel da mulher, como refere a Organização das Nações Unidas para a Alimentação e a Agricultura, continua esquecido. Posteriormente procederemos à recolha de amostras de álcoois tradicionais, nas duas principais ilhas, para análise (pelo Laboratório de Estudos Farmacêuticos e Laboratório Nacional de Engenharia Civil) e determinar os metais pesados no processo de produção e impacto na esperança média de vida.Material e Métodos: Revisão da literatura nas bases de dados eletrónicas da Organização Mundial da Saúde, Organização Mundial da Saúde África, Organização das Nações Unidas, SCOPUS, MEDLINE, The Lancet e Lancet Global Health. Também considerámos e analisámos os dados disponíveis no Instituto Nacional de Estatística, Ministério das Finanças, Estatísticas da Educação, Ministério da Educação, Cultura e Formação, Estatística da Saúde, Ministério da Saúde e Assuntos Sociais do XV Governo de Iniciativa Presidencial 2013-14. Serão realizadas algumas entrevistas qualitativas aos líderes de todas as comunidades, à igreja e missões católicas com intervenção humanitária e apoio aos mais desfavorecidos. Posteriormente, aplicação de um questionário biográfico, demográfico e socioeconómico sobre o uso de substâncias lícitas e ilícitas a uma amostra de 2064 estudantes. Foram consideradas as caraterísticasdemográficas, sociais e culturais. Após resultados e conclusões, iremos ensaiar algumas intervenções preventivas de comunicação em saúde como o edutainment nas escolas primárias de três distritos (EDUCA_TARTARUGA) e com os jornalistas de rádio (EDUCA_PRESS), as quais serão avaliadas pelos professores primários e pelos jornalistas de rádio.

Consumption of Alcohol and Drugs in the School Population of Sao Tome and Principe.

INTRODUCTION: In Sao Tome and Principe there are no studies on alcohol and drug use among students, who could be potential allies in preventive interventions. The objectives of the present study are 1) to determine the frequency of alcohol and drug consumption in the school population, and 2) to identify the main characteristics associated with this behaviour. MATERIAL AND METHODS: We applied a biographical, demographic and socioeconomic questionnaire on the use of licit and illicit substances to a sample of 2064 students. Demographic and social characteristics are presented based on observed frequencies and comparisons between groups were made using chi-square tests. Significance was assessed at α = 0.05. RESULTS: More than half of the students reported consumed alcohol at least once in their lifetime, and 32% consumed in the last 30 days. Older students were more likely to consume alcohol (p < 0.0001), but even in students under 16 years, 17% consumed in the last 30 days. We also found that 7% consumed one or more times per week in the last 30 days. The reasons presented for frequent consumption were different for boys ("participation in their group of friends") and girls ("decrease anxiety") (p = 0.005). Less than 1% of respondents admitted to having used marijuana, cocaine, crack or ecstasy. DISCUSSION: Despite some limitations, such as self-reporting, we provide a first overview showing high consumption of alcohol by young people and the existence of illegal drugs circulating in the schools. CONCLUSION: It is urgent to implement preventive interventions, namely in the context of public health communication.

Introdução: Em São Tomé e Príncipe não há estudos sobre o uso de álcool e drogas na população escolar, potencial aliada em intervenções preventivas. Os objetivos do presente estudo são 1) determinar a frequência do consumo de álcool e drogas na população escolar e 2) identificar as principais características associadas a estes comportamentos. Material e Métodos: Foi aplicado um questionário biográfico, demográfico e socioeconómico sobre o uso de substâncias lícitas e ilícitas para uma amostra de 2064 alunos. As características demográficas e sociais apresentadas baseiam-se nas frequências observadas e as comparações entre os grupos foram feitas usando testes de qui-quadrado. A significância foi avaliada em α = 0,05. Resultados: Mais de metade dos alunos referiram consumir álcool pelo menos uma vez na vida, e 32% nos últimos 30 dias. Os alunos mais velhos mostraram-se mais propensos a consumir álcool (p < 0,0001), mas mesmo nos alunos com idade inferior a 16 anos, 17% consumiram nos últimos 30 dias. Constatou-se também que entre todos os alunos, 7% consumiram uma ou mais vezes por semana nos últimos 30 dias. As razões apresentadas para o consumo frequente foram diferentes para os rapazes ("participação no grupo de amigos") e raparigas ("diminuição da ansiedade") (p = 0,005). Menos de 1% dos entrevistados admitiram ter usado maconha, cocaína, crack ou ecstasy. Discussão: Apesar de algumas limitações, como o auto reporte, publica-se um primeiro diagnóstico de situação mostrando um elevado consumo de álcool pelos jovens e ainda a utilização de drogas ilegais nas escolas. Conclusão: É urgente o desenvolvimento de intervenções preventivas, nomeadamente, no âmbito da comunicação em saúde pública.

Portuguese version of a stress and well-being evaluation tool (ASSET)at the workplace: validation of the psychometric properties.

OBJECTIVE: The main objective of this work was to translate the English version of ASSET (A Shortened Stress Evaluation Tool) into the Portuguese version and to validate its psychometric properties. Additionally, this work tested the convergent validity of the instrument. METHODS: The translation and retroversion were conducted by experts and submitted to the authors for approval. Within an observational, cross-sectional study, regarding mental health at the workplace, ASSET together with other scales was applied to a sample of 405 participants. The psychometric validity of the subscales was studied using confirmatory factorial analysis. RESULTS: The factorial structure of ASSET is globally supported by the results, with the Perceptions of Your Job and Attitudes Towards your Organisation subscales requiring slight adjustments in the item structure and the Your Health subscales replicating the original structure. The convergent validity also supports the ASSET, showing that all subscales are significantly correlated with variables used to test convergence. CONCLUSIONS: Globally, the results constitute an important contribution to ASSET and open the possibility of its usage among Portuguese-speaking countries. The results provide an evidence on the validity of the instrument and, in particular, of the mental and physical health subscales.

A comparison of in-hospital acute myocardial infarction management between Portugal and the United States: 2000-2010.

OBJECTIVE: To compare healthcare in acute myocardial infarction (AMI) treatment between contrasting health systems using comparable representative data from Europe and USA. DESIGN: Repeated cross-sectional retrospective cohort study. SETTING: Acute care hospitals in Portugal and USA during 2000-2010. PARTICIPANTS: Adults discharged with AMI. INTERVENTIONS: Coronary revascularizations procedures (percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery). MAIN OUTCOME MEASURES: In-hospital mortality and length of stay. RESULTS: We identified 1 566 601 AMI hospitalizations. Relative to the USA, more hospitalizations in Portugal presented with elevated ST-segment, and fewer had documented comorbidities. Age-sex-adjusted AMI hospitalization rates decreased in USA but increased in Portugal. Crude procedure rates were generally lower in Portugal (PCI: 44% vs. 47%; CABG: 2% vs. 9%, 2010) but only CABG rates differed significantly after standardization. PCI use increased annually in both countries but CABG decreased only in the USA (USA: 0.95 [0.94, 0.95], Portugal: 1.04 [1.02, 1.07], odds ratios). Both countries observed annual decreases in risk-adjusted mortality (USA: 0.97 [0.965, 0.969]; Portugal: 0.99 [0.979, 0.991], hazard ratios). While between-hospital variability in procedure use was larger in USA, the risk of dying in a high relative to a low mortality hospital (hospitals in percentiles 95 and 5) was 2.65 in Portugal when in USA was only 1.03. CONCLUSIONS: Although in-hospital mortality due to an AMI improved in both countries, patient management in USA seems more effective and alarming disparities in quality of care across hospitals are more likely to exist in Portugal.

The Atlantic divide in coronary heart disease: Epidemiology and patient care in the US and Portugal.

INTRODUCTION AND OBJECTIVES: We aimed to compare access to new health technologies to treat coronary heart disease (CHD) in the health systems of Portugal and the US, characterizing the needs of the populations and the resources available. METHODS: We reviewed data for 2000 and 2010 on epidemiologic profiles of CHD and on health care available to patients. Thirty health technologies (16 medical devices and 14 drugs) introduced during the period 1980-2015 were identified by interventional cardiologists. Approval and marketing dates were compared between countries. RESULTS: Relative to the US, Portugal has lower risk profiles and less than half the hospitalizations per capita, but fewer centers per capita provide catheterization and cardiothoracic surgery services. More than 70% of drugs were available sooner in the US, whereas 12 out of 16 medical devices were approved earlier in Portugal. Nevertheless, at least five of these devices were adopted first or diffused faster in the US. Mortality due to CHD and myocardial infarction (MI) was lower in Portugal (CHD: 72.8 vs. 168 and MI: 48.7 vs. 54.1 in Portugal and the US, respectively; age- and gender-adjusted deaths per 100000 population, 2010); but only CHD deaths exhibited a statistically significant difference between the countries. CONCLUSIONS: Differences in regulatory mechanisms and price regulations have a significant impact on the types of health technologies available in the two countries. However, other factors may influence their adoption and diffusion, and this appears to have a greater impact on mortality, due to acute conditions.

Work-Family Conflict and Employee Well-Being Over Time: The Loss Spiral Effect.

OBJECTIVE: The development of work-family conflict over time was analyzed using Conservation of Resources Theory. METHOD: The reciprocal effect between work-family conflict and employee well-being was tested with cross-lagged analyses on the basis of three waves. The sample comprised 713 employees of a Portuguese service organization. RESULTS: Structural equation modeling analyses, with sex, age, and parental demand controlled, indicated that the work-family conflict at T1 and T2 decreases the employee psychological well-being at T2 and T3, respectively. Furthermore, employee psychological well-being at T2 had a longitudinal cross-lagged effect on work-family at T3. We concluded that employee psychological well-being at T2 predicted work-family at T3, which was a subsequent outcome of work-family conflict on T1. CONCLUSIONS: This paper highlighted the importance of organizations to consider work-family conflict to ensure employees' well-being because they develop reciprocal relationship with a loss spiral effect.

Patterns and determinants of psychoactive drug use in Lisbon University students--a population-based study.

OBJECTIVE: To study the patterns and determinants of psychoactive drug use by Lisbon University students. MATERIALS AND METHODS: A cross-sectional survey was conducted, from January to April 2000, in a probabilistic sample of 1,147 students. Information about use of psychoactive drugs and co-variates was collected by a questionnaire administered by trained interviewers. Psychoactive drugs were considered to be all medicines classified in group N (nervous system) of the ATC system except the anesthetics (subgroup N01) and the analgesics (subgroup N02). RESULTS: 91 students (7.9%) had taken psychoactive drugs during the fortnight before the interview, 39 of whom (42.8%) mentioned continuous use. The prevalence of use was significantly higher in females (9.6%), older than 25 years (13.1%), married (16%), who considered themselves to have a weak health status (21.7%), as under intense stress (15.5%). After adjustment by multivariate analysis the variables sex, self-evaluation of health status and daily stress retained a higher significant association with psychoactive drug use. A total of 132 drugs were reported as being used in that period. Tranquilizers (ATC = N05B or N05C) were used by 82 students (7.2%), while 22 (1.9%) consumed psychoactive stimulants (N06B) and 19 (1.7%) antidepressants (N06A). In all of these therapeutical subgroups, females had higher consumption prevalence than males, but the difference was statistically significant only for tranquilizers (P < 0.001). Anxiety, depression and insomnia were the most frequently stated health problems. More than 90% of drug consumers considered they had a compliant attitude and about 60% considered themselves well-informed about adverse effects of the drug used. The reported prevalence of self-medication for psychoactive drugs used was 12.8%. CONCLUSIONS: The prevalence of psychoactive drug use among students of Lisbon University was higher than expected, considering age group and the usual health status of this population. The administration of a questionnaire was a very useful tool to characterise the pattern of use and the consumer's knowledge about the drugs consumed.