Evaluating the User Experience of a Smartphone-Delivered Sexual Health Promotion Program for Older Adults in the Netherlands: Single-Arm Pilot Study.

BACKGROUND: Sexual health is an important component of quality of life in older adults. However, older adults often face barriers to attaining a fulfilling sexual life because of issues such as stigma, lack of information, or difficult access to adequate support. OBJECTIVE: We aimed to evaluate the user experience of a self-guided, smartphone-delivered program to promote sexual health among older adults. METHODS: The mobile app was made available to community-dwelling older adults in the Netherlands, who freely used the app for 8 weeks. User experience and its respective components were assessed using self-developed questionnaires, the System Usability Scale, and semistructured interviews. Quantitative and qualitative data were descriptively and thematically analyzed, respectively. RESULTS: In total, 15 participants (mean age 71.7, SD 9.5 years) completed the trial. Participants showed a neutral to positive stance regarding the mobile app's usefulness and ease of use. Usability was assessed as "Ok/Fair." The participants felt confident about using the mobile app. To increase user experience, participants offered suggestions to improve content and interaction, including access to specialized sexual health services. CONCLUSIONS: The sexual health promotion program delivered through a smartphone in a self-guided mode was usable. Participants' perception is that improvements to user experience, namely in content and interaction, as well as connection to external services, will likely improve usefulness and acceptance.

Topological Kolmogorov complexity and the Berezinskii-Kosterlitz-Thouless mechanism.

Topology plays a fundamental role in our understanding of many-body physics, from vortices and solitons in classical field theory to phases and excitations in quantum matter. Topological phenomena are intimately connected to the distribution of information content that, differently from ordinary matter, is now governed by nonlocal degrees of freedom. However, a precise characterization of how topological effects govern the complexity of a many-body state, i.e., its partition function, is presently unclear. In this paper, we show how topology and complexity are directly intertwined concepts in the context of classical statistical mechanics. We concretely present a theory that shows how the Kolmogorov complexity of a classical partition function sampling carries unique, distinctive features depending on the presence of topological excitations in the system. We confront two-dimensional Ising, Heisenberg, and XY models on several topologies and study the corresponding samplings as high-dimensional manifolds in configuration space, quantifying their complexity via the intrinsic dimension. While for the Ising and Heisenberg models the intrinsic dimension is independent of the real-space topology, for the XY model it depends crucially on temperature: across the Berezkinskii-Kosterlitz-Thouless (BKT) transition, complexity becomes topology dependent. In the BKT phase, it displays a characteristic dependence on the homology of the real-space manifold, and, for g-torii, it follows a scaling that is solely genus dependent. We argue that this behavior is intimately connected to the emergence of an order parameter in data space, the conditional connectivity, which displays scaling behavior. Our approach paves the way for an understanding of topological phenomena emergent from many-body interactions from the perspective of Kolmogorov complexity.

Acute Compartment Syndrome of the Thigh After Contusion in a Football Player.

Acute compartment syndrome of the thigh is an exceptionally uncommon condition that can have severe consequences if not promptly and effectively treated. A 19-year-old man presented to our emergency department with severe and progressive pain in his left thigh after sustaining a direct trauma during a football game 24 hours prior. Compartment pressure was assessed, confirming the diagnosis of compartment syndrome arising from a sizable intramuscular hematoma without detection of any other contributing factors. Fasciotomy incisions were closed using the shoelace technique with excellent functional results. This case highlights the importance of high suspicion and intra-compartmental pressure measurement to diagnose this condition accurately.

Fermentation of coffee fruit with sequential inoculation of Lactiplantibacillus plantarum and Saccharomyces cerevisiae: Effects on volatile composition and sensory characteristics.

Mixed starter cultures of lactic acid bacteria and yeasts used in the production of fermented foods, including coffee, can improve the sensory quality and food safety. The objective of this study was to evaluate the effects of fermentation of coffee with inoculation of Lactiplantibacillus plantarum followed by Saccharomyces cerevisiae and the effects of fermentation time on the aroma and flavor of the coffee beverage and on the volatile composition of the roasted coffee beans. The coffee was fermented for 48 h or 96 h after inoculation of Lactiplantibacillus plantarum followed by inoculation of Saccharomyces cerevisiae or the respective controls. The aroma and flavor of the coffee beverage fermented with sequential inoculation showed complexity, with a predominance of fruity and fermented sensory notes. Forty-seven volatile compounds were identified. In addition, the sequentially inoculated coffees had greater formation of volatiles and led to greater perception of fruity and fermented flavor and aroma.

Validation of the Portuguese version of the supportive care needs survey short-form questionnaire (SCNS-SF34-Pt) and the breast cancer supplementary module (SCNS-BR8-Pt).

OBJECTIVE: This study aimed to test the psychometric properties of the Portuguese Supportive Care Needs Survey-Short Form-34 (SCNS-SF34-Pt) and its breast cancer-specific complementary module (SCNS-BR8-Pt). A further aim was to characterize Portuguese Breast Cancer Survivors' (BCS) unmet supportive care needs, using these measures. METHODS: A convenient sample of BCS was recruited from five hospitals in Portugal and invited to complete SCNS-SF34-Pt and SCNS-BR8-Pt, EORTCQLQC30 and QLQBR23, the Generalized Anxiety Disorder, and the Patient Health-Questionnaire. The validity (i.e. convergent, discriminant and convergent validity) and reliability of SCNS-SF34-Pt and SCNS-BR8-Pt were statistically evaluated. BCS' unmet supportive care needs were descriptively assessed. FINDINGS: 336 BCS participated in the study. A four-factor solution was produced for SCNS-SF34-Pt. This solution included the Physical and daily living needs, Psychological needs, Sexuality needs, and Health system, information, and patient support needs dimensions (73% of the total variance; Cronbach's alpha=.82 to .97). SCNS-SF34-Pt demonstrated good convergent validity. It could also discriminate between known-groups regarding age, disease staging, treatment performed, and ECOG performance status. SCNS-BR8-Pt revealed a single-factor structure (62% of the total variance; Cronbach's alpha=.91).Portuguese BCS' most prevalent unmet supportive care needs were associated with the Psychological, and Physical and daily living domains. Fear of cancer spreading, the inability to do things as usual, and lack of energy/tiredness were perceived as issues requiring further supportive care. CONCLUSIONS: SCNS-SF34-Pt and the SCNS-BR8-Pt are valid and reliable tools to assess Portuguese BCS' unmet supportive care needs. Fear of cancer spreading and lack of energy/tiredness concerns should be a target of supportive care services.

Highly Resolved Spectral Functions of Two-Dimensional Systems with Neural Quantum States.

Spectral functions are central to link experimental probes to theoretical models in condensed matter physics. However, performing exact numerical calculations for interacting quantum matter has remained a key challenge especially beyond one spatial dimension. In this work, we develop a versatile approach using neural quantum states to obtain spectral properties based on simulations of the dynamics of excitations initially localized in real or momentum space. We apply this approach to compute the dynamical structure factor in the vicinity of quantum critical points (QCPs) of different two-dimensional quantum Ising models, including one that describes the complex density wave orders of Rydberg atom arrays. When combined with deep network architectures we find that our method reliably describes dynamical structure factors of arrays with up to 24×24 spins, including the diverging timescales at critical points. Our approach is broadly applicable to interacting quantum lattice models in two dimensions and consequently opens up a route to compute spectral properties of correlated quantum matter in yet inaccessible regimes.

Breast Cancer Survivors' Attitudes toward eMental Health: A Cross-Sectional Study.

BACKGROUND: Breast cancer survivors' (BCS) attitudes toward eMental Health (eMH) are largely unknown, and adoption predictors and their interrelationships remain unclear. This study aimed to explore BCS' attitudes toward eMH and investigate associated variables. METHODS: A cross-sectional study involving 336 Portuguese BCS was conducted. Attitudes toward eMH, depression and anxiety symptoms, health-related quality of life, and sociodemographic, clinical, and internet-related variables were assessed using validated questionnaires. Spearman-ranked correlations, χ2, and multiple regression analyses were computed to explore associations between attitudes and collected variables. RESULTS: BCS held a neutral stance toward eMH. In models adjusted for age and education, positive attitudes were statistically significantly associated with increased depressive symptoms and worse emotional, cognitive, and body image functioning. Social network use, online health information and mental healthcare seeking, higher self-reported knowledge of eMH, and previous use of remote healthcare were positively associated with better attitudes toward eMH. CONCLUSIONS: eMH programs targeting BCS seem to be a promising strategy for providing supportive psychosocial care to BCS. However, increasing awareness about eMH efficacy and security may be necessary to improve its acceptance and use among BCS. Additional research is necessary to understand how BCS' unmet care needs, and specifically their psychological distress severity, may impact BCS' acceptance and use of eMH.

A Smartphone-Delivered Program (Anathema) to Promote the Sexual Health of Older Adults, Colorectal Cancer Survivors, and Stroke Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial.

BACKGROUND: Despite the prevalence of sexual distress and dysfunction in older adults in general and stroke and colorectal cancer survivors in particular, access to specialized care is limited by organizational barriers and stigma, embarrassment, and discrimination. The internet allows reaching services that would otherwise be difficult or impossible to reach, and as smartphones are personal (intimate) technologies, they are a promising vehicle to close this gap. However, research focusing on smartphone-delivered sexual health promotion programs is scarce. OBJECTIVE: This study aims to assess the acceptability, feasibility, and preliminary efficacy of Anathema, an 8-week, iOS/Android smartphone-delivered, individually tailored, cognitive-behavioral sexual health promotion program developed to improve relationship and sexual satisfaction, sexual functioning, sexual distress, sexual pleasure, and health-related quality of life (HRQoL) in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition. METHODS: Two-arm, parallel, open-label, waiting list, feasibility, pilot randomized controlled trials (RCTs) will be conducted involving older adults, stroke survivors, and colorectal cancer survivors. The primary outcomes are the acceptability, usability, and feasibility of Anathema. Sexual function, relationship and sexual satisfaction, sexual pleasure, sexual distress, anxiety, depression, and HRQoL are the secondary outcomes. This study has been reviewed and approved by the ethics committees of Instituto Português de Oncologia do Porto Francisco Gentil, Europacolon Portugal, Faculty of Psychology and Educational Sciences, University of Porto, and Sigmund Freud University (approval numbers: CES218R/021, CES19/023, and 2022/01-05b). RESULTS: This project is funded by the European Commission through the Active and Assisted Living (AAL) Programme (reference: AAL-2020-7-133-CP) from April 2021 to December 2023. Recruitment for the pilot RCTs started on January 2023 in Portugal, Austria, and the Netherlands and is currently ongoing. As of May 2023, we randomized 49 participants in the trials. We expect to complete the RCTs in September 2023. The results on the acceptability, feasibility, and preliminary efficacy of Anathema are expected in the second semester of 2023. We expect Anathema to be highly accepted by the populations under study; to prove feasible to scale up to parent RCTs; and to be potentially efficacious in improving sexual functioning, relationship and sexual satisfaction, sexual distress, sexual pleasure, and HRQoL in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition. The study results will be published in open-access venues according to COREQ (Consolidated Criteria for Reporting Qualitative Research) and CONSORT EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines. CONCLUSIONS: The study results will inform the refinement and scale-up of Anathema. Anathema's wider-scale implementation can potentially promote the sexual health of largely neglected user groups such as older adults, colorectal cancer survivors, and stroke survivors. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46734.

[Total expenditure of the municipalities on primary healthcare in Brazil: a method to adjust the declared expenditure from 2015 to 2020]. / Gasto total dos municípios em atenção primária à saúde no Brasil: um método para ajuste da despesa declarada de 2015 a 2020.

Recently, interest on the expenditure on primary healthcare (PHC) has grown due to a series of reforms to its organization and funding. Data on these and other expenses are declared via subfunctions by public health managers through the Brazilian Information System for the Public Budgets in Health (SIOPS). In the public budget, subfunctions detail in which expenditure area the government action was carried out. However, there are problems in the information via subfunctions, and the expenditures in main object areas - such as PHC - are commonly underestimated, if only the records of the specific subfunction are considered. Thus, this article proposes a method to adjust the total expenditure in primary care of each municipality, from 2015 to 2020, allowing for the production of adjusted databases to be used in PHC finance studies in Brazil. Therefore, an investigation based on budgetary-financial execution data in public health actions and services was conducted to produce a methodological framework, observing the following steps: (i) data identification; (ii) development; and (iii) validation of the methodological framework. The methodological framework was created and tested, confirming the validity of the proposed method for adjusting the expenditure declared for PHC in the period from 2015 to 2020. If the adjustment had not been made, the PHC expenditure would have been underestimated by BRL 11.4 billion, in 2015, and BRL 9.6 billion, in 2020, (at current prices), corresponding to a 19.8% and 12.6% underestimation, respectively.

Nos últimos anos, o interesse no gasto em atenção primária à saúde (APS) cresceu em virtude de uma série de reformas realizadas na sua organização e financiamento. Dados sobre esses e outros gastos são declarados por subfunções pelos gestores da saúde por meio do Sistema de Informações sobre Orçamentos Públicos em Saúde (SIOPS). No orçamento público, as subfunções detalham em que área de despesa a ação governamental foi realizada. Contudo há problemas na informação por subfunções, sendo comum que os gastos em áreas finalísticas, como a APS, sejam subestimados, se considerados apenas os registros da subfunção específica. Assim, o objetivo deste artigo é propor um método para ajuste do gasto total de 2015 a 2020 de cada município, em atenção primária, que permita a produção de bases de dados ajustadas a serem utilizadas em estudos sobre o financiamento da APS no Brasil. Para tanto, uma investigação baseada em dados de execução orçamentário-financeira em ações e serviços públicos de saúde (ASPS) foi realizada para a produção de um quadro metodológico, sendo observadas as seguintes etapas: (i) identificação dos dados; (ii) desenvolvimento; e (iii) validação do quadro metodológico. O quadro metodológico foi produzido e testado, confirmando-se a validade do método proposto para ajuste da despesa declarada em APS no período de 2015 a 2020. Caso o ajuste não tivesse sido realizado, a despesa em APS teria sido subestimada em R$ 11,4 bilhões em 2015 e R$ 9,6 bilhões em 2020 (a preços correntes), o que corresponde a um percentual de subestimação de 19,8% e 12,6%, respectivamente.

En los últimos años, el interés por el gasto en atención primaria de salud (APS) ha incrementado debido a una serie de reformas realizadas en su organización y financiación. Los datos sobre estos y otros gastos son declarados por subfunción por los gestores sanitarios a través del Sistema de Información sobre Presupuestos de Salud Pública (SIOPS). En el presupuesto público, las subfunciones detallan el área de gasto en la que se ha llevado a cabo la acción de gobierno. Sin embargo, hay problemas en la información por subfunción, y es común que los gastos en áreas finalistas, como la APS, se subestimen si solo se consideran los registros de la subfunción específica. Así, el objetivo de este artículo es proponer un método para ajustar el gasto total de 2015 a 2020 de cada municipio en atención primaria, permitiendo la producción de bases de datos ajustadas para ser utilizadas en estudios sobre la financiación de la APS en Brasil. Para ello, se realizó una investigación basada en datos sobre la ejecución presupuestaria y financiera en las acciones y servicios de salud pública (ASPS) para la producción de un marco metodológico, observándose las siguientes etapas: (i) identificación de datos; (ii) desarrollo; e (iii) validación del marco metodológico. Se elaboró y se probó el marco metodológico, lo que confirma la validez del método propuesto para ajustar el gasto declarado en APS en el período 2015-2020. Si no se hubiera realizado el ajuste, el gasto en APS se habría subestimado en BRL 11,4 mil millones en 2015 y en BRL 9,6 mil millones en 2020 (a precios corrientes), lo que corresponde a un porcentaje de subestimación del 19,8% y 12,6%, respectivamente.

Understanding Mental Health Professionals' Perspectives and Practices Regarding the Implementation of Digital Mental Health: Qualitative Study.

BACKGROUND: Despite the potential of digital mental health to provide cost-effective mental health care, its adoption in clinical settings is limited, and little is known about the perspectives and practices of mental health professionals regarding its implementation or the factors influencing these perspectives and practices. OBJECTIVE: This study aims to characterize in depth the perspectives and practices of mental health professionals regarding the implementation of digital mental health and explore the factors affecting such perspectives and practices. METHODS: A qualitative study using in-depth semistructured interviews with Portuguese mental health professionals (N=13)-psychologists and psychiatrists-was conducted. The transcribed interviews were thematically analyzed. RESULTS: Mental health professionals deemed important or engaged in the following practices during the implementation of digital mental health: indication evaluation, therapeutic contract negotiation, digital psychological assessment, technology setup and management, and intervention delivery and follow-up. Low-threshold accessibility and professionals' perceived duty to provide support to their clients facilitated the implementation of digital mental health. Conversely, the lack of structured intervention frameworks; the unavailability of usable, validated, and affordable technology; and the absence of structured training programs inhibited digital mental health implementation by mental health professionals. CONCLUSIONS: The publication of practice frameworks, development of evidence-based technology, and delivery of structured training seem key to expediting implementation and encouraging the sustained adoption of digital mental health by mental health professionals.

Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study.

BACKGROUND: Despite the efficacy of psychosocial interventions in minimizing psychosocial morbidity in breast cancer survivors (BCSs), intervention delivery across survivorship is limited by physical, organizational, and attitudinal barriers, which contribute to a mental health care treatment gap in cancer settings. OBJECTIVE: The aim of this study is to develop iNNOV Breast Cancer (iNNOVBC), a guided, internet-delivered, individually tailored, acceptance and commitment therapy-influenced cognitive behavioral intervention program aiming to treat mild to moderate anxiety and depression in BCSs as well as to improve fatigue, insomnia, sexual dysfunction, and health-related quality of life in this group. This study also aims to evaluate the usefulness, usability, and preliminary feasibility of iNNOVBC. METHODS: iNNOVBC was developed using a user-centered design approach involving its primary and secondary end users, that is, BCSs (11/24, 46%) and mental health professionals (13/24, 54%). We used mixed methods, namely in-depth semistructured interviews, laboratory-based usability tests, short-term field trials, and surveys, to assess iNNOVBC's usefulness, usability, and preliminary feasibility among these target users. Descriptive statistics were used to characterize the study sample, evaluate performance data, and assess survey responses. Qualitative data were recorded, transcribed verbatim, and thematically analyzed. RESULTS: Overall, participants considered iNNOVBC highly useful, with most participants reporting on the pertinence of its scope, the digital format, the relevant content, and the appropriate features. However, various usability issues were identified, and participants suggested that the program should be refined by simplifying navigation paths, using a more dynamic color scheme, including more icons and images, displaying information in different formats and versions, and developing smartphone and tablet versions. In addition, participants suggested that tables should be converted into plain textboxes and data visualization dashboards should be included to facilitate the tracking of progress. The possibility of using iNNOVBC in a flexible manner, tailoring it according to BCSs' changing needs and along the cancer care continuum, was another suggestion that was identified. CONCLUSIONS: The study results suggest that iNNOVBC is considered useful by both BCSs and mental health professionals, configuring a promising point-of-need solution to bridge the psychological supportive care gap experienced by BCSs across the survivorship trajectory. We believe that our results may be applicable to other similar programs. However, to fulfill their full supportive role, such programs should be comprehensive, highly usable, and tailorable and must adopt a flexible yet integrated structure capable of evolving in accordance with survivors' changing needs and the cancer continuum.

Gasto total dos municípios em atenção primária à saúde no Brasil: um método para ajuste da despesa declarada de 2015 a 2020 / Total expenditure of the municipalities on primary healthcare in Brazil: a method to adjust the declared expenditure from 2015 to 2020 / Gasto total de los municipios en atención primaria de salud en Brasil: un método para ajustar el gasto declarado de 2015 a 2020

Nos últimos anos, o interesse no gasto em atenção primária à saúde (APS) cresceu em virtude de uma série de reformas realizadas na sua organização e financiamento. Dados sobre esses e outros gastos são declarados por subfunções pelos gestores da saúde por meio do Sistema de Informações sobre Orçamentos Públicos em Saúde (SIOPS). No orçamento público, as subfunções detalham em que área de despesa a ação governamental foi realizada. Contudo há problemas na informação por subfunções, sendo comum que os gastos em áreas finalísticas, como a APS, sejam subestimados, se considerados apenas os registros da subfunção específica. Assim, o objetivo deste artigo é propor um método para ajuste do gasto total de 2015 a 2020 de cada município, em atenção primária, que permita a produção de bases de dados ajustadas a serem utilizadas em estudos sobre o financiamento da APS no Brasil. Para tanto, uma investigação baseada em dados de execução orçamentário-financeira em ações e serviços públicos de saúde (ASPS) foi realizada para a produção de um quadro metodológico, sendo observadas as seguintes etapas: (i) identificação dos dados; (ii) desenvolvimento; e (iii) validação do quadro metodológico. O quadro metodológico foi produzido e testado, confirmando-se a validade do método proposto para ajuste da despesa declarada em APS no período de 2015 a 2020. Caso o ajuste não tivesse sido realizado, a despesa em APS teria sido subestimada em R$ 11,4 bilhões em 2015 e R$ 9,6 bilhões em 2020 (a preços correntes), o que corresponde a um percentual de subestimação de 19,8% e 12,6%, respectivamente.

Recently, interest on the expenditure on primary healthcare (PHC) has grown due to a series of reforms to its organization and funding. Data on these and other expenses are declared via subfunctions by public health managers through the Brazilian Information System for the Public Budgets in Health (SIOPS). In the public budget, subfunctions detail in which expenditure area the government action was carried out. However, there are problems in the information via subfunctions, and the expenditures in main object areas - such as PHC - are commonly underestimated, if only the records of the specific subfunction are considered. Thus, this article proposes a method to adjust the total expenditure in primary care of each municipality, from 2015 to 2020, allowing for the production of adjusted databases to be used in PHC finance studies in Brazil. Therefore, an investigation based on budgetary-financial execution data in public health actions and services was conducted to produce a methodological framework, observing the following steps: (i) data identification; (ii) development; and (iii) validation of the methodological framework. The methodological framework was created and tested, confirming the validity of the proposed method for adjusting the expenditure declared for PHC in the period from 2015 to 2020. If the adjustment had not been made, the PHC expenditure would have been underestimated by BRL 11.4 billion, in 2015, and BRL 9.6 billion, in 2020, (at current prices), corresponding to a 19.8% and 12.6% underestimation, respectively.

En los últimos años, el interés por el gasto en atención primaria de salud (APS) ha incrementado debido a una serie de reformas realizadas en su organización y financiación. Los datos sobre estos y otros gastos son declarados por subfunción por los gestores sanitarios a través del Sistema de Información sobre Presupuestos de Salud Pública (SIOPS). En el presupuesto público, las subfunciones detallan el área de gasto en la que se ha llevado a cabo la acción de gobierno. Sin embargo, hay problemas en la información por subfunción, y es común que los gastos en áreas finalistas, como la APS, se subestimen si solo se consideran los registros de la subfunción específica. Así, el objetivo de este artículo es proponer un método para ajustar el gasto total de 2015 a 2020 de cada municipio en atención primaria, permitiendo la producción de bases de datos ajustadas para ser utilizadas en estudios sobre la financiación de la APS en Brasil. Para ello, se realizó una investigación basada en datos sobre la ejecución presupuestaria y financiera en las acciones y servicios de salud pública (ASPS) para la producción de un marco metodológico, observándose las siguientes etapas: (i) identificación de datos; (ii) desarrollo; e (iii) validación del marco metodológico. Se elaboró y se probó el marco metodológico, lo que confirma la validez del método propuesto para ajustar el gasto declarado en APS en el período 2015-2020. Si no se hubiera realizado el ajuste, el gasto en APS se habría subestimado en BRL 11,4 mil millones en 2015 y en BRL 9,6 mil millones en 2020 (a precios corrientes), lo que corresponde a un porcentaje de subestimación del 19,8% y 12,6%, respectivamente.

Vaccine Innovation for Pandemic Preparedness: Patent Landscape, Global Sustainability, and Circular Bioeconomy in Post-COVID-19 era.

In this article, we present breakthroughs and challenges in vaccine development for COVID-19 pandemic, discussing issues related to pandemic preparedness and their implications for circular bioeconomy and sustainability. Notwithstanding the unprecedented accelerated speed of COVID-19 vaccine development, just 9 months after the emergence of the pandemic in Wuhan, China, benefiting from previous developments in SARS and MERS vaccines, significant gaps persist in global vaccine preparedness. These gaps include issues related to immunity and protection, particularly to the limited vaccine protection against recent emergence of concerning new viral variants in the UK, South Africa, and Brazil and the consequent need for vaccine redesign. We examine these gaps and discuss the main issues that could impact on global vaccine availability in the current pandemic scenario: (1) breakthroughs and constraints in development and production of leading global COVID-19 vaccines; (2) innovation and technological development advances and gaps, providing information on global patent assignees for COVID-19, SARS, and MERS vaccine patents; (3) local capacity for development and production of COVID-19, SARS, and MERS vaccines in three emerging agro-based countries (India, Brazil, and South Africa); and (4) future scenarios, examining how these issues and vaccines redesign for new SARS-CoV-2 variants could impact on global access to vaccines and implications for circular bioeconomy and sustainability in the post-COVID era.

Evidence of the validity of a novel version of the computerized cognitive screening battery CompCog / Evidência de validade de uma nova versão da bateria computadorizada de rastreio cognitivo CompCog

ABSTRACT Although the availability of the computer-based assessment has increased over the years, neuropsychology has not carried out a significant paradigm shift since the personal computer's popularization in the 1980s. To keep up with the technological advances of healthcare and neuroscience in general, more efforts must be made in the field of clinical neuropsychology to develop and validate new and more technology-based instruments, especially considering new variables and paradigms when compared to paper and pencil tests. Objective: This study's objective was to produce concurrent validity evidence of the novel version of the computerized cognitive screening battery CompCog. Methods: Participants performed a traditional paper and pencil neuropsychological testing session and another session where CompCog was administrated. The data of a total of 50 young adult college students were used in the analyses. Results: Results have shown moderate and strong correlations between CompCog's tasks and their equivalents considering paper and pencil tests. Items clustered in agreement with the subtest division in a principal component analysis. Conclusions: The findings suggest that CompCog is valid for measuring the cognitive processes its tasks intend to evaluate.

RESUMO Embora a disponibilidade de instrumentos computadorizados para avaliação tenha aumentado ao longo dos anos, a neuropsicologia não passou por uma mudança significativa de paradigma desde a popularização do computador pessoal nos anos 1980. Para acompanhar os avanços tecnológicos da saúde e da neurociência em geral, mais esforços devem ser feitos no campo da neuropsicologia clínica para desenvolver e validar novos instrumentos de base mais tecnológica, especialmente considerando novas variáveis e paradigmas quando comparados aos testes de lápis e papel. Objetivo: O objetivo deste estudo foi produzir evidências de validade concorrente da nova versão da bateria computadorizada de rastreio cognitivo CompCog. Métodos: Os participantes passaram por uma sessão de avaliação neuropsicológica com testes tradicionais de lápis e papel e de outra sessão em que o CompCog foi administrado. Os dados do total de 50 jovens adultos universitários foram utilizados nas análises. Resultados: Os resultados mostraram correlações moderadas e fortes entre as tarefas do CompCog e seus equivalentes nos testes tradicionais. Uma análise de componentes principais mostrou que os itens formaram fatores em concordância com a divisão de subtestes da bateria. Conclusões: Os resultados sugerem que o CompCog é válido para medir os processos cognitivos que suas tarefas pretendem avaliar.

Evidence of the validity of a novel version of the computerized cognitive screening battery CompCog.

Although the availability of the computer-based assessment has increased over the years, neuropsychology has not carried out a significant paradigm shift since the personal computer's popularization in the 1980s. To keep up with the technological advances of healthcare and neuroscience in general, more efforts must be made in the field of clinical neuropsychology to develop and validate new and more technology-based instruments, especially considering new variables and paradigms when compared to paper and pencil tests. Objective: This study's objective was to produce concurrent validity evidence of the novel version of the computerized cognitive screening battery CompCog. Methods: Participants performed a traditional paper and pencil neuropsychological testing session and another session where CompCog was administrated. The data of a total of 50 young adult college students were used in the analyses. Results: Results have shown moderate and strong correlations between CompCog's tasks and their equivalents considering paper and pencil tests. Items clustered in agreement with the subtest division in a principal component analysis. Conclusions: The findings suggest that CompCog is valid for measuring the cognitive processes its tasks intend to evaluate.

Embora a disponibilidade de instrumentos computadorizados para avaliação tenha aumentado ao longo dos anos, a neuropsicologia não passou por uma mudança significativa de paradigma desde a popularização do computador pessoal nos anos 1980. Para acompanhar os avanços tecnológicos da saúde e da neurociência em geral, mais esforços devem ser feitos no campo da neuropsicologia clínica para desenvolver e validar novos instrumentos de base mais tecnológica, especialmente considerando novas variáveis e paradigmas quando comparados aos testes de lápis e papel. Objetivo: O objetivo deste estudo foi produzir evidências de validade concorrente da nova versão da bateria computadorizada de rastreio cognitivo CompCog. Métodos: Os participantes passaram por uma sessão de avaliação neuropsicológica com testes tradicionais de lápis e papel e de outra sessão em que o CompCog foi administrado. Os dados do total de 50 jovens adultos universitários foram utilizados nas análises. Resultados: Os resultados mostraram correlações moderadas e fortes entre as tarefas do CompCog e seus equivalentes nos testes tradicionais. Uma análise de componentes principais mostrou que os itens formaram fatores em concordância com a divisão de subtestes da bateria. Conclusões: Os resultados sugerem que o CompCog é válido para medir os processos cognitivos que suas tarefas pretendem avaliar.

Saúde

O objetivo deste capítulo é analisar a resposta brasileira no campo da saúde à pandemia de Covid-19 e as perspectivas para o período pós-Covid nesta área, tendo por recorte temporal o período compreendido entre fevereiro de 2020, quando o primeiro caso da doença é registrado no Brasil, e a primeira quinzena de dezembro de 2020, quando se intensifica o debate em torno de um plano nacional de imunização anticovid. O texto está dividido em três seções principais, além desta apresentação. Na seção 2, discutem-se a situação pré-pandemia e alguns fatores que condicionaram a resposta do SUS no enfrentamento da doença no período recente. Na seção 3, apresentam-se as principais medidas adotadas internacionalmente e analisa-se a resposta brasileira à pandemia, à luz dos fatores condicionantes pré-covid destacados e da conjuntura política atual. E, por fim, na seção 4, discutem-se algumas perspectivas futuras para o período pós-pandemia.

Mitigating COVID-19 Impact on the Portuguese Population Mental Health: The Opportunity That Lies in Digital Mental Health.

COVID-19 mitigation measures present unprecedented challenges in mental healthcare delivery, posing high risk to the mental health of at-risk populations, namely patients diagnosed with COVID-19, frontline healthcare providers, and those submitted to quarantine or isolation measures, as well as the general population. Ensuring safe and equitable access to mental healthcare by these groups entails resorting to innovative psychosocial intervention strategies, such as digital mental health. In this perspective piece, we describe the impact of COVID-19 on the Portuguese population's mental health, present an overview on initiatives developed to address the challenges currently faced by the Portuguese mental healthcare system, and discuss how the timely implementation of a comprehensive digital mental health strategy, coupling research, education, implementation, and quality assessment initiatives, might buffer COVID-19's impact on the Portuguese society.

SUS financing and Covid-19: history, federative participation, and responses to the pandemic / Financiamento do SUS e Covid-19: histórico, participações federativas e respostas à pandemia

This essay discusses financial resources for Brazil's Unified Health System (SUS) in a historical and future perspective, considering the health and economic challenges imposed by the Covid-19 pandemic. As always and more than ever, we need to discuss SUS financing. This is aggravated in intensity by the context of chronic economic recession that the country has been experiencing in 2015 and 2016, followed by  stagnation in the following years and accentuated in urgency by the recession in the second quarter of 2020 and that is expected to deepen in the coming years. The pandemic happens in a context of diminishing federal participation in SUS financing, little space for states to expand their sources of financing and several problems of coordination between federal entities. We argue that facing the pandemic necessarily involves an expansion of resources for financing SUS and it has a great dependence on the performance of the federal government. However, even with the urgency that the pandemic demanded, the new resources approved by the National Congress for public health system has been quite slow. We conclude that the prospects do not point to prioritizing the SUS and expanding its funding in the post-pandemic period.

Esse ensaio discute o financiamento do Sistema Único de Saúde (SUS) em perspectiva histórica e futura, considerando os desafios sanitários e econômicos impostos pela pandemia de Covid-19. Como sempre e mais do que nunca, precisamos discuti-lo. Essa necessidade cresce em premência a partir da recessão econômica que o país viveu em 2015 e 2016, pela estagnação da economia nos anos seguintes e pela recessão que já surge no segundo trimestre de 2020 com previsão de aprofundar-se nos próximos anos. A pandemia acontece em um contexto de redução da participação federal no financiamento, pouco espaço para estados ampliarem suas fontes de financiamento e problemas de coordenação entre os entes federativos. No caso do financiamento das ações e serviços públicos de saúde (ASPS) para enfrentamento à pandemia, argumentamos nesse texto, que ele passa necessariamente pela ampliação dos recursos alocados ao SUS, com grande dependência da atuação do governo federal. Contudo, nem com a urgência que demanda a pandemia houve rapidez na liberação e execução dos novos recursos aprovados pelo Congresso Nacional. Concluímos que as perspectivas não apontam para uma priorização do SUS e ampliação do seu financiamento no período pós-pandêmico.

Covid-19 and federative coordination in Brazil: consequences of federal dissonance for the pandemic response / Covid-19 e coordenação federativa no Brasil: consequências da dissonância federal para a resposta à pandemia

This essay aims to discuss the trajectory of federative coordination in the Unified Health System (SUS) and the response coordination efforts to covid-19 pandemic. To support the discussion, it addresses theoretical framework on the relationship between federalism and the public policies, and on the development of federative coordination in the SUS. It also discusses recent decisions by the Ministry of Health that resulted in the weakening of the SUS's coordination instruments. It considers that the deficient federal coordination in the response to the pandemic is not due to the absence of federative coordination mechanisms in SUS or to the constraint of these mechanisms imposed by the other entities of the federation. What is observed is the deliberate weakening of the federal coordination mechanisms by the federal government. It concludes that the health crisis accelerated the ministry of health distancing process of its role as national director of SUS and made explicit the decision of the federal government for inaction, relegating to the Ministry a secondary role in the efforts against the pandemic, with serious consequences for the population access to health care, especially intensive care, and for the effectiveness of actions in the field of health surveillance.

Este ensaio tem por objetivo discutir a trajetória da coordenação federativa no Sistema Único de Saúde (SUS) e a coordenação dos esforços de resposta à pandemia de covid-19. Para dar suporte à discussão, aborda referencial teórico sobre a relação entre federalismo e a implementação de políticas públicas, e sobre o desenvolvimento da coordenação federativa no SUS. Também discute decisões recentes do Ministério da Saúde que resultaram na fragilização dos instrumentos de coordenação do sistema. Pondera que a coordenação federal deficiente na resposta à pandemia não se deve à ausência de mecanismos de coordenação federativa do SUS ou ao constrangimento desses mecanismos imposto pelos demais entes da federação. O que se observa é a deliberada fragilização desses instrumentos pelo governo federal. Conclui que a crise sanitária acelerou o processo de distanciamento do Ministério da Saúde do seu papel de dirigente nacional do SUS e explicitou a decisão do governo federal pela inação, relegando ao órgão papel secundário nos esforços de enfrentamento à pandemia, com graves consequências para o acesso da população aos cuidados de saúde, especialmente os intensivos, e para a efetividade das ações no campo da vigilância em saúde.  

Portuguese Psychologists' Attitudes Toward Internet Interventions: Exploratory Cross-Sectional Study.

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.