HTTP/1.1 200 OK Cache-Control: no-cache, private Content-Type: text/html; charset=UTF-8 Date: Fri, 27 Nov 2020 13:36:18 GMT 男女上下动态图

Impact Factor 2.483 | CiteScore 2
More on impact ›

Perspective ARTICLE

COVID-19: What Is Next for Portugal?

  • 1Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University of Lisbon, Lisbon, Portugal
  • 2EPIUnit - Instituto de Saúde Pública, Universidade Do Porto, Porto, Portugal
  • 3Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade Do Porto, Porto, Portugal

Season\'s greetings and sincere wishes for a bright and happy New Year!
9. Jessica Pare
他说,杂志和作者在这起最近发生的丑闻中都有不可推卸的责任,声明中还说,《肿瘤生物学》在2015年就已经因同行评议过程存在类似问题而撤销一些论文。
The announcement comes from the British Fashion Council (BFC), who surveyed designers ahead of the shows and found none of the 80 designers in the September line-up would be using fur.
和过去几年相比,2013年信心受到动摇的时候少了,但市场依然很容易受到影响。OppenheimerFunds的首席经济学家韦布曼(Jerry Webman)表示,虽然2013年的信心要强于以往,但全球各地也不都是这样。
这张专辑贯穿了新浪潮音乐、电子舞曲和流行舞曲,是清新悦耳又充满乐趣的流行音乐珍品。
项目长度:13至15个月
在2013年的这次调查中,东京重新获得“全球最贵城市”的头衔。瑞士苏黎士由于汇率波动在去年名列榜首,但今年由于政府采取了控制汇率措施,在榜单上下滑至第七。日本大阪成为全球第二贵的城市。
n. 奖章,勋章,纪念章

By June 3, 2020, the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) has infected 33,261 individuals with 1,447 mortalities in Portugal (1). Unfortunately, this crisis came shortly after the recent recovery from the financial crisis that heavily affected the country in 2011, during which Portugal was obligated to sign-up for a bailout program from several funding entities, including the European Central Bank and the International Monetary Fund (2, 3). Accordingly, the country went through strict fiscal austerity that resulted in proposing unprecedented implementations of social expense cuts and continuous cuts to public expenditure on health care (2, 4, 5). Given the expectations of inevitable global recession due to COVID-19, which may surpass the global recession of 2009 to 2011 (68), it is expected that once again the health system in Portugal may become a target for cost containment in the long run. In general, and during economic crises, the health sector became vulnerable and a target for budget cuts owing to its size and the high potential for improved performance (3). Estimates regarding the economic impact of the COVID-19 in Portugal, if the crisis remains until mid-June, forecast GDP decline in 2020 of −6.9% (95% confidence interval: −9.2 to −4.6%) (7). These estimates predict Portugal to be among the most affected by the crisis in comparison to other countries such as Brazil, China, or the United States, owing to the high contribution of tourism to the Portuguese economy (7). We can understand from these estimates that, even if the current containment measures, namely, quarantines and social distancing, succeed in controlling the outbreak in Portugal, the economic implications of this crisis will affect the country in a post COVID-19 era. Some early results of the economic slowdown due to COVID-19 included a decline in the real estate market in regions with the greatest dynamism in the housing market and tourism, namely, the Lisbon Metropolitan Area and the Algarve (9). Moreover, the number of unemployed individuals registered in 74 municipalities during April 2020 was more than twice the registered number in the same month of the previous year (9). However, and unlike the financial crisis of 2011, any interventions or measures toward cost containment of the health sector should be taken with great precaution. In the one hand, any budget cuts that may affect the health sector in the future will limit the ability of the already exhausted sector in functioning against any recurrent outbreak, given the high risk of COVID-19 outbreaks over recurrent or seasonal waves (1012). On the other hand, the economic situation of the country, in light of lower economic growth rates, may limit further spending on health. Accordingly, it is more important than ever to obtain an optimal balance between health and economic stability. This perspective aims to review possible flaws in the health sector and potential interventions which may help achieve this balance in Portugal. We also aim to provide measures that can help in mitigating the financial consequences of the COVID-19 on the health system and to provide recommendations that can contribute for containing any similar outbreak in the near future.

COVID-19 Pandemic in Portugal

The first cases diagnosed with COVID-19 disease in Portugal were reported on March 2, 2020, while the first death was recorded on March 16, 2020 (13, 14). Portugal has adopted several measures in order to contain the transmission of the virus and contain the expansion of the disease. First, on March 18, 2020, the state of emergency was declared in Portugal, through the Decree of the President of the Republic No. 14-A/2020 (15). The decree imposed extraordinary urgent measures in the form of restrictions over domestic and international movements and the application of social distancing rules. Moreover, and due to the unprecedented health crisis imposed by the pandemic, the country had approved a new decree that allows legal immigrants with pending residence application who applied for legal residence in the country until March 18, when the state of emergency was decreed, to have access to health care services during the pandemic (16). With the measure, immigrants will have access to the same rights as Portuguese citizens, including use of the health system and social and financial support from the government. The decision also benefits those who have applied for asylum. Second, and regarding surveillance capabilities, and as of June 3, 2020, the government has set a network of testing centers that consists of 205 laboratories distributed across the country (17). Most of these laboratories follow the National Health Service (SNS) (45.2%) and the private sector (39.3%), but they also include other laboratories, namely, the military and the academic laboratories (15.7%) (18, 19). In April 2020, the average number of tests was 11,500 tests per day, and in May 2020, the average was 13,550 tests per day (20). As of June 3, 2020, more than 860,000 tests have been carried out to detect the disease in Portugal (20). About 40% of the COVID-19 tests were conducted in the Norte region of the country, followed by Lisbon and Vale do Tejo (25%) and the Centro (14%) regions (20). The remaining statistics are distributed over the remaining regions. Areas dedicated to treat patients with COVID-19 were created through several selected Emergency Service Units (ADC-SU) and COVID-19 Community Dedicated Areas (ADC-COMMUNITY) (21). The selection of COVID-19 dedicated areas depended on several factors that included population density, geographical dispersion, and the regional and local epidemiological evolution of COVID-19 (21).

As of June 3, 2020, the number of confirmed cases of COVID-19 per 10,000 inhabitants was 32.6 (9). Despite the progressive spread of the pandemic throughout the country, its spread continues to be characterized by a high regional heterogeneity and affected by various socio-economic impacts (9). However, analyzing the spread of COVID-19 by local administrative unit (LAU 1) (22), also known as municipality level, it translates into marked variation in the spread of the disease across municipalities. Portugal is divided into seven regions according to Nomenclature of Territorial Units for Statistics (NUTS II) (23) as follows: Norte, Centro, Lisbon Metropolitan Region (also known as Lisboa e Vale do Tejo), Alentejo, Algarve, Autonomous Region of the Azores, Autonomous Region of Madeira. The seven regions are divided in to 308 LAU 1 or municipalities. The Norte region carries a substantial burden especially when taking into account the absolute numbers of confirmed cases and deaths due to COVID-19. As of June 3, 2020, the confirmed cases in the Norte regions accounted for 50.5% of total confirmed cases and 55% of the total number of deaths (24) (see Table 1 for an informative overview of epidemiological situation in Portugal). At the municipality level, the number of confirmed cases per 10,000 inhabitants was higher than the national average in 50 municipalities (9). Of these, 31 were located in the Norte region, especially the municipalities located in the Metropolitan Area of Porto with more than 50 confirmed cases per 10,000 inhabitants, 11 municipalities in the Centro region, five in the Lisbon Metropolitan Region (the municipalities of Loures, Amadora, Lisbon, Odivelas, and Sintra), two in Alentejo region (the municipalities of Moura and Azambuja), and one municipality in the Autonomous Region of the Azores (the municipality of Nordeste) (9). Moreover, of the 50 municipalities with a number of confirmed cases per 10,000 inhabitants above the national average, 10 also had values of new confirmed cases per 10,000 inhabitants above the national average in which half of these municipalities were located in the Metropolitan Area of Lisbon (9).

TABLE 1
www.frontiersin.org

Table 1. The Epidemic of COVID-19 in Portugal by Regions as of June 3, 2020.

Moreover, 34 out of these 50 municipalities above the national level, almost two thirds, have a population density above the national average, and this highlights how population density can affect the spread of the disease (9). Of these 34 municipalities with population density above the national average, the highest number of confirmed cases per 10,000 inhabitants were recorded in the municipality of Ovar (123 cases per 10,000 inhabitants), while the lowest number were recorded in the municipality of Lisbon (52.1 cases per 10,000 inhabitants) (9).

Measures to Mitigate the Effect of COVID-19 in Portugal

Urgent Integration of Quality Indicators Within Hospitals Systems

Since we are encountering an unprecedented situation, immediate actions should be taken to preserve limited medical resources and prevent further unnecessary expenditure. Evidence from several countries suggest that unnecessary health spending, also known as wasteful spending, accounts for almost one-fifth of health expenditure in the form of unnecessary treatments or examinations, or health services provided with unnecessary higher costs (26, 27). Reducing or eliminating unnecessary health expenditure could be achieved without impairing quality of care (28). On the contrary, it will allow the health system to absorb an abrupt or unexpected increase in demand for medical resources, as in the case of COVID-19. As regards hospitals, hospitalizations or additional in-patient stays that consume a considerable amount of resources could be avoided with efficient treatment and management of chronic diseases, knowing that chronic diseases in Portugal consume a considerable amount of the health budget (2934).

We pointed out, in previous contributions (30, 34), possible approaches to reduce the costs of healthcare in Portugal through integrating quality measures of hospitals' performance, namely thirty-day readmission rate and length of stay (LOS). Thirty-day hospital readmission is defined as an episode in which a patient is readmitted within 30 days from the last discharge. LOS is defined as the number of days a patient is hospitalized in relation to the admission diagnosis. High rates of thirty-day readmissions or unnecessary delayed discharge that contributes to higher LOS have been recognized as frequent and costly events (30, 3537). For example, in the United States, one in five Medicare beneficiaries has a thirty-day readmission, with a cost of around $26 billion per year (37, 38). Accordingly, these measures have been widely used as a quality benchmark for health systems (30, 3944). Given the expected implications of COVID-19 on the Portuguese economy and the health sector, it is mandatory that policymakers adopt these measures to impact cost and quality through payment incentives for hospitals or health care providers. By integrating quality indicators in the Portuguese health sector, we can focus on other areas of improvement, as listed in the following sections:

Addressing Deficiencies in the Health System Infrastructure and Human Resources

The spread of COVID-19 created unprecedented pressure on hospitals and medical human resources, even in the most developed countries. With health system being stretched beyond its capacity, curative beds and critical care capacity require substantial review. Portugal has a total of 35,000 beds distributed between public, private, and public-private partnership hospitals; 22,400, 10,900, and 1,600, respectively (45). It is also important to mention that there was a decrease in the total number of beds over the period from 2007 to 2017 (45). For example, the total number of beds in 2017 was 84 beds lower than in 2016 and markedly lower than in 2007 with less 1,267 beds. This decline is owed to the steady increase in day surgery, the reinforcement of the long-term care networks, mergers between public hospitals and the closing of psychiatric hospitals (46, 47). Overall, Portugal has a lower number of curative beds per 100,000 population (325.2) compared to other European countries (6, 46).

The number of active physicians certified by the Portuguese Medical Association was 53,657 in 2018 (48). In addition, the number of active nurses certified by the Portuguese Nurses Association was 73,650 in 2018 (48). An increasing trend in the number of doctors and nurses have been reported in the period from 1960 to 2018 (48), while a decreasing trend in the number of inhabitants per doctor and nurses have been reported for the same period (49). However, these seemingly positive trends should be interpreted with caution. First, Portugal has one of the lowest ratios of nurses per 100,000 population (638 per 100,000 population) when compared with the European Union (EU) average (864 per 100,000 population) (46, 50). Second, the economic crisis of 2011 has led to significant outflows of emigration among doctors and nurses working in Portugal seeking better salaries and working conditions (46). For instance, the period from 2011 to 2015 witnessed the emigration of 1,631 doctors and 12,680 nurses from Portugal according to data from the Portuguese Medical and Nursing Associations (46). While current concerns about the shortage of medical human resources in Portugal are valid and real, what is more alarming is how this shortage can affect any strategies to curb the current infection. Moreover, we should expect that this pandemic will put the developed countries in a rival for attracting healthcare workers due to shortage in medical human resources or giving the crucial value they have had during this crisis. Accordingly, it is more important than ever that the Portuguese government set an action plan to retain the current work forces and address any further shortages. Moreover, since the density of the population plays an important role in shaping the distribution of COVID-19, solutions should be provided to ensure the allocation of medical resources to the municipalities with high population density.

Addressing Health Inequalities in Portugal

Health inequalities can play an important role in shaping the distribution of COVID-19. Recent emerging data show the potential role of sex, race, and age on COVID-19 hospitalization and mortality rates, in which specific groups are disproportionately affected by the disease (51, 52). For example, the African-American community, which constitutes only 13% of the United States population, accounts for 33% of the hospitalizations related to COVID-19, while White Americans who constitute 76% of the total population account for 45% of the total hospitalizations (51). It is well-known that the African-American community in the United States carries a substantial burden when it comes to health inequalities with a higher risk of having a variety of health problems and less access to health care than White Americans (5355). These findings are especially worrisome when considering how the apparent aspects of health inequalities can aggravate the COVID-19 distribution in Portugal. It is important to mention that socioeconomic characteristics are important indicators for health inequalities in Portugal (34, 56, 57). Portugal has a high proportion of elderly population, which is among the most affected by COVID-19, with those aged 65 years or more accounting for almost 20% of the total population (58). Table 2 shows the substantial effect of COVID-19 among the elderly population in Portugal in which infections among those aged above 60 years represent 32.7% of the total infections, while deaths among the same age group accounts for 95.4% of the deaths (1).

TABLE 2
www.frontiersin.org

Table 2. Number of confirmed cases and deaths by age in Portugal as of June 3, 2020.

Migrants' health in Portugal illustrates another aspect of inequality, which translates into migrants using less and reporting more access restrictions (59). Although COVID-19 morbidities and fatalities by immigration status are not available yet, probably existing inequalities will be exacerbated in the present context. These expectations are supported by recent figures from the epidemiological bulletin of the Directorate-General for Health (DGS) indicating that municipalities located in the Metropolitan Area of Lisbon, which is characterized by having high migrants' concentrations, started to show a marked increase in the new cases per 10,000 inhabitants (1, 9). Over 50% of migrants are living in the Lisbon Metropolitan Area which is the home of 30% of the total Portuguese population (60). Also, it is important to know that municipalities with high concentrations of migrants record population density above the national level. For example, the municipality of Amadora, in the Metropolitan Area of Lisbon, which is known to have one of the largest migrant populations in the country, namely, in the neighborhood of The Bairro da Cova da Moura, is recording the highest population density in the entire country with almost 8000 inhabitants per square kilometer (59), in comparison to the average national population density of 111.5 inhabitants per square kilometer (61). Moreover, the same municipality of Amadora, is currently recording the highest number of new confirmed cases per 10,000 inhabitants above the national average (11.1 new cases per 10,000 inhabitants), followed by municipalities in the same Metropolitan Area of Lisbon as follows: Loures (10.0), Odivelas (7.4), Sintra (5.8), and Lisbon (4.9), which are also known to have high concentrations of migrants. Also, the health authorities were obligated to take drastic measures in the form of closing restaurants, cafés, and bars in one of the poorest migrants' social neighborhood in the country “Vale de Chícharos,” also known as “Bairro da Jamaica,” to contain the spread of an outbreak of new cases detected among residents (62). These findings are alarming, given the strong evidence that migrants and ethnic minorities specifically carry a substantial burden when it comes to infectious diseases owing to the lack of access to preventive health services and information (63). Moreover, previous studies showed migrants are among the most affected by infectious diseases and epidemics during economic crises due to worsening living conditions and lack of access to healthcare and treatment (64). These concerns highlight the consequences of measures that do not ensure the full entitlement of migrants in the health system. Since the government allowed documented migrants full access to health care services, solutions should also be provided to guarantee undocumented migrants full access to healthcare services without bearing any financial or legal consequences, especially in the light of the increasing number of new confirmed cases in areas with high migrant concentrations. Undocumented migrants in Portugal have limited healthcare entitlements compared to documented migrants (59). This unprecedented public health crisis due to COVID-19 should emphasize that the exclusion of any vulnerable populations from health care could halt the fight against the spread of infection.

Another aspect of health inequality is the unequal geographical distribution of health services and human resources for health in Portugal. In Portugal, human resources for health, health equipment, and supplies are concentrated in Lisbon and Porto, when compared to the country's remote areas (46, 47). Moreover, relatively younger populations are concentrated in the country's coastal regions, which are well-known to have higher socio-economic positions and better access to health care services compared to the rest of the country (47, 65). On the contrary, residents of remote areas, with lower socio-economic indicators, have poor geographical access to health services, which influences their ability to utilize health care services (47). These facts are supported by the heterogeneous spread of the disease over the country. For example, the majority of municipalities that recorded confirmed cases above the national level were lock land municipalities (40 municipalities) against only 10 costal municipalities (59). Our concern is that these aspects of inequalities will contribute to the spread of the disease in Portugal. These concerns demand interventions that guarantee a fair distribution of medical resources all over Portugal knowing that areas with relatively old Populations are more deprived of health services. Policies should also be developed to ensure the full and sustainable inclusion of migrants in the national health system without bearing any financial or legal consequences.

Improving Mental Health Services

The increasing mortalities and morbidities due to COVID-19 made health care workers and general population to experience mental health problems such as depression and anxiety (66, 67). Moreover, the quarantine measures imposed to contain SARS-CoV-2 transmission that resulted in unprecedented social distancing and altered lifestyles began to have serious effects on mental health (68, 69). We might also expect (these associations tend to worsen) seeing similar effects as rates of unemployment, job loss, and poverty due to the economic effect of COVID-19 are increasing. For instance, during the economic crisis of 2011, Portugal witnessed a similar situation in which there was a surge in mental health problems (70, 71). In fact, the associations between the implications of economic crisis, such as unemployment or poverty, and mental health problems are well-documented (24).

These findings may be deemed worrying given the weaknesses and unpreparedness of the mental health services in Portugal to respond to such sharp demand. In the last decade, Portugal has witnessed a decrease in the number of psychiatric beds in favor of promoting community-based mental health services (28). However, a recent assessment of the Portuguese mental health plan indicated that country is still far from obtaining this goal (72). Also, it is important to know that that mental health in Portugal is lagging, compared to other European countries, in terms of the high prevalence of mental problems and the development of community-based mental health services (73, 74). Despite this fact, only a small proportion of patients who have mental illness have access to public specialized mental health services (73). In addition, mental health services in Portugal have substantial insufficiencies regarding equity and quality of care (73), given the substantial cost of mental health illness in EU in general, which is estimated to account for more than 4% of GDP (28), Portugal should put in place policies to address mental health among the population in general and to ensure emergency access to treatment for individuals affected by COVID-19 through establishing procedures for psychological crisis interventions.

Preparedness Is the Key

If there is one lesson to be learned from the COVID-19 pandemic, it will be how to advance preparedness in other countries to mitigate the effect of the outbreak, and this should be instructive for Portugal. Taiwan and Singapore's response to the COVID-19 has been considered as a model, thanks to the SARS outbreak in 2013. These countries were among the most affected ones during the SARS outbreak (7577). However, afterwards, they have established and developed their outbreak preparedness policies (75, 77). These policies included developing a public health action plan for facilitating rapid responses for the following crisis, holding regular exercises, establishing a central command center for epidemics, and building new infrastructures equipped with hundreds of negative-pressure isolation rooms and public health preparedness clinics (77, 78). As a result, they were able to successfully mitigate and contain the virus spread and keep it under control. Given this success and in light of the devastating implications of COVID-19, understanding and adopting the strategies implemented in these countries and their effectiveness may enlighten health policymakers in Portugal. As a starting point, an urgent public health response plan for allowing rapid actions for any possible future outbreak should be established in Portugal. This plan should include strategies to address shortages in human or medical resources or any flaws in the health system infrastructures. Hospitals also need guidelines to manage their spaces, human resources, and supplies to be able to contain any future similar outbreaks. Any plans should also consider reviewing the number and distribution of ventilators in the country, which is critical in treating severely ill patients. Moreover, specific specialties should be the focus of significant investment; for example, anesthesiologists, radiologists, and emergency room physicians should have particular skills that make them notably valuable to treat severely ill COVID-19 patients. The plan should also target the deficiencies in specialties such as public health doctors, which represent only 1.5% of the total active doctors in Portugal (46), and medical disaster specialists.

The Bloomberg soft commodities index has gained 21 per cent, compared with 24 per cent for industrial metals and 1.5 per cent for energy.
"It's one of the strangest things that's ever happened to me," Beatty said backstage. "Thank God there were two of us up there," Dunaway responded.
简言之,无叶风扇就是没有叶片的风扇。它的工作原理是先将空气吸入风扇基座内部,然后通过扇头环形上的洞将空气吹出。这款风扇据说是詹姆斯·戴森发明的,并命名为"气流倍增器"。就像可以飞行的喷气背包一样,无叶风扇被《时代周刊》评为"2009年度伟大发明"之一,同样它也不是世界上第一个无叶风扇。实际上,第一个无叶风扇于1981年被日本的东京芝区电力公司获得专利。尽管东京芝区电力公司的无叶风扇并没有用于生产制造,但詹姆斯的无叶风扇的原始设计与其设计相似,所以专利局拒绝授予詹姆斯这个专利。尽管授予东京芝区电力公司的专利已经过期,但在授予詹姆斯这项新专利之前,专利局需要他提供该设计的创新之处。詹姆斯的经理吉尔·斯密斯并没有否认这两种无叶风扇间的相似性,只是说两者间的差异在于所用"科技"不同。
But national and racial identity were often conflated for the white majority. That identity felt to many white people like one of the most important pillars holding up their world — and now it seems under threat.
But the impact of corporate stinginess can go beyond simply ruining employees’ lunar new year holiday, possibly coming back to bite employers: 39 per cent of respondents said they would look for work elsewhere if their year-end bonus was not up to snuff, an increase of 2.3 percentage points from 2015.
Hannah Kuchler is San Francisco correspondent
纸筒插秧机
Among 36,000 who have reached celebrity status on the Internet, 74 percent are women and 87.8 percent are between 17 to 33 years old, while 89 percent have a college education.
我国近日发行的2016年猴票同样由黄永玉创作。面值为每张1.2元钱,也颇受关注。在正式发布之前,收集者已经在邮局外排起了长队。
Form without content. Which is why devolving to such familiar forms seems like a safe bet, and why it really isn’t. It’s empty and disposable — which is in turn why the 1960s keep being identified as a “trend,” with the associated implication that at some point they will also be identified as “over.” Even though that “over” has yet to come.
Though many people associate Porsche with pure performance cars, in recent years the brand has expanded their lineup to include the Panamera, a luxury large car shown here, as well as the Cayenne and Macan SUVs. According to most reviewers, the Panamera not only lives up to the performance heritage of the Porsche’s brand, but also coddles occupants with an opulent interior and the connectivity features today’s luxury buyer demands.
One such development is 60 Water Street in Dumbo, a 290-unit rental with a 24-hour concierge and a roof deck offering Manhattan views. Leasing begins next month, with rent for a two-bedroom starting at a jaw-dropping $6,018 a month. “People want that condo-like living, even though they’re renting and not owning,” said Jodi Ann Stasse, the managing director of new developments for Citi Habitats.

Data Availability Statement

n. 石油
我们前面已经指出,我们已经能够让聋子听到声音,但是让盲人看见画面是更复杂的事情。当人们失去视力,他们的视网膜不再把光感受器的信号发送给大脑。为了制造人工眼睛,我们需要了解视网膜是如何取得这些信号,而这正是科学家尚未解决的关键之处。

Author Contributions

Last but by no means least is our favourite fact that Norway once knighted a penguin. His name is Nils Olav, and he is a king penguin who now resides on Edinburgh Zoo, Scotland. He is the mascot and Colonel-in-Chief of the Norwegian Royal Guard. He was knighted on 15th August, 2008, which was approved by King Harald V, who stated during the ceremony that Nils was "in every way qualified to receive the honour and dignity of knighthood".
planet
他说,薪酬是个问题(2010年记者的年薪中值为3.6万美元)。他不知道自己能否靠做记者的薪水供养家庭并送孩子上大学。而且还有一点没错,记者的压力和工作时间可能会令人感到精疲力竭。但他说,我不确定自己换个工作是否会开心,也想不出任何一个工作会像做记者这样让我觉得兴奋或有成就感。

Funding

精准扶贫脱贫
It’s been one of the worst years for investment decision-making on record, almost across the board. No strategy worked consistently, save for the type of shareholder activism that only a handful of Wall Street’s billionaire titans are able to engage in.
Imports grew 6.7 per cent year-on-year to $152.2bn after falling 1.4 per cent the previous month, according to China’s General Administration of Customs, defying a median forecast predicting contraction would worsen to 1.9 per cent.
Only two people know the Oscars winners list and supervise the counting procedures - PwC tax adviser Martha Ruiz and Brian Cullinan an accountant.
I agreed with Craig and Neil immediately that Ellen is the ideal host for this year’s show. We’re looking forward to an entertaining, engaging and fun show.
当大脑没有得到充分休眠时,它确实就开始自噬了。在我们睡觉的时候,“清除”程序通常就会启动,但长期缺乏睡眠会使该程序处于高速运转状态,促使大脑清除大量神经元连接和突触连接。
《老友记》里几乎都是白人演员,所以它在当时并不是一部以兼容并包著称的电视剧。剧中的主要角色没有一个是"非主流"。甚至乔伊还经常拿罗斯的第一个老婆是同性恋这事开玩笑,而且经常能在台词中看到性别歧视的只言片语。
The eighth grader's candidacy is also about overcoming age discrimination, which he sees as a barrier to equality, and he says his quest for the top state spot is no joke.
['minits]
这些模子能让普通水果长出有趣的形状。

Conflict of Interest

"The online Internet anti-corruption bid mostly relies on text, photos and videos and it is easy to be superficial if corrupt officials are only exposed this way."
Regulators in other countries will draw lessons from the success or failure of the Japanese model.

References

2. Sakellarides C, Castelo-Branco L, Barbosa P, Azevedo H. The Impact of the Financial Crisis on the Health System and Health in Portugal. Copenhagen: World Health Organization (2014).

Google Scholar

3. Baeten R, Thomson S. Health care policies: European debate and national reforms. In: Social Developments in the European Union. Brussels: European Social Observatory (2011) 2012:187–212.

4. Augusto GF. Cuts in Portugal's NHS could compromise care. Lancet. (2012) 379:400. doi: 10.1016/s0140-6736(12)60174-3

PubMed Abstract | CrossRef Full Text | Google Scholar

5. Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D, et al. Financial crisis, austerity, and health in Europe. Lancet. (2013) 381:1323–31. doi: 10.1016/S0140-6736(13)60102-6

PubMed Abstract | CrossRef Full Text | Google Scholar

6. Barua S. Understanding coronanomics: the economic implications of the Coronavirus (COVID-19) pandemic. SSRN Elect J. (2020). Available online at: 太原:贷款买房可“部分商转公”

Google Scholar

7. Fernandes N. Economic effects of Coronavirus outbreak (COVID-19) on the world economy. SSRN Elect J. (2020). Available online at: 央行:进一步平衡好稳增长和防风险的关系

Google Scholar

8. Ruiz E, Arturo M, Economic waves: the effect of the wuhan COVID-19 on the world economy (2019-2020). SSRN Elect J. (2020). Available online at: 落户放宽抢人大战重燃 房价会“转身”向上吗?

Google Scholar

9. Instituto Nacional de Estatística (INE). Indicadores de contexto para a pandemia COVID-19 em Portugal. COVID-19: uma leitura territorial do contexto demográfico e do impacto socioeconómico - Dados até 03 de junho. (2020). Available online at: 来自5个不同国家的5所商学院今年首次进入排行榜。新加坡李光前商学院(Lee Kong Chian School of Business)是新进入者中排名最高的,直接跃居第36位。加拿大女王大学史密斯商学院(Queen’s Smith School of Business)的排名提高最大,跃升32位至第67名。 (accessed June 5, 2020).

10. Xu S, Li Y. Beware of the second wave of COVID-19. The Lancet. (2020)

PubMed Abstract | Google Scholar

11. Leung K, Wu JT, Liu D, Leung GM. First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: a modelling impact assessment. The Lancet. (2020)

PubMed Abstract | Google Scholar

12. Sajadi MM, Habibzadeh P, Vintzileos A, Shokouhi S, Miralles-Wilhelm F, and Amoroso A. Temperature, humidity and latitude analysis to predict potential spread and seasonality for COVID-19. SSRN Elect J. (2020). Available online at: 百安居让人不心安

PubMed Abstract | Google Scholar

14. Direção-Geral da Saúde (DGS). Relatório de Situação n° 001. Available from: 去年八月北韩一位边界士兵试图射击一些气球,但最终引致了边界双方的一场重机枪交火。 (accessed March 03, 2020).

16. Diário da República. DESPACHO N.° 3863-B/2020 - DIÁRIO DA REPÚBLICA N.° 62/2020, 3° SUPLEMENTO, SÉRIE II DE. Available online at: 时尚界通常视历史为潜在灵感的百宝囊,可供随时汲取、混合搭配。即便如此,目前这一阶段对历史的依赖也太过极端。 (accessed March 27, 2020).

17. Direção-Geral da Saúde (DGS). Laboratórios Referenciados. Available online at: 李克强:不会让经济运行滑出合理的区间 (accessed June 7, 2020).

18. Direção-Geral da Saúde (DGS). Portugal já realizou mais de 600 mil testes de diagnóstico à COVID-19. Available online at: 如果现在的闪电侠韦德减掉30磅肌肉,那你可能就分不清NBA版和高中版的韦德了。 (accessed June 3, 2020).

19. Direção-Geral da Saúde (DGS). Portugal já fez mais de um milhão de testes de diagnóstico. Available online at: 1.Rain Man
大学的发言人告诉记者:如果Siddeeq先生在之后的53年还是收不到这封信,他肯定会抱怨我们的效率。
(accessed June 17, 2020).

21. Direção-Geral da Saúde (DGS). Áreas Dedicadas COVID-19. Available online at: 小区业主卖房时联合涨价是否违法?涉嫌扰乱市场吗 (accessed June 7, 2020).

22. European Commission Eurostat. Local Administrative Units (LAU). Available online at: China's Ministry of Education (MOE) said at a news conference that most of the world's foreign students who study abroad are from China. (accessed May 30, 2020).

Google Scholar

23. European Commission Eurostat. NUTS - Nomenclature of Territorial Units. Available online at: 3C国标或“强制洗牌” 能否引导LED产业走上“净土”? (accessed May 30, 2020).

24. World Health Organization. Impact of Economic Crises on Mental Health. Copenhage: World Health Organization, Regional Office for European Union (2011).

Google Scholar

25. Direção-Geral da Saúde (DGS). Ponto de Situação Atual em Portugal. Available online at: https://covid19.min-saude.pt/ (accessed June 10, 2020).

26. Limb M. A Fifth of Healthcare Spending is Wasted, Says OECD Report. London: British Medical Journal Publishing Group (2017).

Google Scholar

27. OECD/EU. Health at a Glance: Europe 2018: State of Health in the EU Cycle. Paris: OECD Publishing (2018).

28. Caldas de Almeida J, Mateus P, Tomé G. Joint Action on Mental Health and Well-Being Towards Community-Based and Socially Inclusive Mental Health Care. (2015) Available online at: 在春运期间,国内的交通运输将面临极大的挑战,车票供小于求。铁路局会采取多种措施来应对春运压力,比如开设临客(L字头的列车)、延长售票时间以及开设更多的售票点。 (accessed March 26, 2020).

29. Lopes JM, Gonçalves FR, Borges M, Redondo P, Laranja-Pontes J. The cost of cancer treatment in Portugal. Ecancermedicalscience. (2017) 11:765. doi: 10.3332/ecancer.2017.765

PubMed Abstract | CrossRef Full Text | Google Scholar

30. Shaaban AN, Martins O, Rosario M. The importance of improving the quality of care among HIV/AIDS hospitalizations in Portugal. Front Public Health. (2019) 7:266. doi: 10.3389/fpubh.2019.00266

PubMed Abstract | CrossRef Full Text | Google Scholar

31. Ferreira de Magalhães M, Amaral R, Pereira AM, Sá-Sousa A, Azevedo I, Azevedo LF, et al. Cost of asthma in children: a nationwide, population-based, cost-of-illness study. Pediatr Allergy Immunol. (2017) 28:683–91. doi: 10.1111/pai.12772

PubMed Abstract | CrossRef Full Text | Google Scholar

32. Barbosa J, Ferreira-Magalhães M, Sá-Sousa A, Azevedo L, Fonseca J. Cost of asthma in Portuguese adults: a population-based, cost-of-illness study. Rev Port Pneumol. (2017) 23:323–30. doi: 10.1016/j.rppnen.2017.07.003

PubMed Abstract | CrossRef Full Text | Google Scholar

33. Fiorentino F, Ascenção R, Gouveia M, Costa J, Broeiro P, Fonseca C, et al. The cost of illness of heart failure in Portugal. Value Health. (2017) 20:A610. doi: 10.1016/j.jval.2017.08.1203

CrossRef Full Text | Google Scholar

34. Shaaban AN, Dias SS, Muggli Z, Peleteiro B, Martins MRO. Risk of readmission among HIV patients in public portuguese hospitals: longitudinal multilevel population-based study. Front Public Health. (2020) 8:15. doi: 10.3389/fpubh.2020.00015

PubMed Abstract | CrossRef Full Text | Google Scholar

36. Joynt KE, Jha AK. Thirty-day readmissions—truth and consequences. New Engl J Med. (2012) 366:1366–9. doi: 10.1056/NEJMp1201598

PubMed Abstract | CrossRef Full Text | Google Scholar

37. Leppin AL, Gionfriddo MR, Kessler M, Brito JP, Mair FS, Gallacher K, et al. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Intern Med. (2014) 174:1095–107. doi: 10.1001/jamainternmed.2014.1608

PubMed Abstract | CrossRef Full Text | Google Scholar

38. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. New Engl J Med. (2009) 360:1418–28. doi: 10.1056/NEJMsa0803563

PubMed Abstract | CrossRef Full Text | Google Scholar

39. Nijhawan AE, Kitchell E, Etherton SS, Duarte P, Halm EA, Jain MK. Half of 30-day hospital readmissions among HIV-infected patients are potentially preventable. AIDS Patient Care and STDs. (2015) 29:465–73. doi: 10.1089/apc.2015.0096

PubMed Abstract | CrossRef Full Text | Google Scholar

40. Coelho LE, Ribeiro SR, Japiassu AM, Moreira RI, Lara PC, Veloso VG, et al. Thirty-day Readmission Rates in an HIV-infected Cohort From Rio de Janeiro, Brazil. J Acquir Immune Defic Syndr. (2017) 75:e90–e8. doi: 10.1097/QAI.0000000000001352

PubMed Abstract | CrossRef Full Text | Google Scholar

41. Berry S, Fleishman J, Moore R, Gebo K. Thirty-day hospital readmissions for adults with and without HIV infection. HIV Med. (2016) 17:167–77. doi: 10.1111/hiv.12287

PubMed Abstract | CrossRef Full Text | Google Scholar

42. Boccuti C, Casillas G. Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program. The Henry J. Kaiser Family Foundation (2015). Available online at: 据信,宝能借入了大笔资金来购买万科的股票。现在,它已是万科最大的股东,持股比例为25%。 (accessed April 2, 2020).

Google Scholar

43. Brasel KJ, Lim HJ, Nirula R, Weigelt JA. Length of stay: an appropriate quality measure? Arch Surg. (2007) 142:461–6. doi: 10.1001/archsurg.142.5.461

PubMed Abstract | CrossRef Full Text | Google Scholar

44. Kahn KL, Keeler EB, Sherwood MJ, Rogers WH, Draper D, Bentow SS, et al. Comparing outcomes of care before and after implementation of the DRG-based prospective payment system. JAMA. (1990) 264:1984–8. doi: 10.1001/jama.1990.03450150084036

PubMed Abstract | CrossRef Full Text | Google Scholar

45. Instituto Nacional de Estatística - Estatísticas da Saúde 2017. Lisboa: INE (2019). Available online at: 智能皮带 (accessed March 17, 2020).

47. OECD/European Observatory on Health Systems and Policies (2017), Portugal: Country Health Profile 2017, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

48. PORDATA. Healthcare Personnel: Doctors, Dentists, Odontologists, Nurses and Pharmacists. Available online at: Song “Taste of China” (Phoenix Legend) (accessed Apr 11, 2020).

49. PORDATA. Number of Inhabitants Per Doctor and Healthcare Personnel. Available from: In month-on-month terms, consumer prices fell 0.1 per cent after having risen 0.7 per cent a month earlier. (accessed Apr 11, 2020).

51. Garg S. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019—COVID-NET, 14 States, March 1–30, (2020). MMWR Morbidity and Mortality Weekly Report. Atlanta, GA (2020) 69.

Google Scholar

52. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. (2020) 323:1239–42. doi: 10.1001/jama.2020.2648

PubMed Abstract | CrossRef Full Text | Google Scholar

53. Dressler WW. Health in the African American community: accounting for health inequalities. Med Anthropol Quarterly. (1993) 7:325–45. doi: 10.1525/maq.1993.7.4.02a00030

CrossRef Full Text | Google Scholar

54. Schulz A, Israel B, Williams D, Parker E, Becker A, James S. Social inequalities, stressors and self reported health status among African American and white women in the Detroit metropolitan area. Social Sci Med. (2000) 51:1639–53. doi: 10.1016/s0277-9536(00)00084-8

PubMed Abstract | CrossRef Full Text | Google Scholar

55. Jackson PB. Health inequalities among minority populations. J Gerontol Series B. (2005) 60:S63–7. doi: 10.1093/geronb/60.Special_Issue_2.S63

PubMed Abstract | CrossRef Full Text | Google Scholar

56. Santana P. Acessibilidade e utilizaçao dos serviços de saúde. Ensaio metodológico em economia da saúde. Coimbra: Faculdade de Letras da Universidade de Coimbra Universidade de Coimbra. (1993)

57. Giraldes MdR. Morbilidade declarada no INS 1995/96. Que respostas?–Uma abordagem realizada numa perspectiva de equidade. Lisbon: Revista Portuguesa de Sáude Pública. (1998) 16:43–60.

58. PORTUGAL REPORT. United Nations Economic Commission for Europe (UNECE) Third Review and Appraisal of the Regional Implementation Strategy (RIS) of the Madrid International Plan of Action on Ageing (MIPPA). (2017) Available online at: Mr. Nathan was among the few dealers actively bidding at the evening sales. Buying on behalf of a client, he paid 506,500, or twice the estimate, at Christie’s for Charles-Antoine Coypel’s 1737 painting, “The Destruction of the Palace of Armida.” (accessed April 1, 2020).

59. Shaaban AN, Morais S, Peleteiro B. Healthcare services utilization among migrants in Portugal: results from the National Health Survey 2014. Journal of immigrant and minority health. (2018) 21:219–29. doi: 10.1007/s10903-018-0744-3

PubMed Abstract | CrossRef Full Text | Google Scholar

60. Migration Integration Policy Index Health Strand (MIPEX). Country Report Portugal. Brussels: International Organization for Migration (2015).

Google Scholar

63. Lancet T. Migration and Health: A Complex Relation. London: Elsevier (2006).

64. Ayuso-Mateos JL, Barros PP, Gusmão R. Financial crisis, austerity, and health in Europe. Lancet. (2013) 382:391–2.

PubMed Abstract | Google Scholar

65. Oliveira MD, Bevan G. Measuring geographic inequities in the Portuguese health care system: an estimation of hospital care needs. Health Policy. (2003) 66:277–93. doi: 10.1016/S0168-8510(03)00118-0

PubMed Abstract | CrossRef Full Text | Google Scholar

66. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. (2020) 7:e14. doi: 10.1016/S2215-0366(20)30047-X

PubMed Abstract | CrossRef Full Text | Google Scholar

67. Xiang Y-T, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. (2020) 7:228–9. doi: 10.1016/S2215-0366(20)30046-8

PubMed Abstract | CrossRef Full Text | Google Scholar

68. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. (2020) 395:912–20. doi: 10.1016/S0140-6736(20)30460-8

PubMed Abstract | CrossRef Full Text | Google Scholar

69. Venkatesh A, Edirappuli S. Social distancing in covid-19: what are the mental health implications? BMJ. (2020) 369:m1379. doi: 10.1136/bmj.m1379

PubMed Abstract | CrossRef Full Text | Google Scholar

70. Augusto GF. Mental health in Portugal in times of austerity. Lancet Psychiatry. (2014) 1:109–10. doi: 10.1016/S2215-0366(14)70251-2

PubMed Abstract | CrossRef Full Text | Google Scholar

71. Santos JC, Cutliffe J. The recent global socioeconomic crisis and its effects on mental health in Portugal. Ment. Health Nurs. (2013) 33:33-5.

Google Scholar

72. Comissão Técnica de Acompanhamento da Reforma da Saúde Mental. Relatório da Avaliação do Plano Nacional de Saúde mental 2007–2016 e propostas prioritárias para a extensão a 2020. Lisbon: Serviço Nacional de Saúde (2017). Available online at: 这套邮票价格如此之高的原因是因为这是中华人民共和国1949年建国以来,第一次中国邮政发行的生肖邮票。 (accessed March 26, 2020).

Google Scholar

73. Caldas de Almeida JM. Portuguese National Mental Health Plan (2007-2016) executive summary. Ment Health Fam Med. (2009) 6:233–44.

PubMed Abstract | Google Scholar

74. Caldas de Almeida J, Mateus P, Tomé G. Joint Action on Mental Health and Well-Being Towards Community-Based and Socially Inclusive Mental Health Care. Lisbon: Europe Union Reports (2015).

75. Chen K-T, Twu S-J, Chang H-L, Wu Y-C, Chen C-T, Lin T-H, et al. SARS in Taiwan: an overview and lessons learned. Int J Infect Dis. (2005) 9:77–85. doi: 10.1016/j.ijid.2004.04.015

PubMed Abstract | CrossRef Full Text | Google Scholar

76. Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, et al. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth. (2020) 67:732–45. doi: 10.1007/s12630-020-01620-9

PubMed Abstract | CrossRef Full Text | Google Scholar

77. Liew MF, Siow WT, MacLaren G, See KC. Preparing for COVID-19: early experience from an intensive care unit in Singapore. Critical Care. (2020) 24:83. doi: 10.1186/s13054-020-2814-x

PubMed Abstract | CrossRef Full Text | Google Scholar

78. Wang CJ, Ng CY, Brook RH. Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing. JAMA. (2020) 323:1327–1420. doi: 10.1001/jama.2020.3151

PubMed Abstract | CrossRef Full Text | Google Scholar

Keywords: COVID-19, health inequalites, health system, quality indicators—healthcare, mental health, economic crisis

Citation: Shaaban AN, Peleteiro B and Martins MRO (2020) COVID-19: What Is Next for Portugal? Front. Public Health 8:392. doi: 10.3389/fpubh.2020.00392

Received: 16 April 2020; Accepted: 03 July 2020;
Published: 21 August 2020.

Edited by:

Tarun Stephen Weeramanthri, University of Western Australia, Australia

Reviewed by:

Lawrence Ulu Ogbonnaya, Federal Teaching Hospital Abakaliki, Nigeria
Gregory Dore, University of New South Wales, Australia

Copyright © 2020 Shaaban, Peleteiro and Martins. This is an open-access article distributed under the terms of the 中宇卫浴曝会计丑闻 日本建材企业巨亏5.3亿美元. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Ahmed Nabil Shaaban, anshaaban@brandeis.edu