Health literacy, a more complex concept than knowledge, is a required capacity to obtain, understand, integrate and act on health information [1], in order to enhance individual and community health, which is defined by different levels, according to the autonomy and personal capacitation in decision making [2]. Medium levels of Health literacy in an adolescent population were found in a study conducted in 2013/2014, being higher in sexual and reproductive health and lower in substance use. It was also noticed that the higher levels of health literacy were in the area adolescents refer to have receipt more health information. The health literacy competence with higher scores was communication skills, and the lower scores were in the capacity to analyze factors that influence health. Higher levels were also found in younger teenagers, but in a higher school level, confirming the importance of health education in these age and development stage. Adolescents seek more information in health professionals and parents, being friends more valued as a source information in older adolescents, which enhance the importance of peer education mainly in older adolescents [3]. As a set of competences based on knowledge, health literacy should be developed through education interventions, encompassing the cultural and social context of individuals, since the society, culture and education system where the individual is inserted can define the way the development and enforcement of the health literacy competences [4]. The valued sources of information should be taken into account, as well as needs of information in some topics referred by adolescents in an efficient health education. Schizophrenia is a serious and chronic mental illness which has a profound effect on the health and well-being related with the well-known nature of psychotic symptoms. The exercise has the potential to improve the life of people with schizophrenia improving physical health and alleviating psychiatric symptoms. However, most people with schizophrenia remains sedentary and lack of access to exercise programs are barriers to achieve health benefits. The aim of this study is to evaluate the effect of exercise on I) the type of intervention in mental health, II) in salivary levels of alpha-amylase and cortisol and serum levels of S100B and BDNF, and on III) the quality of life and selfperception of the physical domain of people with schizophrenia. The sample consisted of 31 females in long-term institutions in the Casa de Saúde Rainha Santa Isabel, with age between 25 and 63, and with diagnosis of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Physical fitness was assessed by the six-minute walk distance test (6MWD). Biological variables were determined by ELISA (Enzyme-Linked Immunosorbent Assay). Psychological variables were assessed using SF-36, PSPP-SCV, RSES and SWLS tests. Walking exercise has a positive impact on physical fitness (6MWD -p = 0.001) and physical components of the psychological test...

There is limited information about wildland firefighters' exposure to polycyclic aromatic hydrocarbons (PAHs), being scarce studies that included the impact of tobacco consumption. Thus, this work evaluated the individual and cumulative impacts of firefighting activities and smoking on wildland firefighters' total exposure to PAHs. Six urinary PAH metabolites (1-hydroxynaphthalene (1OHNaph), 1-hydroxyacenaphthene (1OHAce), 2-hydroxyfluorene (2OHFlu), 1-hydroxyphenanthrene (1OHPhen), 1-hydroxypyrene (1OHPy), and 3-hydroxybenzo[a]pyrene (3OHB[a]P)) were quantified by high-performance liquid chromatography with fluorescence detection. Firefighters from three fire stations were characterized and organized in three groups: non-smoking and non-exposed to fire emissions (NSNExp), smoking non-exposed (SNExp), and smoking exposed (SExp) individuals. 1OHNaph+1OHAce were the most predominant OH-PAHs (66-91% ∑OH-PAHs), followed by 2OHFlu (2.8-28%), 1OHPhen (1.3-7%), and 1OHPy (1.4-6%). 3OHB[a]P, the carcinogenicity PAH biomarker, was not detected. Regular consumption of tobacco increased 76-412% ∑OH-PAHs. Fire combat activities promoted significant increments of 158-551% ∑OH-PAHs. 2OHFlu was the most affected compound by firefighting activities (111-1068%), while 1OHNaph+1OHAce presented the more pronounced increments due to tobacco consumption (22-339%); 1OHPhen (76-176%) and 1OHPy (20-220%) were the least influenced ones. OH-PAH levels of SExp firefighters were significantly higher than in other groups, suggesting that these subjects may be more vulnerable to develop and/or aggravate diseases related with PAHs exposure.

Aims To study the correlation between the workload of intensive care nursing teams and the sociodemographic, anthropometric and clinical characteristics of patients in critical condition in a Portuguese Intensive Care Unit (ICU) during a 5‐year period. Background Currently, indices of nursing workload quantification are one of the resources used for planning and evaluating ICUs. Evidence shows that there are several factors related to critical patients and their hospitalisation which potentially influence the nursing workload. Design Retrospective cohort analysis of a health record database from adult patients admitted to a Portuguese ICU between 1 January 2015–31 December 2019. Methods Simplified Therapeutic Intervention Scoring System (TISS‐28) scores of 730 adult patients. Three TISS‐28 assessments were considered: first assessment, last assessment and average. The STROBE guidelines were used in reporting this study. Results The TISS‐28 has an average of 34.2 ± 6.9 points at admission, which is considered a high nursing workload. A somewhat lower result was found for the discharge and average assessments. It shows that basic activities accounted for the highest percentage of time spent (38.0%), followed by the cardiovascular support category (26.5%). The TISS‐28 shows consistent results throughout the study period, despite a small trend reduction in the last 2 years. Conclusions Lower workloads were found for age ≤44 years and with a shorter length of stay. Higher workload was more probable in patients classified in Cullen Class IV (OR = 2.5) and with a normal to higher weight percentile (OR = 1.9 and 1.5, respectively). Relevance to clinical practice Knowledge of the factors influencing the nursing workload facilitates the implementation of rules to improve performance in nursing interventions, based on the redefinition of care priorities, increased productivity, human resources management and reduction of additional costs to the organisation, related to possible adverse events, among others.

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

Background Hypothenar hammer syndrome (HHS) is an uncommon vascular overuse syndrome caused by trauma to the palmar portion of the ulnar artery. Objective In this report, we describe a representative case in the volleyball player as well as a brief approach to clinical features, pathogenesis, diagnosis, imaging and management. Design Case report. Setting Volleyball National Team. Methods The athlete is a 22-year-old right-hand dominant male, national team middle blocker, who presented to the Medical Department for evaluation of painful and paresthetic fourth and fifth digits. He described the affected fingertips and hypothenar region as being tender and sensitive to touch. When queried, he stated that he would use the hypothenar portion of his right hand to spike and block. There was an abnormal Allen test in the right hand with refill of the palmar vasculature with release of the radial artery but no refill with release of the ulnar artery, consistent with a diagnosis of HHS. He started a platelet aggregation inhibitor and was instructed and trained to change his hitting technique. Results On follow-up the athlete's remaining symptom was mild cold sensitivity. He was able to perform his usual sports activities without impairment. Conclusions Typically, HHS occurs in men in their 40s involving the dominant hand and in occupational settings where the workers use the hypothenar portion of the hand as a tool to hammer, push or squeeze hard objects (metal workers, machinists, brick layers, carpenters, etc.). It is a curable and preventable cause of upper extremity digital ischemia, rarely seen in volleyball.