Background To control the spread of the SARS-CoV-2 virus, countries around the world implemented lockdowns with varying intensities. Lockdowns, however, have been associated with a deterioration of mental health, including post-traumatic stress symptoms, anger and anxiety. Exposure to nature might reduce stress and provide relaxation opportunities. Objective Firstly, we aimed to determine which sociodemographic, housing and lockdown-related characteristics were associated with changes in exposure to nature during the COVID-19 lockdown in Portugal and Spain. Secondly, we sought to estimate the associations of these changes with mental health, and test whether these associations differed according to sociodemographic characteristics and between the two countries, which experienced different restrictions and epidemiological situations. Methods A cross-sectional study was conducted between March 27 and May 6, 2020, using an online questionnaire to measure changes in exposure to nature (including private green space and other greenery, views of nature from home and public natural spaces); sociodemographic, housing and lockdown-related characteristics; stress levels (visual stress scale); psychological distress (General Health Questionnaire − 12 items) and somatization (somatization scale). Adjusted regression models were fitted to estimate associations. Results This study included 3157 participants (1638 from Portugal, 1519 from Spain). In Portugal, maintaining/increasing the use of public natural spaces during the lockdown was associated with lower levels of stress (adjusted beta −0.29; 95%CI −0.49, −0.08) and maintaining/increasing the frequency of viewing nature from home was associated with reduced psychological distress (0.27; −0.51, −0.03), somatization (−0.79; −1.39, −0.20), and stress levels (−0.48; −0.74, −0.23). In Spain, maintaining/increasing contact with private green space and greenery was associated with lower stress levels: for contact with indoor plants (−0.52; −0.96, −0.07) and for use of private community green spaces (−0.82; −1.61, −0.03). Conclusion Exposure to nature was associated with better mental health outcomes during lockdowns, but the natural features associated with improved mental health differed between the two countries. Nature should be incorporated into urban planning interventions and housing design and exposure to nature should be promoted during lockdowns.

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By extending its euthanasia law to minors in 2014, Belgium has fuelled the international debate on this issue. In fact, Medicine does not always have something to offer when it comes to a child's serious disease. Nevertheless, should euthanasia be considered a viable solution? Keeping in mind the Belgian reality, this article analyses the relevance of the new law, considering, on one hand, children's growing self-determination capacity and, on the other hand, their lack of "life experience". Let's not forget, in addition, classical arguments against euthanasia, such as the disrespect for the value of human life and the eventual approaching of the slippery slope. An obvious solution for this problem is the implementation of a proper palliative care system. However, evidence about the quality of pediatric end-of-life care is scarce. Therefore, additional investigation is necessary in order to formulate and propose an appropriate public policy on the matter. Keywords: Euthanasia. Child. Belgium. Palliative care. Resumo Caso belga de eutanásia em crianças: solução ou problema?A aprovação da extensão da prática da eutanásia a menores de idade em 2014, pela Bélgica, reacendeu o debate internacional sobre as decisões médicas em fim de vida em crianças. De fato, a medicina nem sempre tem resposta para a doença grave de uma criança. No entanto, será a eutanásia uma solução equacionável? Partindo da realidade belga, este artigo analisa a premência da nova legislação, considerando, por um lado, a capacidade crescente de autodeterminação das crianças e, por outro, a sua falta de "experiência de vida", não esquecendo argumentos clássicos que contrariam a prática da eutanásia, como o desrespeito pelo valor da vida humana e a eventual concretização do argumento da ladeira escorregadia. Uma solução óbvia passa pela realização de cuidados paliativos apropriados. Todavia, sendo escassa a evidência sobre a qualidade dos cuidados pediátricos em fim de vida, é necessária investigação adicional para que se possam formular e propor políticas públicas adequadas a respeito da matéria. Palavras-chave: Eutanásia. Criança. Bélgica. Cuidados paliativos. Resumen Caso belga de la eutanasia en niños, ¿solución o problema?La aprobación de la práctica de la extensión de la eutanasia a menores en 2014 por Bélgica ha reavivado el debate internacional sobre las decisiones médicas en el fin de la vida de los niños. De hecho, la medicina no siempre ha de responder a la enfermedad grave de un hijo. Sin embargo, ¿debería considerarse la eutanasia como una solución viable? Partiendo de la realidad belga, este artículo analiza la emergencia de la nueva ley: considerando, por un lado, la creciente capacidad de autodeterminación de los niños y, en segundo lugar, su falta de "experiencia de vida", sin olvidar los clásicos argumentos que contradicen la práctica de la eutanasia, como el desprecio por el valor de la vida humana y la eventual realización de "rampa de deslizamiento". Una solución obvia es implementar los cuidados paliativos adecuados. Si...

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