Community interventions for appropriate use of antibiotics should be designed with a special focus on women. This should be done through public awareness campaigns and improving access to reliable medical services. Drug prescribers are key not only to appropriate antimicrobial prescription, but also to adequate dispensing, and are strong advocates for the possible misconceptions on antimicrobial usage by lay people.

Adaptive surfing is an outdoor sports activity which is practice in a natural, dynamic and high challenging environment. The moving waves, rip currents, tides and the beach appears as an innovative approach if compared to other traditional adaptive water sports (such as swimming, rowing or sailing). In this basis we can divide adaptive surfing in three major types of interventions: as recreative/leisure activity and play, as sportive competition and high-performance sports; or as therapeutic technic or with rehabilitation proposes. Nowadays adaptive surfing is finally being considered as highly important not only by surfers, therapists and social workers but also by the general public and a number of politicians as a crucial instrument for social inclusion worldwide. We hope to see more adaptive surfing programs and projects worldwide in the next years and hope it will gain more attention from governmental and non-governmental organizations in order to obtain more funding to support these programs. More funding would enable researchers to conduct this kind of work more often and produce more extensive data to support the case for the usefulness of adaptive surfing.

Introduction: Studies about urbanicity and psychosis show contradictory results. In northern European countries and China there is a positive relationship; in southern European and underdeveloped countries, a significant difference between rural and urban rates of psychosis has not been found. Methods: We carried out a 5‐year retrospective observational study, with patients admitted to two inpatient units for first‐episode psychosis (FEP), in a rural area (Évora) and an urban area (Lisbon). We excluded affective or organic psychosis. Socio‐demographic and clinical data were extracted and analyzed.Results: The prevalence of FEP was the same for both areas (42/100 000 inhabitants), with a predominance of unemployed (63%) and lonesome individuals (81% in Évora versus 72% in Lisbon). The mean age was similar (Évora 43.4 years old; Lisbon 41.4 years old). Lisbon had a greater diversity of nationalities (16.3% vs 4.6%) and a higher rate of psychotic disturbance due to substance use (26.5% vs 21.6%). The most prevalent diagnosis in the Lisbon was unspecified psychotic disorder (UPD) (34.7%), while in Évora it was delusional disorder (DD) (21.5%) and acute andtransient psychotic disorder (21.5%). DD was a prevalent diagnosis in both areas, affecting mainly women and those with a higher median age. Duration of untreated psychosis (DUP) of less than 1 month was higher in Lisbon (24.5% vs 4.5%), but there was a high prevalence of DUP of more than 2 years in both samples (20.4% vs 23.1%). Discussion: The mean age of FEP was higher than in other studies, which may translate a significant prevalence of DD or reflect a higher DUP. A reduced DUP of less than 1 month in the rural area can be explained by greater isolation of the population, lower health literacy or better integration of patients in the community. The prevalence of UPD was higher in the urban area, possibly due to different forms of registration or a lower DUP. Conclusion: Our results are in line with studies reported in southern European countries, where no association was found between psychosis and urbanicity, and further studies are needed to elucidate this issue.

BackgroundA significant percentage of antibiotics worldwide are prescribed inappropriately (context, dosage and duration), especially the use of quinolones, carbapenems and anti-MRSA agents. In order to optimise interventions in a paper-free hospital, a platform has been developed locally allowing prescription monitoring and registration of multidisciplinary interventions under the platform that supports antimicrobial prescription (PAPA), complementing automatically generated email notifications when prescribing conditioned antibiotics or outside the local guidelines. Interventions are made by physician and pharmacist members of the Prevention and Control of Infection and Antimicrobial Resistance Group (GCL-PPCIRA) in real time.PurposeTo characterise hospital prescriptions for quinolones, carbapenems and anti-MRSA agents in March 2016, using the platform.Material and methodsThis was a pilot prospective analysis on the use of a PAPA platform, which integrates data relating to the prescriber, scope and characteristics of the prescription, initial GCL-PPCIRA interventions, follow-up by pharmacists, medical acceptance and registration of clinical and laboratory variables.ResultsThe analysis involved 220 conditioned prescriptions, automatically generated by the prescription system and introduced into platform. Of these, 48% required GCL-PPCIRA interventions. 47.2% of the suggested interventions were accepted. In only 6.6% of non-accepted interventions was there an automatic justification and in 46.2% there was no given justification. Most suggested interventions (41.5%) included antibiotic exchange, suspension (26.4%), duration of therapy (12.3%), change of dosage (4.7%) and addition of another antibiotic (1.9%). Most interventions made were for carbapenems (34.9%), followed by quinolones (13.2%) and anti-MRSA agents (9.4%), with an acceptance profile, respectively, of 17/6/4 cases. 34.9% of interventions were made in the emergency department.ConclusionIn order to reduce the emergence of resistances, conducting interventions under a PAPA should be complemented by evaluation of prescription quality and adequacy of interventions, requiring tools that integrate information and enable real time interventions by multiple professionals. This analysis concluded that the rate of interventions in total prescriptions generated meets the estimated international values, which translates into a good robustness. The data analysis related to the reasons for interventions and acceptance rate, and other data not mentioned in this analysis, makes it possible to define improvement strategies for good antibiotic prescribing practices, particularly in the conditioned antibiotics from the prescriber to the institutional level.No conflict of interest