HTTP/1.1 200 OK Cache-Control: no-cache, private Content-Type: text/html; charset=UTF-8 Date: Fri, 04 Dec 2020 17:57:07 GMT 黄色强奸网站

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

第二步 重复标志性动作
在桑迪飓风登陆新泽西Mantoloking之后的早晨,洪水包围了Mantoloking大桥附件的房屋。
以美元值计,11月中国的进口总值同比上升17.7%,比10月的17.2%高,高于11.3%的预期增速。
It seems safe to predict lots more noise and very little progress for the rest of 2017. And that will continue to be a damaging combination for business and the UK economy.
桑尼伯恩说他不仅对特朗普的错误决定和无知时期感到失望,同时也因为总统对8月在弗吉尼亚州夏洛茨维尔举行的白人种族主义集会上反抗者被杀害后做出的回应感到失望——这也更加坚定了桑尼伯恩竞选州长的决心。
n. 谣言,传闻
['?mnesti]
比利时
彭博(Bloomberg)软性大宗商品指数上涨21%,工业金属和能源指数则分别上涨24%和1.5%。

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.

有趣的是,“真诚的问候”(unfeigned regards)又重回我们的视野——人们现在可以在印度服务中心的邮件上见到这一18世纪末的流行语。而更胜一筹的是这个签名,一个周五我收到了一则消息,末尾处写到:“周末好”(weekend well)。我差点将最佳名词使动用法奖也颁给它,不料最后一刻却杀出一匹黑马,一位顾问无意中说了句:“我们能把那件事冷毛巾一下吗?”(Can we cold towel that?)
May the coming New Year bring you joy, love and peace.
They also arrived 40 minutes late for the official welcome and were running late to an event in Vancouver, too.
Selling that many cars would make Tesla larger than the U.S. arms of luxury makers like Lincoln and Porsche, both of which have more diverse product portfolios, long-established dealer networks, and refined strategies for marketing and advertising. Half the sales would come from the aging Model S sedan and the other half the new Model X seven-seat crossover that goes into production early next year.
SIZE: 3,073 square feet
12岁的年纪,大多数的小女孩都还在向父母争取打耳洞的机会,努力适应高中生活,从青少年时代开始为将来做准备。
“在ETF壮大的地区(美国和欧洲),有一个庞大的理财顾问生态系统,”他表示,“你需要一个更加依靠顾问的模式。但在你看到人们为建议付费(而不是支付佣金)之前,很难设想它何时起飞。”
单词designer 联想记忆:
2017已经是詹姆斯在联盟中的第十四个赛季,但他的场均助攻和篮板竟然还创下了职业新高。在这个赛季的前两个月里,他拿出了整个职业生涯最好的三分表现,但鉴于这已经被各方专家们讨论和剖析,并且被媒体广泛的报道了,我在这里就不加赘述了。
3. The government bothlocal and national will invest in more technology-driven sectors, includingadvanced agriculture, transportation, medicine and other sectors. Thisinitiative will be aimed squarely at improving China’s productivity andmanufacturing competitiveness. There will be a national effort aimed atachieving quality, first-time yield and ensuring “productivity driven” globalcompetitiveness.
一家贷款给农业企业的大型银行称,中国对棉花和糖等原材料官方储备的处置,将成为影响2017年大宗农产品走势的一个关键因素。
“有个人说自己去上厕所,然后就再没回来。”

Data Availability Statement

The Good Place
For democrats, the outburst of such primal emotions is disturbing because they are so hard to contain.

Author Contributions

[k?ut?]
结果那些要求进行设身处地和角色扮演的人在随后的提问环节表现最好。准确地说,这些运用设身处地法进行记忆的人记单词的效率是使用其他记忆方式的人的三倍。虽然主持这项实验的科学家们研究的是设身处地法对患有记忆力损伤的人恢复记忆的影响,但无论人们有没有记忆损伤,皆可能受益于此。如果你想记住朋友在哪买了一双鞋子,不妨就试着想象走进店里买鞋的是自己。
vt

Funding

Wealthy Chinese bought at least seven overseas islands in 2014.
不会。傻子才会去预测足球比赛的结果。最好是作事后诸葛亮。目前已经举办过20届世界杯。其中,巴西(5次捧杯)和德国(4次捧杯)是决赛常客。主场优势有所帮助,东道国赢得了6次奖杯。但是明年的世界杯将在俄罗斯举行,而这位东道主在参赛队伍中排名垫底。
Cheng继续说道:“一旦你找到适合自身需求的列表,只需轻按该列表即可看到推荐店铺的位置,然后通过左右滑动来查看更多选项,点击"阅读更多"或者屏幕底部的箭头可以选择地点和获得更多细节。”
To make a long story short, the Seppenwolde group went bankrupt shortly after Christmas of 1772. The disaster was a top story in Dutch newspapers. It ruined some of Amsterdam’s merchants and bankers. To prevent a general credit collapse, the city of Amsterdam stepped in temporarily as a lender of last resort. Sound familiar?
但3D版吉祥猴的形象却未能避开炮击,挑剔的网友纷纷吐槽:“这让我想起红绿灯!”;“水墨画的精髓全然不见”;“耳朵下面的两个球是什么呀,太抢镜了……”;“已被它丑哭。”
The Magic have bounced between average and bad, and they're currently on a downswing. Now Aaron Gordon and Nikola Vucevic are coming off the bench and Mario Hezonja is buried.
几年前,有人发明了一辆会飞的自行车,叫做"Paravelo"。称一辆自行车会飞,并不是开玩笑,而是这辆自行车真的会飞(车头有一个巨大的降落伞)。它在陆地和空中的时速分别为25千米(15英里)和40千米(25英里),可飞至1200米(4000英尺)高空。最棒的地方是什么呢?那就是你不需要有飞行驾照。Paravelo号称世界上第一辆会飞的自行车,但我们必须指出它并不是第一辆会飞的自行车。
这块白板经常被写满公式。但你是否曾好奇过这些公式都有什么含义?我们也许没有机会知道它们代表什么,但它们的确都是真实准确的公式。这一点相当给力。
Judge Business School at the University of Cambridge jumps five places to fifth. Not only is it the first time it has broken into the top five, but it is also the first occasion that LBS is not the top-placed UK school in the MBA ranking.
[ri'f?:m]

Conflict of Interest

萎靡不振的不光是那些挑选个股的基金。截止12月1日,对冲基金整体回报严重落后于市场。彭博收集的数据显示,对冲基金平均同比上涨了2%,其回报率也就勉强赶上无风险10年期美国国债的票面利率。2014年将有1000多只基金倒闭,是自2009年以来破产清算最多的一年。
联合国世界知识产权组织(WIPO)、英士国际商学院和美国康奈尔大学联合发布的年度报告显示,全球第二大经济体正在赶追创新领域那些传统的领先者。目前,第一集团主要是由瑞士、瑞典、英国和美国引领。

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: 二手交易持续攀升 二线城市土地市场成焦点

Google Scholar

7. Fernandes N. Economic effects of Coronavirus outbreak (COVID-19) on the world economy. SSRN Elect J. (2020). Available online at: 社科院蓝皮书:租房市场价格是稳中有降的趋势

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: 建材4单位列“中小企业公共服务示范平台”

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: One of the more notorious incidents was when Zhu Ling, a student at the prestigious Tsinghua University, was paralyzed when her roommate allegedly poisoned her with thallium in 1994. (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: 济南一楼盘退房退款现场 :20余名保安严查 不能开车进

PubMed Abstract | Google Scholar

13. Direção-Geral da Saúde (DGS). Relatório de Situação n° 015. Available online at: The aspiring actress is also hoping her online following will secure her an audition to appear on ABC show 'Once Upon A time' which is adding Elsa as a character next season. (accessed March 17, 2020).

14. Direção-Geral da Saúde (DGS). Relatório de Situação n° 001. Available from: The TV version premiered on Jan 30 and starred two popular actresses, Yang Mi and Dilraba. It is about a fairy’s romance with a god in their three different lives. (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: Thousands of supporters awaited Rossello’s arrival for the post-swearing-in inauguration ceremony at the island’s seaside Capitol building, clutching umbrellas to protect themselves from a searing sun. (accessed March 27, 2020).

17. Direção-Geral da Saúde (DGS). Laboratórios Referenciados. Available online at: 楼市“去库存”空间:只卖不建存量也够卖几年 (accessed June 7, 2020).

19. Direção-Geral da Saúde (DGS). Portugal já fez mais de um milhão de testes de diagnóstico. Available online at: After Google and Apple, are Amazon and Microsoft.
谢亚轩估计,11月中国外储下降的大约40%(350亿美元左右)可归因于欧元和其他货币相对于美元走弱的估值影响,而不是资本外流。
(accessed June 17, 2020).

21. Direção-Geral da Saúde (DGS). Áreas Dedicadas COVID-19. Available online at: 石材业“变革”中的七大关键词:行业将面临大尺度整合 (accessed June 7, 2020).

23. European Commission Eurostat. NUTS - Nomenclature of Territorial Units. Available online at: “旅游+区块链”未来市场广阔 (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: In this Sept. 18, 1990, file photo, Steve Jobs, president and CEO of NeXT Computer Inc., shows off his company's new NeXTstation after an introduction to the public in San Francisco (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

35. Horwitz L, Partovian C, Lin Z, Herrin J, Grady J, Conover M, et al. Hospital-Wide (All-Condition) 30-Day Risk-Standardized Readmission Measure. New Haven, CT (2011). Available online at: The company advises consumers or businesses using any of the passwords on the list to change them immediately. Splashdata warned that even passwords with common substitutions like "dr4mat1c" can be vulnerable to attackers' increasingly sophisticated technology.
['?:b?n]
(accessed October 27, 2013)

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

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

46. Simões J, Augusto GF, Fronteira I, Hernández-Quevedo C. Portugal: health system review. Health Syst Trans. (2017) 19:1–184. Available on line at: In early November the government further tightened controls over outbound investment by requiring regulatory approval for some foreign acquisitions conducted through an offshore entity.

Google Scholar

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: 我猜弗兰克-沃格尔正在试验阵容以找到能赢球的轮换阵容。但是这个阵容实在是太不均衡了,最有希望的球员没有被安置在最好的位置上。 (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: 全球化和世界的和平发展合作是一体的、不可分的。 (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

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 陕西涂料季节性明显 差异化营销受宠. 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