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Background: On March 16, 2020, the first death from CO­VID-19 was recorded in Portugal. Since then, there has been a reorganization of health services, changing the normal approach for the different cases of public health. Excess deaths recorded without a COVID-19 diagnosis are called excess mortality without COVID-19 (EM non-COVID-19). This study aims to estimate the EM non-COVID in the 7-month period after the first registered Covid-19 death. Methods: The following 2 methods were used to estimate the excess mortality in this period: the daily historical average of reported deaths and an adapted auto regressive integrated moving average (ARIMA) model, considering the previous 5 years of records until October 16. For this model, after March 16, data was replaced with the daily historical average deaths from the previous 5 years, simulating the closest scenario possible as there was no pandemic. Only deaths from natural causes were selected for these estimations. For EM non-COVID-19 estimation, we subtracted the COVID-19 deaths from the overall excess mortality. Results: Between March 16, 2020, and October 16, 2020, there was an excess of 6,330 deaths from natural causes, i.e., nearly 12% more than expected. Both methods estimated an EM non-COVID-19 of around 66–67% in this period, with a greater relevance in mid-July and mid-September. Conclusions: Excess mortality was present almost every day during the study period. EM non-COVID-19 seemed to vary over time, showing some inadequacy of healthcare services in management of other patients free of COVID-19 in Portugal during periods with a greater patient volume. It is necessary to take care and monitor COVID-19 cases but also non-COVID-19 cases.

Background: The role of demographic and socio-economic determinants of COVID-19 transmission is still unclear and is expected to vary in different contexts and epidemic periods. Exploring such determinants may generate a hypothesis about transmission and aid the definition of prevention strategies. Objectives: To identify municipality-level demographic and socio-economic determinants of COVID-19 in Portugal. Methods: We assessed determinants of COVID-19 daily cases at 4 moments of the first COVID-19 epidemic wave in Portugal, related with lockdown and post-lockdown measures. We selected 60 potential determinants from 5 dimensions: population and settlement, disease, economy, social context, and mobility. We conducted a multiple linear regression (MLR) stepwise analysis (p < 0.05) and an artificial neural network (ANN) analysis with the variables to identify predictors of the number of daily cases. Results: For MLR, some of the identified variables were: resident population and population density, exports, overnight stays in touristic facilities, the location quotient of employment in accommodation, catering and similar activities, education, restaurants and lodging, some industries and building construction, the share of the population working outside the municipality, the net migration rate, income, and renting. In ANN, some of the identified variables were: population density and resident population, urbanization, students in higher education, income, exports, social housing buildings, production services employment, and the share of the population working outside the municipality of residence. Conclusions: Several factors were identified as possible determinants of COVID-19 transmission at the municipality level. Despite limitations to the study, we believe that this information should be considered to promote communication and prevention approaches. Further research should be conducted.

Background The use of transfusions leads to excessive blood consumption, implying risks such as infections and immunological reactions, so it should be used only when strictly necessary. Patient Blood Management (PBM) aims to minimize the use of allogeneic blood and improve clinical outcomes, with better cost-effectiveness, using three essential points: improving hematopoiesis, minimize blood loss in and optimize the hemoglobin reserves of each patient. The aim of this work is to assess the preoperative haemoglobin optimization using ferric carboxymaltose as part of PBM implementation, in elective orthopaedic, cardiac and colorectal surgery in Portuguese hospitals. Methods This is an observational study materialized in a retrospective and multicenter cohort with data collection from medical records. The population and sample will be patients over 18 years from elective orthopaedic, cardiac and colorectal surgeries, treated according with local standards before PBM implementation were assigned to the pre-PBM cohort and patients after PBM implementation with ferric carboxymaltose to preoperative haemoglobin optimization to the PBM cohort. The criteria for selecting hospitals will be the implementation of PBM during the study period. Expected Results Based on a previous review, it is expected that the results of the use of ferric carboxymaltose to correct iron deficiency anaemia for preoperative haemoglobin optimization will contribute positively to reducing the number of transfusions, the length of hospital stays and will have a direct impact on economic results. Conclusions The use of ferric carboxymaltose and other ferric compounds, as part of PBM program, has demonstrated a positive impact on patients' outcomes (morbility and mortality), adverse events and on economic results. This study might show that clinical guidelines and programs like PBM are a major contribution not just for hemovigilance and blood safety but also for patient safety and health quality. Key messages This work is focused on Portuguese hospitals and aims to assess the impact of ferric carboxymaltose and its benefit on PBM strategy. Specially this study intends to conduct the assessment on health outcomes and costs.

Problem Different countries have incorporated models of decentralization in their health reforms to achieve efficiency, by increasing the training of local governments, responsibility and gains in areas such as quality, costs and equity. In Portugal, the 21st government program established the autonomy of local authorities and the democratic decentralization of public administration. Accordingly, a decentralization law was approved and local governments have now a crucial role on health policies. Description of the Problem For this framework, a situational diagnosis and an intersectoral approach to policies are needed. This is an observational, analytical and cross-sectional study developed at council level in two Portuguese municipalities. This study aims to: Adjust responses to health needs at the local level; Set priorities by taking into account installed capacity and responses to populations; Promote the articulation between entities; Strengthen the focus on health promotion and healthy lifestyles; Strengthen health interventions in educational communities; Promote the creation of programs at local level, in conjunction with the national level, to reduce inequalities. Results The preliminary results in health, social and economic indicators show that this framework, while taking in consideration population characteristics, allows the development of local strategies regarding health services coverage, health services type and medication. At council level, the preliminary results also show a lack of data on healthy lifestyles and social indicators. Lessons The implementation of a decentralization process involves a broad range of requirements such as a situational diagnosis, strategies development and a periodic update of quality life and health indicators. Those are needed to assess council level priorities, which allow the development of public policies and interventions, in line with population characteristics, to tackle health inequalities and inequities. Key messages Performance improvement of health system is linked to the implementation of local citizen centred policies. These are actions which promote quality of life through health-friendly ecosystems. The local health intervention has contributed to promote inequalities reduction, increasing equity and dynamize new frameworks of organization with individual and community participation.

Background and aims Nowadays in Portugal we are witnessing an excessive demand for differentiated health services which generates misuse of resources, increase in costs and a tendency of rupture to the system itself. We aimed to characterise a paediatric emergency department (PED)’s use and to define whether there is unjustified demand for health care. Methods Retrospective cross sectional analysis of emergency episodes during one year (2012) on a level II PED in Barreiro, Portugal. Episodes were defined as unjustified when classified as standard and non-urgent by Manchester Triage. Demographic and clinical data were analysed. Adequate statistical analysis was performed; level of significance p Results We analysed 37,099 PED episodes. Most patients were male (53%), and There was a significant correlation between PED’s unjustified use and both week’s day and day’s hour: episodes occurred mostly at weekends (p11-years (p Conclusion There was an excessive use of the PED by non-emergent episodes in our study. It’s crucial to create measures to contain this phenomenon, namely promoting and strengthening the primary health care, the chain of care and referral network, as well as increase the population’s health literacy.