Perspectivas sobre o acesso aos tratamentos de fertilidade em Portugal

OBJECTIVE: To analyze users' reasons for choosing in vitro fertilization treatment in public or private services and to identify their suggestions for improving fertility treatment. METHODS: A qualitative study using an interpretative approach was conducted. Fifteen semi-structured interviews were conducted with patients undergoing in vitro fertilization treatment (nine women, one man and five couples) at home or at their workplace in the districts of Viana do Castelo, Braga, Porto and Lisbon, Portugal, between July 2005 and February 2006. RESULTS: Users evaluated access to in vitro fertilization treatment in public and private services based mainly on their individual experiences and called for more access to less costly, faster and friendlier care with suitable facilities, appropriate time management and caring medical providers. These perceptions were also associated with views on the need for fighting stigmatization of infertility, protecting children's rights and guaranteeing sustainability of health care system. Interviewees sought to balance reduced waiting time and more attentive care with costs involved. The choice of services depended on the users' purchase power and place of residence and availability of attentive care. CONCLUSIONS: Current national policies on in vitro fertilization treatment meet user's demands of promoting access to, and quality, availability and affordability of in vitro fertilization treatment. However, their focus on legal regulation and technical-scientific aspects contrasts with the users' emphasis on reimbursement, insurance coverage and focus on emotional aspects of the treatment. The study showed these policies should ensure insurance coverage, participation of user representatives in the National Council for Assisted Reproductive Technology, promotion of infertility research and certification of fertility laboratories.OBJETIVO: Analizar las motivaciones de usuarios para escogencia de tratamientos de fertilización in vitro en servicios públicos y privados e identificar propuestas que mejoren la calidad de los mismos. MÉTODOS: Estudio cualitativo con abordaje interpretativa, basado en 15 entrevistas semi-estructuradas con personas que intentaron concebir por medio de técnicas de procreación con asistencia médica en Portugal (nueve mujeres, un hombre y cinco matrimonios). Las entrevistas fueron realizadas entre julio de 2005 y febrero de 2006 en los distritos de Viana do Castelo, Braga, Porto y Lisboa, en casa o en el lugar de trabajo de los entrevistados. RESULTADOS: Los usuarios evaluaron el acceso a los tratamientos de fertilidad en el servicio público o privado principalmente con base en sus experiencias individuales, reclamando acceso más barato, rápido y amigable, en espacios adecuados, con gestión apropiada de los tiempos de espera y servicios médicos atentos. Tales percepciones fueron asociadas a visiones sobre la necesidad de combatir la estigmatización de infertilidad y defender los derechos del niño y la sustentabilidad del sistema de salud. Los entrevistados buscaron equilibrar la reducción del tiempo de espera y cuidados más atentos con los costos financieros involucrados. La escogencia de los servicios dependió del capital económico y del lugar de residencia de los utilizadores y de la existencia de cuidados atentos CONCLUSIONES: Las actuales políticas nacionales van en paralelo con las expectativas de los utilizadores al promover el acceso a los tratamientos de fertilidad y su calidad, pero se separan de ellas al enfatizar la regulación jurídico-legal y la dimensión técnico-científica de la calidad en la procreación con asistencia médica en detrimento de la activación de seguros de salud y de la valorización de aspectos emocionales. Las políticas a implementar pasan por la cobertura obligatoria de los tratamientos por los seguros de salud, la inclusión de un representante de los utilizadores en el Consejo Nacional de Procreación Con Asistencia Médica, la promoción de la investigación sobre infertilidad en Portugal y la certificación de los laboratorios que realizan pruebas de fertilidad.OBJETIVO: Analisar as motivações para escolha de tratamentos de fertilização in vitro em serviços públicos e privados, bem como identificar propostas que melhorem a qualidade desses. MÉTODOS: Estudo qualitativo e interpretativo, baseado em 15 entrevistas semiestruturadas com pessoas que tentaram conceber por meio de técnicas de procriação medicamente assistida em Portugal (nove mulheres, um homem e cinco casais). As entrevistas foram realizadas entre julho de 2005 e fevereiro de 2006 nos distritos de Viana do Castelo, Braga, Porto e Lisboa, em casa ou no local de trabalho dos entrevistados. RESULTADOS: Os usuários avaliaram o acesso aos tratamentos de fertilidade no serviço público ou privado sobretudo com base nas suas experiências individuais, reclamando acesso mais barato, rápido e amigável, em espaços adequados, com gestão apropriada dos tempos de espera e serviços médicos atenciosos. Tais percepções foram associadas a visões sobre a necessidade de combater a estigmatização da infertilidade e defender os direitos da criança e a sustentabilidade do sistema de saúde. Os entrevistados procuraram equilibrar a redução do tempo de espera e cuidados mais atenciosos com os custos envolvidos. A escolha dos serviços dependeu da renda e do local de residência dos usuários, além da existência de cuidados atenciosos. CONCLUSÕES: As atuais políticas nacionais vão ao encontro das expetativas dos utilizadores ao promover o acesso aos tratamentos de fertilidade e a sua qualidade, mas distanciam-se delas ao enfatizarem a regulação jurídico-legal e a dimensão técnico-científica da qualidade na procriação medicamente assistida em detrimento do acionamento de seguros de saúde e da valorização de aspetos emocionais. As políticas a implementar passam pela cobertura obrigatória dos tratamentos pelos seguros de saúde, pela inclusão de um representante dos usuários no Conselho Nacional de Procriação Medicamente Assistida, pela promoção da investigação sobre infertilidade em Portugal e pela certificação dos laboratórios que realizam testes de fertilidade

Optimal switching of a nanomagnet assisted by microwaves

We develop an efficient and general method for optimizing the microwave field that achieves magnetization switching with a smaller static field. This method is based on optimal control and renders an exact solution for the 3D microwave field that triggers the switching of a nanomagnet with a given anisotropy and in an oblique static field. Applying this technique to the particular case of uniaxial anisotropy, we show that the optimal microwave field, that achieves switching with minimal absorbed energy, is modulated both in frequency and in magnitude. Its role is to drive the magnetization from the metastable equilibrium position towards the saddle point and then damping induces the relaxation to the stable equilibrium position. For the pumping to be efficient, the microwave field frequency must match at the early stage of the switching process the proper precession frequency of the magnetization, which depends on the magnitude and direction of the static field. We investigate the effect of the static field (in amplitude and direction) and of damping on the characteristics of the microwave field. We have computed the switching curves in the presence of the optimal microwave field. The results are in qualitative agreement with micro-SQUID experiments on isolated nanoclusters. The strong dependence of the microwave field and that of the switching curve on the damping parameter may be useful in probing damping in various nanoclusters.Comment: 9 pages, 8 figure

Residents' Dissatisfaction and All-Cause Mortality. Evidence from 74 European Cities

Background: About 2/3 of the Europeans reside in cities. Thus, we must expand our knowledge on how city characteristics affect health and well-being. Perceptions about cities' resources and functioning might be related with health, as they capture subjective experiences of the residents. We characterized the health status of 74 European cities, using all-cause mortality as indicator, and investigated the association of mortality with residents' dissatisfaction with key domains of urban living. Methods: We considered 74 European cities from 29 countries. Aggregated data on residents' dissatisfaction was obtained from the Flash Eurobarometer, Quality of life in European cities (2004–2015). For each city a global dissatisfaction score and a dissatisfaction score by domain (environment, social, economic, healthcare, and infrastructures/services) were calculated. Data on mortality and population was obtained from the Eurostat. Standardized Mortality Ratios, SMR, and 95% Confidence Intervals (95% CI) were calculated. The association between dissatisfaction scores and SMR was estimated using Generalized Linear Models. Results: SMR varied markedly (range: 73.2–146.5), being highest in Eastern Europe and lowest in the South and Western European cities. Residents' dissatisfaction levels also varied greatly. We found a significant association between city SMR and residents' dissatisfaction with healthcare (β = 0.334; IC 95% 0.030–0.639) and social environment (β = 0.239; IC 95% 0.015–0.464). No significant association was found with the dissatisfaction scores related with the physical and economic environment and the infrastructures/services. Conclusions: We found a significant association between city levels of mortality and residents' dissatisfaction with certain urban features, suggesting subjective assessments can be also used to comprehend urban health.This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology, and Higher Education) under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013); and the Postdoc grant SFRH/BPD/97015/2013 (SF), co-funded by the FCT and the POPH/FSE Program

Perceptions of secondary school teachers towards school expulsion of pregnant adolescents at Igunga District, Tanzania—a qualitative study

Background:In Tanzania, adolescent pregnancy results in a denial of the girl’s fundamental right to education. School expulsion of pregnant adolescents is a common practice exercised by teachers in this country for decades. This study aimed to explore the perceptions and feelings of secondary school teachers towards this practice. Methods: The study used a qualitative approach comprising focus groups and individual semistructured interviews with a purposive sample of sixteen teachers and nine headmasters (n=25) from nine secondary schools of the rural Igunga district, in Tabora region, Tanzania. Data was collected in March to June 2017 and submitted to thematic analysis. Results: Though most participants were not satisfied with the practice, their role on the expulsion of pregnant students was perceived as mandatory by law and regulations. Main argument in favor was its deterrent effect, yet the review of schools’ registries did not sustain that perception. Stigma and fear of contamination added a relevant contribution to its implementation. Conflicting feelings among teachers were also disclosed. Conclusion: This study was of most value to understand current perceptions and feelings of those who exercise the practice of banning pregnant adolescents from school in Tanzania, while having identified some of the cultural and social believes acting as influential factors in its pervasiveness. International and national human rights organizations should increase their efforts and campaigns in order to strength social awareness of the benefit of females’ education to society as a whole and of adopting policies and practices in support of their equal right to education.info:eu-repo/semantics/publishedVersio

Household Dysfunction Is Associated With Bullying Behavior in 10-year-old Children: Do Socioeconomic Circumstances Matter?

This study measured the prevalence of bullying behavior in 10-year-old children and investigated the effect of the socioeconomic context on the impact of household dysfunction on bullying. We studied 5,338 members of the Portuguese Generation XXI birth cohort. Information on involvement in bullying, socioeconomic characteristics, and household dysfunction was collected by trained interviewers using structured questionnaires. Being a victim of bullying was reported by 14.4% of participants, being a bully by 1.4%, and being a bully-victim by 3.9%. Being a victim or both bully-victim, simultaneously, was more frequent among children from medium-high income families. Also, children from low-income families who reported household substance abuse, witnessed parents' intimate partner violence, and were victims of physical violence, were more frequently victims of bullying; and those who experienced family violence were more frequently involved as bully-victims. Among children from medium-high income families, all these household adversity experiences significantly increased the odds of being victim, bully, or bully-victim. Thus, although children from medium-high income families are less likely to experience adversity at home, when it happens, there is a greater effect on their behavior, suggesting that better socioeconomic circumstances do not seem to act as a protective factor.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the European Regional Development Fund (ERDF) through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology (FCT), Portuguese Ministry of Science, Technology and Higher Education under the projects “BioAdversity: How childhood social adversity shapes health: The biology of social adversity (POCI-01-0145-FEDER-016838; info:eu-repo/grantAgreement/FCT/9471 - RIDTI/PTDC/DTP-EPI/1687/2014/PT) and HIneC: When do health inequalities start? Understanding the impact of childhood social adversity on health trajectories from birth to early adolescence (POCI-01-0145-FEDER-029567; info:eu-repo/grantAgreement/FCT/9471 - RIDTI/info:eu-repo/grantAgreement/FCT/9471 - RIDTI/PTDC/SAU-PUB/29567/2017/PT017/PT)”; Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (info:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UIDB/04750/2020/PT); Administração Regional de Saúde Norte (Regional Department of Ministry of Health) and Fundação Calouste Gulbenkian; PhD Grant info:eu-repo/grantAgreement/FCT/POR_NORTE/SFRH/BD/108742/2015/PT (to SS) co-funded by the FCT and Human Capital Operational Programme of the European Social Fund (POCH/FSE Program) and FCT Investigator contracts info:eu-repo/grantAgreement/FCT/CEEC IND 2017/CEECIND/01516/2017/CP1406/CT0001/PT (to SF)

Water-like hierarchy of anomalies in a continuous spherical shouldered potential

We investigate by molecular dynamics simulations a continuous isotropic core-softened potential with attractive well in three dimensions, introduced by Franzese [cond-mat/0703681, to appear on Journal of Molecular Liquids], that displays liquid-liquid coexistence with a critical point and water-like density anomaly. Here we find diffusion and structural anomalies. These anomalies occur with the same hierarchy that characterizes water. Yet our analysis shows differences with respect to the water case. Therefore, many of the anomalous features of water could be present in isotropic systems with soft-core attractive potentials, such as colloids or liquid metals, consistent with recent experiments showing polyamorphism in metallic glasses.Comment: 27 pages, 9 figures. to appear in J. Chem. Phy

Typological characterization of the Portuguese traditional schist constructions

Schist constructions represent an important cultural, architectural and historical legacy in Europe, and particularly in Portugal, that urges to preserve. Included among the traditional Portuguese architectural heritage, there are many traditional buildings in schist masonry, distributed from North to South, varying the types of buildings, the constructive methodologies and even the material schist, which may vary in properties and characteristics, depending on the region where it is extracted. Over the years, this traditional architecture has implemented a sustainable construction through the use of natural materials available in the region, as today it is desired to implement in the contemporary construction practice. The constructive techniques and solutions of these traditional structures have been developed in direct relation with various factors as economic, environmental and social, adapting to different requirements over the time, originating a wide diversity of construction typologies that today exist in Portugal. The present study intends to describe and characterize the different building typologies of the traditional schist construction in Portugal mainland. Examples of more prominent constructions, considering its dimensions and/or patrimonial importance are presented and analyzed

What doubts, concerns and fears about COVID-19 emerged during the first wave of the pandemic?

Objectives: The control of the COVID-19 pandemic depends strongly on effective communication, which must be grounded on the population’s perceptions and knowledge. We aimed to analyse the doubts, concerns and fears expressed by the Portuguese population about COVID-19. Methods: We performed a content analysis of 293 questions submitted to online, radio, newspaper and TV channel forums during the first month of the pandemic in Portugal. Results: Most questions contained doubts (n = 230), especially on how to prevent person-to-person transmission (n = 40) and how to proceed in case of symptoms (n = 37). Concerns and fears were also very commonly expressed (n = 144), mostly about which persons could be considered vulnerable (n = 53) and how to prevent transmission during daily life or normal activities (n = 37). Conclusion: As the pandemic evolved and suppression measures were put in place, doubts moved to concerns of vulnerability, quarantine and social isolation, and to doubts about transmission, transmission prevention, and on how to proceed in case of symptoms. Practice implications: These results may inform future communication strategies for a more adequate response in the next phases of the COVID-19 pandemic, as well as in future pandemics.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Migrant and native women's perceptions of prenatal care communication quality: the role of host-country language proficiency

BackgroundDespite the potentially significant impact of women-prenatal care provider communication quality (WPCQ) on women's perinatal health, evidence on the determinants of those perceptions is still lacking, particularly among migrant women.MethodsWe aimed to examine the effect of women's host-country language proficiency on their perceived WPCQ. We analyzed the data of 1210 migrant and 1400 native women who gave birth at Portuguese public hospitals between 2017 and 2019 and participated in the baMBINO cohort study. Migrants' language proficiency was self-rated. Perceived WPCQ was measured as a composite score of 9 different aspects of self-reported communication quality and ranged from 0 (optimal) to 27.ResultsA high percentage of women (29%) rated communication quality as optimal. Zero-inflated regression models were fitted to estimate the association between language proficiency and perceived WPCQ. Women with full (aIRR 1.35; 95% CI 1.22,1.50), intermediate (aIRR 1.41; 95% CI 1.23,1.61), and limited (aIRR 1.72; 95% CI 1.45,2.05) language proficiencies were increasingly more likely to have lower WPCQ when compared to natives.ConclusionsFacilitating communication with migrant women experiencing language barriers in prenatal care could provide an important contribution to improving prenatal care quality and addressing potential subsequent disparities in perinatal health outcomes