HIV screening of tuberculosis patients in Portugal: what are we missing?

BACKGROUND: Knowledge of human immunodeficiency virus (HIV) status is essential to effectively manage both tuberculosis (TB) and HIV infection. This is why the World Health Organization (WHO) recommends routine HIV testing in all TB patients. OBJECTIVE: To determine the number of TB patients with unknown HIV status in Portugal and to identify the factors associated with unknown HIV status. METHODS: A retrospective study of all TB notifications from 2008 to 2014 in Portugal was conducted. A multiple logistic regression model was used to evaluate the association of sociodemographic and clinical factors with unknown HIV status. RESULTS: We examined the records of 18 445 patients with TB notification, 2402 of whom (13%) had unknown HIV status. Unknown HIV status was positively associated with age >= 65 years (adjusted odds ratio [aOR] 1.208, 95%CI 1.037-1.408) and extra-pulmonary TB (aOR 1.381, 95%CI 1.252-1.523), but negatively associated with unemployment (aOR 0.755, 95%CI 0.637-0.895), alcohol dependence (aOR 0.809, 95%CI 0.682-0.959) and drug dependence (aOR 0.566, 95%CI 0.449-0.713). CONCLUSION: Risk perception is the most important barrier to complete knowledge of HIV status in TB patients in Portugal. Given the importance of HIV screening in TB patients, every effort should be made to ensure that all TB patients undergo HIV screening.RG was supported in part by the Centre for Mathematics of the University of Porto, Porto (UID/MAT/00144/2013), which is funded by Fundacao para a Ciencia e a Tecnologia, Lisbon, Portugal, with national (Ministerio da Educacao e Ciencia) and European structural funds (Fonds europeen de developpement regional) under the PT2020 partnership agreement

Anxiety and Depression Symptoms During the COVID-19 Pandemic: A Cluster Analysis of Individuals Living in Portugal

Introduction: The COVID-19 pandemic is an illustration of how a physical illness can damage people's minds. In this regard, the goal of this study was to see how different sociodemographic and behavioral factors were linked to anxiety and depression symptoms in a group of individuals living in PortugalMethods: Between November 2020 and February 2021, a cross-sectional, snowball online study was conducted. The study's target population was adults over the age of 18, residents of the country. For the statistical analysis, the clustering technique - K-means algorithm was applied. The chi-squared test was used to determine the relationships between clusters and sociodemographic and behavioral characteristics. Statistical analyses were conducted in R language, with a significance level of 0.05. A total of 453 participants were included.Results: The majority were female (69.8%), under the age of 40 (60.8%), with a higher education degree (75.3%), and not married (54.4%). Furthermore, the majority were from the country's north region (66%). Cluster 1 (n = 194) was characterized by low or nonexistent levels of anxiety and depression symptoms, which means normal; cluster 2 by severe symptoms (n = 82), meaning case; and cluster 3 by mild symptoms (n = 177), which means border-line. Younger participants (p-value 0.024), female (p-value 0.041), with drinking habits (p-value 0.002), food insecurity (p-value < 0.001), food affordability exacerbation (p-value < 0.001), comorbidity (p-value < 0.001), use of anxiolytics (p-value < 0.001), insufficient household income (p-value 0.017) and income change (p-value < 0.001) were significantly associated with the anxiety-depression clusters. From the three clusters, cluster 2 was mainly repre-sented by younger participants, with more persons stating that their household income was insufficient and that their income has changed as a result of COVID-19 and that they had the highest probability of food insecurity. Conclusion: The impacts of a crisis on mental health extend longer than the event itself. We were able to observe that younger women with insuf-ficient household income who suffered a change in income due to COVID-19 and were classified as food insecure presented higher levels of anxiety and depression symptoms. These results highlight the presence of a social gradient where we saw that people who were less advantaged in terms of socioeconomic position presented worse mental health outcomes, stressing, in this sense, the need to bring the best public health responses for these specific groups of the population.This work was financed by Portuguese Funds through FCT -Foundation for Science and Technology, I.P., under the projects UIDB/04750/2020 and LA/P/0064/2020.Ana Aguiar PhD Grant (Reference: 2020.09390.BD), co-funded by the Fundacao para a Ciencia e a Tecnologia (FCT) and the Fundo Social Europeu (FSE) Program, was also used to assist this research.Rita Gaio has received support from CMUP, which is financed by national funds through FCT - Fundacao para a Ciencia e a Tecnologia, I.P., under the project with reference UIDB/00144/2020.& nbsp;& nbsp

Evaluation of drug-resistant tuberculosis treatment outcome in Portugal, 2000-2016

Treatment of drug-resistant tuberculosis (TB), which is usually less successful than that of drug-susceptible TB, represents a challenge for TB control and elimination. We aimed to evaluate treatment outcomes and to identify the factors associated with death among patients with MDR and XDR-TB in Portugal. We assessed MDR-TB cases reported for the period 2000-2016, using the national TB Surveillance System. Treatment outcomes were defined according to WHO recommendations. We identified the factors associated with death using logistic regression. We evaluated treatment outcomes of 294 MDR- and 142 XDR-TB patients. The treatment success rate was 73.8% among MDR- and 62.7% among XDR-TB patients (p = 0.023). The case-fatality rate was 18.4% among MDR- and 23.9% among XDR-TB patients. HIV infection (OR 4.55; 95% CI 2.31-8.99; p < 0.001) and resistance to one or more second-line injectable drugs (OR 2.73; 95% CI 1.26-5.92; p = 0.011) were independently associated with death among MDR-TB patients. HIV infection, injectable drug use, past imprisonment, comorbidities, and alcohol abuse are conditions that were associated with death early on and during treatment. Early diagnosis of MDR-TB and further monitoring of these patients are necessary to improve treatment outcome.This work was developed under the scope of the project NORTE-01-0145-FEDER-000013 and NORTE-01-0145-FEDER-000023, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER) and projects PTDC/SAU-PUB/29521/2017. This work was partially supported by “Contratos-Programa” UIDB/50026/2020 and UIDB/04050/2020 funded by national funds through the FCT - Foundation for Science and Technology, I.P. OO is supported by the project NORTE-08-5369-FSE-000041, financed by the Operational Program NORTE 2020 and co-financed by the European Social Fund through a doctoral grant (UMINHO/BD/47/2016). This work was also supported by national funds through the FCT, I.P., under the project UIDB / 04750/2020

Reconstructing higher education?: the case of master’s and PhD Programmes in Education in a Portuguese Institution

Whether and to what extent we are in the process of reconstructing higher education following the Bologna Process orientation is the issue underpinning this article. To address this issue, the authors consider data from an exploratory survey conducted in a Portuguese university, focusing on the field of education. They take into account the contents of the educational policies at supranational level in Europe and at national level in Portugal. In addition, they draw upon the conceptual debate about policy and politics. They acknowledge changes taking place in the organisational structure of the academic programmes, as well as in the students’ perceptions. Additionally, critical issues concerning the organisation and implementation of these programmes allow them to identify challenges for universities and issues that need deeper inquiry and continuous monitoring. Lawn M. & Lingard B. (2002) Constructing a European Policy Space in Educational Governance: The role of transnational policy actors, European Educational Research Journal, 1(2), 290–307. https://doi.org/10.2304/eerj.2002.1.2.6 Google Scholar Lima L. (2003) Formação e aprendizagem ao longo da vida: Entre a mão direita e a mão esquerda de Miró, in (A. Quintanilha [org.]) Cruzamento de saberes, aprendizagens sustentáveis. Lisbon: Calouste Gulbenkian Foundation. Google Scholar Lingard B. & Ozga J. (2007) Introduction: Reading education policy and politics, in Lingard B. & Ozga J. (Eds) The RoutledgeFalmer Reader in Education Policy and Politics, 1–8. London: Routledge. Crossref Google Scholar Nóvoa A. (2005) Les États de la politique dans l'espace européen de l'éducation, in Lawn M. & Nóvoa A. (Eds) L'Europe réinventée: Regards critiques sur l'espace européen de l'éducation, 197–223. Paris: L'Harmattan. Google Scholar Popkewitz T., Olsson U. & Petersson K. (2006) The Learning Society, the Unfinished Cosmopolitan, and Governing Education, Public Health and Crime Prevention at the Beginning of the Twenty-First Century, Educational Philosophy and Theory, 38(4), 431–449. https://doi.org/10.1111/j.1469-5812.2006.00203.x Google Scholar Usher R. & Edwards R. (2001) Lifelong Learning: A postmodern condition of education? Adult Education Quarterly, 51(4), 273–287. https://doi.org/10.1177/07417130122087296 ISI Google Scholar Biographies MARIANA GAIO ALVES is an Assistant Teacher in Educational Sciences in the Faculty of Science and Technology at the New University of Lisbon, Caparica, Portugal. Her research interests cover higher education, lifelong learning and transitions from education to work. CLAUDIA NEVES has a degree in Social Policy, a Master's degree in Education and Society, and has just finished her PhD on ‘Lifelong Learning in the European Union: comparative analysis of the strategies of five member states’. She is a member of the Education and Development Research Unit in the Faculty of Science and Technology at the New University of Lisbon, Caparica, Portugal. Her major research interests include education politics and policies, lifelong learning, the European Union, forms of regulation in education, global education agendas, and the influence of international organizations, education indicators and statistics. ELISABETE XAVIER GOMES is a PhD student in Educational Sciences at the New University of Lisbon, Caparica, Portugal, working on children's educational processes in contemporary cities. In early 2000 she worked on teacher training courses at the Polytechnic Institute of Beja, where she was also involved in the elaboration of regional education charters. Her major interests concern the development of relational approaches to school and out-of-school intentional education, the connections between educational studies and urban studies, different levels of educational policies and contemporary educational relationships.info:eu-repo/semantics/publishedVersio

Uterine artery Doppler in the management of early pregnancy loss: a prospective, longitudinal study

The pharmacological management of early pregnancy loss reduced substantially the need for dilation and curettage. However, prognostic markers of successful outcome were not established. Thus the major purpose of this study was to determine the sensitivity and specificity of the uterine artery pulsatility (PI) and resistance (RI) indices to detect early pregnancy loss patients requiring dilation and curettage after unsuccessful management

Internal iliac and uterine arteries Doppler ultrasound in the assessment of normotensive and chronic hypertensive pregnant women

The objective of this work was to compare Doppler flows pulsatility index (PI) and resistance indexes (RI) of uterine and internal iliac arteries during pregnancy in low risk women and in those with stage-1 essential hypertension. From January 2010 and December 2012, a longitudinal and prospective study was carried out in 103 singleton uneventful pregnancies (72 low-risk pregnancies and 31 with stage 1 essential hypertension)at the 1(st), 2(nd) and 3(rd) trimesters. Multiple linear regression models, fitted using generalized least squares and whose errors were allowed to be correlated and/or have unequal variances, were employed; a model for the relative differences of both arteries impedance was utilized. In both groups, uterine artery PI and RI exhibited a gestational age related decreasing trend whereas internal iliac artery PI and RI increased. The model testing the hemodynamic adaptation in women with and without hypertension showed similar trend. Irrespective of blood pressure conditions, the internal iliac artery resistance pattern contrasts with the capacitance pattern of its immediate pelvic division, suggesting a pregnancy-related regulatory mechanism in the pelvic circulation