Hepatitis A: At-Risk Populations

Hepatitis A virus (HAV) is transmitted mostly through exposure to contaminated food or water, or through exposure to infected persons. This infection can occur sporadically or in an epidemic form, confers lifelong immunity and it is preventable by a safe and effective vaccine. Therefore, prevention strategies are crucial and could eradicate the infection if they were successfully employed. In this chapter, authors summarize mode of transmission and preventive measures for HAV among the following population groups: travellers, health care workers, men who have sex with men, individuals who use illicit drugs, sewage workers, food handlers, military personnel, prisoners, blood transfusions recipients, haemophiliacs and patients with HIV and chronic liver disease. Moreover, authors describe which of these groups are eligible for HAV vaccination according to available data

Eliminação da hepatite C em Portugal: um mito urbano?

© 2020 Sociedade Portuguesa de Gastrenterologia Published by S. Karger AG, Basel. This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permissionThe burden of hepatitis C virus infection remains very high despite huge progress in the cure of the infection. The high prevalence of hepatitis C, especially in vulnerable groups and particularly drug users, may compromise the achievement of the 2030 WHO targets with a 90% reduction in new infections and a 65% reduction in mortality. Therapy with the latest pangenotypic direct-acting antivirals provides cure rates in the order of 97% with short-term oral treatment (8-12 weeks) and with an excellent safety and tolerability profile. Curing the infection causes significant health gains derived from preventing complications from cirrhosis, especially hepatocellular carcinoma, and from liver transplantation. Elimination of hepatitis seems feasible with the implementation of a massive therapy program, focusing particularly on vulnerable populations, through micro-elimination strategies, and in the general population with age-based screening. The reduction of the virus reservoir (humans are the only reservoir) is a determining factor in eradicating the virus.O peso relativo da infecção pelo vírus da hepatite C permanece muito elevado apesar dos enormes progressos verificados na cura da infecção. A elevada prevalência da hepatite C, sobretudo nos nos grupos vulneráveis e em particular nos utilizadores de drogas, pode comprometer o atingimento das metas da WHO para 2030 com redução de 90% de novas infecções e redução de mortalidade em 65%. A terapêutica com os antivíricos de acção directa mais recentes, pangenotípicos, proporciona taxas de cura da ordem dos 97% com tratamento oral de curta duração (8–12 semanas), e com excelente perfil de segurança e to­lerabilidade. A curada infecção ocasiona significativos ganhos em saúde derivados da prevenção das complicações da cirrose, sobretudo do carcinoma hepatocelular, e do transplante hepático. A eliminação da hepatite parece exequível com a aplicação de um programa de massificação da terapêutica, incidindo particularmente nas populações vulneráveis, através de estratégias de microeliminação, e na população geral com rastreio baseado na idade. A redução do reservatório do vírus (o homem é o único reservatório), é determinante para a sua eliminação.info:eu-repo/semantics/publishedVersio

The effect of functional indispensability in the succession of senior workers

The fact that we are working for the first time with people from different generations, along with the continuous aging of the population, brings with it intergroup conflicts in the organizational context. This creates ageist responses, not only from young workers, but also from senior workers. One of these responses is the Succession of senior workers over a resource handout for younger people. Therefore, and in order to study this Succession response, we sought to find a variable that would attenuate this perspective, and consequently, attenuate the ageist responses and conflicts between different generations at work. We then set out to explore the effect that the Functional Indispensability of senior workers might have on reducing these responses. Two studies were created, one focused on young workers (N = 150) and another focused on senior workers (N = 19), in which we hypothesized that under a condition of high indispensability, they would support less the Succession of senior workers, in relation to a control condition. For this, an experimental manipulation of the Functional Indispensability variable was made, using an altered news. Additionally, we decided to see to what extent other contextual variables could increase or decrease the relationship between the main variables. The results showed that our initial hypothesis was nulled, and the manipulation did not have the desired effect. However, other additional hypotheses, as well as the correlation between the measure of Functional Indispensability and Succession were corroborated. This is presented and discussed in this study, relating methodological, theoretical and practical issues, in order to contribute to future research on the subject.O facto de estarmos pela primeira vez a trabalhar com pessoas de diferentes gerações, junto com o envelhecimento contínuo da população, trás consigo conflitos intergrupais no contexto organizacional. Isto trás consigo respostas idadistas, não só por parte dos trabalhadores jovens, mas também por parte dos trabalhadores seniores. Uma dessas respostas é a Sucessão dos trabalhadores seniores em detrimento de uma passagem de recursos para os mais jovens. Assim sendo, e com o intuito de estudar esta resposta de Sucessão, procuramos encontrar uma variável que permitisse atenuar esta perspetiva, e consequentemente, atenuar as respostas idadistas e os conflitos entre diferentes gerações no trabalho. Propusemo-nos então a explorar o efeito que a Indispensabilidade Funcional dos trabalhadores seniores possa ter na redução destas respostas. Foram criados 2 estudos, um focado nos trabalhadores jovens (N=150) e outro focado nos trabalhadores seniores (N=19), em que colocamos como hipótese que numa condição de alta indispensabilidade, estes apoiassem menos a Sucessão dos trabalhadores seniores, em relação a uma outra condição de controlo. Para isto foi feita uma manipulação experimental da variável de Indispensabilidade Funcional, utilizando uma notícia alterada. Adicionalmente, decidimos ver em que medida outras variáveis contextuais poderiam aumentar ou diminuir a relação entre as variáveis principais. Os resultados mostraram que a nossa hipótese inicial é nula, sendo que a manipulação não surtiu o efeito desejado. No entanto, outras hipóteses adicionais, assim como a correlação entre a medida de Indispensabilidade Funcional e Sucessão foram corroboradas. Tal é apresentado e discutido neste estudo, relacionando questões metodológicas, teóricas e práticas, com o intuito de contribuir para pesquisa futura sobre o tema

Caracterização dos Agregados Familiares das Crianças e Jovens Sinalizados na CPCJ de Leiria nos anos de 2012 e 2013

É através da família que as crianças e jovens encontram as ferramentas necessárias para o seu desenvolvimento, mas quando as condições para que isso aconteça não são encontradas, compete às entidades competentes em matérias de infância e juventude proporcionar um meio de proteção para que estas se desenvolvam de forma adequada. Mas só conhecendo as necessidades da população fragilizada é que se torna possível a execução de uma intervenção eficaz. Neste sentido, o presente trabalho de investigação tem como principal objetivo a caracterização da população sinalizada na Comissão de Proteção de Crianças e Jovens em Risco de Leiria. Este trabalho caracteriza os agregados dos menores sinalizados na CPCJ, nos anos de 2012 e 2013. São tidas em conta as características demográficas e de saúde do menor sinalizado e dos seus representantes legais e/ou elementos que sejam responsáveis pelo mesmo. Para cumprir este objetivo é tida em conta a informação recolhida até à fase de conclusão da avaliação diagnóstica dos processos de promoção e proteção. Os resultados salientam o progenitor como principal fonte de perigo, sendo que, das diversas problemáticas, a mais incidente no concelho é a violência doméstica e os menores vítimas dessas problemáticas têm na sua maioria menos de cinco anos de idade. A investigação acerca da população sinalizada pela CPCJ de Leiria serve para averiguar algumas das singularidades acerca da mesma que podem auxiliar a futuras intervenções. / It is within the family that children find the necessary tools for their development, but when the necessary conditions in order for that to happen are not found, the competent authorities in the field of youth and child protection have to provide means of protection so that they can develop adequately. However, only by knowing the needs of the specific population is it possible to execute an effective intervention. In this regard, this research aims to provide a characterization the population signaled at Leiria’s children protection services (CPCJ- Comissão de Protecção de Crianças e Jovens de Leiria). This work characterizes the households flagged in CPCJ, between the years 2012 and 2013. It is taken into account the demographic and health characteristics of the children and their legal guardian, representatives and /or the person responsible for them. To achieve this goal it has been taken into account the information gathered until the completion of the diagnosis evaluation of the promotion and protection processes. The results highlight the parent as the main source of danger, also that within the various issues, the most observed is domestic violence and finally, that the victims of these issues are mostly children under five years old. Investigating and characterizing the population signaled by the CPCJ Leiria serves to determine some of its singularities in the prospect of assisting in future interventions

Ultralight boson cloud depletion in binary systems

Ultralight scalars can extract rotational energy from astrophysical black holes through superradiant instabilities, forming macroscopic boson clouds. This process is most efficient when the Compton wavelength of the boson is comparable to the size of the black hole horizon, i.e. when the "gravitational fine structure constant" $\alpha\equiv G \mu M/\hbar c\sim 1$. If the black hole/cloud system is in a binary, tidal perturbations from the companion can produce resonant transitions between the energy levels of the cloud, depleting it by an amount that depends on the nature of the transition and on the parameters of the binary. Previous cloud depletion estimates considered binaries in circular orbit and made the approximation $\alpha\ll 1$. Here we use black hole perturbation theory to compute instability rates and decay widths for generic values of $\alpha$, and we show that this leads to much larger cloud depletion estimates when $\alpha \gtrsim 0.1$. We also study eccentric binary orbits. We show that in this case resonances can occur at all harmonics of the orbital frequency, significantly extending the range of frequencies where cloud depletion may be observable with gravitational wave interferometers.Comment: 12 pages, 6 figures. v2: references added, matches published versio

CPRE e Ecoendoscopia: um mesmo viajante em estradas convergentes

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) were initially introduced into the world of gastroenterology as purely diagnostic procedures. With progressive evolution of intervention, both these techniques conquered fields in the treatment of many conditions that had once been exclusively surgical domains. Nowadays, more and more clinical situations have an indication to perform both EUS and ERCP, and these two techniques are frequently required at the same time for the same patient. More than competitors, ERCP and EUS are truly complementary, with great ability for mutual aid. They share their main indications, equipment, accessories, and main technical gestures. OBJECTIVES AND METHODS: We review the major indications to perform both techniques, sequentially or complementarily, describe the common things that these two techniques essentially share, and discuss the ERCP-EUS single session. Also, the issues of learning curves and education of upcoming biliopancreatic endoscopists are highlighted. CONCLUSION: In recent years the complementation between ECRP and EUS has been growing both from a diagnostic and a therapeutic point of view, allowing optimization of the use of these techniques and the creation of a more systematized approach of patients with biliopancreatic pathology. Endoscopists with experience in both techniques will be increasingly important, suggesting a parallel formation in the training plans of future endoscopists with interest in the area.info:eu-repo/semantics/publishedVersio

Demystifying endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy

Background: For many years, ERCP was avoided in pregnancy given the concerns regarding the adverse effects that, with special focus on radiation, could occur in the developing fetus. However, the postponement or rejection of ERCP in pregnant women, may lead to a higher risk for mother and fetus, especially when the indication is unequivocal, namely cholangitis, biliary pancreatitis and symptomatic choledocholithiasis. Summary and key messages: This review aims to summarize the scarce literature on the subject in order to plan ERCP in pregnancy with the highest safety. The use of techniques that reduce radiation and increase the protection of pregnant women allow radiation levels far below the safety limits. We also discuss the various alternatives of ERCP without radiation. EUS can eliminate the need for ERCP with doubtful choledocholithiasis and plan the best approach in those with previous evidence. The possibility of performing “ERCP” with a linear echoendoscope uniquely under ultrasound control has been described. Conversely, the two-step strategy (initial sphincterotomy with stent placement without fluoroscopy and after delivery, ERCP with lithiasis extraction) proved to be safe obviating fluoroscopy. In conclusion, ERCP can be performed in pregnancy safely and effectively with minimal radiation or even no-radiation at all.info:eu-repo/semantics/publishedVersio