Healthcare professionals perspectives on tuberculosis barriers in Portuguese prisons-a qualitative study

BACKGROUND

Tuberculosis (TB) remains a significant public health concern, particularly within prison settings, where the confluence of adverse health factors and high-risk behaviors contribute to a heightened risk of transmission. This study delves into the perspectives of medical doctors, regarding the implementation of the 2014 TB protocol in Portugal.

METHODS

The study has a qualitative, descriptive design. Individual semi-structured interviews with medical doctors from TB outpatient centers in Porto and Lisbon were used for data collection. For the analysis thematic analysis method was used.

RESULTS

The study population comprised 21 medical doctors with the majority being female (61.9%) and 57.1% specializing in pulmonology. The results indicate varied perceptions of the protocol's usefulness, with positive impacts on coordination reported by some participants. Improved communication and evolving collaboration between TB outpatient centers and prisons were highlighted, although challenges in contact tracing and resource constraints were acknowledged. The study also sheds light on the role of nurses in patient education.

CONCLUSION

Despite overall positive perceptions, challenges such as sustaining therapy post-symptomatic improvement and delays in diagnostic methods were identified. The findings underscore the importance of continuous collaboration between prisons and TB control programs to address challenges, improve disease control and prevent TB transmission.

Urgent Attention Needed for Mental Health Challenges Arising from Prolonged Grief During and in the Aftermath of COVID-19

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Preoperative diagnostic criteria for scleroatrophic gallbladder: A systematic review protocol

BACKGROUND

Although scleroatrophic gallbladder is a rare condition, it presents significant clinical challenges in diagnosis and management. More agreement is needed on this disorder's diagnostic criteria and optimal management approach. We will conduct a systematic review to summarise the scleroatrophic gallbladder's preoperative diagnostic criteria, including imaging modalities.

METHODS

A systematic review will be undertaken using the PRISMA guidelines. The protocol has been registered in PROSPERO (CRD42024503701). We will search in Medline (via PubMed), Embase, SCOPUS, the Cochrane Library, and Web of Science to find original studies reporting about scleroatrophic gallbladder or synonymous. Two reviewers will independently screen the titles and abstracts following the eligibility criteria. We will include all types of studies that describe any diagnostic criteria or tools. After retrieving the full text of the selected studies, we will conduct a standardised data extraction. Finally, a narrative synthesis will be performed. The quality of the identified studies will be assessed using the Quality Assessment of Diagnostic Accuracy Studies- 2 tool.

DISCUSSION

This systematic review will provide information on the preoperative diagnostic criteria of the scleroatrophic gallbladder and the value of imaging studies in its diagnosis. In addition, this work will aid doctors in the decision-making process for diagnosing scleroatrophic gallbladder and propose treatment approaches to this condition.

SYSTEMATIC REVIEW REGISTRATION

The protocol has been registered in PROSPERO (CRD42024503701).

Characterization of students with high intellectual capacity: the approach in the Portuguese school context and importance of teacher training for their educational inclusion

This paper takes a terminological approach to the concept of high intellectual abilities, highlighting the distinctive aspects of the way it is addressed in the Portuguese educational context. It outlines the existing conceptual differentiation in the field of higher abilities, emphasizing how the main characteristics are described and including the strengths and weaknesses of current teaching and learning processes in Portugal. As we will show, educational work with these students in Portuguese schools is characterized by unequal regulation compared to other educational needs, by an imbalance of educational processes aimed at these gifted students, and by clear underdiagnosis that sometimes leads to them being ignored in the classroom, with the consequent harm that this can cause to their overall development and to their academic and professional careers. The paper emphasizes the importance of teacher training in Portugal as an aspect that could be key to reversing, as far as possible, this gap in educational processes-which currently include educational inclusion for all their students as part of the key action principles in the Portuguese educational system.

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 Portugal.

METHODS

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 borderline. 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 represented 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 insufficient 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.

Calibration Assessment of Low-Cost Carbon Dioxide Sensors Using the Extremely Randomized Trees Algorithm

As the monitoring of carbon dioxide is an important proxy to estimate the air quality of indoor and outdoor environments, it is essential to obtain trustful data from CO₂ sensors. However, the use of widely available low-cost sensors may imply lower data quality, especially regarding accuracy. This paper proposes a new approach for enhancing the accuracy of low-cost CO₂ sensors using an extremely randomized trees algorithm. It also reports the results obtained from experimental data collected from sensors that were exposed to both indoor and outdoor environments. The indoor experimental set was composed of two metal oxide semiconductors (MOS) and two non-dispersive infrared (NDIR) sensors next to a reference sensor for carbon dioxide and independent sensors for air temperature and relative humidity. The outdoor experimental exposure analysis was performed using a third-party dataset which fit into our goals: the work consisted of fourteen stations using low-cost NDIR sensors geographically spread around reference stations. One calibration model was trained for each sensor unit separately, and, in the indoor experiment, it managed to reduce the mean absolute error (MAE) of NDIR sensors by up to 90%, reach very good linearity with MOS sensors in the indoor experiment (r² value of 0.994), and reduce the MAE by up to 98% in the outdoor dataset. We have found in the outdoor dataset analysis that the exposure time of the sensor itself may be considered by the algorithm to achieve better accuracy. We also observed that even a relatively small amount of data may provide enough information to perform a useful calibration if they contain enough data variety. We conclude that the proper use of machine learning algorithms on sensor readings can be very effective to obtain higher data quality from low-cost gas sensors either indoors or outdoors, regardless of the sensor technology.

Correlation between individual autoantibodies and clinical features in primary biliary cholangitis: results of a retrospective longitudinal study

BACKGROUND AND AIMS

Primary biliary cholangitis (PBC) is an immune-mediated liver disease. The immunological profile seems to relate to clinical prognosis. This study aims to determine the role of autoantibodies in the course of liver disease and in the response to ursodeoxycholic acid.

METHODS

Between January 2016 and December 2020, 143 patients with PBC who underwent immunological liver profile evaluation were enrolled. All data were extracted retrospectively from electronic clinical records. Chi-square test, Fisher's exact test and Mann-Whitney test were used to evaluate the relationship between autoantibodies and biochemical parameters, clinical outcomes and therapeutic response scores. A significance level of 0.05 was used.

RESULTS

Antimitochondrial antibodies were present in 91.6%, antiglycoprotein-210 antibody (anti-gp210) in 18.2% and anti-Sp100 in 19.6% of patients. The incidence of liver-related death was higher in patients with autoimmune hepatitis variants. The occurrence of cirrhosis or portal hypertension was not linked to the presence of any of the autoantibodies tested. No relationship was found with the probability of dying or being transplanted. Patients with anti-Sp100 antibodies had higher baseline levels of aspartate aminotransferase and alanine aminotransferase and lower immunoglobulin M levels. Patients with anti-gp210 were more likely to have a lower median transplant-free survival rate and higher median risk of liver transplant or liver-related death using the GLOBE and UK-PBC scores.

CONCLUSION

Our findings confirm a strong association between anti-gp210 antibodies and a worse outcome. The association between anti-Sp100 and hepatic lesions requires further elucidation.

Tuberculosis and COVID-19 related stigma: Portuguese patients experiences

INTRODUCTION

Stigmatization of tuberculosis (TB) patients is well-documented, and several health-related organizations have also reported the stigmatization of COVID-19 patients. Because stigmatization can have many adverse consequences, we performed a qualitative study to evaluate the stigmatization of TB and COVID-19 patients. We examined changes in stigmatization throughout the pandemic; perceptions of stigmatization by patients with these diseases before and during COVID-19 pandemic; and differences in stigmatization perceived by individuals who had both diseases.

METHODS

A semi-structured interview was developed based on the available literature, and was administered to a convenience sample during April 2022. All participants were adults who have/had pulmonary TB and/or COVID-19, and were from a single Portuguese Outpatient TB Center. All participants provided written informed consent. Patients who had latent TB, asymptomatic TB, or asymptomatic COVID-19 were excluded. Data were analyzed using thematic analysis.

RESULTS

We interviewed 9 patients (6 females and 3 males; median age: 51±14.7 years-old). Three had TB and COVID-19, 4 had TB alone, and 2 had COVID-19 alone. Interviews allowed to identify 8 main themes: knowledge and beliefs, with several misconceptions identification; attitudes towards the disease, from social support to exclusion; knowledge and education, assumed to be very important; internalized stigmatization, with self-rejection; experience of stigmatization, with discrimination episodes; anticipated stigmatization, with modifying actions for prevention; perceived stigmatization, in which judgment by others prevailed; and temporal changes in stigmatization.

CONCLUSIONS

Individuals who had TB or COVID-19 reported they were stigmatized. De-stigmatization of these diseases is crucial for improving the well-being of affected patients.

Behavior Guidance during the Covid-19 Pandemic: Health Literacy as a Weapon against the Virus

Portugal was hit by COVID-19 on the 2^nd of March 2020. For almost two months, the country was confined due to the declaration of the emergency state. The confinement was always conveyed by the media, who clearly guided citizens toward preventive behaviors and so became a means of fighting this pandemic by helping the country stay home. Several authors recognize the importance of health communication and health literacy in fighting COVID-19. In a public health crisis like this, media are important actors in the promotion of health and prevention of disease, and they can have a central role in behavior change. To further understand how the media guided citizens toward preventive behaviors we applied a questionnaire survey to Portuguese journalists. More than 90% assumed citizens' behavior guidance. Journalists' perceptions about their work reflect a true concern with the promotion of health literacy, and their assumption of a public service mission was crucial in people's adherence to confinement. Health literacy achieved its maximum during this confinement period, not only because these were extraordinary times but also because Portuguese journalists had an exemplar behavior.

COVID-19 vaccine effectiveness against symptomatic disease and severe outcomes, 2021-2022: a test-negative case-control study

Objectives

This study evaluated the effectiveness of COVID-19 vaccines in preventing symptomatic and severe disease.

Study design

This was an observational test-negative case-control study.

Methods

Study participants were adults with at least one symptom included in the World Health Organization COVID-19 definition who sought healthcare in a public emergency department between 1 November 2021 and 2 March 2022 (corresponding with the fifth pandemic wave in Portugal dominated by the Omicron variant). This study used multivariable logistic regression models to estimate and compare the odds ratio of vaccination between test-positive cases and test-negative controls to calculate the absolute and relative vaccine effectiveness.

Results

The study included 1059 individuals (522 cases and 537 controls) with a median age of 56 years and 58% were women. Compared with the relative effectiveness of the primary vaccination scheme that had been completed ≥180 days earlier, the effectiveness against symptomatic infection of a booster administered between 14 and 132 days earlier was 71% (95% confidence interval [CI]: 57%, 81%; p < 0.001). The effectiveness of the primary series against symptomatic infection peaked at 85% (95% CI: 56%, 95%) between 14 and 90 days after the last inoculation and decreased to 34% (95% CI: −42.6%, 49.5%) after ≥180 days.

Conclusions

Despite the known immunological evasion characteristics of the Omicron variant, results from this study show that vaccine effectiveness increases after booster administration. COVID-19 vaccine effectiveness decreases to less than 50% between 3 and 6 months after completion of the primary cycle; therefore, this would be an appropriate time to administer a booster to restore immunity.

Vehicle-to-infrastructure IEEE 802.11ad Wi-Fi dataset

Despite not being designed for vehicular use, the high bandwidth offered by IEEE 802.11ad makes it an enticing proposition for opportunistic Vehicle-to-Infrastructure (V2I) communication. Because it operates at a high frequency of 60 GHz, 802.11ad suffers from high attenuation. To combat this, it uses antenna directionality to improve communication range. Directionality is primarily achieved by selecting an antenna configuration, or sector, from a list of preconfigured ones. Choosing a good antenna sector is difficult in V2I environments, as the fast mobility involved affects the alignment between communicating nodes. This article describes a dataset that supports analysis of Commercial Off-The-Shelf (COTS) 802.11ad device behavior in an experimental V2I communication scenario. More specifically, the dataset summarizes the results from a set of experiments in which a mobile client drove around a stationary Access Point (AP) while downloading data from it. Information regarding the client's mobility, control frames exchanged, and achieved throughput was collected. This dataset can support realistic analysis of 802.11ad COTS equipment behaviors, such as antenna selection and communication range, in a vehicular communication scenario.

[Promoting Better Indoor Air Quality in Portugal for Disease Prevention and Control]

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Kaolin particle films disrupt landing, settling behavior and feeding of Trioza erytrae on lemon plants

BACKGROUND

The citrus greening disease or Huanglongbing (HLB) is the most devastating disease of citrus crops. Trioza erytreae is a vector of HLB. Since its introduction in Europe, the insect reached the northern region of Spain and the southern region of Portugal, threatening relevant citrus production areas. Limiting the spread of HLB vectors is mandatory to prevent this disease. In this work, we assessed the effect of kaolin, a white mineral clay, on the landing, settling behavior and feeding behavior of Trioza erytreae on lemon plants.

RESULTS

After kaolin application, the number of plants on which the insect was found was significantly lower than on untreated plants in the laboratory and in the field. Moreover, there were significantly fewer T. erytreae and a shorter duration of phloem-related events on kaolin-treated than untreated plants.

CONCLUSION

The use of kaolin could be a suitable and efficient tool for inclusion into integrated pest management programs or organic production to reduce populations of T. erytreae and subsequently limit the spread of HLB in citrus crops. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Evolving operational guidance and experiences for radiology and nuclear medicine facilities in response to and beyond the COVID-19 pandemic

The resulting pandemic from the novel severe acute respiratory coronavirus 2, SARS-CoV-2 (COVID-19), continues to exert a strain on worldwide health services due to the incidence of hospitalization and mortality associated with infection. The aim of clinical services throughout the period of the pandemic and likely beyond to endemic infections as the situation stabilizes is to enhance safety aspects to mitigate transmission of COVID-19 while providing a high quality of service to all patients (COVID-19 positive and negative) while still upholding excellent medical standards. In order to achieve this, new strategies of clinical service operation are essential. Researchers have published peer-reviewed reference materials such as guidelines, experiences and advice to manage the resulting issues from the unpredictable challenges presented by the pandemic. There is a range of international guidance also from professional medical organizations, including best practice and advice in order to help imaging facilities adjust their standard operating procedures and workflows in line with infection control principles. This work provides a broad review of the main sources of advice and guidelines for radiology and nuclear medicine facilities during the pandemic, and also of rapidly emerging advice and local/national experiences as facilities begin to resume previously canceled non-urgent services as well as effects on imaging research.

Assessment of Potentially Inappropriate Medications Using the EU (7)-PIM List, in a Sample of Portuguese Older Adults' Residents in Nursing Homes

Abstract

Prescription of potentially inappropriate medication (PIM) in older adults is associated with poor clinical outcomes. The EU (7)-PIM list was created for the European market to improve pharmacotherapy in older adults.

Purpose

This work aims to characterize the medication profile and assess the presence of PIM, using the EU (7)-PIM list in older adults’ residents at nursing homes.

Methods

Retrospective data were collected from the anonymized nursing home records. After PIM identification, a descriptive analysis was performed, and a generalized linear model for dependent negative binomial-type variables was constructed to assess the risk of PIM.

Results

Of the 210 participants (mean age 85.10), 82.40% were polymedicated. PIM was observed in 86.4% participants (mean per patient = 2.30± 0.10). The most common PIM were proton pump inhibitors (n = 121, 57.62%), followed by anxiolytics (n = 96, 45.71%). 64.30% of all patients take 2–4 PIM and 5.80% take five or more PIM. The occurrence of PIM is influenced by the number of prescribed medicines (RR 1.14; 95% CI 1.1.-1.17) and the presence of digestive system diseases (RR 1.05; 95% CI 1.0–1.09).

Conclusion

The high prevalence of PIM observations highlights the necessity of the implementation of guidelines to prevent PIM.

Evaluation of the Real-World Effectiveness of Vaccines against COVID-19 at a Local Level: Protocol for a Test-Negative Case-Control Study

Vaccines against COVID-19 approved for use in the EU/EEA have been shown to be highly effective against wild-type SARS-CoV-2. However, their effectiveness against new variants may be reduced. This study aims to evaluate the effectiveness of vaccines against COVID-19 in the prevention of symptomatic and severe disease, during pre- and post-omicron phases. Individuals who sought treatment at the emergency department of a Portuguese hospital with COVID-19-like disease and were tested for SARS-CoV-2 are the subjects of the study. Patients who received a positive result are considered cases, while those with negative results are the controls. The test-negative case–control method is one of the study designs recommended by WHO to estimate the effectiveness of vaccines against COVID-19. The main advantage of this design is that it controls for the healthcare seeking bias, commonly present in traditional cohort and case–control designs. This study may have broad implications for understanding the real-world performance of the COVID-19 vaccines at the local level, which may play a key role in promoting adherence to vaccination. Moreover, this study may contribute to inform decisions regarding booster doses and variant-specific vaccine formulations leading to the control of this and future pandemics.

A qualitative study on the impact of death during COVID-19: Thoughts and feelings of Portuguese bereaved adults

As a global threat, the COVID-19 pandemic has been an important factor in increasing death rate worldwide. As the virus spreads across international borders, it causes severe illness, death, and disruptions in our daily lives. Death and dying rituals and customs aid bereaved people in overcoming their grief. In this sense, the purpose of this study was to access thoughts and feelings of Portuguese adults and the impact of the loss in daily life during COVID-19. A structured online questionnaire was applied (snowball sampling) and qualitative data on death and mourning namely the impact of the loss in daily life, was collected. One hundred and sixty-six individuals have lost someone since the beginning of the pandemic and were included. Analysis was inspired by Braun and Clark's content analysis. Most participants were female (66.9%), the median age was of 37.3 years, and 70.5% had a high education degree. Moreover, 30.7% of the participants present anxiety symptoms and 10.2% depression symptoms. The answers of studied participants gave insights on the extent of the loss in day-to-day life and four thematic themes were found: (1) The perceived inadequacy of the funeral rituality, (2) Sadness, fear and loneliness, (3) Changes in sleeping and concentration and increased levels of anxiety and (4) Concerns regarding the pandemic situation. We found a high prevalence of anxiety and depression symptoms in the study sample. Also, the changes in post mortem procedures, have shown to be of great importance in the mourning procedure of the participants.

Food Insecurity in Portugal during the COVID-19 Pandemic: Prevalence and Associated Sociodemographic Characteristics

Introduction

The current worldwide COVID-19 pandemic has been having a considerable impact not only on health but also on the economy of societies, emphasizing food insecurity as a significant public health concern.

Aim

The objective of this study was to characterize the scenario of food insecurity in Portugal during the COVID-19 pandemic and explore its related sociodemographic characteristics.

Methodology

This is a cross-sectional study, using data from an online survey, performed from November 2020 until February 2021, including 882 residents aged 18 years or older in Portugal. Data on sociodemographics and food security status were collected, the latter was evaluated using the United States Household Food Security Survey Module: Six-Item Short Form. Crude and adjusted logistic regression models were performed (covariates: education, household income perception, and the working status during the COVID-19 pandemic). The odds ratio (OR) and respective 95% confidence intervals (CI) were estimated.

Results

Most participants were women (71.3%), with a mean age of 36.8 years (SD 11.0). Food insecurity prevalence was 6.8%. Less-educated individuals (≤12 years of schooling; OR 2.966; 95% CI 1.250–7.042), and those who were and remained unemployed since the beginning of the pandemic (OR 2.602; 95% CI 1.004–6.742) had higher odds of belonging to a food-insecure household, regardless of education, working status during the COVID-19 pandemic, and household income perception. Moreover, lower odds of belonging to a food-insecure household were observed among those reporting a comfortable household income (OR 0.007; 95% CI 0.001–0.062) than those who perceived their household income as insufficient, independently of education and the working status during the COVID-19 pandemic.

Conclusions

These findings highlight the population groups that are at a greater risk of food insecurity during the current COVID-19 pandemic. Effective public health strategies should be developed aiming to address food insecurity during this crisis, especially among the higher risk groups.

The bad, the ugly and the monster behind the mirror - Food insecurity, mental health and socio-economic determinants

INTRODUCTION

Food insecurity is associated with poor mental health outcomes, including depression and anxiety and COVID-19 could increase these relations. In this sense, we aimed to explore the relationship between food insecurity and mental health features and behaviors in adults from Portugal.

METHODOLOGY

We conducted a cross-sectional online snowball study from November 2020 until February 2021. A total of 882 Portuguese residents 18 years of age or older with food security data were included. Data on socio-demographics, food security status, and anxiety and depression symptoms were collected. Crude and adjusted logistic regression models were performed. Odds ratio (OR) and respective 95% confidence intervals (CI) were estimated.

RESULTS

Most participants were women (71.3%), with a mean (SD) age of 36.8 (10.9) years, three-thirds had a university degree (76.7%), and 65.3% lived in the country's northern region. Regarding the characteristics associated with food insecurity, we observed that less-educated participants (OR = 7.84; 95% CI: 3.67-16.73), with depression symptoms (OR = 5.91; 95% CI: 3.12-11.19) and with anxiety symptoms (OR = 6.41; 95% CI: 3.02-13.59), had a higher odds of belonging to a food-insecure household. After adjustments less educated individuals (OR = 8.37; 95% CI: 3.81-18.35), those who faced a reduction in income (OR = 0.27; 95% CI: 0.13-0.53) and, presenting anxiety symptoms (OR = 7.32; 95% CI: 3.53-15.17) had a higher odds of belonging to a food-insecure household.

CONCLUSIONS

Approaching food insecurity without addressing mental health, and the opposite is making partial and reductive interventions. It is important to have an integrative approach.

The Rise and Fall of SARS-CoV-2 Variants

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