bluuebunny/crossref_metadata_2025_split huggingface dataset:
The health of immigrant children: a cohort study in the Metropolitan area of Lisbon - Portugal
Authors: Muggli Z , Amado R , Oliveira Martins M R , Pires M , Vaz D 
Published: October 2020

Abstract

Background
Studies in Europe show immigrant children to be more vulnerable to health problems. Portugal has a gap in knowledge about the health of immigrant children. The objective of this paper is to present results on a cohort study for health trajectories of immigrant children in the Amadora Municipality which has one of the highest numbers of immigrants in Portugal. We will analyse health profile characteristics of immigrant and native children and their utilisation of health services.

Methods
Prospective cohort study in Amadora health units (questionnaires and patient registers data). Participants: 420 native and immigrant children born in 2015 registered in Amadora Primary Health Care Centers (PHCC); recruitment from June 2019 to March 2020. Main outcomes: psychomotor development (Mary Sheridan); emotional and behavioural problems (SDQ); BMI; vaccination;

Results
From the 420 children recruited, 48,3% were immigrant mostly from Brazil and Portuguese speaking African countries, 41 children were born outside the EU (1st generation).
From the 126 children who had no routine medical examination at the age of 4, 59% were immigrant. Almost all immigrant children had vaccinations up to date (90%). Around 70% of native and 60% of immigrant children achieved all parameters in Mary Sheridan's test (p = 0.09). Overweight was found in 28% of native and 22% of immigrant children (p = 0.2). Median SDQ score for externalizing behaviours is different for 1st generation immigrants suggesting higher behaviour problems for this group of children (p = 0,003).

Conclusions
Most differences in overall outcomes occur between 1st generation immigrant and other children; immigrants showed significantly higher emotional and behaviour problems. Early identification of above difficulties and higher utilisation of routine health examinations should be a priority.

Key messages
1st generation immigrant children appear more at risk for emotional and behaviour difficulties. Early identification of above difficulties and higher utilisation of routine health examinations should be a priority.
Health curricular training with a focus on gender diversity in selected countries
Authors: Freitas C A M , Carvalho V N , Jesus N N , Bezerra M V R , Kochergin K N , Santos A M , Prado N M B L 
Published: October 2020

Abstract

Background
The discussion on the inclusion of sexuality in the school curriculum is old, but the same cannot be said of the proposition of this theme as a guide of national public policies in the area of education. We discussed in this article, how the absence of the biopsychosocial dimension of sexuality in the training of health professionals compromises the recognition of people's diversity, assistance and the guarantee of human rights.

Methods
Review of the literature in the scientific databases Science Direct, Web of Science and BVS. 16 articles constituted the corpus. This review followed the recommendations of PRISMA. The instrument proposed by CASP was used to evaluate the methodological quality of the selected studies.

Results
The publications on health training highlighted several aspects, from the need for training for the team of health professionals, regarding the reception and clinical care of LGBT people until the creation of teaching materials to fill the curriculum gaps on this subject. Several studies discuss the near absence of LGBT teaching hours in the medical and nursing curricula. The low permeability of LGBT discussions in academia reinforces a sexist, heterocisnormative training that has repercussions on the low quality of care provided to these individuals.

Conclusions
It makes it necessary to understand the uniqueness of the LGBT community for health support for different sexual genders. The inclusion of these themes in the training path can make possible a professional practice that overcomes the prejudices, violence and binarism present in a sexist and heteronormative society and implies breaking with hegemonic power relations. The construction of a pedagogy that values the diversities and a curriculum that does not standardize the subjects from standards, whatever they are, and that even meet those who are on the borders, is necessary for a true democratization.

Key messages
We cannot deny the constant setbacks in the scope of these policies guided in a conservative society in a kind of political and social game with confrontations sometimes aggressive. Promote the longitudinal improvement and insertion along the training, in the interface with other determinants that go through the health care of the integral being.
Stakeholders, Primary Health Care and Dispersed Rurality
Authors: Jaramillo-Mejia M C , Nuñez-Cabrera A , Gil J C 
Published: October 2020

Abstract

Objective
To characterize the existing tensions between actors which condition the implementation of the renewed primary healthcare (PHC), in the context of the most recent Colombian post-conflict years, in the territories of high rurality of the Pacific Coast.

Methods
We performed a qualitative study based on action research methodology with a critical and reflexive analysis of the social and institutional actors in the implementation of the Renewed PHC model in dispersed rural areas (Afro-Colombian and indigenous) the Pacific coast. We analyzed the different interested parties and the concordance between the community and institutional actors.

Results
The level of implementation of the Renewed PHC in high rurality territories of the Colombian Pacific Coast, intersects with tensions arising from the armed conflict, that affect sustainability and governance of the territory, and the intercultural tensions between the national health model in Colombia and the communities' social representations of their own health and development. Only 25% of the Renewed PHC elements are present, under low or medium conditions. Analysis of actors -Stakeholders-, according to their nature, level of presence, and power in the area indicates the absence of the Colombian government in these territories. Members of the community and their health resources constitute 48% of the Renewed PHC parties.

Conclusions
Limited understanding of the ethnic logics on health and development stands out as the main tension among actors to advance with the implementation of the Renewed PHC in post-conflict territories with high rurality. The national health model has a low capacity to accurately address health priorities from the Afro-descendant and Indigenous communities occupying such territories, with a differentiated, intercultural offer that would be able to act integrally on the dynamics of the illegal economy (illegal mining and illicit crops), which can seriously compromise their food security.

Key messages
Only 25% of the components of the renewed PHC are present in the territories with high dispersed rurality. In the post-conflict period, there are still tensions between community actors and stakeholders (Institutions).
Asylum seekers and inequalities in healthcare: a mixed-method research in Emilia-Romagna region
Authors: Gherardi G , Mammana L , Quargnolo M , Bodini C , Damosto D , Florescu C , Fantini M P 
Published: October 2020

Abstract

Background
In the past few years more than 30,000 asylum seekers arrived in Emilia-Romagna region. Guidelines were developed to screen the newly arrived, mainly focused on communicable diseases (CDs). However, asylum seekers who are out of the institutional reception system do not have access to such screenings. In order to assess the implementation and reach of these guidelines with respect to the target population, in 2019 a mixed-method survey was carried out.

Methods
A questionnaire with 35 closed and 11 open questions, based on a synthesis of the regional and national guidelines, was carried out with referents of the regional clinics that provide healthcare to asylum seekers. The collected questionnaires were processed through descriptive statistical analysis for the closed questions and text analysis for the open questions.

Results
Questionnaires were collected from 14 clinics. All clinics provide first visit and screening for CDs upon arrival, following the regional guidelines. However, enrolment in the national healthcare system was found to be delayed for periods of up to 6 months, resulting in discontinuity of care. Administrative and cultural barriers in accessing health and social services were repeatedly reported, the latter often linked to lack of cultural mediation services. Financial barriers were also reported, particularly with respect to dental care and pharmaceuticals. Results also show that asylum seekers within the institutional reception system can more easily overcome the reported barriers compared to those out of the system. Such inequality in accessing healthcare is reported also for the TB screening process.

Conclusions
Even if access to healthcare for asylum seekers is regulated by norms and guidelines, barriers are consistently reported. Moreover, asylum seekers within or outside the reception system face different barriers in accessing healthcare services. Such local evidence can be very relevant to inform actions that improve health equity.

Key messages
Even if access to healthcare for asylum seekers is regulated by law, barriers are consistently reported and impact disproportionately on those who are out of the institutional reception system. A mixed-method approach that generates local evidence on the barriers that asylum seekers face in accessing healthcare and on their causes is key to inform actions that improve health equity.
Restricted care for asylum seekers. An explorative study of rationing practices
Authors: Ziegler S , Bozorgmehr K 
Published: October 2020

Abstract

Background
Access to health care for refugees in many European countries is initially restricted. In Germany, during the first 18 months after arrival, any health services except for acute needs must be requested on a case-by-case basis. As the procedures and criteria applied by medical and state actors leading to provision or denial of services are intransparent, we explored ways to study them and derived first hypothesis about resource allocation criteria to identify possible factors leading to inequities.

Methods
A mixed-method-study was carried out, including six weeks of ethnographic exploration in two refugee outpatient clinics, documention of requests, a free-listing task and 20 in-depth interviews with public administrators, health workers, and translators.

Results
Of 101 requested services, 53 % were granted, 30% denied, 37 % not answered in time. Preliminary qualitative findings show that in dealing with restrictions, medical professionals develop enabling strategies as well as anticipatory obedience, the latter based on speculations about authorities' decision criteria. The effects of observed social classification e.g. of patient's behavior or reasons for migration need further exploration. Interviews suggest that in allocation decisions of authorities, structural and political considerations such as the prospect to remain in Germany, might play a role.

Conclusions
Procedures and strategies of care provision can be explored ethnographically. We found, that in addition to medical factors, individual, formal, social, structural and political factors might play a role in distribution decisions. Continuous documentation of requests is needed to gain further insights. To ensure equal care for all refugee patients information and training of care providers and officials is necessary as well as exchange between the involved actors. The lack of transparent rationing principles opens up opportunities for discriminiation and should be reduced via open discussion.

Key messages
Decision making criteria and procedures to grant or deny medical care for asylum seekers in Germany are intransparent and have not been sufficiently studied yet. Heterogenous local implementation of legal regulations – through medical actors and state officials – can lead to health care inequities within vulnerable populations.
Level of literacy and clinical outcomes in patients with Chagas disease: SaMi-Trop project
Authors: Quintino N , David G , Sabino E , Silva J L , Ribeiro A L , Ferreira A , Oliveira L , Oliveira C , Cardoso C 
Published: October 2020

Abstract

Background
Chagas disease (CD) is a neglected tropical disease that affects mainly vulnerable population, whose majority has low ability to understand health information. This study aimed to assess the prevalence of health literacy (HL) and its association with sociodemographic, quality of life, health care aspects and worse clinical outcomes.

Methods
This is a cross-sectional study developed inside a cohort study (SaMi-Trop) including 1959 patients. It has been conducted in an endemic region to CD in Brazil. The eligible criteria for HL evaluation was the ability to read. The HL was assessed with SALPHA-18 scale and literacy was categorized in inadequate HL; adequate HL and; illiterate. Multiple models were adjusted using binary logistic regression, multinomial and beta regression models using the gamlss framework.

Results
Of the patients included, 1136 (74.1%) are illiterate. For HL assessment, only 397 managed to complete the HL evaluation. The prevalence of inadequate HL was 85.1% (338), only 59 patients (14.9%) had adequate HL. Our results are as following: 1) being illiterate increases the chance of using more drugs when compared to individuals with adequate HL - 1 or 2 drugs (OR: 1.96; CI: 1.06-3.62) and 3 to 4 medications (OR: 3.06; CI:1.44-6.52), to have hypertension (OR: 2.24; CI: 1.29-3.90), report an average self-perceived health (OR: 2.97; IC: 1.63-5.42) and report poor self-perceived health (OR: 3.67; CI: 1.71-7.89); 2) inadequate literacy increases the chance of using 3 to 4 medications (OR: 2.26; CI: 1.04-4.93) and report an average self-perceived health (OR: 2.48; CI: 1.34-4.62); 3) Illiterate patients present worst quality of life scores in Physical (OR: 0,730; CI: 0,583-0,914), Psychological (OR: 0,671; CI: 0,544-0,828) and Environmental (OR: 0,727; CI: 0,601-0,880) domains.

Conclusions
We found a high prevalence of inadequate HL; it was associated with worse clinical outcomes and poor self-perceived health.

Key messages
Our findings reinforce the importance of improving health communication in CD patients seeking to avoid unfavorable outcomes. A high prevalence of inadequate health literacy was observed in our study, which can impact the self-care ability of patients with CD.
Will mild atypical pneumonia remain underdiagnosed and undertreated in primary care setting?
Authors: Gatsura S , Deriushkin V , Gatsura O , Ulyanova E 
Published: October 2020

Abstract

Background
Non severe community acquired pneumonia (CAP) is a common problem in primary care. So called “walking” CAP is frequently caused by atypical intracellular pathogens Chlamydia pneumoniae and Mycoplasma pneumonia which are resistant to beta-lactams and can be transmitted from an infected person to a healthy one. Taking into account medical and epidemiologic importance of this problem we aimed to estimate appropriateness of the antimicrobial agent (AM) choice for outpatient treatment of mild CAP by current and future primary care providers with regard to atypical pathogens coverage.

Methods
Total 240 final year medical students of A.I.Yevdokimov Moscow State University of Medicine and Dentistry (Group 1) and 206 Moscow primary care physicians (Group 2) were surveyed in 2019. Respondents were asked to specify in writing what particular AM they would recommend to 35 year old previously healthy male patient with subfebrile body temperature (37.3 °C), non-productive cough and documented CAP. Chi-square test was used to compare the data obtained in both groups.

Results
Group 1 respondents returned questionnaires with 271 recommendations, Group 2 participants named 230 items. AMs with atypical pathogens coverage (macrolides, fluoroquinolones and doxycycline) accounted for just 33.2% in Group 1 versus 20.0% in Group 2 (p=.0009). Amoxicillin/clavulanate was the leading choice equally popular both in students and physicians (42.1% and 40.9% respectively). The rest of recommendations in both Groups included amoxicillin and various cephalosporins.

Conclusions
Only one of three students and one of five physicians made the right choice in offered clinical scenario. A majority of respondents in both groups hastily recommended beta-lactams instead of clinical estimation of atypical CAP probability in given situation, but students indicated appropriate AMs more often. This problem obviously persists and requires action from both academics and healthcare managers.

Key messages
Medical students and primary care physicians’ awareness of atypical CAP presentation and treatment is not quite satisfactory. Resulting undertreatment of atypical CAP may harm the patient and promote further spread of causative pathogen within the community.
Tuberculosis at Public Health Unit of Santa Maria da Feira and Arouca (Portugal)
Authors: Fernandes D , Reina L 
Published: October 2020

Abstract

Introduction
In the last decade Portugal has seen a decrease of about 40% in the notification and incidence rate of tuberculosis, with incidence values below 20/100,000 inhabitants since 2015. In 2018, a notification rate estimated at a national level was 16,6/100,000 inhabitants and an incidence rate of 16.4/100,000 inhabitants. With this investigation we intend to I) determine the notification and incidence rate of tuberculosis at the Public Health Unit (PHU) of Santa Maria da Feira and Arouca (Portugal); II) analyze the clinical and sociodemographic characteristics.

Methods
The confirmed cases of tuberculosis between January 1, 2015 and December 31, 2019 were analyzed.

Results
105 cases of tuberculosis were identified, most of them male (67%), aged between the 1 year and 94 years age (median: 52 years). About ⅓ of the patients were retired. Among the co-morbidities that constitute a risk for tuberculosis, we highlight COPD (7.6%), alcohol abuse (5.7%) and HIV (3.8%). The pulmonary location prevailed (81.9%). We emphasize that 52 cases had positive smear microscopy and 42 cases cavitation. From 2017 to 2019 we have a median of 61 days from the onset of symptoms to diagnosis. From 2015 to 2019, 4 cases with poly-resistance to isoniazid and streptomycin were identified. In 2019, the incidence rate tuberculosis was 12.5/100,000 inhabitants and the notification rate of 16.3/100,000 inhabitants.

Conclusions
The incidence and notification rate like the median between the onset of symptoms and the diagnosis, by the public health unit (PHU), are below the national average. Regarding these results, we recommend that the strategy adopted by the PHU should be maintained.

Key messages
In the last decade Portugal has seen a decrease of about 40% in the notification and incidence rate of tuberculosis, with incidence values below 20/100,000 inhabitants since 2015. In 2019, the incidence rate tuberculosis at PHU was 12.5/100,000 inhabitants and the notification rate of 16.3/100,000 inhabitants.
Assessment of changes in efficacy of antimalarials: a systematic review and network meta-regression
Authors: Youdom S W , Tchouenkou R S , Ndong-Nguema E-P , Basco L K 
Published: October 2020

Abstract

Background
The fight against diseases such as malaria requires the synthesis of evidence from existing studies to inform decision makers. Indeed, at a cross road of antimalarial drug resistance, several artemisinin-based combination therapies (ACT) with multiple doses are available to fight uncomplicated malaria. However, little is known on how these combinations are combined as well as how different formulations are tested.

Methods
A systematic review was performed to identify randomized trials. Articles were sought by hand-searching and scanning references. Additional covariates effect on treatment outcome was assessed, and a modeling approach to reduce heterogeneity among trials was evaluated. We explored one single interaction effect for all treatment with age as the main covariate in a meta-regression. A Bayesian analysis was used to implement the consistency and inconsistency models under the WinBUGS software. Ranking measure was used to obtain a hierarchy of the competing interventions.

Results
In total, 77 articles meet the inclusion criteria with 15 combinations tested in 36,000 patients. Results were compared to that of frequentist approach and presented according to the Prisma NMA checklist. The consistency model showed a good performance than the inconsistency model under the hypothesis of homogeneity. It was found that compared to artemether-lumefantrine, the dihydro-artemisinin-piperaquine was more effective before (B, OR = 1.83; 95% CI = 1.31-2.56) and after (A, OR = 1.70; 95% CI = 1.20-2.43) covariate adjustment, and occupied the top rank.

Conclusions
The application of the methods described here may be helpful to gain better understanding of treatment efficacy and improve future decisions in malaria programs. Based on the available evidence, this study demonstrated the superiority of DHAP among currently recommended ACT in preventing as well as treating uncomplicated malaria.

Key messages
Choosing the best therapy requires data triangulation and data science. Network meta-analysis could be a solution but need more methodological studies.
HIV/AIDS: a 30 year history at the Northern Region of Portugal
Authors: Neves L Reina , Santos M , Oliveira A 
Published: October 2020

Abstract
Since 1981, when the first cases of human immunodeficiency virus (HIV) infection were diagnosed, the need to monitor what emerged shortly afterwards as an epidemic arose. Portugal was not immune, and over the years different measures have been taken to control the national epidemic. The goal of this research is to contribute to the previous knowledge about the trend of HIV infection at the regional level that allows adequate planning focused on controlling the epidemic. This is an observational, descriptive and cross-sectional study, whose data were anonymized at the source, based on the analysis of cases notified by doctors. The data were analyzed using the software Microsoft® Excel version 16.16.4 and IBM® SPSS® Statistics version 25. To check if there is a proven statistical relationship between the variables, the Chi-Square independence test (X2) was used. The results obtained revealed 14512 accumulated cases, in the different stages of infection, 76.7% of which are male, with a higher incidence between 25-29 years of age. Type HIV-1 covers 97.1% of all cases. From 2013 to 2017 it was observed that 74.2% lived in urban areas. Late diagnosis was found in rural areas, particularly in heterosexual transmission. It was concluded that there are several similarities between data at regional and national levels, such as the occurrence of late diagnosis in the category of heterosexual transmission. Regarding legislative changes, no conclusion can be inferred, although hypotheses were raised that can should be discussed in future studies.

Key messages
Late diagnosis in rural areas. Late diagnosis in heterosexual transmission.