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- Overlooking workplace violence in health workforce planning in sub-Saharan AfricaPublication . Ferrinho, Paulo; Sidat, Mohsin; Delgado, António Pedro; Pascoal, Eva; Instituto de Higiene e Medicina Tropical (IHMT); Global Health and Tropical Medicine (GHTM); Population health, policies and services (PPS); Wiley
- Telemedicine to deliver diabetes care in low-and middle-income countriesPublication . Correia, Jorge César; Meraj, Hafsa; Teoh, Soo Huat; Waqas, Ahmed; Ahmad, Maaz; Lapão, Luis Velez; Pataky, Zoltan; Golay, Alain; Global Health and Tropical Medicine (GHTM); Instituto de Higiene e Medicina Tropical (IHMT); Population health, policies and services (PPS); World Health Organisation / World Health OrganizationObjective To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. Methods We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties. Findings We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of −0.38 for glycated haemoglobin (95% confidence interval, CI: −0.52 to −0.23; I2 = 86.70%), −0.20 for fasting blood sugar (95% CI: −0.32 to −0.08; I2 = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I2 = 93.75%), 0.55 for diabetes knowledge (95% CI: −0.10 to 1.20; I2 = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I2 = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of −0.04 for body mass index (95% CI: −0.13 to 0.05; I2 = 35.94%), −0.06 for total cholesterol (95% CI: −0.16 to 0.04; I2 = 59.93%) and −0.02 for triglycerides (95% CI: −0.12 to 0.09; I2 = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications. Conclusion Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias. Objetivo Determinar la eficacia de la telemedicina en la prestación de servicios de atención sanitaria de la diabetes en los países con ingresos bajos y pocos medios. Métodos Se realizaron búsquedas en siete bases de datos hasta julio de 2020 para encontrar ensayos controlados aleatorios que investigaran la eficacia de la telemedicina en la prestación de servicios de atención de la diabetes en países con ingresos bajos y pocos medios. Se extrajeron datos sobre las características del estudio, las principales variables de evaluación y los tamaños del efecto de los resultados. Utilizando el análisis de los efectos aleatorios, realizamos una serie de metaanálisis tanto para los resultados bioquímicos como para las propiedades relacionadas con los pacientes. Resultados Incluimos 31 intervenciones en nuestro metaanálisis. Se observaron diferencias medias estandarizadas significativas de -0,38 para la hemoglobina glicosilada (intervalo de confianza del 95%, IC: -0,52 a -0,23; I2 = 86,70%), -0,20 para la glucemia en ayunas (IC del 95%: -0,32 a -0,08; I2 = 64,28%), 0,81 para el cumplimiento del tratamiento (IC del 95%: 0,19 a 1,42; I2 = 93,75%), 0,55 para el conocimiento de la diabetes (IC del 95%: 0,10 a 1,20; I2 = 92,65%) y 1,68 para la autoeficacia (IC del 95%: 1,06 a 2,30; I2 = 97,15%). No se observaron efectos significativos del tratamiento para otros resultados, con diferencias medias estandarizadas de -0,04 para el índice de masa corporal (IC del 95%: -0,13 a 0,05; I2 = 35,94%), -0,06 para el colesterol total (IC del 95%: -0,16 a 0,04; I2 = 59,93%) y -0,02 para los triglicéridos (IC del 95%: -0,12 a 0,09; I2 = 0%). Las intervenciones telefónicas y el servicio de mensajes cortos de texto produjeron los efectos de tratamiento más altos en comparación con los servicios basados en la telemetría y las aplicaciones de los teléfonos inteligentes. Conclusión Aunque se determinó que la telemedicina es eficaz para mejorar varios resultados relacionados con la diabetes, la certeza de las pruebas fue muy baja debido a la considerable heterogeneidad y el riesgo de sesgo.
- Determinants of COVID-19 Vaccine Hesitancy in Portuguese-Speaking Countries:Publication . Sousa, Álvaro Francisco Lopes de; Teixeira, Jules Ramon Brito; Lua, Iracema; Souza, Fernanda de Oliveira; Ferreira, A. J. F.; Schneider, Guilherme; Carvalho, Herica Emilia Félix de; Oliveira, Layze Braz de; Lima, Shirley; Sousa, Anderson Reis de; Araújo, Telma Maria Evangelista de; Camargo, Emerson Lucas Silva; Oriá, Mônica Oliveira Batista; Craveiro, Isabel; Araújo, Tânia Maria de; Mendes, I.A.C.; Ventura, Carla Arena Aparecida; Sousa, Isabel; Oliveira, Rodrigo Mota de; Simão, Manuel; Fronteira, Ines; Instituto de Higiene e Medicina Tropical (IHMT); Global Health and Tropical Medicine (GHTM); Population health, policies and services (PPS); MDPI - Multidisciplinary Digital Publishing InstituteCOVID-19 vaccine hesitancy (VH) has caused concerns due to the possible fluctuations that may occur directly impacting the control of the pandemic. In this study, we aimed to estimate the prevalence and factors associated with COVID-19 VH in Portuguese-speaking countries. We developed a web survey (N:6,843) using an online, structured, and validated questionnaire. We used Measurement Models, Exploratory Factor Analysis, Exploratory Structural Equation Models, and Confirmatory Factor Analysis for the data analysis. The overall prevalence of COVID-19 VH in Portuguese-speaking countries was 21.1%. showed a statistically significant direct effect for VH: vaccine-related conspiracy beliefs (VB) (β = 0.886), perceived stress (PS) (β = 0.313), COVID-19 Misinformation (MIS) (β = 0.259) and individual responses to COVID-19 (CIR) (β = −0.122). The effect of MIS and CIR for VH was greater among men and of PS and VB among women; the effect of PS was greater among the youngest and of VB and CIR among the oldest. No discrepant differences were identified in the analyzed education strata. In conclusion, we found that conspiracy beliefs related to the vaccine strongly influence the decision to hesitate (not to take or to delay the vaccine). Specific characteristics related to gender, age group, social and cognitive vulnerabilities, added to the knowledge acquired, poorly substantiated and/or misrepresented about the COVID-19 vaccine, need to be considered in the planning of vaccination campaigns. It is necessary to respond in a timely, fast, and accurate manner to the challenges posed by vaccine hesitancy.
- Organisation of the State, model of health system and COVID-19 health outcomes in six European countries, during the first months of the COVID-19 epidemic in 2020Publication . Simões, Jorge; Magalhães, João Paulo Moreira; Biscaia, André; da Luz Pereira, António; Augusto, Gonçalo Figueiredo; Fronteira, Inês; Population health, policies and services (PPS); Instituto de Higiene e Medicina Tropical (IHMT); Global Health and Tropical Medicine (GHTM); WileyThe time and type of the States' responses to the COVID-19 pandemic varied with the severity of the epidemiological situation, the perceived risk, the political organisation and the model of health system of the country. We discuss the response of Germany, Spain, France, Italy, Portugal and the United Kingdom during the first months of the COVID-19 epidemic in 2020, considering the political organisation of the country and its health system model. We analyse public health measures implemented to contain or mitigate the pandemic, as well as those related to governance, resources and reorganisation of services, financing mechanisms, response of the health system itself and health outcomes. To measure the burden of COVID-19, we use several indicators. The adoption of measures, to contain and mitigate epidemic varied in degree and time of adoption. All countries reorganised their governance structure and the provision of care, despite the differences in political models and health systems (ranging from a more unitary and centralised political organisational model—France and Portugal; to a decentralised matrix—Germany, Spain, Italy and the United Kingdom). Rather than the differences in political models and health systems, the explanation for the success in tackling the epidemic seems to lay in other social determinants of health.
- Socioeconomic impact of COVID-19 among immigrants in Lisbon RegionPublication . Shaaban, A.; Abecasis, AB; Fronteira, I; Muggli, Z; Amado, R; Vaz, Dora; Silva, A. C.; Martins, MR; TB, HIV and opportunistic diseases and pathogens (THOP); Global Health and Tropical Medicine (GHTM); Instituto de Higiene e Medicina Tropical (IHMT); Population health, policies and services (PPS); Wiley
- Statistical models for analyzing count dataPublication . Shaaban, Ahmed Nabil; Peleteiro, Bárbara; Martins, Maria Rosario O.; Population health, policies and services (PPS); Global Health and Tropical Medicine (GHTM); Instituto de Higiene e Medicina Tropical (IHMT); BioMed Central (BMC)Background: This study offers a comprehensive approach to precisely analyze the complexly distributed length of stay among HIV admissions in Portugal. Objective: To provide an illustration of statistical techniques for analysing count data using longitudinal predictors of length of stay among HIV hospitalizations in Portugal. Method: Registered discharges in the Portuguese National Health Service (NHS) facilities Between January 2009 and December 2017, a total of 26,505 classified under Major Diagnostic Category (MDC) created for patients with HIV infection, with HIV/AIDS as a main or secondary cause of admission, were used to predict length of stay among HIV hospitalizations in Portugal. Several strategies were applied to select the best count fit model that includes the Poisson regression model, zero-inflated Poisson, the negative binomial regression model, and zero-inflated negative binomial regression model. A random hospital effects term has been incorporated into the negative binomial model to examine the dependence between observations within the same hospital. A multivariable analysis has been performed to assess the effect of covariates on length of stay. Results: The median length of stay in our study was 11 days (interquartile range: 6–22). Statistical comparisons among the count models revealed that the random-effects negative binomial models provided the best fit with observed data. Admissions among males or admissions associated with TB infection, pneumocystis, cytomegalovirus, candidiasis, toxoplasmosis, or mycobacterium disease exhibit a highly significant increase in length of stay. Perfect trends were observed in which a higher number of diagnoses or procedures lead to significantly higher length of stay. The random-effects term included in our model and refers to unexplained factors specific to each hospital revealed obvious differences in quality among the hospitals included in our study. Conclusions: This study provides a comprehensive approach to address unique problems associated with the prediction of length of stay among HIV patients in Portugal.
- O papel do estado, do setor privado e do setor social nos diferentes ciclos políticos de saúde em portugalPublication . Simões, Jorge; Fronteira, Inês; Population health, policies and services (PPS); Instituto de Higiene e Medicina Tropical (IHMT); Global Health and Tropical Medicine (GHTM); Associação Brasileira de Saúde Coletiva (Abrasco)The Portuguese health system comprises three critical sectors: The State, which intervenes as a regulator of the entire system, and as a planner, provider, and financer of the National Health Service (NHS); the social sector, with a relevant intervention, mainly in continued care; and the private sector, with an essential role in the provision of some types of care. During the last forty years, the State, social, and private sectors’ roles have changed either in its definition or terms of the relationship between them. In general, it is possible to identify, and we shall present them in this opinion article, eight political cycles that reflect the political contexts in Portugal, and, consequently, the ideological framework of each cycle.
- The 2019 health basic law in PortugalPublication . Simões, Jorge; Fronteira, Inês; Augusto, Gonçalo Figueiredo; Instituto de Higiene e Medicina Tropical (IHMT); Global Health and Tropical Medicine (GHTM); Population health, policies and services (PPS); Elsevier Science B.V., Amsterdam.The Portuguese National Health Service (NHS) was established in 1979. Since its inception, the relationship of the NHS with private-for-profit and private-non-profit organisations has been controversially discussed between left and right-wing political parties, and this has also led also to academic debate. In 1990, a Health Basic Law was approved by right-wing parties, which allowed public-private partnerships (PPPs) in the health system and led to an increased role of the private sector in health care provision. During the 2015 general elections, the role of PPPs in the health system was an important topic of discussion, with all left-wing parties calling for an end of PPPs in the NHS. In 2019, after two years of intense political controversies, left-wing parties supporting the minority socialist government approved a new Health Basic Law. This paper analyses the process of policy formulation, tracing the process of adoption and the views of the main political parties involved. Although some parties wished to eliminate PPPs and to mandate that services in the NHS should be provided exclusively by public providers, this was not included in the final version of the law. Nevertheless, the new Health Basic Law re-enhances the central role of the NHS in the health system, clarifying that the private and non-profit sectors should only play a complementary role.
- Utilización de textiles impregnados con antimicrobianos en los servicios sanitariosPublication . Schneider, Guilherme; Bim, Felipe Lazarini; de Sousa, Álvaro Francisco Lopes; Watanabe, Evandro; de Andrade, Denise; Fronteira, Inês; Population health, policies and services (PPS); Global Health and Tropical Medicine (GHTM); Instituto de Higiene e Medicina Tropical (IHMT); Revista Latinoamericana de Enfermagem / Universidade de S�o PauloObjective: to analyze evidence concerning the feasibility of antimicrobial-impregnated fabrics in preventing and controlling microbial transmission in health services. Method: An integrative review using the following databases: MEDLINE (via PubMed), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Latin American and Caribbean Health Sciences Literature (LILACS), regardless of language and date of publication. Seven studies were included in the analysis to verify the types of fabrics and substances used to impregnate the fabrics, applicability in health services, and decrease in microbial load. Results: Silver nanoparticles and copper oxide are the main antimicrobial substances used to impregnate the fabrics. The patients’ use of these fabrics, such as in bed and bath linens and clothing, was more effective in reducing antimicrobial load than in health workers’ uniforms. Conclusion: The use of these antimicrobial-impregnated textiles, especially by patients, is a viable alternative to prevent and control microbial transmission in health services. Implementing these fabrics in health workers’ uniforms requires further studies, however, to verify its effectiveness in decreasing microbial load in clinical practice.
- Demographic, clinical and pathological characterisation of patients with colorectal and anal cancer followed between 2013 and 2016 at Maputo Central Hospital, MozambiquePublication . Selemane, Carlos; Jamisse, Luisa; Arroz, Jorge; Túlsidas, Satish; Morais, António Gudo; Carrilho, Carla; Modcoicar, Prassad; Sidat, Moshin; Rodrigues, Jessica; Moreira-Gonçalves, Daniel; Ismail, Mamudo; Santos, Lúcio Lara; Instituto de Higiene e Medicina Tropical (IHMT); Global Health and Tropical Medicine (GHTM); ecancer Global FoundationPurpose: The aim of this study was to investigate colorectal cancer (CRC) data and anal cancer data from Maputo Central Hospital (MCH), the largest hospital and a reference for oncological diseases in Mozambique, with the aim of characterising the disease profile in view to define an appropriate control programme. Methods: MCH records from the Pathology and Surgery Services and MCH Cancer Registry database were assessed to obtain retrospective clinical and pathologic data of patients with CRC or anal cancer admitted to and treated between 13 December 2013 and 23 March 2016. Results: The female gender was more prevalent (54.8%), even when anal cancers were excluded. Median age was 54 years (20 99). Most patients (51.6%) lived in the city of Maputo. The most common presenting symptom was found to be rectal bleeding. Adenocarcinoma was the most frequent histological type, and the most prevalent anatomical site was the rectum. Most of the cases were diagnosed at MCH in advanced stages. Colostomy was the most frequent surgical procedure and performed in 38.7% of the patients. Most cases of anal cancer occurred in human immunodeficiency virus-infected patients. Most patients had a poor prognosis due to advanced stage at first diagnosis. Conclusion: We observed an increase in cases of CRC and anal cancer in Mozambique and mostly diagnosed at advanced stages, which anticipates a dismal prognosis. Our data supports the urgent need of a comprehensive public health programme dedicated to solving this growing concern.