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HIV incidence among men who have sex with men (MSM) has risen in most Western countries. This has been largely attributed to increased high-risk sexual behaviours that occur from combinations of drivers operating in specific social, economic, cultural, and political contexts. MSM constitute a key population at increased risk for HIV, but not all MSM are at equivalent risk. Male and transgender sex workers (SW) are MSM subgroups considered most vulnerable to HIV infection. So far, knowledge on drivers of increased HIV among MSM is limited. Difficulties in reaching hard-to-reach groups have challenged research with key populations. Several methods for recruiting difficult-toaccess populations have emerged. This thesis intends to contribute to improve knowledge on prevalence of HIV, high risk behaviours and its determinants among MSM in Portugal. The specific objectives are to: 1)Estimate the prevalence of HIV and assess high-risk behaviours among a population of MSM in Portugal; 2)Explore and understand the complex links of HIV risk-taking practices and the adoption of protective measures among MSM most vulnerable groups; and 3)Critically analyse different methods for most effectively targeting MSM in HIV research and reach those most-at-risk. This thesis is expected to contribute to improve knowledge on HIV burden and risk factors among MSM in Portugal, and identify prevention needs to inform actions for reducing the spread of infection in MSM. This thesis is also expected to contribute to conducting future research with this hard-to-reach population. This work was based on the literature review on HIV and MSM developed throughout the thesis, the results obtained in the cross-sectional studies conducted about the prevalence of HIV, high-risk behaviours and drivers of infection among MSM, and the critical review of the methods for most appropriately targeting MSM in HIV research. Our findings show a high prevalence of HIV among the MSM studied – 8.8% (95%CI: 7-11%). More than a third of respondents reported visiting venues where MSM frequently seek sexual partners and have sex (cruising venues). A significantly higher proportion of cruising venues' visitors reported to be HIV-positive (14.6% [95%CI: 11-18%] vs. 5.5% [95%CI: 4-7%] among non-visitors). Cruising venues' visitors also engage more frequently in high-risk sexual behaviours as multiple sexual partners, group sex, and unprotected anal sex. Our findings show that different subgroups of MSM present disparate levels of HIV risk. Male SW presented high levels of HIV infection (5.0% [95%CI: 1-10%] self-reported; 10.7% [95%CI: 0-23%] reactive to rapid test), and reported frequently high-risk sexual behaviours as multiplicity of sexual partners, inconsistent condom use and drugs use. Among transgender SW (TSW), the proportion of HIV infection was 14.9% [95%CI: 8-21%]; findings show an overlap of sexual risk behaviours and an association of poor socioeconomic context with increased HIV risk and underuse of health services. Emerging methods for most effectively targeting MSM in HIV research - chain-referral, venue-based, respondent-driven, time-location, internet sampling methods, and community-based participatory approach - face common challenges but present several advantages on recruitment efficiency, especially of mostvulnerable subgroups, and evidence obtained on MSM's needs. There are diverse risk profiles of MSM population. Tailored interventions should integrate strategies to reduce risk behaviours, intensify harm reduction, improve uptake of HIV testing and promote access to HIV health services, while tackling socioeconomic, partnering, and structural contexts conducive to increased risk. Further research producing relevant knowledge more 'translatable' into effective actions that address MSM's health needs and improve health gain is needed. ; A incidência da infecção pelo VIH em homens que praticam sexo com homens (HSH) tem aumentado na maioria dos países ocidentais. Tal tem sido atribuído ao aumento de comportamentos de risco resultantes de combinações de factores que operam em contextos sociais, económicos, culturais e políticos específicos. Os HSH constituem uma população-chave em maior risco para o VIH, mas nem todos os HSH se encontram em igual nível de risco. Homens e pessoas transgénero trabalhadores do sexo (TS) são subgrupos de HSH considerados particularmente vulneráveis à infecção pelo VIH. O conhecimento actual sobre os factores do aumento da infecção pelo VIH em HSH é limitado. As dificuldades em alcançar grupos de difícil acesso têm desafiado a investigação com populações-chave. Neste contexto têm emergido vários métodos para recrutar estas populações. Esta tese pretende contribuir para aumentar o conhecimento sobre a prevalência do VIH, comportamentos de risco e seus determinantes em HSH em Portugal. Os objectivos desta tese são: 1)Estimar a prevalência do VIH e examinar os comportamentos de risco numa população de HSH em Portugal: 2)Explorar e compreende as complexas ligações de práticas de risco para o VIH e a adopção de medidas protectoras em grupos mais vulneráveis de HSH; e 3)Analisar criticamente diferentes métodos para alcançar mais adequadamente HSH na investigação em VIH e alcançar os grupos em maior risco. Com esta tese espera-se contribuir para um melhor conhecimento sobre a prevalência de VIH e factores de risco em HSH em Portugal, e identificar necessidades de prevenção para informar acções com vista à redução da transmissão do VIH nos HSH. Com esta tese espera-se também contribuir para o desenvolvimento de investigação futura com esta população de difícil acesso. O presente trabalho baseia-se na revisão de literatura sobre VIH e HSH desenvolvida ao longo do período da tese, nos resultados obtidos nos estudos transversais realizados sobre a prevalência de VIH, comportamentos de risco e factores da infecção em HSH, bem como na análise crítica dos métodos para alcançar mais adequadamente HSH na investigação em VIH. Os nossos resultados mostram uma elevada prevalência de VIH nos HSH estudados - 8.8% (IC95%: 7-11%). Mais de um terço dos inquiridos reportou frequentar locais onde HSH procuram parceiros sexuais e têm relações sexuais (locais de encontro sexual). Uma proporção significativamente mais elevada de frequentadores de locais de encontro sexual reportou ser VIH-positivo (14.6% [IC95%: 11-18%] vs. 5.5% [IC95%: 4-7%] nos nãofrequentadores). Os frequentadores de locais de encontro sexual também reportam mais frequentemente comportamentos sexuais de risco como múltiplos parceiros sexuais, sexo em grupo e sexo anal desprotegido. Os nossos resultados indicam que diferentes subgrupos de HSH apresentam diferentes níveis de risco para o VIH. Homens TS apresentam elevados níveis de infecção pelo VIH (5.0% [IC95%: 1-10%] auto-reportado; 10.7% [IC95%: 0-23%] resultado reactivo ao teste rápido), e reportam frequentemente comportamentos sexuais de risco como a multiplicidade de parceiros sexuais, o uso inconsistente do preservativo e o uso de drogas. Nos indivíduos transgénero TS, a proporção de infecção pelo VIH foi de 14.9% [IC95%: 8-21%]; os resultados mostram uma intersecção de comportamentos sexuais de risco e uma associação de contextos socioeconómicos desfavoráveis com um aumento do risco para o VIH e reduzida utilização dos serviços de saúde. Métodos emergentes para alcançar mais adequadamente HSH na investigação em VIH – de referência em cadeia, baseados em locais, orientados pelos respondentes, de tempo-local, por internet, e abordagem de investigação baseada na comunidade – enfrentam desafios comuns, mas apresentam várias vantagens ao nível da eficiência do recrutamento, especialmente de subgrupos mais vulneráveis, e da evidência obtida sobre as necessidades dos HSH. Existem diferentes perfis de risco na população de HSH. Intervenções adequadas devem integrar estratégias para reduzir comportamentos de risco, intensificar a redução de danos, aumentar a realização do teste para o VIH e promover o acesso aos serviços de saúde e VIH, abordando os contextos socioeconómicos, relacionais e estruturais que conduzem a um maior risco. É necessária investigação que produza conhecimento relevante e mais "traduzível" em acções efectivas, que respondam às necessidades em saúde dos HSH e contribuam para ganhos de saúde.

PurposeCombining ownership and management might lead concentrated shareholders, such as families, to wealth expropriation. The lack of external monitors and disciplinary agents potentially permits them to pursue this path. Thus, monitoring activity is one of the major drawbacks in family controlled firms. The purpose of this paper is to provide an integrated analysis of the governance roles of various block‐holders, institutional investors and corporate boards in firm performance in the context of publicly‐listed family‐controlled firms.Design/methodology/approachUsing a multi‐industry data set of 208 firms listed on the Milan Stock Exchange (MSE), this study employs the generalized method of moments (GMM) to address the issue of endogeneity on panel data over the period 200‐2006.FindingsThe results show that family firms have better accounting performance than non‐family firms. So, active family involvement in management positions seems to reduce managerial opportunism. However, higher accounting performance does not translate into an increase in valuation levels, and thus might not accrue to minority shareholders. Additionally, the results also show an alignment incentive between a coalition of large shareholders (two families) and firm value.Research limitations/implicationsThis study provides empirical evidence consistent with a block‐holder coalition framework that sustains an incentive alignment effect of the coalition of large shareholders (two families) and the firm value. Additionally, the results also support evidence that board dominance is another channel through which families can extract private benefits.Originality/valueThis study contributes to understanding that the family firm performance depends on the efficiency of various governance mechanisms. Thus, it offers insights to policy makers to verify board appointment mechanisms used by family firms. Since external board members might be vetted and approved by the family or other dominant block‐holders, what is the extent of their independence from the dominant owners?

Aim: This study aimed to describe perceptions and experiences related to access and utilization of health care services of African and Brazilian immigrant women in Portugal. Subjects and methods: Six focus groups were conducted with 35 African and Brazilian women with low income and living in Lisbon, chosen through purposive sampling. Content analysis was undertaken through identification of themes and categories. Results: African and Brazilian women expressed different perceptions and patterns of use of health care services. Most participants pointed out several barriers to access and utilization of services related to legal issues, economic constraints or health professionals' attitudes. Conclusion: These results highlight the challenges to providing health care within a multicultural setting and the need to assure the provision of integrated and comprehensive health care services. Improving access to general health care is essential in order to minimize disadvantages from vulnerable subgroups, like immigrant women. Supporting better integration into the health system may lead to improved health outcomes.

Intro -- Foreword -- Contents -- Abbreviations and Acronyms -- List of Figures -- List of Tables -- 1 Introduction -- 2 Theoretical Background -- 2.1 The Evolution of the Family Business Academic Field -- 2.2 The Definition of Family Firm -- 2.3 The Relevance of Family Businesses -- 3 Family Influence and Performance -- 3.1 Family Influence: F-PEC Dimensions -- 3.1.1 The Influence of the Family Through the Power Dimension -- 3.1.2 The Influence of the Family Through the Experience Dimension -- 3.1.3 The Influence of the Family Through the Culture Dimension -- 3.2 Family Firm Performance -- 3.2.1 The Relationship Between Ownership and Family Management: The Perspectives of Agency Theory and Stewardship Theory -- 3.2.1.1 The Agency Theory -- 3.2.1.2 The Stewardship Theory -- 3.2.2 Different Family Business Performance Dimensions -- 4 Research Hypotheses -- 4.1 Research Hypotheses Development -- 4.2 Theoretical Framework -- 5 Research Methodology -- 5.1 Sample -- 5.2 Data Collection -- 5.3 Variables -- 5.3.1 Dependent Variables: Economic and Noneconomic Performance -- 5.3.2 Independent Variables: Family Influence -- 5.3.2.1 Power Subscale -- 5.3.2.2 Experience Subscale -- 5.3.2.3 Culture Subscale -- 5.3.3 Mediating Variables: Stewardship Variables -- 5.3.4 Control Variables -- 5.4 Methods -- 6 Analyses and Discussion of Results -- 6.1 Characterization of the Sample -- 6.1.1 Location and Activity Sector -- 6.1.2 Firm Size -- 6.1.3 Ownership and Management Structure -- 6.1.4 Continuity and Leadership (Succession) -- 6.1.5 Profile of Respondents (Administrator/Manager) -- 6.2 Variable Measurement -- 6.2.1 Performance -- 6.2.2 Family Influence -- 6.2.3 Stewardship Behavior -- 6.3 Results of Multiple Linear Regression Models -- 6.3.1 Variables of the Regression Models -- 6.3.2 Validation of the Assumptions of Linear Regression Models.

PurposeMost countries often have public companies with large controlling owners, typically a family. This empirical evidence aims to contrast with the classical view of the largest dispersed firm presented by Berle and Means and challenge the findings by Bhattacharya and Ravikumar, who predict that the shares held by families will decrease if an efficient financial market is put in place. Therefore, family firms represent an important group in the stock market today. Thus, the purpose of this paper is to analyze the effect of the family as a controlling owner on firms' performance, valuation and capital structure.Design/methodology/approachThe paper reviews the current literature related to how family (taking into account specific governance characteristics such as family ownership, family control and family management) affects firms' performance and value.FindingsThe literature review showed that founder family control and professional (outside) management increase performance, whereas excess control via control enhancing mechanisms (such as dual class shares and pyramidal structures) and descendent management produce both lower valuation and performance. This evidence suggests that families have the incentives and the power to systematically expropriate wealth from minority shareholders.Originality/valuePrevious research shows that family firms on average perform better than non‐family firms. But this is a non‐linear relation due the fact that the relationship between family ownership and performance cannot be identified without distinguishing between control and cash‐flow rights. Thus, the literature review as a whole emphasizes that the incentives for the controlling shareholder to engage in expropriation are a function of the institutional framework in which the firm operates. So, for further research, it is important to investigate how family firms perform in different corporate governance systems. A policy implication is the necessity to improve minority shareholders' protection from the risk of expropriation by large shareholders.

Objetivo: realizar uma revisão integrativa de literatura sobre as características de vozes normais e disfônicas e a prevalência de lesões nas pregas vocais em crianças. Métodos: trata-se de uma revisão integrativa da literatura. Foi realizado o levantamento dos artigos científicos por meio das bases de dados Medline, LILACS, IBECS, PubMed e ISI Web of Science. Na busca dos artigos foram utilizados os descritores "Distúrbios da Voz", "Disfonia", "Rouquidão", "Qualidade da Voz", "Acústica da Fala", "Voz", "Fonação", "Pregas Vocais", "Pediatria", "Criança", "Pré-Escolar". Para a análise dos dados, as informações coletadas foram organizadas de maneira concisa em um banco de dados, realizado de forma descritiva, considerando as informações referentes à amostra, objetivos, metodologia e resultados principais, e organizadas por similaridade de conteúdo. Resultados: foram identificados 770 artigos, dos quais 36 estavam diretamente relacionados ao objetivo da revisão e foram analisados. Conclusões: a qualidade vocal das crianças sem alterações vocais é caracterizada por valores de frequência fundamental que decrescem com o aumento da idade e com diferenças em relação ao sexo. O tempo máximo de fonação aumenta com a idade. Em crianças disfônicas a qualidade vocal é soprosa e rugosa, com um grau de alteração de leve a moderado; as medidas acústicas da voz, os valores de tempo máximo de fonação estão alterados; a frequência fundamental é grave. A lesão de prega vocal mais prevalente até seis anos de idade é o cisto, e após esta idade é o nódulo vocal.

Funding Information: The first author received a grant from the Portuguese Foundation for Science and Technology (FCT) [grant number PD/BD/135771/2018], for her PhD. This study was supported by ELE-VATE??EarLy dEtection of cerVical cAncer in hard-to-reach populations of women through port-able and point-of-care HPV Testing?, financed by the European Union?s Horizon 2020 Framework Programme for Research and Innovation Action (project number 825747). Funding Information: Funding: The first author received a grant from the Portuguese Foundation for Science and Technology (FCT) [grant number PD/BD/135771/2018], for her PhD. This study was supported by ELEVATE—"EarLy dEtection of cerVical cAncer in hard-to-reach populations of women through portable and point-of-care HPV Testing", financed by the European Union's Horizon 2020 Framework Programme for Research and Innovation Action (project number 825747). Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. Copyright: Copyright 2021 Elsevier B.V., All rights reserved. ; Cervical cancer screening (CCS) has been proven to reducing mortality of cervical cancer; yet migrant women show a lower participation in screening compared to non-migrants. This study explores the perspectives of healthcare workers and community workers on the factors influencing the CCS participation of migrant women living in Portugal. A qualitative study with online focus groups was conducted. Healthcare workers experienced in CCS and community workers working with migrant communities were purposively sampled. A semi-structured guide was used covering the participation of migrant women in CCS, barriers, and strategies to overcome them. Data were analyzed using content analysis. Participants considered that migrant women have low participation in CCS related to insufficient knowledge, low risk perception, and lack of interest on preventive care. Other barriers such as difficulties in accessing the healthcare services, relationship with healthcare workers, language, and cultural differences were highlighted. Promoting continuity of care, disseminating culturally tailored information, and use of self-sampling methods were suggested to improve participation in CCS. Inequalities in access to CCS among migrant women are mostly caused by information gaps and healthcare system-related barriers. Building a migrant-friendly healthcare system that creates opportunities for healthcare workers to establish relationships with their patients and delivering culturally and linguistically adapted information may contribute to overcoming those barriers and increasing the participation of migrant women in screening. ; publishersversion ; published

Across the European Union, the market size of crowdfunding totals €16.9 billion with 1,231 active platforms (Chervyakov and Rocholl, 2019). However, the shares of microcredit (MC) allocated to business and personal loans are difficult to compute (European Commission, 2007a), and accessing the availability of banking industry MC is equally hard to ascertain (European Commission, 2007b). Recent efforts by the European Microfinance Network (EMN) report that between 2012 and 2017 business loans were losing ground to personal loans both in the number (60% to 41%) and the value of disbursed loans (80% to 52%) as well as in terms of active borrowers (61% to 41%) (Bendig et al. 2014; Botti et al. 2016; Diriker et al. 2018). Personal loans are thus quickly catching up with business microloans and verged on €1 billion in 2017. Based on data about Eastern European countries sourced from the online peer-to-peer (P2P) crowdfunding platform Kiva, this paper examines the relation between soft information and prosocial P2P crowdfunding performance, in particular the funding speed, both for personal and for business loans. To the best of our knowledge, this paper represents the first to identify a relationship between soft information, measured by the text length describing the loan purpose on personal and business loans, and P2P crowdfunding performance. In keeping with previous studies (e.g., Dorfleitner et al., 2019a; Dorfleitner and Oswald, 2016), we apply a censored tobit regression model to predict the speed of loan funding on Kiva, by controlling for field partner, loan, borrower, and socioeconomic-geopolitical characteristics respectively. We furthermore deployed two datasets: the Kiva P2P crowdfunding platform and the World Bank. The Kiva's dataset comprises 29,739 loans applied for between 2011 to 2018 from five European countries (two countries from the lower middle-income group: the Republic of Moldova and Ukraine, and three from the upper middle-income group: Albania, Armenia, and Georgia). This paper identifies how applying for personal loans increases the speed of funding time compared to business loans. Additionally, the results support the hypothesis of a quasi-U-shaped relationship between soft information and funding speed but applicable only to business loans. We provide new evidence on the relationship between personal versus business loans and crowdfunding performance. The resulting policy recommendations suggest P2P crowdfunding may require a greater focus on personal loans which constitute the "weakest link" in P2P lending marketplaces such as Kiva and furthermore gain less support from lenders. The results provide insights about microentrepreneurs to lenders with investing in education, skills and entrepreneurial training therefore appearing as crucial to their business success in line with thematic objective 10 (FI-Compass, 2018, 2016)

Objetivo: verificar o tempo ideal do exercício de vibração sonorizada de língua (EVSL) na voz de crianças disfônicas. Método: participaram vinte e sete crianças, entre 04 e 11 anos, com diagnóstico de nódulo ou cisto de pregas vocais. Dessas crianças, onze fizeram parte do grupo experimental (GE) e 16 do grupo controle (GC). A vogal sustentada /ε/ e a contagem de 1 a 10 foram registradas antes (m0) e após o primeiro (m1), terceiro (m3), quinto (m5) e o sétimo (m7) minuto de execução do EVSL. As gravações foram apresentadas a três fonoaudiólogas, que julgaram se houve modificação da qualidade vocal. Os parâmetros acústicos avaliados na vogal sustentada foram frequência fundamental, jitter, shimmer, glotal to noise excitation (GNE) e ruído. Resultados: na avaliação perceptivo-auditiva, não houve modificações significativas entre os momentos de execução do EVSL. Na análise acústica, observou-se que o parâmetro ruído diminuiu e o parâmetro GNE aumentou após três minutos de realização do exercício no GE, em comparação com o GC. Conclusão: não houve melhora em nenhum dos tempos na avaliação perceptivo-auditiva da voz de crianças disfônicas com o EVSL. A análise acústica indicou melhora da qualidade vocal aos três minutos de execução do exercício.

It is critical to develop tailored strategies to increase acceptability of the COVID-19 vaccine and decrease hesitancy. Hence, this study aims to assess and identify factors associated with COVID-19 vaccine hesitancy in Portugal. We used data from a community-based survey, "COVID-19 Barometer: Social Opinion", which includes data regarding intention to take COVID-19 vaccines, health status, and risk perception in Portugal from September 2020 to January 2021. We used multinomial regression to identify factors associated with intention to delay or refuse to take COVID-19 vaccines. COVID-19 vaccine hesitancy in Portugal was high: 56% would wait and 9% refuse. Several factors were associated with both refusal and delay: being younger, loss of income during the pandemic, no intention of taking the flu vaccine, low confidence in the COVID-19 vaccine and the health service response during the pandemic, worse perception of government measures, perception of the information provided as inconsistent and contradictory, and answering the questionnaire before the release of information regarding the safety and efficacy of COVID-19 vaccines. It is crucial to build confidence in the COVID-19 vaccine as its perceived safety and efficacy were strongly associated with intention to take the vaccine. Governments and health authorities should improve communication and increase trust.

It is critical to develop tailored strategies to increase acceptability of the COVID-19 vaccine and decrease hesitancy. Hence, this study aims to assess and identify factors associated with COVID-19 vaccine hesitancy in Portugal. We used data from a community-based survey, "COVID-19 Barometer: Social Opinion", which includes data regarding intention to take COVID-19 vaccines, health status, and risk perception in Portugal from September 2020 to January 2021. We used multinomial regression to identify factors associated with intention to delay or refuse to take COVID-19 vaccines. COVID-19 vaccine hesitancy in Portugal was high: 56% would wait and 9% refuse. Several factors were associated with both refusal and delay: being younger, loss of income during the pandemic, no intention of taking the flu vaccine, low confidence in the COVID-19 vaccine and the health service response during the pandemic, worse perception of government measures, perception of the information provided as inconsistent and contradictory, and answering the questionnaire before the release of information regarding the safety and efficacy of COVID-19 vaccines. It is crucial to build confidence in the COVID-19 vaccine as its perceived safety and efficacy were strongly associated with intention to take the vaccine. Governments and health authorities should improve communication and increase trust. ; publishersversion ; published