Suchergebnisse

IntroductionIt is estimated that over half of newly diagnosed HIV infections in Europe present late. An HIV positive individual presenting late to care represents a missed opportunity to benefit from treatment, increasing the risk of morbidity and mortality at an individual level, and onward disease transmission at population level. Reducing late presentation is a strategic priority of the Portuguese HIV/AIDS program. We set out to describe the characteristics of late presentation in the two largest transmission risk groups currently in Portugal to inform HIV prevention and treatment.MethodsWe extracted details of all notified cases from individuals over 15 years with a laboratory confirmed HIV diagnosis made between January 2011 and December 2013 from the Portuguese HIV surveillance database and selected cases from heterosexuals and men who have sex with men (MSM). We defined late presentation as an initial CD4 count <350 cells/mm3 or presence of AIDS‐defining disease at time of HIV diagnosis. We calculated adjusted odds ratios (aOR) with 95% confidence intervals (CI) for characteristics associated with late presentation in separate logistic regression for heterosexuals and MSM.ResultsOf 4219 HIV positive cases notified, 2589 (61%) were heterosexuals and 1220 (29%) were MSM. A total of 1586 (38%) cases presented late of which 1037 (40%) were heterosexual and 328 (27%) were MSM. The median age at late presentation was 40 in heterosexual women, 46 in heterosexual men and 35 in MSM. A total of 1446 (55%) of heterosexual HIV positive adults were unaware of having had a high risk sexual contact. Late presentation among heterosexuals was associated with being male (aOR=1.58 95% CI 1.29–1.93), not knowing a partners' HIV status (OR=1.59 95% CI 1.35–1.87) and age, increasing the odds of late presentation by a factor of 1.02 per year (95% CI 1.01–1.03). Among MSM, only age was associated with late presentation, increasing by 1.04 (95% CI 1.03–1.05) per year.ConclusionsPortuguese HIV prevention programs need to increase the risk awareness of heterosexuals, particularly men, to reduce missed opportunities for early diagnosis. As half of all cases presenting late are aged 40 and over, we recommend that general HIV outreach services and specialist services for MSM review their accessibility and acceptability to both middle and older‐aged clients.

OBJECTIVE: To analyze the obstacles and challenges faced by managers and coordination professionals in their practices in municipal coordinating centers. METHODS: An exploratory descriptive study with a qualitative focus, applied in 40 managers and coordination professionals, from September 2017 to November 2018, with semi-structured interviews, resulting in two categories of analysis: limiting factors and factors that facilitate the management and operationalization of the Brazilian Unified Health System (SUS) coordinating sector. RESULTS: Analyzing the statements, we found evidence of the following limiting factors: failure in the criteria of referral, unavailability of beds, high demand, systemic difficulties in relation to the coordinating system, procedures of difficult scheduling and execution, increased repressed demand for elective procedures and difficulties in the flow of information between primary care and coordination. In the category of facilitating factors, the most significant possibilities were: expansion of the capability to know the user's reality, improvement in primary care and increase in health financial resources, health training and education and restructuring, in addition to reorganizing internal coordinating procedures. CONCLUSION: The limiting factors of coordination show the need to promote actions that offer all SUS users full access to health services. ; OBJETIVO: Analisar os entraves e desafios enfrentados pelos gestores e profissionais de regulação em suas práticas nas centrais reguladoras municipais. MÉTODOS: Estudo descritivo exploratório com enfoque qualitativo, aplicado em quarenta gestores e profissionais de regulação, no período de setembro de 2017 e novembro de 2018, por meio de entrevista semiestruturada, resultando em duas categorias de análise: fatores limitantes e fatores facilitadores da gestão e operacionalização do setor de regulação do SUS. RESULTADOS: Na análise dos enunciados, foram encontradas evidências dos seguintes fatores limitantes: falha nos critérios de encaminhamento, indisponibilidade de leitos, grande demanda, dificuldades sistêmicas em relação ao sistema de regulação, procedimentos de difícil agendamento e execução, aumento da demanda reprimida de procedimentos eletivos e dificuldades no fluxo de informações entre a atenção primária e a regulação. Na categoria de fatores facilitadores, as possibilidades mais significativas foram: ampliação da capacidade de conhecer a realidade do usuário, melhoria na atenção primária e incrementos de recursos financeiros para a saúde, capacitação e formação em saúde e reestruturação, além de reorganização dos procedimentos internos de regulação. CONCLUSÃO: Os fatores limitantes da regulação demonstram a necessidade de fomentar ações que ofereçam a todos os usuários do SUS o acesso pleno aos serviços de saúde.

ABSTRACT OBJECTIVE To analyze the obstacles and challenges faced by managers and coordination professionals in their practices in municipal coordinating centers. METHODS An exploratory descriptive study with a qualitative focus, applied in 40 managers and coordination professionals, from September 2017 to November 2018, with semi-structured interviews, resulting in two categories of analysis: limiting factors and factors that facilitate the management and operationalization of the Brazilian Unified Health System (SUS) coordinating sector. RESULTS Analyzing the statements, we found evidence of the following limiting factors: failure in the criteria of referral, unavailability of beds, high demand, systemic difficulties in relation to the coordinating system, procedures of difficult scheduling and execution, increased repressed demand for elective procedures and difficulties in the flow of information between primary care and coordination. In the category of facilitating factors, the most significant possibilities were: expansion of the capability to know the user's reality, improvement in primary care and increase in health financial resources, health training and education and restructuring, in addition to reorganizing internal coordinating procedures. CONCLUSION The limiting factors of coordination show the need to promote actions that offer all SUS users full access to health services.

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. https://creativecommons.org/licenses/by-nc/4.0/ ; You are free to: Share — copy and redistribute the material in any medium or format; Adapt — remix, transform, and build upon the material. ; Under the following terms: 1) Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. 2) NonCommercial — You may not use the material for commercial purposes. 3) No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. ; "Desde una concepción multidimensional de las expectativas, este artículo pretende analizar la validez y precisión psicométrica de una escala para su medida en los estudiantes universitarios de primer año. La muestra (N = 759) estaba compuesta por alumnado de primer año, de diversas titulaciones académicas de la Universidad de Vigo-Campus de Ourense y de la Universidad de Minho. El valor de la Mdn de edad fue de 19, siendo sólo el 5.3% mayor de 23 años. A los participantes se les aplicó un conjunto de 56 ítems agrupados en siete dimensiones diferentes de expectativas. Los resultados del análisis factorial confirmatorio, se obtuvieron con el LISREL. Se garantizó la validez factorial, tanto convergente como discriminante de los factores. Ésta junto con su fiabilidad sugieren que el Cuestionario de Percepciones Académicas quedaría finalmente con 42 ítems distribuidos en siete dimensiones de expectativas: Formación para el empleo/carrera, Desarrollo personal y social, Movilidad estudiantil, Implicación política/ciudadanía, Presión social, Calidad de formación e Interacción social. Se comprobó la equivalencia del modelo de medida del instrumento en los dos idiomas y en dos grupos resultantes de la bipartición aleatoria de la muestra. Los resultados de la validez estructural de este estudio avalan la utilización del cuestionario para la medida de las expectativas de los estudiantes que inician por primera vez sus estudios en la Enseñanza Superior." ; "This paper aims to test the psychometric validity and reliability of a measure of first-year university students' expectations, based on a multidimensional conception of expectations. The sample consisted of 759 first-year students, attending various academic degrees at the Universities of Vigo - Ourense and University of Minho. The value Mdn age was 19, with only 5.3% with ages above 23 years. Participants answered a set of 56 items based on seven different dimensions of expectations. Results of confirmatory factor analysis, were carried out with LISREL. Factorial validity, and factors' convergent and discnmmant validity were assured. These results, along with evidences reliability, suggest that the Academic Perceptions Questionnaire presents a final structure composed of seven expectation dimensions, including 42 items: Training for employment/career, Personal and social development, Student mobility, Political and citi%enship involvement, Social pressure, Quality of education, and Social interaction. The equivalence of measurement model in the two languages and in two groups randomly derived from the full sample was also verified. The results of this structural validity study support the assessment of the expectations of first-year students in Higher Education with the questionnaire."