Alexandra Oliveira

Social control of immigrant sex workers: transforming a group recognized as “at risk” into a group viewed as “a risk”

Purpose – In this paper, the aim is to present an historical analysis to account for the association between prostitution, disease, and victimization. It also seeks to examine how stigmatization and rejection are currently focused on the immigrant sex worker.Design/methodology/approach – The analysis is based on historical data about regulations in Portugal, in a recent ethnography carried out with street prostitutes and in a current study on immigrant sex workers and health care.Findings – Sex workers have been recognized as a group “at risk” both because they are associated with sexually transmitted diseases and because they are acknowledged as victims of traffic and sexual exploitation. This label “group at risk” justifies some state policies often expressed in sanitary and social control measures, as regulations. Because migrant sex workers are simultaneously immigrants and sex workers they are perceived as a threat to social order and a sign of moral disorder and, so, they experience processes of rej...

Longitudinal clustering of tuberculosis incidence and predictors for the time profiles: the impact of HIV.

BACKGROUND Portugal remains the country with the highest tuberculosis (TB) incidence in Western Europe. OBJECTIVES To identify longitudinal trends in TB incidence in Portugal from 2002 to 2012 and investigate the longitudinal effect of sociodemographic and health-related predictors among the resident population on the TB incidence rate. METHODS We used data from the National Tuberculosis Surveillance System and other national institutions. K-means longitudinal clustering algorithm was performed on TB incidence time profiles from districts of Portugal. RESULTS Three longitudinal profiles for the TB incidence rate of Portugal were identified. In all of them, TB incidence decreased over time. Among all studied sociodemographic and health-related predictors, human immunodeficiency virus (HIV) notification rate and unemployment were shown to have (positive) significant effects on TB incidence. In particular, the greatest effects were found for the HIV notification rate. CONCLUSIONS Our study supports the view that combined TB-HIV strategies and the improvement of social determinants can contribute to decreases in TB incidence.

Toxicidade pulmonar induzida pela rapamicina

Resumo As doencas pulmonares induzidas por farmacos constituem uma causa crescente de morbilidade, tendo sido descritas diferentes formas de toxicidade associadas a inumeras substâncias. O sirolimus (rapamicina) e um farmaco imunossupressor usado de forma crescente no contexto do transplante de orgaos solidos, nomeadamente no transplante renal. A toxicidade pulmonar tem sido descrita como um dos potenciais efeitos laterais, nomeadamente causando formas de pneumonite intersticial ou, mais raramente, hemorragia alveolar. Os autores descrevem os casos de quatro doentes (3 do sexo masculino, 1 do sexo feminino) com idades compreendidas entre os 46–71 anos, recipientes de transplante renal (rim cadaver) ha 3 anos (1 doente) e 7 anos (3 doentes). A imunosupressao consistia em micofenolato mofetil, prednisolona e rapamicina. Os quatro doentes foram admitidos por febre, tosse produtiva (2) e dispneia (3). Apresentavam imagem radiologica de infiltrados pulmonares bilaterais de predominio basal. O LBA mostrou alveolite linfocitica em 3 doentes, tendo-se observado no entanto diferentes relacoes CD4/CD8., para alem de neutrofilia em 2 deles. No restante doente, observou- se hemorragia alveolar grave. Nao houve em nenhum dos casos qualquer isolamento de micro organismos patogenicos no LBA. As queixas apresentadas, bem como as alteracoes radiologicas regrediram com a suspensao do farmaco. Estes quatro casos revelaram alguma variedade, quer na apresentacao clinica, quer nos achados dos exames subsidiarios efectuados, nomeadamente no LBA. Este facto pode ter como causa diferentes mecanismos fisiopatologicos a nivel do pulmao induzidos pelo sirolimus.

Data Mining in HIV-AIDS Surveillance System

The Human Immunodeficiency Virus (HIV) is an infectious agent that attacks the immune system cells. Without a strong immune system, the body becomes very susceptible to serious life threatening opportunistic diseases. In spite of the great progresses on medication and prevention over the last years, HIV infection continues to be a major global public health issue, having claimed more than 36 million lives over the last 35 years since the recognition of the disease. Monitoring, through registries, of HIV-AIDS cases is vital to assess general health care needs and to support long-term health-policy control planning. Surveillance systems are therefore established in almost all developed countries. Typically, this is a complex system depending on several stakeholders, such as health care providers, the general population and laboratories, which challenges an efficient and effective reporting of diagnosed cases. One issue that often arises is the administrative delay in reports of diagnosed cases. This paper aims to identify the main factors influencing reporting delays of HIV-AIDS cases within the portuguese surveillance system. The used methodologies included multilayer artificial neural networks (MLP), naive bayesian classifiers (NB), support vector machines (SVM) and the k-nearest neighbor algorithm (KNN). The highest classification accuracy, precision and recall were obtained for MLP and the results suggested homogeneous administrative and clinical practices within the reporting process. Guidelines for reductions of the delays should therefore be developed nationwise and transversally to all stakeholders.

Social profile of the highest tuberculosis incidence areas in Portugal.

ith a tuberculosis (TB) prevalence of over 20 cases per 00 000 individuals, Portugal is one of the countries with he highest TB burden in the European Union.1--3 From 999 to 2011, TB incidence in Portugal showed a consisent decrease of 4.3% per year, leading to a total decline of 2.1%2 and to the disappearance of high incidence regions ≥50 cases/100 000 habitants).4 Despite this progressive ecline, the country’s heterogeneity is remarkable and the istricts of Oporto, Lisbon and Setubal still have an interediate incidence of Tuberculosis (>20 cases/100 000 and 50 cases/100 000 population). Couceiro et al.3 showed that igh risk of TB in some areas of Portugal was related to he high prevalence of HIV/AIDS, incarceration, nonstandard nd/or crowded accommodation, unemployment and immirant populations from countries with high TB incidence. A oncentration of young adults might also contribute to the ncrease of the number of TB cases since the incidence is ighest in individuals aged 25--44 years.3--5 Realizing the importance of the social determinants in he control of TB, the authors wanted to characterize the rofile of the Portuguese regions with higher incidence ates. The analyzed demographic and socio-economic facors included the population density, proportion of people t working age (15--64 years old), proportion of immigrants nd unemployment rate and the TB incidence between 2002 nd 2012 in Greater Oporto, Greater Lisbon and Setúbal eninsula. The territorial unit used was NUTS 3 (Nomenclatura das nidades Territoriais para Fins Estatísticos). New TB cases ere identified from the tuberculosis national surveillance ystem; unemployment rate values were obtained from the mployment and Vocational Training Institute reports and he remaining data were collected from National Statisics Institute database. The number of immigrants was only vailable from 2008 to 2012. Greater Oporto presented the highest incidence of B, followed by Greater Lisbon and Setúbal Peninula. Until 2008, the decline of the incidence rate was t f a t

Exploratory study on the prevalence of suicidal behavior, mental health, and social support in female street sex workers in Porto, Portugal.

ABSTRACT We investigated suicidal behavior, mental health, and satisfaction with social support in 52 female street sex workers in Porto, Portugal, using the Suicidal Ideation Questionnaire, the Social Support Satisfaction Scale, and structured interviews. Almost half our interviewees (46.15%) reported high suicidal ideation and 44.2% had made at least one suicide attempt. Most had a mental health diagnosis, most commonly depression (88.2%). Social support and suicidal ideation were moderately negatively correlated. Further research is needed to improve understanding of suicidal behaviors in female sex workers and develop interventions to improve social support and reduce suicidal ideation and associated risk factors.

The incidence of AIDS in Portugal adjusted for reporting delay and underreporting

The Human Immunodeficiency Virus can evolve to severe illness having a major impact on socio-demographic and economic features of the affected countries. Most countries rely on surveillance systems to monitor the status of the epidemic which are based on cases notification by physicians. It can take several months until the diagnosed cases are notified and there are even cases that are not reported at all. The purpose of this paper is to adjust the Portuguese notification data to these main possible biasing problems. For the reporting delay we will use the traditional conditional likelihood estimation for count data assuming a Poisson distribution. For the cases that are not reported at all, we will use a mixture of Poisson distributions, based on natural conjugate prior distributions, and estimate the unknown parameters through maximum likelihood. The Poisson model suggests that approximately 80% of the Portuguese AIDS cases were reported within one year after the diagnosis and that the majority of cases were notified in the first three months. The BB/NBD model suggests that the probability of a new AIDS case being notified gets higher once a large amount of AIDS cases has been notified.

“To Suffer in Paradise”: Feelings Mothers Share on Portuguese Facebook Sites

Background: Motherhood is an emotional rollercoaster. This is overlooked by most literature, which tends to refer mothers’ pathological states of postpartum depression and anxiety, mainly seeking to understand their causes or predicting factors, and consequences on children’s development. Objective: In this study, we aim to observe the diversity of mothers’ emotional states, and to analyze both positive and negative feelings they disclose on specific public and closed motherhood sites on Facebook. We hypothesize that the intensive motherhood model is prevalent in Portuguese society, thus influencing the type of feelings and circumstances in which mothers disclose them. Methods: We collected posts and comments from the four most popular Portuguese Facebook motherhood sites during 2015 and, then, conducted a quantitative and content analysis to identify the expressed range of feelings concerning motherhood. Results: Mothers preferably share their positive feelings on public pages, whereas negative feelings are shared more in closed groups (CGs). Expressed positive and negative feelings were significantly different whether we look at normative or non-normative, public or closed sites. Discussion: We assume that motherhood sites on Portuguese Facebook reflect an intensive motherhood model that is normative in Portuguese society. Positive feelings toward children are promoted and openly shared in public normative sites, while negative feelings concerning motherhood are dealt with in the privacy of CGs. We propose an extensive motherhood model to overcome this duality and to allow women to pursue several different social roles simultaneously in an equally rewarding way.

Trabajadores del sexo y salud pública: intersecciones, vulnerabilidades y resistencia

Since the 19th century with syphilis and most recently with AIDS, sex workers have been seen as a means for disease transmission and a public health problem that requires intervention. However, researchers have shown that in Western countries, HIV rates in people involved in commercial sex are low, except for in specific groups, such as intravenous drug users. Moreover, the risks faced by sex workers due to stigmatization and other forms of violence have been put into evidence. Based on an urban ethnography with street sex workers carried out in Porto (Portugal), between 2004 and 2005, this article discusses the social, labor, and legal vulnerabilities affecting people involved in commercial sex and how these interfere with their health. Focus is placed on the strategies used by sex workers to minimize health risks and their discourses of resistance in fighting vulnerabilities.

Preoperative pulmonary function and respiratory muscle strength in Portuguese adolescents with idiopathic scoliosis.

Idiopathic scoliosis is a 3-dimensional deformity of the spine, with direct effects on the thoracic cage, characterized by the lateral displacement (greater than 10◦) and rotation of vertebral bodies during periods of rapid somatic growth.1 Adolescent idiopathic scoliosis (AIS) is found between the age of 10 and skeletal maturity2 and its prevalence is estimated at 2--4% in children between 10 and 16 years of age.2,3 This condition encompasses several complications including back pain, poor body image, and impaired pulmonary function.3 In fact, previous studies have shown a decreased pulmonary function in adolescents with idiopathic scoliosis,4 and an inverse correlation between scoliosis Cobb angles and pulmonary function.4 Adolescents with severe scoliosis, with Cobb angles above 45--50◦, are routinely managed with spinal fusion surgery.3 In addition to the mechanical restriction to ventilation, changes in spine and thoracic cage position may alter the length of respiratory muscles influencing the ability to generate tension. Therefore, the aim of this study was to evaluate pulmonary function and respiratory muscle strength in subjects with AIS. From November 2012 to May 2013, 12 females with AIS (15.1 ± 1.6 years of age) and 12 age-matched controls (15.2 ± 1.4 years of age) were enrolled in this study. The AIS group was recruited in the Paediatrics Department of Centro Hospitalar Porto-Hospital Santo António, Portugal, whereas the control group was recruited in the Porto metropolitan area. Eligible participants were those idiopathic scoliosis preoperative patients aged 10 or over, with thoracic Cobb angles of ≥40◦. Exclusion criteria for this study included bronchial asthma and other pulmonary, cardiovascular or skeletal muscle problems, and previous spinal surgery. The study procedures were in accordance with the ethical stan-