Dinossáurios Eocretácicos de Lagosteiros

According to an ancient folkloric legend, Our Lady, stepping down from the sea, would have rided on a mule to the platform above the cliffs named Pedra da Mua at Lagosteiros'bay, near Espichel cape. Mule's footprints, regarded by fishermen as evidence, would be clearly recognizable on exposed surfaces of the rocks. Indeed there are footprints but from Dinosaurs of latest Jurassic, Portlandian age, this spectacular locality being specially rich in giant Sauropod tracks (that have seldom been found elsewhere in Europe). As we proceeded to its study, another locality with Dinosaur footprints, Lower Cretaceous (Hauterivian) in age, was found on the northern cliffs at Lagosteiros. It is probably the richest one in european Lower Cretaceous and the only of this age known in Portugal, so we decided to give priority to its study. Dinosaur tracks have been printed on calciclastic sands in a lagoonal environment protected by fringing coral reefs. There have been emersion episodes; beaches were frequented by Dinosaurs. Later on, the marine barremian ingression restablished a gulf and such animals could not come here any more. Under a paleogeographical viewpoint, the evidence of a marine regression near the end of Hauterivian is to be remarked. Five types of tracks and footprints have been recognized: - Neosauropus lagosteirensis, new morphogenus and species, tracks from a giant Sauropod, perhaps from Camarasaurus; with its proportions the total length of the author would be about 15,5 m. These are the only Sauropod tracks known till now in Europe's Lower Cretaceous. - tracks from a not so big quadruped, maybe a Sauropod (young individual?); however it is not impossible that they were produced by Stegosaurians or Ankylosaurians. -Megalosauropus (?Eutynichnium) gomesi new morphospecies, four Theropod tracks most probably produced by megalosaurs. - Iguanodon sp., represented by some footprints and specially by a set corresponding to the feet and tail from an individual standing in a rest position. - problematical, quite small-sized biped (maybe an Ornithopod related to Camptosaurus). Evidence points to a richer fauna than that known in barremian "Dinosaur sandstones" from a nearby locality, Boca do Chapim. Lagosteiros' association clearly indicates the predominance of herbivores, which required large amounts of vegetable food in the neighbourhood. This is an indirect evidence of the vegetal wealth, also suggested by associations of plant macrofossils, polen and spores found in early Cretaceous sediments at the same region. The relatively high proportion of Theropoda is related to the wealth of the whole fauna, which comprised a lot of the prey needed by such powerful flesh-eaters. The evidence, as a whole, points out to a warm and moist climate. All the tracks whose direction could be measured are directed to the southern quadrants, this being confirmed by the approximative direction of other footprints. Massive displacements (migration?) could take place during a brief emersion episode. This may result from the ingression of barremian seas, flooding the region and restablishing here a small gulf. Even if the arrival of the waters damaged certain footprints it has not destroyed them completely, thus allowing the preservation of such evidence from a remote past.

Estudo Estratigráfico e Paleontológico do Jurássico do Algarve Ocidental

Algarve Province, Southern Portugal, corresponds in part to a meso-cenozoic basin running along the coast from Cabo S. Vicente to beyond Spanish border. Structurally it is a big monocline plunging southwards much deformed mainly by two East-West longitudinal flexures. Lithostratigraphical and chronostratigraphical studies dealt specially with Jurassic formations. This and the geological mapping of the post-Hercynian sedimentary formations allow us to define the following units: Triassic-Lower Liassic Arenitos de Silves (Silves sandstones sensu P. Choffat, pro parte) - At their base the Silves sandstones (0-150m) are represented mainly by cross-bedded red sandstones. This unit is Upper Triassic (Keuper) in age, on the evidence of some Brachiopoda. Complexo margo-carbonatado de Silves (Silves marl-limestone complex=Silves sandstones sensu P. Choffat, pro parte) (80-200m) overlies the preceding, it may be reported to the Upper Triassic-Hettangian. It consists of a thick pelite-marl-dolomite-limestone series with many intercalations of greenstones. Since no fossils were found it is not possible to conclude whether it is still Hettangian or if it does correspond, in the whole or in part, already to the Sinemurian. Liassic Dolomitos e calcários dolomíticos de Espiche (Espiche dolomite-rocks and dolomitic-limestones) - The usually massive and finely crystalline or saccharoidal dolomites and dolomitic-limestones are the toughest strata of the Algarve margin giving rise to several hills. Its thickness attains in certain points 60 metres at least. Based on geometry and on lithological similarities with the carbonated complex of the northern basin of Tagus river (Peniche, São Pedro de Muel, Quiaios), this formation can be accepted as Sinemurian in age. As it happens with the carbonated complex, here also the first dolomite beds are non-isochronal throughout the region; upper time-limit of the dolomitic facies is either Lower Carixian, Lower Toarcian or even Lower Dogger. The dolomitization is secondary but not much later than sedimentation. However, between Cabo S. Vicente-Vila do Bispo there is evidence of an even later secondary dolomitization related to the regional fault complex. Calcário dolomítico com nódulos de silex da praia de Belixe (Belixe beach dolomitic-limestone with silex nodules) (50-55m) - Ascribed to Lower or Middle Carixian on the basis of Platypleuroceras sp., Metaderoceras sp. nov. and M. gr. Venarense. Calcário cristalino compacto com Protogrammoceras, Fuciniceras e ? Argutarpites de Belixe (Belixe compact crystalline limestone with Protogrammoceras, Fuciniceras and ? Argutarpites) (30m) - Ascribed to Lower Domerian. Middle and Upper Domerian are indicated but by a single specimen of ? Argutarpites. Calcários margosos e margas com Dactylioceras semicelatum e Harpoceratídeos de Armação Nova (Armação Nova marly limestones and marls with D. semicelatum and Harpoceratidae) (25m) -Ascribed to Lower Toarcian. Middle and Upper Toarcian formations are not known in the Algarve. Dogger Calcários oolíticos, c. corálicos, c. pisolíticos, c. calciclásticos, c. dolomíticos e dolomitos de Almadena (Almadena oolitic-limestones, coral-reef-limestones, pisolite-limestones, limeclastic-limestones, dolomitic-limestones and dolomite-rocks) (more than 50 metres), with lagoonal facies. Ascribed to Aalenian-Bathonian-? Callovian. Margas acinzentadas e calcários detríticos com Zoophycos da praia de Mareta (Mareta beach greyish marls and detritical limestones with Zoophycos) (40m) - Pelagic transreef facies with Upper Bajocian and Bathonian ammonites. Calcários margosos e margas da praia de Mareta (Mareta beach pelagic marly-limestones and marls) (110m) - Ascribed to the Callovian on its ammonites. Malm Near Cabo S. Vicente and Sagres the first Upper Jurassic level consists of a yellowish-brown nodular, compact, locally phosphated and ferruginous, sometimes conglomeratic, marly limestone (0,35-1,50m) containing a rich macrofauna, which includes: 1) Callovian forms unknown at Lower Oxfordian; 2) Upper Callovian forms that still survived in Lower and Middle Oxfordian; 3) Lower Oxfordian forms (Mariae and Cordatum Zones); 4) Lower and Middle Oxfordian forms (Mariae to Plicatilis Zone); 5) Middle Oxfordian forms (plicatilis Zone), and some ones appearing in Middle Oxfordian. This condensed deposit is therefore dated from Middle Oxfordian (Plicatilis Zone). The other Upper Jurassic lithostratigraphical units were also mapped but their detailed study is not presented in this work. Correlations between lithostratigraphical and chronostratigraphical scales from P. Choffat, J. Pratsch, C. Palain and from the author are stated. Further correlations are attempted between zonc scales of Carixian-Lower Toarcian and Upper Bajocian-Middle Oxfordian of France, Spain (Asturias, Iberian and Betic Chains), Argel (Orania) and Portugal (northern Tagus basin and Algarve). The study of pyritous fossil assemblages common in Upper Bathonian-Lower Callovian marly levels of the praia da Mareta seems to suggest that these sediments were deposited in a bay or in an almost closed coastal re-entrance virtually without deep water circulation. Although such conditions may occur at any depth one may suppose that these ones actually correspond to an infralittoral neritic environment. The thaphocoenosis collected there are almost entirely composed of nektonic (ammonites, Belemnites) and planktonic (Bositra) faunas. The sedentary (crinoids, brachiopods) or free (sea-urchins, gastropods) epibenthonic forms are very scarce; endobenthonic forms are not known. The palaeontological study of all Nautiloids and Ammonoids of the Liassic and Dogger is presented (except Kosmoceratidae and Perisphinctaceae). Among the thirty one taxa dealt with, one is new (Metaderoceras sp. nov.) and the great majority of the others has been identified for the first time in Algarve. Some others have never been reported before in Portuguese formations. The evolution, during Jurassic times, of the sedimentary basins of the Portuguese plate margin is described. The absence of Cephalopods in the very extensive marly and dolomitic limestones, partly marine, suggests that, during Lower Liassic, palaeogeography underwent no great changes. Dolomitic-limestone with silex nodules from Cabo S. Vicente contain the first ammonites recorded at the base of the Middle Liassic. This facies, although very common in Tethys, is unknown north of the Tagus. The faunal assemblage has a mediterranean to submediterranean character. Comparisons between faunal assemblage" from Algarve with the ones known north of the Tagus show that communications between Boreal Europe and Tethys, virtually non-existent during Lower and Middle Carixian, became very easy during Lower Domerian. In earlier Pliensbachian times two distinct seas were adjacent to the Iberian plate. One, an epicontinental sea with a tethyan fauna, extended southwards from the Meseta margin. Another, was a boreal sea; during its transgressive episodes boreal faunas attained into the basin north of the Tagus. During Middle Carixian and Lower Domerian, owing to simultaneous transgressions, these two seas joined together allowing faunal exchanges along the epicontinental areas which limited the emerging hercynian chains belts. During Liassic, the Algarve belonged undoubtedly to the tethyan submediterranean province. The area north of the Tagus, on the contrary, was a complex realm where subboreal and tethyan affinities alternatively prevailed. In the Algarve the first Middle Jurassic deposits do frequently show lateral thickness reductions as well as unconformities contemporaneous with other generalized disturbances on the sedimentation processes in other parts of Europe. By this time, near Sagres, a barrier reef developed separating lagoonal or ante-reef facies from the transreef pelagic zone. The presence of tethyan fauna, the abundance of Phylloceratidae and the absence of boreal forms allow us to consider the Algarve basin as a submediterranean province. The presence of Callovian pelagic fossiliferous formations in the Loulé area shows that during Middle Jurassic the marl-limestone transreef sedimentation was not confined to the western Algarve. They would extend eastwards where they only can be seen in the core of some anticlines. This is due to the progressive sinking of the meso-cenozoic formations as we proceed towards the South of the Sagres-Algoz-Querença flexure. In the whole of the Peninsule, and as for the Middle Callovian, an important regression can be clearly recognized on the evidence of an erosion surface which strikes obliquely the Middle and Upper Callovian strata. The geographic boundaries of the different faunal provinces are not changed by the presence of many Kosmoceratidae in the phosphate nodules since they are but a minority in comparison with the tethyan forms. An abstract model can be constructed showing that in Western Europe the Kosmoceratidae may have migrated South and westwards through a channel of the sea that linked Paris basin to Poitou and Aquitaine. By migrating between the Iberian meseta and the Armorican massif this fauna reached northern Tagus basin at the beginning of Upper Callovian (Athleta Zone); this south and southwest bound migration would have proceeded, allowing such forms to reach Algarve basin only in latest Callovian times (Lamberti Zone). This migration means that during Middle Jurassic a widely spread North Atlantic sea would exist, flooding the western part of Portugal up to the Poitou.

The AIDS epidemic in the Amazon region: a spatial case-control study in Rondonia, Brazil

OBJECTIVE To analyze spatial changes in the risk of AIDS and the relationship between AIDS incidence and socioeconomic variables in the state of Rondonia, Amazon region. METHODS A spatial, population case-control study in Rondonia, Brazil, based on 1,780 cases reported to the Epidemiological Surveillance System and controls based on demographic data from 1987 to 2006. The cases were grouped into five consecutive four-year periods. A generalized additive model was adjusted to the data; the dependent variable was the status of the individuals (case or control), and the independent variables were a bi-dimensional spline of the geographic coordinates and some municipality-level socioeconomic variables. The observed values of the Moran’s I test were compared to a reference distribution of values generated under conditions of spatial randomness. RESULTS AIDS risk shows a marked spatial and temporal pattern. The disease incidence is related to socioeconomic variables at the municipal level in Rondônia, such as urbanization and human capital. The highest incidence rates of AIDS are in municipalities along the BR-364 highway and calculations of the Moran’s I test show positive spatial correlation associated with proximity of the municipality to the highway in the third and fourth periods (p = 0.05). CONCLUSIONS Incidence of the disease is higher in municipalities of greater economic wealth and urbanization, and in those municipalities bisected by Rondônia’s main roads. The rapid development associated with the opening up of once remote regions may be accompanied by an increase in these risks to health.

Les ostracodes du Miocène inférieur de la region de Lisbonne (basin du Tage)

Forty-five species of ostracoda from the Aquitanian of the Lisbon area, belonging in thirty-two genera, are presented. These are the first species belonging to this group reported for the Miocene formations in Portugal. Ostracoda assemblages are typical of fresh water, brackish and marine environments (littoral and inner continental shelf). References are made to the stratigraphically more significant species. Data on the paleoenvironments are also presented. A list of the studied species includes a comparison with their distribution in the Aquitaine and Rhone Miocene basins.

Particularités de la microfaune (Foraminifère) à la limite Carixien/Domérien de quelques gisements de la region de Coimbra (Portugal)

The Middle Liassic outcrops of the Coimbra region (Portugal) show, at Carixian-Domerian boundary, an unusual high frequence of the Falsopalmula, morphogenus,that is generally well represented in the Lower Toarcian. The study of the Nodosaridea association shows that the massive presence of this morphogenus excludes the Lenticulina s. st. genus. These faunistic particularities should be ascribed to the environment and to the sedimentation pattern. The development of the Falsopalmula morphogenus should have been simultaneous to that of the pelitic sedimentation.

Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil

OBJECTIVE : To analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil. METHODS : Data were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Cear&#225;, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model. RESULTS : A sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother&#8217;s education, toilet and tap water availability, children&#8217;s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting. CONCLUSIONS : Socioeconomic development, along with health interventions, may have contributed to improvements in children&#8217;s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition.

Children and sand play: screening of potential harmful microorganisms in sandboxes, parks, and beaches

Sand serves as a reservoir for potentially pathogenic microorganisms. Children, a high-risk group, can acquire infections from sand in sandboxes, recreational areas, and beaches. This paper reviews the microbes in sands, with an emphasis on fungi. Recreational areas and beach sands have been found to harbor many types of fungi and microbes. A newly emerging group of fungi of concern include the black yeast-like fungi. After establishing that sand is a reservoir for fungi, clinical manifestations of fungal infections are described with an emphasis on ocular and ear infections. Overall, we recommend environmental studies to develop monitoring strategies for sand and studies to evaluate the link between fungi exposure in sand and human health impacts.

Regional governance: strategies and disputes in health region management

OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes.METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics.RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee&#8217;s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table). The study determined that &#8220;facilitators&#8221; under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical) services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System.CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of governance and intermediate institutionalism. The regional interagency committee&#8217;s managerial routine needs to incorporate more democratic devices for connecting with educational institutions, devices that are more permeable to social demands relating to regional policy making.

Cervical cancer screening coverage in a high-incidence region

OBJECTIVE To analyze the coverage of a cervical cancer screening program in a city with a high incidence of the disease in addition to the factors associated with non-adherence to the current preventive program.METHODS A cross-sectional study based on household surveys was conducted. The sample was composed of women between 25 and 59 years of age of the city of Boa Vista, RR, Northern Brazil who were covered by the cervical cancer screening program. The cluster sampling method was used. The dependent variable was participation in a women&#8217;s health program, defined as undergoing at least one Pap smear in the 36 months prior to the interview; the explanatory variables were extracted from individual data. A generalized linear model was used.RESULTS 603 women were analyzed, with an mean age of 38.2 years (SD = 10.2). Five hundred and seventeen women underwent the screening test, and the prevalence of adherence in the last three years was up to 85.7% (95%CI 82.5;88.5). A high per capita household income and recent medical consultation were associated with the lower rate of not being tested in multivariate analysis. Disease ignorance, causes, and prevention methods were correlated with chances of non-adherence to the screening system; 20.0% of the women were reported to have undergone opportunistic and non-routine screening.CONCLUSIONS The informed level of coverage is high, exceeding the level recommended for the control of cervical cancer. The preventive program appears to be opportunistic in nature, particularly for the most vulnerable women (with low income and little information on the disease). Studies on the diagnostic quality of cervicovaginal cytology and therapeutic schedules for positive cases are necessary for understanding the barriers to the control of cervical cancer.

Alterations in psychosocial health of people affected by asbestos poisoning

OBJECTIVE To analyze the state of psychosocial and mental health of professionals affected by asbestos.METHODS A cross-sectional study was conducted with 110 professionals working in the Ferrolterra region of Spain, who were affected by asbestos poisoning. This group was compared with a group of 70 shipyard workers with no manifestation of work-related diseases. All the participants were male with a mean age of 67 years. This study was conducted in 2013, between January and June, and used the SCL-90 questionnaire by Derogatis as its primary measure for research. This questionnaire consists of 9 variables that measure psychosomatic symptoms. In addition, an overall index of psychosomatic gravity was calculated. The participants were also asked two questions concerning their overall perception of feeling good. Data were analyzed by ANOVA and logistic regression.RESULTS Participants affected by asbestos poisoning showed high occurrence rates of psychological health variables such as somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and global severity index.CONCLUSIONS Social interaction as a differentiating factor between workers affected by work-related chronic syndromes as compared to healthy participants will possibly aid in the development of intervention programs by improving the social network of affected individuals.

Spatial distribution and socioeconomic context of tuberculosis in Rio de Janeiro, Brazil

OBJECTIVE To analyze the spatial distribution of risk for tuberculosis and its socioeconomic determinants in the city of Rio de Janeiro, Brazil.METHODS An ecological study on the association between the mean incidence rate of tuberculosis from 2004 to 2006 and socioeconomic indicators of the Censo Demográfico (Demographic Census) of 2000. The unit of analysis was the home district registered in the Sistema de Informação de Agravos de Notificação (Notifiable Diseases Information System) of Rio de Janeiro, Southeastern Brazil. The rates were standardized by sex and age group, and smoothed by the empirical Bayes method. Spatial autocorrelation was evaluated by Moran&#8217;s I. Multiple linear regression models were studied and the appropriateness of incorporating the spatial component in modeling was evaluated.RESULTS We observed a higher risk of the disease in some neighborhoods of the port and north regions, as well as a high incidence in the slums of Rocinha and Vidigal, in the south region, and Cidade de Deus, in the west. The final model identified a positive association for the variables: percentage of permanent private households in which the head of the house earns three to five minimum wages; percentage of individual residents in the neighborhood; and percentage of people living in homes with more than two people per bedroom.CONCLUSIONS The spatial analysis identified areas of risk of tuberculosis incidence in the neighborhoods of the city of Rio de Janeiro and also found spatial dependence for the incidence of tuberculosis and some socioeconomic variables. However, the inclusion of the space component in the final model was not required during the modeling process.

Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo

OBJECTIVE To evaluate the individual and contextual determinants of the use of health care services in the metropolitan region of Sao Paulo.METHODS Data from the Sao Paulo Megacity study &#8211; the Brazilian version of the World Mental Health Survey multicenter study &#8211; were used. A total of 3,588 adults living in 69 neighborhoods in the metropolitan region of Sao Paulo, SP, Southeastern Brazil, including 38 municipalities and 31 neighboring districts, were selected using multistratified sampling of the non-institutionalized population. Multilevel Bayesian logistic models were adjusted to identify the individual and contextual determinants of the use of health care services in the past 12 months and presence of a regular physician for routine care.RESULTS The contextual characteristics of the place of residence (income inequality, violence, and median income) showed no significant correlation (p > 0.05) with the use of health care services or with the presence of a regular physician for routine care. The only exception was the negative correlation between living in areas with high income inequality and presence of a regular physician (OR: 0.77; 95%CI 0.60;0.99) after controlling for individual characteristics. The study revealed a strong and consistent correlation between individual characteristics (mainly education and possession of health insurance), use of health care services, and presence of a regular physician. Presence of chronic and mental illnesses was strongly correlated with the use of health care services in the past year (regardless of the individual characteristics) but not with the presence of a regular physician.CONCLUSIONS Individual characteristics including higher education and possession of health insurance were important determinants of the use of health care services in the metropolitan area of Sao Paulo. A better understanding of these determinants is essential for the development of public policies that promote equitable use of health care services.

Multi-region routing

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para a obtenção do grau de Mestre em Engenharia Electrotécnica e de Computadores

Access to childbirth care by adolescents and young people in the Northeastern region of Brazil

ABSTRACT OBJECTIVE To identify the factors that interfere with the access of adolescents and young people to childbirth care for in the Northeast region of Brazil. METHODS Cross-sectional study with 3,014 adolescents and young people admitted to the selected maternity wards to give birth in the Northeast region of Brazil. The sample design was probabilistic, in two stages: the first corresponded to the health establishments and the second to women who had recently given birth and their babies. The data was collected by means of interviews and consulting the hospital records, from pre-tested electronic form. Descriptive statistics were used for the univariate analysis, Pearson&#8217;s Chi-square test for the bivariate analysis and multiple logistic regressions for the multivariate analysis. Sociodemographic variables, obstetrical history, and birth care were analyzed. RESULTS Half of the adolescents and young people interviewed had not been given guidance on the location that they should go to when in labor, and among those who had, 23.5% did not give birth in the indicated health service. Furthermore, one third (33.3%) had to travel in search of assisted birth, and the majority (66.7%) of the postpartum women came to maternity by their own means. In the bivariate analysis, the variables marital status, paid work, health insurance, number of previous pregnancies, parity, city location, and type of health establishment showed a significant association (p < 0.20) with inadequate access to childbirth care. The multivariate analysis showed that married adolescents and young people (p < 0.015), with no health insurance (p < 0.002) and from the countryside (p < 0.001) were more likely to have inadequate access to childbirth care. CONCLUSIONS Adolescents and young women, married, without health insurance, and from the countryside are more likely to have inadequate access to birth care. The articulation between outpatient care and birth care can improve this access and, consequently, minimize the maternal and fetal risks that arise from a lack of systematic hospitalization planning.

Reshaping higher education systems in the MENA region: the contribution of remote and virtual labs

Learning is not only happening in school or university; it is also an important aspect of the daily life that allows students to remain in their biological and physical environment helping to reshape it, by applying what they have learnt. Today, the higher education sector is a part of important strategies used by countries in order to foster their development. Despite its geographical location, i.e. its closeness to Europe and Asia, the MENA (Middle East and North Africa) region still needs an integrated strategy for the advancement, reform, and update of its higher educational landscape. Although some solutions have been experimented in the region in the field of higher education, they have not been able to raise the quality of education to the level comparable that observed in developed countries. In other words, many MENA higher education systems are facing problems, for which solution ought to be sought. We analyse the situation of higher education systems in the MENA countries and the factors that affect the delay in achieving the level of education existing in other world regions, e.g. Europe, especially in the higher education sector. During the discussion, the impact of new technology-enhanced tools, such as remote laboratories, in the process of development and consolidation of MENA universities, is particularly stressed.