Nursing Home-Acquired Pneumonia Presenting at the Emergency Department

Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5 % of patients and median age was 84 years old (IQR 77-90). Comorbidities were present in 69.8 % of cases and 48.3 % of patients had used healthcare services during the previous 90 days. In-hospital mortality rate was 46.6 % and median length-of-stay was 9 days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n = 0; one: n = 7 (0 %); two: n = 18 (38.9 %); three: n = 26 (38.5 %); four: n = 30 (53.3 %); and five; n = 22 (68.2 %); and sepsis n = 50 (34.0 %), severe sepsis n = 43 (48.8 %) and septic shock n = 22 (72.7 %). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p = 0.001), age ≥ 75 years (p = 0.02), and severe sepsis or shock (p = 0.03) at the ED. Microbiological testing in 78.4 % of cases was positive in 15.4 % (n = 15): methicillin-resistant Staphylococcus aureus (26.7 %), Pseudomonas aeruginosa (20.0 %), S. pneumoniae (13.3 %), Escherichia coli (13.3 %), others (26.7 %); the rate of MDR bacteria was 53.3 %. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.

Mutational Analysis of Portuguese Families with Multiple Endocrine Neoplasia Type 1 Reveals Large Germline Deletions

OBJECTIVE: To determine the spectrum of MEN1 mutations in Portuguese kindreds, and identify mutation-carriers. PATIENTS, DESIGN AND RESULTS: Six unrelated MEN1 families were studied for MEN1 gene mutations by single-strand conformational polymorphism (SSCP) and DNA sequence analysis of the coding region and exon-intron boundaries of the MEN1 gene. These methods identified 4 different heterozygous mutations in four families: two mutations are novel (mt 1539 delG and mt 655 ims 11 bp) and two have been previously observed (mt 735 del 46p and mt 1656 del C) all resulting in a premature stop codon. In the remaining two families, in whom no mutations or abnormal MEN1 transcripts were detected, segregation studies of the 5' intragenic marker D11S4946 and codon 418 polymorphism in exon 9 revealed two large germline deletions of the MEN1 gene. Southern blot and tumour loss of heterozygosity analysis confirmed and refined the limits of these deletions, which spanned the MEN1 gene at least from: exon 7 to the 3' untranslated region, in one family, and the 5' polymorphic site D11S4946 to exon 9 (obliterating the initiation codon), in the other family. Twenty-six mutant-gene carriers were identified, 6 of which were asymptomatic. CONCLUSIONS: These results emphasize the importance of the detection of MEN1 germline deletions in patients who do not have mutations of the coding region. Important clues indicating the presence of such deletions may be obtained by segregation studies using the intragenic polymorphisms D11S4946 and at codon 418. The detection of these mutations will help in the genetic counselling of clinical management of the MEN1 families in Portugal.

Biological and Biochemical Characterization of Mutants of the RNase II family of enzymes

Dissertação para a obtenção de grau de doutor em Biologia pelo Instituto de Tecnologia Química e Biológica. Universidade Nova de Lisboa.

Benchmarking in primary health care: An application of the stochasticd frontier analysis and the grades of membership approach to Portuguese family health units

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

Family occurrence of schistosomal hepatosplenomegaly and maternal effect

In this paper we present a study of members of 265 nuclear families, aged six or more. This study is based of family heredograms, and takes into account the clinical form ofschistosomiasis observed before treatment with oxamniquine. The probability of occurrence of two or more cases ofhepatosplenomegaly is low, notwithstanding the fact that it was observed in 38 families. Even less frequent is the occurrence of three or more cases observed in 17 families (P=0.002). The concentration of the hepatosplenic form was higher among siblings than it was among mothers and children, or fathers and children. It was found to be not significant between husband (father) and wife (mother). These observations reinforce the evidence for the presence of a genetic component in susceptibility to the hepatosplenic form of the disease. In cases in which the mother was hepatosplenic there was a higher incidence of hepatosplenic children; the relative risk was a least five times higher than in those in which the father was the affected member (the maternal effect). In cases where both members were affected by the hepatointestinal form, the risk to the filial generation was similar to that of the population in general. Thus, in the process towards severe forms of Schistosomiasis mansoni, pre and post natal factors might be involved.

Expressão e purificação da proteína E3 do vírus chikungunya (CHIKV)

RESUMO: O vírus chikungunya (CHIKV) é um vírus de RNA, com invólucro, da família Togaviridae, transmitido por mosquitos Aedes spp. Distribuído por largas regiões de África e Ásia, causa grandes epidemias de artrite grave. A semelhança de sintomas com outras doenças como a dengue e a malária e a persistência de IgM específicas, dificultam o diagnóstico da infeção por CHIKV. A deteção no sangue de E3, uma glicoproteína viral secretada, a incluir num ensaio imunoenzimático poderá melhorar o diagnóstico nos países onde as técnicas de biologia molecular são de difícil acesso. Para testar a utilidade de E3 num ensaio de diagnóstico, esta deverá ser expressa em quantidade, purificada e usada para produção de anticorpos específicos. Para expressar E3 numa forma solúvel, suscetível de ser purificada num único passo cromatográfico sem proteases, recorreu-se à estratégia da fusão com o domínio de ligação à quitina (CBD)-inteína (IMPACT™ System, NEB). A sequência codificadora de E3 foi amplificada a partir de RNA viral, clonada em pTYB21 e expressa em E. coli como uma proteína de fusão insolúvel de 64 kDa. A expressão a 12ºC induzida por IPTG 0,1 mM aumentou a solubilidade de CBD-inteína-E3. A aplicação de lisados celulares em colunas de quitina originou a retenção de CBD-inteína-E3 na matriz. Porém, a autoclivagem da inteína na coluna, induzida com reagentes tiol, foi pouco eficiente e mesmo a proteína E3 separada não eluiu da coluna. E3 foi ainda expressa em E. coli com uma cauda de seis histidinas (E3[His]6) por clonagem no vetor pET28b(+). Lisados celulares aplicados em colunas de níquel permitiram a eluição de uma proteína de 9 kDa, compatível com a massa molecular estimada para E3[His]6, ainda que com outros contaminantes proteicos. A identidade da proteína de 9 kDa será confirmada pela indução de anticorpos com esta preparação e reatividade daqueles com células infetadas com CHIKV.----------------ABSTRACT: Chikungunya virus (CHIKV) is an enveloped, positive strand RNA virus belonging to the family Togaviridae. Transmitted by Aedes spp mosquitoes, CHIKV causes large epidemics of severe arthritogenic disease in Africa and Asia and represents a serious threat in countries where vectors are present. Symptoms similarity with other diseases, e.g. dengue and malaria, along with CHIKV IgM persistence turns accurate CHIKV diagnosis a difficult task in low-income countries. Detection of E3, a small secreted viral glycoprotein, to be included in an immunoenzymatic test was envisaged as a possible improvement in CHIKV diagnosis. To test the diagnostic value of E3, recombinant E3 should be expressed and purified to generate antibodies. In order to express CHIKV E3 in a soluble form amenable to purification by a single step affinity chromatography, the chitin binding domain (CBD)-intein fusion strategy without proteases (IMPACT™ System, NEB) was employed. The E3 coding sequence was amplified from viral RNA, cloned in pTYB21 and expressed in E. coli ER2566 as an insoluble 64 kDa CBD-intein-E3 fusion protein. Solubility was partially achieved by lowering the expression temperature to 12ºC and the inducer (IPTG) concentration to 0.1 mM. Clarified cell lysate loaded onto a chitin column allowed ligation of the fusion protein but the intein-mediated cleavage efficiency was low and E3 failed to elute from the column as demonstrated by SDS-PAGE. E3 was further expressed with a six histidine tag, E3[His]6, employing the pET System (Novagen). E3[His]6 was expressed in E. coli Rosetta (30ºC, 0.4 mM IPTG) as a 9 kDa protein. Soluble cell extracts in 20-40 mM imidazole, applied onto a nickel column and eluted with 500 mM imidazole yielded a protein preparation enriched in the 9kDa protein. The 9 kDa will be used as antigen to generate antibodies that upon reaction with CHIKV infected cells will confirm its identity.

Caracterização de estirpes Mycobacterium Tuberculosis da família Lisboa: análise de regiões de diferença e single nucleotide polymorphisms

Dissertação apresentada para a obtenção do Grau de Mestre em Genética Molecular e Biomedicina, pela Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia

A nanopore-based stochastic detection method: Single molecule characterisation of nanoparticles using ()- hemolysin

Dissertation presented to obtain the Ph.D degree in Chemistry.

The Evolution of Function in the Rab family of Small GTPases

Dissertation presented to obtain the PhD degree in Computational Biology.

Perfil sociodemográfico e saúde mental em cuidadores informais de idosos no município de São Paulo-Brasil: desafios para as políticas públicas

RESUMO: INTRODUÇÃO: O rápido envelhecimento populacional, o aumento da prevalência de transtornos neuropsiquiátricos, o aumento das taxas de morbilidade clínica e incapacidade entre idosos de países em desenvolvimento têm trazido preocupações sobre a saúde mental e sobrecarga de cuidadores informais. Está bem estabelecida a elevada prevalência de transtornos mentais comuns (TMC) associada à adversidade socioeconômica, baixo nível educacional, estresse e gênero. Idosos e cuidadores vivendo em comunidade compartilham fatores de risco para morbilidade física e psiquiátrica. Adicionalmente, os cuidadores tem uma tripla carga, sendo simultaneamente familiares, trabalhadores leigos em saúde sem suporte dos serviços de saúde e assistência social e um paciente com necessidades não atendidas. O cuidador informal é o principal provedor de cuidado em todos os países. OBJETIVOS: Acessar perfil sociodemográfico, níveis de transtorno mental comum (TMC) e sobrecarga em cuidadores, características do cuidado e prevalência de demência e depressão no idosos, numa área carente da região oeste de São Paulo –Brasil. MÉTODO: Esta pesquisa transversal deriva do São Paulo Ageing and Health Study (SPAH) que incluiu idosos com 65 anos ou mais e seus respectivos cuidadores. Os participantes foram identificados por arrolamento domiciliar e entrevistadas em suas casas com protocolo padronizado de pesquisa. O instrumento utilizado para acessar os transtornos mentais comuns, foi o Self Rating Questionnaire SRQ-20.A sobrecarga foi quantificada pelo Zarit Caregiver Burden Scale. Diagnósticos psicogeriátricos foram mensurados através do SRQ-20 e critérios do CID-10 e do DSM-IV. 8 RESULTADOS: 588 cuidadores e respectivos idosos foram incluídos. Nos idosos, a prevalência de demência foi 15,9%, de depressão pelo CiD-10 9.9% e de TMC 39,25% Nos cuidadores, a prevalência de TMC foi de 55,1% e 32,8% dos cuidadores apresentaram sobrecarga elevada. O perfil do cuidador foi filha,com idade em torno dos 49 anos, casada e com baixo nível educacional.------------------ABSTRACT: BACKGROUND: With the fast population aging, growing prevalence of neuropsychiatric disorders, clinical morbidity and disability among the elderly particularly in low income countries (LAMIC), has brought concerns about informal caregiver Mental Health and Burden. It is well established the high prevalence of Common Mental Disorders (CMD) associated to socioeconomic adversity, low educational attainment, stress and gender. Community-dwelling elders and caregivers share risk factors for physical and psychiatric morbidity. In addition, caregivers have a triple strain, being simultaneously, family members, lay health workers with lack of support from health and social work services and a hidden patient with unmet needs. The world main source of caregiving relies on informal caregiver. AIMS: To assess 1) the sociodemographic profile, levels of CMD and burden among caregivers, and 2) the characteristics of care and prevalence of dementia and depression in elderly in a socioeconomic underprivileged area in western region of Sao Paulo – Brazil. METHOD: The present investigation is a cross-sectional part of Sao Paulo Ageing and Health Study (SPAH) which included participants aged 65 or older and their respective caregivers. Participants were identified by household enrollment and interviewed in their homes using a standardized research protocol. The assessment of common mental disorders was performed with the Self Rating Questionnaire – 20 (SRQ-20), used to establish psychiatric caseness. The assessment of burden was performed with Zarit Caregiver Burden Scale. Dementia and psychogeriatric diagnosis were reached through ICD-10, SRQ-20 and DSM-IV criteria. 10 RESULTS: 588 caregivers and respective elderly relatives were included. Prevalence of dementia was 15.9%, ICD-10 depression 9.9% and CMD 39.3% among the elderlys. Common mental disorder prevalence in caregivers was 55.1% and high burden was reached in 32.8% of the caregiver sample. Most of the caregivers were married and co-resident daughters with a mean age of 49 years (CI 95% - 48.7 to 51).

Developing clinical trials in the portuguese family medicine : challenges and opportunities in the European context

RESUMO: Introdução: A hipótese colocada nesta tese é a de que poderia haver um número bastante mais elevado de ensaios clínicos na medicina familiar portuguesa se os obstáculos fossem removidos e as oportunidades exploradas de modo adequado. Contexto: Em Portugal existe uma nova geração de Médicos de Família que está a assumir postos de trabalho um pouco por todo o país e que é aceite como sendo a mais bem preparada geração de sempre. Métodos: Busca na MEDLINE. Leitura de artigos na única publicação científica dedicada à Medicina Geral e Familiar – RPMGF. Consulta em livros portugueses de política da saúde e acerca do Plano Nacional de Saúde. O INFARMED foi contactado e relatórios seus sobre ensaios clínicos foram analisados. Os Médicos de Família portugueses foram contactados e convidados a responder a questionários. Além disso, quinze personalidades da Medicina Portuguesa foram chamadas a sugerir soluções. Resultados: De acordo com dados do INFARMED, de 2006 a 2011 houve apenas quatro centros de saúde envolvidos em ensaios clínicos. Em Portugal: Existe um número pouco significativo de ensaios académicos; Praticamente não há infraestruturas de suporte ou treino; Os registos clínicos eletrónicos são usados de forma ineficiente; a investigação é fracamente ligada às carreiras médicas; há isolamento interno e externo; a já complexa regulamentação da União Europeia é complicada ainda mais; há um subfinanciamento da Investigação Clínica. Os Médicos de Família portugueses estão disponíveis para participar ativamente numa mudança. Discussão: Com os presentes resultados o diagnóstico para a presente situação é claramente negativo. Felizmente existem muito boas oportunidades para melhorar. Conclusão/Recomendações: Tempo, dinheiro e apoio têm de ser fornecidos aos Médicos de Família portugueses. É nesse sentido que são fornecidas vinte recomendações para obter uma verdadeira mudança no panorama dos Ensaios Clínicos na Medicina Familiar portuguesa.-------------ABSTRACT: Introduction: The hypothesis of this thesis is that there could be a much greater number of Clinical Trials in Portuguese Family Medicine if obstacles were removed and opportunities explored properly. Background: In Portugal there is a new generation of Family Doctors that is assuming permanent positions all over the country and is accepted to be the most well prepared generation ever. Methods: Search on MEDLINE. Relevant articles were also identified in the only jornal dedicated to Portuguese Family Medicine, RPMGF. A search was made on Portuguese health policy textbooks and national health plan policy. INFARMED was also contacted and their reports about Clinical Trials were analysed. Portuguese Family Doctors themselves were contacted and invited to answer questionnaires. Besides that, fifteen key opinion leaders related to Portuguese Medicine were approached for solutions. Results: According to INFARMED data, from 2006 to 2011 there were only four health centres involved in clinical trials. In Portugal there is: A negligible number of academic trials; almost no support infrastructures or training; inefficiently used electronic health records; a research weakly linked to medical careers; an uninformed isolation internally and externally; an already complex European Union regulation that is compounded even more; Scarce funding for clinical research. Portuguese Family Doctors are keen to actively participate in a change. Discussion: With the present results the diagnosis for the current situation is clearly negative. Fortunately there are very good opportunities to improve. Conclusion/Recommendations: Time, money and support must be given to Portuguese Family Doctors. In this context, twenty recommendations are provided intending to promote a true change in Portuguese Family Medicine Clinical Trials panorama.

Paracoccidioidomycosis: no genetic damage in human peripheral blood cells of patients assessed by single-cell gel (comet) assay

Paracoccidioidomycosis is a systemic fungal infection caused by Paracoccidioides brasiliensis. As infectious diseases can cause DNA damage, the authors aimed at analyzing DNA breakage in peripheral blood cells of patients with paracoccidioidomycosis by using the comet assay. The results suggested that paracoccidioidomycosis does not cause genotoxicity.

Caracterização de múltiplos polimorfismos de Pneumocystis Jirovecii por multiplex-PCR/Single base extension

Pneumocystis jirovecii é conhecido por causar infecções específicas no aparelho respiratório de seus hospedeiros, principalmente em doentes imunocomprometidos, manifestando-se por uma pneumonia grave e por vezes fatal, normalmente designada por pneumonia por Pneumocystis. A caracterização da diversidade genética de P. jirovecii tem demonstrado que determinados polimorfismos de base única poderão ser reconhecidos como marcadores moleculares de eleição para o estudo da distribuição geográfica, vias de transmissão, resistência/susceptibilidade a fármacos, factores de virulência e genética populacional de subtipos genéticos. Este estudo teve como objectivo a caracterização de polimorfismos de P. jirovecii, através da metodologia PCR multiplex/Extensão de base única (do inglês single base extension), com a principal finalidade de constatar eventuais associações entre polimorfismos de base única, genótipos multilocus, e dados clínicos e demográficos da infecção. Sessenta e seis espécimes pulmonares, previamente considerados positivos para P. jirovecii, obtidos entre 2001 e 2012, a partir de doentes portugueses imunocomprometidos, foram seleccionados de forma aleatória para este estudo multilocus. PCR multiplex foi utilizada para a amplificação simultânea de três regiões genómicas: subunidade grande do rRNA mitocondrial, superóxido dismutase e dihidropteroato sintetase. Cinco polimorfismos de base única, previamente correlacionados com parâmetros da doença, foram genotipados por extensão de base única: mt85, SOD110, SOD215, DHPS165 e DHPS171. Um total de 330 polimorfismos de base única e 29 genótipos multilocus putativos de P. jirovecii foram identificados e caracterizados nos espécimes pulmonares analisados. Os padrões de distribuição dos polimorfismos foram analisados, sendo considerada a variação temporal e/ou geográfica das suas formas alélicas. Constatou-se grande diversidade genotípica entre os isolados de P. jirovecii que poderá ter influência a nível epidemiológico. Foram observadas associações estatísticas entre mt85/genótipos multilocus e parâmetros demográficos e clínicos. A correlação mais importante verificou-se entre mt85C e cargas parasitárias baixas a moderadas, enquanto mt85T foi associado com cargas parasitárias altas; MLG5, MLG9 e MLG13 foram associados com cargas parasitárias baixas, moderadas e altas, respectivamente. Tais associações demonstram que potenciais marcadores moleculares da infecção por P. jirovecii poderão existir e que polimorfismos/genótipos específicos poderão determinar perfis epidemiológicos da pneumonia por Pneumocystis. A análise genética cruzada permitiu verificar associações entre polimorfismos de base única. Os polimorfismos SOD110T e SOD215C, SOD110C e SOD215T, DHPS165A e DHPS171C, DHPS165G e DHPS171T foram associados estatisticamente. Os genótipos multilocus mais prevalentes foram considerados para o teste recombinatório d1. Dois genótipos multilocus (MLG7 e MLG9) foram observados com elevada frequência, e a análise genética indicou que estes se encontravam sobre-representados na população de P. jirovecii estudada. Estas evidências indicam que o fenómeno de desequilíbrio de ligação e a propagação clonal de subtipos genéticos é frequente, considerando que a espécie P. jirovecii poderá ser representada por uma população com estrutura epidémica. O presente trabalho confirmou a importância do estudo de polimorfismos em P. jirovecii, sugerindo que a caracterização multilocus poderá fornecer informação relevante para a compreensão dos padrões, causas e controlo da infecção, melhorando assim a investigação deste importante patogéneo.

Determinants of mother-baby relationship evaluated during pregnancy

ABSTRACT Background Mental health promotion is supported by a strong body of knowledge and is a matter of public health with the potential of a large impact on society. Mental health promotion programs should be implemented as soon as possible in life, preferably starting during pregnancy. Programs should focus on malleable determinants, introducing strategies to reduce risk factors or their impact on mother and child, and also on strengthening protective factors to increase resilience. The ambition of early detecting risk situations requires the development and use of tools to assess risk, and the creation of a responsive network of services based in primary health care, especially maternal consultation during pregnancy and the first months of the born child. The number of risk factors and the way they interact and are buffered by protective factors are relevant for the final impact. Maternal-fetal attachment (MFA) is not yet a totally understood and well operationalized concept. Methodological problems limit the comparison of data as many studies used small size samples, had an exploratory character or used different selection criteria and different measures. There is still a lack of studies in high risk populations evaluating the consequences of a weak MFA. Instead, the available studies are not very conclusive, but suggest that social support, anxiety and depression, self-esteem and self-control and sense of coherence are correlated with MFA. MFA is also correlated with health practices during pregnancy, that influence pregnancy and baby outcomes. MFA seems a relevant concept for the future mother baby interaction, but more studies are needed to clarify the concept and its operationalization. Attachment is a strong scientific concept with multiple implications for future child development, personality and relationship with others. Secure attachment is considered an essential basis of good mental health, and promoting mother-baby interaction offers an excellent opportunity to intervention programmes targeted at enhancing mental health and well-being. Understanding the process of attachment and intervening to improve attachment requires a comprehension of more proximal factors, but also a broader approach that assesses the impact of more distal social conditions on attachment and how this social impact is mediated by family functioning and mother-baby interaction. Finally, it is essential to understand how this knowledge could be translated in effective mental health promoting interventions and measures that could reach large populations of pregnant mothers and families. Strengthening emotional availability (EA) seems to be a relevant approach to improve the mother-baby relationship. In this review we have offered evidence suggesting a range of determinants of mother-infant relationship, including age, marital relationship, social disadvantages, migration, parental psychiatric disorders and the situations of abuse or neglect. Based on this theoretical background we constructed a theoretical model that included proximal and distal factors, risk and protective factors, including variables related to the mother, the father, their social support and mother baby interaction from early pregnancy until six months after birth. We selected the Antenatal Psychosocial Health Assessment (ALPHA) for use as an instrument to detect psychosocial risk during pregnancy. Method Ninety two pregnant women were recruited from the Maternal Health Consultation in Primary Health Care (PHC) at Amadora. They had three moments of assessment: at T1 (until 12 weeks of pregnancy) they filed out a questionnaire that included socio-demographic data, ALPHA, Edinburgh post-natal Depression Scale (EDPS), General Health Questionnaire (GHQ) and Sense of Coherence (SOC); at T2 (after the 20th weeks of pregnancy) they answered EDPS, SOC and MFA Scale (MFAS), and finally at T3 (6 months after birth), they repeated EDPS and SOC, and their interaction with their babies was videotaped and later evaluated using EA Scales. A statistical analysis has been done using descriptive statistics, correlation analysis, univariate logistic regression and multiple linear regression. Results The study has increased our knowledge on this particular population living in a multicultural, suburb community. It allow us to identify specific groups with a higher level of psychosocial risk, such as single or divorced women, young couples, mothers with a low level of education and those who are depressed or have a low SOC. The hypothesis that psychosocial risk is directly correlated with MFAS and that MFA is directly correlated with EA was not confirmed, neither the correlation between prenatal psychosocial risk and mother-baby EA. The study identified depression as a relevant risk factor in pregnancy and its higher prevalence in single or divorced women, immigrants and in those who have a higher global psychosocial risk. Depressed women have a poor MFA, and a lower structuring capacity and a higher hostility to their babies. In average, depression seems to reduce among pregnant women in the second part of their pregnancy. The children of immigrant mothers show a lower level of responsiveness to their mothers what could be transmitted through depression, as immigrant mothers have a higher risk of depression in the beginning of pregnancy and six months after birth. Young mothers have a low MFA and are more intrusive. Women who have a higher level of education are more sensitive and their babies showed to be more responsive. Women who are or have been submitted to abuse were found to have a higher level of MFA but their babies are less responsive to them. The study highlights the relevance of SOC as a potential protective factor while it is strongly and negatively related with a wide range of risk factors and mental health outcomes especially depression before, during and after pregnancy. Conclusions ALPHA proved to be a valid, feasible and reliable instrument to Primary Health Care (PHC) that can be used as a total sum score. We could not prove the association between psychosocial risk factors and MFA, neither between MFA and EA, or between psychosocial risk and EA. Depression and SOC seems to have a clear and opposite relevance on this process. Pregnancy can be considered as a maturational process and an opportunity to change, where adaptation processes occur, buffering risk, decreasing depression and increasing SOC. Further research is necessary to better understand interactions between variables and also to clarify a better operationalization of MFA. We recommend the use of ALPHA, SOC and EDPS in early pregnancy as a way of identifying more vulnerable women that will require additional interventions and support in order to decrease risk. At political level we recommend the reinforcement of Immigrant integration and the increment of education in women. We recommend more focus in health care and public health in mental health condition and psychosocial risk of specific groups at high risk. In PHC special attention should be paid to pregnant women who are single or divorced, very young, low educated and to immigrant mothers. This study provides the basis for an intervention programme for this population, that aims to reduce broad spectrum risk factors and to promote Mental Health in women who become pregnant. Health and mental health policies should facilitate the implementation of the suggested measures.

Avaliação das necessidades, incapacidade, qualidade de vida e satisfação com os serviços de indivíduos com esquizofrenia em Cabo Verde

RESUMO: OBJECTIVO: Avaliar as necessidades, incapacidade, qualidade de vida, satisfação com os serviços e as características sociodemográficas numa amostra de pacientes com esquizofrenia num Serviço de Psiquiatria, em Cabo Verde. MÉTODOS: Realizou-se estudo transversal com 122 doentes com recurso a instrumentos estruturados para as necessidades (CAN), incapacidade (WHODAS II), qualidade de vida (WHOQOL-BREF) e satisfação com os serviços (VSSS) e uma ficha para recolha de dados sociodemográficos. RESULTADOS: Os doentes eram maioritariamente do sexo masculino (73,8%) com uma idade média de 35,23 anos, uma escolaridade baixa (59,8%), solteiros (81.1%), residindo em meio urbano (72,1%) e desempregados (63,2%). A maioria estava a tomar medicação antipsicótica (97,5%), tinha história de internamento (76.2%), uma média de início da doença aos 23,43 anos e uma duração média de 11,80 anos. As necessidades referidas foram baixas e as facetas mais identificadas foram a informação, os subsídios e benefícios sociais, as actividades diárias, os contactos sociais e sofrimento psicológico. Cerca 20% dos participantes manifestaram uma incapacidade, sobretudo no domínio da da participação na sociedade (47,2%). A média da qualidade de vida foi 65,08 (desvio-padrão: 21,35), com o domínio psicológico a apresentar o valor mais alto (74,21, desvio-padrão: 14,87) e o ambiental o mais baixo (59,27, desvio-padrão: 15,15). A satisfação com os serviços foi avaliada de forma positiva nas dimensões satisfação global e competência dos profissionais. As dimensões informação, envolvimento dos familiares, eficácia e acesso tiveram avaliação insatisfatória. Os tipos de intervenções, com vários serviços pouco disponibilizados, tiveram uma satisfação relativa. DISCUSSÃO: Num contexto de carência, os resultados revelaram-se mais satisfatórios do que esperados, mas com grandes insuficiências no processo de cuidados. CONCLUSÃO: O estudo permitiu conhecer o processo de cuidados aos doentes com esquizofrenia e disponibilizou elementos para programas de cuidados.-----------ABSTRACT: OBJECTIVE: Assess needs, disability, quality of life, satisfaction with the services and the socio-demographic characteristics in a sample of patients with schizophrenia in a Psychiatric Service in Cape Verde. MATHODS: It was carried out a cross-sectional study with 122 patients using the structured instruments for the needs (CAN), disability (WHODAS II), quality of life (WHOQOLBREF),satisfaction with the services (VSSS) and socio-demographic data collection. RESULTS: The patients are mainly of the male sex (73.8%) with average age of 35.23 years old, low education level (59.8%), single (81.1%), living in urban area and unemployed (63.2%). Most of them were taking antipsychotic medication (97.5%), had a history of hospitalization (76.2%), an average of disease onset at 23.43 years old and an average duration of 11.80 years. The needs mentioned were low and the most identified facets were information, subsidies and social benefits, daily routines, social contacts and psychological distress. Around 20% of the participants expressed one disability, especially at the domain of the participation in the society (47.2%). The average quality of life was 65.08 (standard deviation: 21.35), with the domain of the psychological presenting the highest value (74.21, standard deviation: 14.87) and environmental the lowest (59.27, standard deviation: 15.15). The satisfaction with services was positively assessed in the dimensions of overall satisfaction and competency of the professionals. The dimensions information, family involvement, effectiveness and access had positive evaluation. The types of intervention with services poorly available had a relative satisfaction. DISCUSSION: In a context of shortage, the results were considered more satisfactory than expected, but with many inadequacies in the process of care. CONCLUSION: This study allowed to know the process of care to the patients with schizophrenia and provided elements for the programs of care.