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Early introduction of appropriate antibiotherapy is one of the major prognostic-modifying factors in community acquired pneumonia (CAP). Despite established guidelines for empirical therapy, several factors may influence etiology and, consequently, antibiotic choices. The aims of this study were to analyze the etiology of CAP in adults admitted to a northern Portugal University Hospital and evaluate the yield of the different methods used to reach an etiological diagnosis, as well as analyze of the impact of patient demographic and clinical features on CAP etiology. We retrospectively analyzed 1901 cases of CAP with hospitalization. The diagnostic performance increased significantly when blood and sputum cultures were combined with urinary antigen tests. The most frequent etiological agent was Streptococcus pneumoniae (45.7%), except in August, when it was overtaken by gram-negative bacilli (GNB) and Legionella pneumophila infections. Viral infections were almost exclusive to winter and spring. A negative microbiological result was associated with increasing age, non-smoking and lack of both blood/sputum cultures. Younger age was a predictor for S. pneumoniae, Influenza and L. pneumophila infections. Active smoking without any previously known respiratory disease was a risk factor for legionellosis. COPD was associated with Haemophilus influenzae cases, while dementia was typical in GNB and S. aureus patients. Diabetes mellitus (DM) and heart disease were negative predictors of S. pneumoniae and H. influenzae, respectively. P. aeruginosa was an independent risk factor for mortality (OR 13.02, 95% CI 2.94–57.7). This study highlights the importance of a comprehensive microbiological diagnostic workup and provides clues to predicting the most probable CAP causative agents, based on a patient's clinical profile. These may be taken into account when establishing first line antibiotherapy.

A pandemia da COVID-19 expôs fragilidades tanto na prontidão de respostas em matéria de saúde pública como na própria estrutura dos sistemas e serviços de saúde. Mas os seus efeitos extravasam aqueles que, de forma estanque, se enquadram na categoria de crise de saúde pública. É muito mais do que isto, na medida em que afeta as sociedades e economias no seu âmago, como avançam as ‘Diretrizes das Nações Unidas para a resposta socioeconômica imediata à COVID-19’. Este ensaio focaliza, sobretudo, os custos psicossociais da pandemia nas sociedades que integram a União Europeia, bem como o seu impacto na nova estratégia delineada no Regulamento (UE) 2021/522 (‘Programa UE pela Saúde’). O texto radica no argumento de que o enfrentamento da crise de saúde pública não se esgota na ciência, exigindo também um reequacionamento das esferas públicas da política e do direito.

[Excerto] Tive o privilégio de partilhar a lecionação de algumas unidades curriculares com Benedita Mac Crorie – desde as suas primeiras aulas aos caloiros da licenciatura em Direito na UMinho, até as suas últimas aulas à distância aos mestrandos em Direitos Humanos em outubro de 2021. Quando trocávamos impressões para a atribuição de notas aos mestrandos, sempre me impressionou a diligência com que Benedita lia e relia os trabalhos, a fim de aproximar-se o máximo possível de uma solução justa. E dizia sempre muito divertida que “dezoito valores era para um trabalho pronto a publicar”! Neste Liber Amicorum entendi evocar a sua memória oferecendo-lhe o fruto da semente que plantou, consubstanciado na imortalidade do conhecimento. Assim, escrevo este ensaio em coautoria com Maria Inês Costa, que integrou a última turma do Mestrado em Direitos Humanos cujas provas públicas já tiveram lugar, e nas quais a hoje Mestre congregou a classificação final de dezanove valores. Segundo o critério de Benedita Mac Crorie, as ideias de Maria Inês Costa estão “prontas a publicar”! Neste ensaio as Autoras procuram explorar algumas pistas de reflexão filosófica sobre os direitos humanos numa Europa confrontada com a barbárie – já que toda a sabedoria do mundo se reduz, por fim, a ensinar-nos a não temer morrer. Filosofar é aprender a morrer – e a morte é tão só a origem de uma outra vida, pois há algo de muito especial em nós, que não reside propriamente em nós, mas naqueles que nos amam e admiram.

The pronounced ageing of the European population has multidimensional repercussions at the socio-economic level, which the European Union has been addressing. In this context, concerns about intergenerational solidarity and social sustainability are gaining prominence and constitute the cornerstones of the life-cycle approach embodied in the European Commission’s Green Paper on Ageing: Fostering solidarity and responsibility between generations, published in 2021. In this article, we aim to address the underlying challenges, as well as the opportunities that these demographic trends present in the European Union today, placing special focus on the aforementioned report. We also highlight important stakeholder inputs on this issue, notably the recommendation to put in place a human-rights based approach regarding the rights of older people in the European Union. It is also our intention to explore the notion of vulnerability associated with the elderly, essentially addressing the extent to which it can be applied uniformly to this group, and to briefly evaluate the concept of vulnerability in light of emerging theories that render it as a universal aspect of human life.

Viral infections are known to be the main trigger for Chronic obstructive pulmonary disease (COPD) exacerbations. Face masks are acknowledged for effective viral aerosol shedding reduction. COVID-19 pandemic generated an opportunity to study the impact of face masks and confinement on droplet transmission diseases, usually implicated in acute exacerbations of COPD (AECOPD). We aimed to evaluate the variation on severe AECOPD (sAECOPD) rate in a Portuguese COPD cohort during the first COVID-19 lockdown and following months. This retrospective self-controlled study enrolled 322 adult patients followed at COPD-specialized consultation in a tertiary hospital from February 2016 to July 2020, of whom 286 met inclusion criteria. Severe AECOPD events were registered from March 2020 (beginning of state of emergency) until July 2020. From 2016 to 2019 there was a mean of 38 patients per year with sAECOPD. During 2020, 11 patients experienced sAECOPD. Over the course of 2020 there was a 73.4% (p < 0.001) decrease in sAECOPD events comparing with previous years' average. After the end of State of Emergency, the rate of sAECOPD events also declined by 74.6% (p < 0.001) comparing with the same timeline of previous years. Results were consistent and statistically significant when comparing 2020 with each of previous years for every period of analysis. Our findings suggest a sustained decrease in the rate of sAECOPD during confinement and in the following months. The widespread use of face mask and social distancing during COVID-19 pandemic may play an important role in preventing the transmission of respiratory infections and consequently reducing sAECOPD.

Mestrado em Mathematical Finance Esta dissertação aplica o método da Signature como medida de similaridade entre dois objetos de séries temporais usando as propriedades de ordem 2 da Signature e aplicando-as a um método de Clustering Asimétrico. O método é comparado com uma abordagem de Clustering mais tradicional, onde a similaridade é medida usando Dynamic Time Warping, desenvolvido para trabalhar com séries temporais. O intuito é considerar a abordagem tradicional como benchmark e compará-la ao método da Signature através do tempo de computação, desempenho e algumas aplicações. Estes métodos são aplicados num conjunto de dados de séries temporais financeiras de Fundos Mútuos do Luxemburgo. Após a revisão da literatura, apresentamos o método Dynamic Time Warping e o método da Signature. Prossegue-se com a explicação das abordagens de Clustering Tradicional, nomeadamente k-Means, e Clustering Espectral Assimétrico, nomeadamente k-Axes, desenvolvido por Atev (2011). O último capítulo é dedicado à Investigação Prática onde os métodos anteriores são aplicados ao conjunto de dados. Os resultados confirmam que o método da Signature têm efectivamente potencial para Machine Learning e previsão, como sugerido por Levin, Lyons and Ni (2013). This thesis applies the Signature method as a measurement of similarities between two time-series objects, using the Signature properties of order 2, and its application to Asymmetric Spectral Clustering. The method is compared with a more Traditional Clustering approach where similarities are measured using Dynamic Time Warping, developed to work with time-series data. The intention for this is to consider the traditional approach as a benchmark and compare it to the Signature method through computation times, performance, and applications. These methods are applied to a financial time series data set of Mutual Exchange Funds from Luxembourg. After the literature review, we introduce the Dynamic Time Warping method and the Signature method. We continue with the explanation of Traditional Clustering approaches, namely k-Means, and Asymmetric Clustering techniques, namely the k-Axes algorithm, developed by Atev (2011). The last chapter is dedicated to Practical Research where the previous methods are applied to the data set. Results confirm that the Signature method has indeed potential for machine learning and prediction, as suggested by Levin, Lyons, and Ni (2013). info:eu-repo/semantics/publishedVersion

Repensar o suburbano em contexto de frente riberinha com o Douro: Proposta de intervenção para Crestuma, parte de um lugar, entendido como periférico e suburbano, que integra a memória de uma comunidade; e de uma vontade - investigar, imaginar e criar possibilidades de revitalização de um lugar de frente ribeirinha, que actualmente se apresenta como um anónimo colectivo, comprometido pela acção do tempo. Aproximações, é um espaço para pensar como se gere, planeia e conforma cidade, entendida como matéria complexa, difusa, dispersa, extensa e por vezes intangível; é seguir uma linha cronológica através de constantes aproximações às diferentes variações e considerações, que a imagem da cidade remete. Reconhecimento, é a confrmação do objecto de estudo como lugar vulnerável aos constantes processos de transformação territorial; é um espaço para reconhecer a frente ribeirinha e imagem que desenvolve, desde a foz até à nascente, como palco de memória colectiva do Douro; é reconhecer o valor social e cultural de uma área no desenho urbano, e leitura contínua de cidade; é a consciencialização sobre as oportunidades relativamante a lugares outrora mais habitados por oposição à consequente desvalorização dos mesmos. Apropriação, é o espaço que se cria para conformar um território impreciso; é a culminação de três propostas de intervenção através de uma leitura entre as partes, que são um importante exercício na interacção com o existente. Uma vez que a imagem da cidade está em constante alteração, expansão e segregação, propõe-se um sistema aberto, com espaço para a novidade e improbabilidade que um território contém. Reconheceu-se a imagem dispersa e difusa que Crestuma apresenta como área periférica, e trabalhou-se com base na mesma, sem pretender transcrever uma imagem do que é, e do que acontece numa cidade. To re-think the suburban on the context of the forefront of 'ribeirinha' with Douro river: Overture of the intervention to Crestuma, takes origin in a place, understood as peripheral and suburban, which integrates the memory of a community; and of a will - to investigate, to imagine and to create possibilities of revitalization of a place forefront, which nowadays presents itself as an anonymous collective compromised by the action of time. Approximations, it's a space to think how the city is managed, planned and resigned, understood as a complex matter, diffused, strewn, extensive and at times unattainable, it's to follow a chronological line through constants approximations to the different variations and considerations which the city image alludes to. Recognition, it's the confrmation of the object of study as a vulnerable space to the constant processes of the territorial transformation; It's a space to recognize the forefronts and images which manifest from the outfall to spring, as a stage of the collective memories of Douro; It's to recognize the social and cultural value of an area of the urban drawing and the continuous read-out of the city; It's the awareness about the opportunities concerning places earlier more inhabited by opposition to the consequent undervalue of the same. Appropriation, its the space created to conform an imprecise territory; It's the culmination of three proposals of intervention through the reading between it's elements, which are themselves an important exercise of the interaction with the existent. Since the image of the city, is on a constant modifcation, expansion and segregation, it's offered an open system, with space for the innovation and unlikelihood that a territory possesses. It has been recognized the diffused and pervasive picture that Crestuma presents and it has been worked on that same basis, without attempting to transcribe an image of what is and of what happens within a city.

Activated-sludge is the most common biotechnology to treat wastewaters. In the aerating tank of these systems, a true ecosystem develops, being bacteria the key play-ers in the depuration process. Frequently, filamentous bacteria grow exaggeratedly, being the source of two well phenomena that cause significant throwbacks in the process: bulking and foaming. (Rhodococcus eryth-ropolis) is a gram positive filamentous bacterium previ-ously identified as responsible for the formation of foams in activated-sludge wastewater treatment plants (WWTP). Bacteriophages (phages) are viruses that specif-ically infect bacteria, using the bacterial machinery to reproduce themselves in a very efficient way. They are the most abundant entities in the biosphere, being found in every environment where their bacterial hosts are present. In this work, one lytic phage for (R. eryth-ropolis) was isolated, using sewage water from an urban WWTP. The phage was tested against other species found in WWTP to conclude about its lytic spectra. Stability of the phage solution at different temperatures and pH was determined. Morphologic analysis by Transmission Electron Microscopy (TEM) and Genomic Sequencing were also performed. Results clearly indicate the potential of this bac-teriophage for future studies in wastewater treatment system management., info:eu-repo/semantics/publishedVersion

A integração de elementos narrativos nos videojogos deu origem a um conflito entre narrativa e gameplay, provocando momentos muito distintos entre interação e passividade, competindo pela atenção dos jogadores e apelando para estilos e preferências de jogo específicos. Esta dissertação está focada na investigação da narrativa e do gameplay, nomeadamente nas relações dinâmicas existentes entre a tensão dramática e a tensão do gameplay e circunscreve-se apenas a jogos story-driven e single player. A investigação foi executada através de um estudo de casos múltiplos de oito videojogos com recurso a uma análise formal focada na compreensão da implementação dos componentes hardcoded na narrativa, estória e os componentes hardcoded do gameplay no sistema e as suas relações; e no close reading centrado no estudo e identificação de fenómenos que surgem na relação entre tensão dramática e tensão do gameplay. No final, foram realizados de dois workshops de forma a validar os resultados da investigação. Este estudo resultou na descoberta de cinco paradigmas: Alternância, Sobreposição e Paridade, Escolhas e Ações do Jogador, Gameplay promove a Estória e Estória promove o Gameplay, que surgem através das dinâmicas das tensões dramática e do gameplay. O modelo conceptual dos paradigmas foi validado, de modo a comprovar a sua aplicabilidade no desenvolvimento e design de videojogos.

Begun operating in 1992 and today is ready to be bought and to grow massively in the upcoming years .LNA Santé, the fifth French player in the long-term care market ,will be acquired in 2019 in a Private Equity deal and will improve its operations in Europe. This deal is expected to return 3.1 x the money invested by the fund and an internal rate of return of almost 26% with an exit in five years(2023). This successful exit is possible due to an ageing population that is set to in crease demand for dependent care which is reflected in the number of nursing home beds forecasted to double. By the time of exit, the firm will amount €828 Mofre venues and €94 Mof EBITD As treaming from consolidation of operations in the current operating countries–France and Belgium–and an internationalization bet in the Netherlands. It is presumed that this paper will inform how a deal in Private Equity -term care market in Europe is conducted.

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Introduction: Although underdiagnosed, COPD is the 4th cause of death worldwide and affects up to 14,2% of the Portuguese population. Hospital admission is associated with severe disease. Mortality assessement in these patients showed a higher death ratio due to comorbid conditions (heart failure (HF), diabetes mellitus (DM), hypertension (HT) or neuropsychological disorders) than from COPD. Aim: Characterize the COPD population, identify their main comorbidities and assess their impact on mortality. Methods: Retrospective study of all patients with chronic respiratory disease hospitalized in 2015 at an Universitary Hospital (n=763). COPD cases were selected and analyzed. Results: 279 patients(36,6%) had COPD diagnosed, 78,9% of them men. Mean age was 74years. 86,7% had smoking history. Bronchiectasis were documented in 33,8%, a third were symptomatic. Lung cancer was present in 6,5% and other active cancers in 9,7%. Conserning non-respiratory comorbidities, 49,1% had 1 or 2 of the studied diseases and 33,3% had 3 or 4 chronic conditions. HT, HF, DM and chronic kidney disease were diagnosed in 62%, 48,7%, 24,7% and 22,6% respectively. Also prevalent were dementia (13,6%), depression (10,8%) and anxiety (9%). Thirty-five percent of the cases were admitted in the emergency room in the 1st year after discharge, and 22.9% were hospitalized in this period. The 1-year mortality rate was 21,1%, with higher mortality within the first month after discharge. Statistical significance in mortality was demonstrated for other active types of cancer, smoking and dementia. Conclusion: This study emphasizes the impact of comorbidities and its real burden in COPD. For better outcomes and quality of life each comorbidity should be individually assessed and treated

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2017-06-21T19:29:04Z No. of bitstreams: 1 Ana Rita. Ines Dourado et al. 2016.pdf: 1104114 bytes, checksum: d0ac518937519a3173397c12ad23894f (MD5) Made available in DSpace on 2017-06-21T19:29:04Z (GMT). No. of bitstreams: 1 Ana Rita. Ines Dourado et al. 2016.pdf: 1104114 bytes, checksum: d0ac518937519a3173397c12ad23894f (MD5) INTRODUCTION: Of all syphilis-related pregnancy outcomes, fetal death is certainly the most common one, being directly related to the availability, accessibility and quality of prenatal care. The present study aimed to analyze the underreporting of fetal and infant deaths and other maternal factors associated with congenital syphilis (CS) death. METHODS: This cross-sectional study integrated data of infants that were diagnosed and/or died of CS from the Sistema de Informação de Agravos de Notificação-Sinan (Notifiable Diseases Information System) and the Sistema de Informação de Mortalidade-SIM (Mortality Information System) in Fortaleza, Northeastern Brasil to identify unreported cases of congenital syphilis. We assessed data during the period from 2007 to 2013. RESULTS: The underreporting of CS as a cause of fetal or infant death increased from 41 to 415 cases (90.1%) during 2007-2013. Exactly 3,209 cases of CS were identified in Sinan and 6,578 deaths in SIM. After database linkage, we identified 382 cases that were reported in the SIM and SINAN databases consisting of 309 fetal deaths and 73 infant deaths related to CS. From the children notified at Sinan that born alive, 3.0% (78/2,542) died; Out of these, 39 (50.0%) were early and 25 (32.1%) were late neonatal deaths. The proportion of death by CS increased from 0.62 to 5.8 from 2007 to 2013. At logistic regression, the variable that maintained statistical significance with fetal and infant death outcomes was the presence of CS signs and/or symptoms at birth (OR = 3.20; IC 95% 1.54-6.62; p = 0.002). CONCLUSIONS: Neonatal and Infant deaths following CS-associated live births are underreported in Northeastern Brazil. Data base linkage identified unreported fetal and neonatal deaths due to CS leading to an increased awareness of fetal/infant mortality due to this infection. London

Resumo: O objetivo do trabalho é investigar os fatores associados à violência por parceiro íntimo perpetrada após a revelação do diagnóstico de doenças sexualmente transmissíveis (DST), em Fortaleza, Ceará, Brasil. Estudo transversal realizado com 221 pessoas atendidas em serviços de referência para DST. Realizou-se análise multivariada com modelo de regressão logística. Praticaram algum tipo de violência por parceiro íntimo após a revelação do diagnóstico 28,1% das pessoas. Praticar violência por parceiro íntimo apresentou associação com o uso de álcool (OR = 2,79; IC95%: 1,25-6,22; p = 0,012), o parceiro ter se relacionado com outra pessoa durante o relacionamento atual (OR = 4,71; IC95%: 2,24-9,91; p = 0,000), ter cometido violência anterior à DST (OR = 2,87; IC95%: 1,22-6,73; p = 0,015) e ter sofrido violência após o diagnóstico de DST (OR = 6,53; IC95%: 3,06-13,93; p = 0,000). A violência por parceiro íntimo após a revelação do diagnóstico de DST sinaliza que profissionais que atendem esta demanda devem identificar as dificuldades enfrentadas pelo paciente ao revelar o diagnóstico ao parceiro. Abstract: The objective of this study was to investigate factors associated with intimate partner violence after disclosing the diagnosis of sexually transmissible diseases (STDs) in Fortaleza, Ceará State, Brazil. This cross-sectional study enrolled 221 individuals treated at STD clinics. Multivariate logistic regression was performed. A total of 28.1% of individuals committed some type of intimate partner violence after disclosure of the diagnosis. Committing intimate partner violence was associated with alcohol use (OR = 2.79; 95%CI: 1.25-6.22; p = 0.012), the partner having relations with someone else during the current relationship (OR = 4.71; 95%CI: 2.24-9.91; p = 0.000), a history of violence prior to the STD (OR = 2.87; 95%CI: 1.22-6.73; p = 0.015), and having suffered violence after diagnosis of the STD (OR = 6.53; 95%CI: 3.06-13.93; p = 0.000). Intimate partner violence following disclosure of the STD signals that health professionals should identify patients' difficulties in revealing an STD diagnosis to their partners. Resumen: El objetivo del estudio es investigar los factores asociados a la violencia por parejas sentimentales perpetrados tras la revelación del diagnóstico de enfermedades de tranmisión sexual (ETS), en Fortaleza, Ceará, Brasil. Estudio transversal realizado con 221 personas atendidas en servicios de referencia para DST. Se usó la razón de oportunidad con un intervalo de confianza de un 95%. Practicaron algún tipo de violencia por parejas sentimentales tras la revelación del diagnóstico, 28,1% de las personas. Practicar violencia por parejas sentimentales presentó asociación con el uso de alcohol (OR: 2,79; IC95%: 1,25-6,22; p = 0,012), que el compañero se hubiera relacionado con otra persona durante la relación actual (OR: 4,71; IC95%: 2,24-9,91; p = 0,000), haber cometido violencia anterior a ETS (OR: 2,87; IC95%: 1,22-6,73; p = 0,015) y haber sufrido violencia tras el diagnóstico de ETS (OR: 6,53; IC95%: 3,06-13,93; p = 0,000). La violencia por parejas sentimentales tras la revelación del diagnóstico de ETS indica que profesionales que atienden esa demanda, deben identificar las dificultades enfrentadas por el paciente al revelar el diagnóstico al compañero.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2016-04-22T13:45:20Z No. of bitstreams: 1 Artigo per nac. Ines Dourado 2. 2015.pdf: 371807 bytes, checksum: a08524625341b779ea539966720d1578 (MD5) Made available in DSpace on 2016-04-22T13:45:20Z (GMT). No. of bitstreams: 1 Artigo per nac. Ines Dourado 2. 2015.pdf: 371807 bytes, checksum: a08524625341b779ea539966720d1578 (MD5) Previous issue date: 2015-09 Introdução: No âmbito da atual política de prevenção do HIV/AIDS é necessário reconhecer a importância do preservativo masculino e discutir seus limites. Esse artigo objetivou investigar o uso do preservativo masculino no Brasil e elaborar reflexões críticas sobre o papel do mesmo no novo contexto da prevenção do HIV/AIDS. Métodos: Revisão narrativa sobre o uso do preservativo masculino no Brasil em diferentes grupos populacionais e fatores associados ao uso, por meio de buscas realizadas entre março e abril de 2013, utilizando-se descritores em inglês categorizados na base PubMed. Incluíram-se também documentos provenientes de inquéritos nacionais que orientam a vigilância epidemiológica e comportamental do Ministério da Saúde. Resultados: Incluí-se 40 artigos e 3 relatórios para caracterizar a produção de conhecimentos e outros 11 estudos de intervenção para promoção do uso de preservativos. Observou-se que: 1) apesar do aumento de estudos nacionais, estes apresentam baixa regularidade; 2) há poucos estudos sobre fatores associados ao uso de preservativo entre os grupos nos quais a epidemia se concentra, como homens que fazem sexo com homens (HSH), trabalhadoras sexuais (TS), usuários de drogas (UD) e travestis e transexuais (TT), e concentração entre adolescentes e mulheres; 3) combinação de intervenções mostrou-se mais efetiva do que uma só. Discussão: A reflexão e discussão do uso do preservativo no âmbito das novas tecnologias de prevenção devem não só enfatizar a importância do mesmo, mas também considerar o papel do prazer e do sexo nas intervenções combinadas, além do potencial de redução do risco de infecção por HIV. São Paulo

Submitted by Maria João Antunes (mariajoao@fd.ul.pt) on 2015-12-09T15:10:49Z No. of bitstreams: 1 ulfd130819_tese.pdf: 782657 bytes, checksum: 5d12653d27a4f08f995b1380357678b0 (MD5) Made available in DSpace on 2015-12-09T15:11:06Z (GMT). No. of bitstreams: 1 ulfd130819_tese.pdf: 782657 bytes, checksum: 5d12653d27a4f08f995b1380357678b0 (MD5) Previous issue date: 2015-07-28

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-05-07T17:31:26Z No. of bitstreams: 1 Ines Dourado. 2013.pdf: 44607 bytes, checksum: 50e64ac432db23d6bc7d37e4ce018331 (MD5) Made available in DSpace on 2015-05-07T17:31:27Z (GMT). No. of bitstreams: 1 Ines Dourado. 2013.pdf: 44607 bytes, checksum: 50e64ac432db23d6bc7d37e4ce018331 (MD5) Exclusive and safe formula feeding can eliminate the risk of vertical HIV transmission due to breastfeeding. Therefore many countries advise all HIV-positive women to avoid breastfeeding their infants. However, little research explores the experiences of women attempting to exclusively formula feed (EFF) in countries with free and universal access to HAART. This article examines the success of Brazil in supporting HIV-positive women as they EFF their infants. We conducted in-depth interviews with 30 HIV-positive women receiving care at the primary facility for HIV/AIDS in Salvador, Brazil about their attitudes and practices related to EFF as well as challenges with adhering to EFF. All interviews were recorded, professionally transcribed and translated, and then analyzed. Our results showed that one woman reported both breastfeeding and formula feeding her infant; all others reported EFF. Postpartum counseling regarding the risk of HIV transmission through breastfeeding was the primary motivation for EFF. Challenges included difficulty reconciling their perceptions that breastfeeding is an important maternal responsibility, trouble accepting that breastfeeding can cause potential to harm their infants, confronting HIV-related stigma associated with EFF, and unexpected financial burdens due to EFF. We conclude that HIV-positive women adhered to national guidelines recommending EFF; this phenomenon has likely contributed to declining rates of vertical transmission in Brazil. Despite this success, many women experienced challenges with EFF. Greater support services may enhance Brazil’s success in empowering HIV-positive women and eliminating vertical HIV transmission via breastfeeding.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-05-07T17:45:43Z No. of bitstreams: 1 Ines Dourado 2. 2013.pdf: 430643 bytes, checksum: 963455fbf6967b1194166dd8bfb82933 (MD5) Made available in DSpace on 2015-05-07T17:45:43Z (GMT). No. of bitstreams: 1 Ines Dourado 2. 2013.pdf: 430643 bytes, checksum: 963455fbf6967b1194166dd8bfb82933 (MD5) Background: Late presentation to testing, treatment and continued care has detrimental impacts on the health of HIV-positive individuals as well as their sexual partners’ health. Men who have sex with men (MSM) experience disproportionately high rates of HIV both globally and in Brazil. However, the factors that inhibit linkage to care among MSM remain unclear. Methods: We conducted a cross-sectional study of HIV-positive MSM (n = 740) enrolled in HIV/AIDS services in a large urban center of Brazil from August 2010 to June 2011. De scriptive, bivariate and multivariate statistics were conducted using STATA 12 to examine the relationship between a range of variables and late presentation, defined as having a first CD4 count