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ObjectiveTo compare the clinical outcomes and cost-effectiveness of routine HIV screening in Portugal to the current practice of targeted and on-demand screening.DesignWe used Portuguese national clinical and economic data to conduct a model-based assessment.MethodsWe compared current HIV detection practices to strategies of increasingly frequent routine HIV screening in Portuguese adults aged 18-69. We considered several subpopulations and geographic regions with varying levels of undetected HIV prevalence and incidence. Baseline inputs for the national case included undiagnosed HIV prevalence 0.16%, annual incidence 0.03%, mean population age 43 years, mean CD4 count at care initiation 292 cells/μL, 63% HIV test acceptance, 78% linkage to care, and HIV rapid test cost €6 under the proposed routine screening program. Outcomes included quality-adjusted survival, secondary HIV transmission, cost, and incremental cost-effectiveness. ResultsOne-time national HIV screening increased HIV-infected survival from 164.09 quality-adjusted life months (QALMs) to 166.83 QALMs compared to current practice and had an incremental cost-effectiveness ratio (ICER) of €28,000 per quality-adjusted life year (QALY). Screening more frequently in higher-risk groups was cost-effective: for example screening annually in men who have sex with men or screening every three years in regions with higher incidence and prevalence produced ICERs of €21,000/QALY and €34,000/QALY, respectively.ConclusionsOne-time HIV screening in the Portuguese national population will increase survival and is cost-effective by international standards. More frequent screening in higher-risk regions and subpopulations is also justified. Given Portugal’s challenging economic priorities, we recommend prioritizing screening in higher-risk populations and geographic settings.

BackgroundIn Western countries, smoking accounts for a large share of socio-economic inequalities in health. As smoking initiation occurs around the age of 13, it is likely that school context and social networks at school play a role in the origin of such inequalities. So far, there has been little generic explanation of how social ties at school contribute to socio-economic inequalities in smoking. The SILNE (Smoking Inequalities – Learning from Natural Experiments) survey was designed to test the hypothesis that a combination of peer effect, homophilous social ties, and school context may explain how smoking inequalities are magnified at school – a theory known as network-induced inequality. In this paper, the survey theory and design are presented.FindingsThe social network survey was carried out in 2013 in six medium-sized European cities with average incomes similar to the national average: Namur (Belgium), Tampere (Finland), Hannover (Germany), Latina (Italy), Amersfoort (The Netherlands), and Coimbra (Portugal). In each city, 6 to 8 schools were selected in a stratified sampling procedure. In each school, two grades in secondary education, corresponding to 14-16-year-olds, were selected. All adolescents in these two grades were invited to participate in the survey. Social ties were reported using the roster approach, in which each adolescent had to nominate up to 5 friends from a directory.The survey collected information from 11,015 adolescents in 50 schools, out of a total of 13,870 registered adolescents, yielding a participation rate of 79%. The SILNE survey yielded 57,094 social ties, 86.7% of which referred to friends who also participated in the survey.DiscussionThe SILNE survey was designed to measure the association between adolescents’ social ties at school, their socio-economic background, and their smoking behaviour. Two difficulties were encountered, however: legal privacy constraints made it impossible to apply the same parental consent procedure in all countries, leading to somewhat lower participation rates in two cities: Hannover and Latina. It was also difficult to match the 6 cities in terms of both age and type of education.The SILNE survey provided a comparable database for the study of smoking inequalities across European cities from a social network perspective.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1041-z) contains supplementary material, which is available to authorized users.

Objetivo: verificar a percepção das puérperas no pós-parto imediato sobre a eficiência do uso de métodos não farmacológicos para alívio da dor no trabalho de parto normal. Metodologia: Pesquisa descritiva, qualitativa, realizada com 40 puérperas na maternidade do Hospital e Maternidade Sagrado Coração de Jesus em Janaúba-MG. Os dados foram coletados entre março e abril de 2016 por meio de entrevista e analisados de acordo Análise do Conteúdo de Bardin. Resultados: o banho de aspersão foi o método mais utilizado, proporcionou alívio e conforto durante o trabalho de parto. Os métodos foram eficazes quanto a sua finalidade e associaram a eles sentimentos de satisfação, relaxamento e tranquilidade. O acompanhante e o profissional de saúde apareceram como estratégia de suporte para efetivação dos métodos usados. Conclusão: evidenciou-se que os métodos não farmacológicos produzem alívio dor durante o trabalho de parto normal e a importância da utilização desses métodos nos períodos pré e trans-parto para prestar assistência humanizada. Descritores: Trabalho de Parto, Parto Normal, Dor do Parto. EFFICACY OF NON-PHARMACOLOGICAL METHODS FOR PAIN RELIEF IN LABOR NORMAL OF PARTURITIONObjective: To verify the perception of puerperae in the immediate postpartum period on the efficiency of the use of nonpharmacological methods for pain relief in normal labor. Methodology: This is a descriptive, qualitative study, carried out with 40 puerperae in the maternity hospital and Maternity Sacred Heart of Jesus in Janaúba-MG. The data were collected between March and April of 2016 through interview and analyzed according to the Bardin Content Analysis. Results: The sprinkler bath was the most used method, provided relief and comfort during labor. The methods were effective in their purpose and associated with them feelings of satisfaction, relaxation and tranquility. The companion and the health professional appeared as a support strategy to implement the methods used. Conclusion: It was shown that non-pharmacological methods produce relief during normal labor and the importance of using these methods in the pre-and trans-partum periods to provide humanized assistance. Descriptors: Labor, Obstetric. Natural Childbirth, Labor Pain EFICIENCIA DE MÉTODOS NO FARMACOLÓGICOS PARA EL ALIVIO DEL DOLOR EN EL TRABAJO DE PARTO NORMALObjetivo: verificar la percepción de las puérperas en el posparto inmediato sobre la eficiencia del uso de métodos no farmacológicos para alivio del dolor en el trabajo de parto normal. Metodología: Se trata de un estudio descriptivo, cualitativo, realizado con 40 puérperas en la maternidad del Hospital y Maternidad Sagrado Corazón de Jesús en Janaúba-MG. Los datos fueron recolectados entre marzo y abril de 2016 por medio de entrevista y analizados de acuerdo Análisis del Contenido de Bardin. Resultados: El baño de aspersión fue el método más utilizado, proporcionó alivio y confort durante el trabajo de parto.Los métodos fueron eficaces en cuanto a su propósito y asociaron a ellos sentimientos de satisfacción, relaja...

Background Studies comparing adolescent e-cigarette use in different countries are scarce. We study students’ e-cigarette and conventional cigarette ever-use, their social correlates and e-liquid use in seven EU countries. Methods SILNE-R data (N=12 167, response rate 79.4%) of 14–17-year-olds from Amersfoort (NL), Coimbra (PT), Dublin (IR), Hanover (GE), Latina (IT), Namur (BE) and Tampere (FI) were used. E-cigarette and conventional cigarette ever-use, dual-use, type of e-liquid and social correlates were measured with a school survey and analyzed with cross-tabulations and multinomial logistic regression. Results About 34% had tried e-cigarettes, but the variation was large between the cities (Latina 50%; Hanover 23%). Of e-cigarette ever-users, 37% had used nicotine e-liquid, 43% exclusively non-nicotine liquid and 20% did not know the content. Nicotine e-liquid was more prevalent among monthly e-cigarette users and weekly smoking e-cigarette users. The social correlates were mainly the same for exclusive e-cigarette ever-use, exclusive conventional cigarette ever-use and dual-use. Boys had greater odds for exclusive e-cigarette and dual-use compared to girls. Of social correlates, low academic achievement and parental smoking were positively associated with all categories of use, but parental education and immigrant background were not. The strongest association was found between peer smoking (most/all best friends smoke) and dual-use (OR 34.29). Conclusions Students’ e-cigarette ever-use varies greatly between EU countries. E-cigarettes seem not to be a substitute for conventional cigarettes but more a complementary product. Tobacco control policies might also prevent e-cigarette use but specific regulations on e-cigarettes are needed to prevent nicotine addiction originating from them.

ObjectivesSmoking contributes to socio-economic health inequalities; but it is unclear how smoking inequalities emerge at a young age. So far, little attention has been paid to the role of friendship ties. We hypothesised that the combination of peer exposure and friendship social homophily may contribute to socio-economic inequalities in smoking at school.MethodsIn 2013, a social network survey was carried out in 50 schools in six medium-size European cities (Namur, Tampere, Hanover, Latina, Amersfoort, and Coimbra). Adolescents in grades corresponding to the 14-to-16 age group were recruited (n = 11.015, participation rate = 79.4 %). We modelled adolescents’ smoking behaviour as a function of socio-economic background, and analysed the mediating role of social homophily and peer exposure.ResultsLower socio-economic groups were more likely to smoke and were more frequently exposed to smoking by their close and distant friends, compared with adolescents of higher SES. The smoking risk of the lowest socio-economic group decreased after controlling for friends smoking and social homophily.ConclusionsSmoking socio-economic inequalities amongst adolescents are driven by friendship networks.Electronic supplementary materialThe online version of this article (doi:10.1007/s00038-016-0830-z) contains supplementary material, which is available to authorized users.

Background. Social integration and the health of adolescents with a migration background is a major

Adolescents are more likely to smoke when their father and mother smoke. Although the susceptibility to parental smoking was similar across social classes, SE differences in parental smoking contribute to the transmission of SE inequalities in smoking.