Prevalence and psychopathology features of mental rituals in patients with obsessive-compulsive disorder: A descriptive exploratory study of 1001 patients.

INTRODUCTION: Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile. OBJECTIVES: The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients. METHODS: This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight. RESULTS: Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation. CONCLUSION: Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.

Plasmodium falciparum community prevalence and health-seeking behaviours in rural Sussundenga District, Mozambique.

BACKGROUND: Impacts of nationally directed malaria control interventions hinge on understanding malaria transmission and prevention at the community level. The decision to seek care or health-seeking behaviours provide valuable insight on knowledge of malaria, access to care, and efficacy of malaria case management. Thus far, few studies have focused on central Mozambique. The aim was to describe community level Plasmodium falciparum prevalence and health-seeking behaviours among residents of Sussundenga, Mozambique, a rural village in Manica Province with high malaria incidence reported at the Sussundenga-Sede health centre (RHC). METHODS: A cross-sectional community-based survey was conducted from December 2019 to February 2020. A random household sampling method was used, based on enumerated households from satellite imagery. All consenting participants completed a survey about malaria risk, prevention, and health-seeking behaviours, and received a P. falciparum malaria rapid diagnostic test (RDT). RESULTS: The study enrolled 358 individuals from 96 households. The P. falciparum prevalence was 31.6% (95% CI [26.6-36.5%]). Ninety-three percent of participants reported using the Sussundenga-Sede RHC for healthcare. Sixty-six percent of participants (N = 233) experienced at least one malaria symptom in the past month, with self-reported fever most frequently reported (19.3%). Of these, 176 (76.5%) sought care in a health facility and 174 (79%) received an RDT with 130 (63%) having a positive test. Of those with a positive RDT, 127 (97%) received artemether-lumefantrine. Following treatment, 123 (97%) participants' symptoms resolved within a median of 3 days (IQR: 3-5) ranging from 2 to 14 days. In this high transmission setting, a high proportion of participants recognized malaria related symptoms then received a proper diagnostic test and treatment in a health facility. CONCLUSIONS: Future interventions that leverage this health-seeking behaviour and strengthen health systems for community interventions will improve malaria control and inform the efficacy of potential interventions at this particular international border.

Exploring socioeconomic and mental health trajectories during times of economic recession: a qualitative study with primary health care users and professionals.

Background: The 2008 economic recession has been shown to affect populations' mental health due to deterioration of socioeconomic and living conditions. Concurrently, mental health problems may have constituted a vulnerability to wider social inequalities during this period.Aims: To explore perceptions and experiences of primary health care users and professionals regarding the relationship between mental health and socioeconomic position during the economic recession in Portugal.Method: Data were collected in three primary health care centres in Lisbon Metropolitan Area. Focus groups and semi-structured interviews were conducted with users and professionals, respectively. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis.Results: Two themes were obtained. The first comprised the relationship between changes in socioeconomic conditions (unemployment, precarious work conditions and financial hardship) and poor mental health. The second involved the consequences of experiencing mental health problems during the recession, namely disability, need of sick leave and early retirement.Conclusions: This study provided a comprehensive overview of the bidirectional relationship between socioeconomic conditions and mental health, emphasizing the need to develop policies to address the drivers of poor mental health during times of economic downturn and tackle the barriers faced by people with mental disorders to promote their full social inclusion.

Malaria mortality characterization and the relationship between malaria mortality and climate in Chimoio, Mozambique.

BACKGROUND: The United Nation's sustainable development goal for 2030 is to eradicate the global malaria epidemic, primarily as the disease continues to be one of the major concerns for public health in sub-Saharan Africa. In 2015, the region accounted for 90% of malaria deaths. Mozambique recorded a malaria mortality rate of 42.75 (per 100,000). In Chimoio, Mozambique's fifth largest city, malaria is the fourth leading cause of death (9.4%). Few data on malaria mortality exists in Mozambique, particularly in relation to Chimoio. The objective of this study was to characterize malaria mortality trends and its spatial distribution in Chimoio. METHODS: Malaria mortality data and climate data were extracted from the Chimoio Civil Registration records, and the Regional Weather station, from 2010 to 2014. The malaria crude mortality rate was calculated. ANOVA, Tukey's, Chi square, and time series were carried out and an intervention analysis ARIMA model developed. RESULTS: A total of 944 malaria death cases were registered in Chimoio, 729 of these among Chimoio residents (77%). The average malaria mortality by gender was 44.9% for females and 55.1% for males. The age of death varied from 0 to 96 years, with an average age of 25.9 (SE = 0.79) years old. January presented the highest average of malaria deaths, and urban areas presented a lower crude malaria mortality rate. Rural neighbourhoods with good accessibility present the highest malaria crude mortality rate, over 85 per 100,000. Seasonal ARMA (2,0)(1,0)12 fitted the data although it was not able to capture malaria mortality peaks occurring during malaria outbreaks. Intervention effect properly fit the mortality peaks and reduced ARMA's root mean square error by almost 25%. CONCLUSION: Malaria mortality is increasing in Chimoio; children between 1 and 4 years old represent 13% of Chimoio population, but account for 25% of malaria mortality. Malaria mortality shows seasonal and spatial characteristics. More studies should be carried out for malaria eradication in the municipality.

Spatio-temporal variation and socio-demographic characters of malaria in Chimoio municipality, Mozambique.

BACKGROUND: In Africa, urban malaria is a major concern, since the towns and especially their suburbs are growing quickly. In Mozambique, malaria represents 45 % of all cases of outpatient visits and 56 % of inpatient visits at paediatric clinics. Malaria is a major public health burden in Chimoio Mozambique and few studies on malaria exist. METHODS: The study was carried out to establish the spatiality and temporality of malaria and describe socio-demographic characteristics of malaria patients in Chimoio. Weekly malaria data for 9 years (2006-2014) were collected from the district Epidemiological Bulletin and incidence by season, age, gender, and residence was calculated. SPSS version 20 was used for statistical analysis and ArcGis 10.1 was used to produce maps. RESULTS: The annual overall average of malaria incidence was 20.1 % and the attributable fraction (AF) of malaria was 16 %. There were differences in weekly and yearly malaria occurrences throughout the period. There was no difference in malaria cases between male and female patients. Children under 5 years of age are three times more prone to malaria than adults (p < 0.05). Three temporal clusters of malaria were identified: cluster 1, weeks 25-47 with average weekly cases of 618 (sd = 251.9), cluster 2, weeks 18-24 and 48-51 with average weekly cases of 1066 (sd = 317.4). cluster 3, weeks 1-17 and 52 with average weekly cases of 1587 (sd = 722.4). Similarly, three different clusters were identified according to residential areas: cluster 1 (10 %) mostly urban, cluster 2 (22 %) mostly suburbs, cluster 3 (28 %) mostly rural areas. CONCLUSION: Malaria is increasing in the suburbs, and rural areas present more cases of malaria compared to urban areas. This article is an initial step to understand the dynamics of malaria in Chimoio. Results suggest that malaria varies in time and space, and that precision public health strategy should be used to control malaria occurrence. Studies on weather factors affecting malaria cases, bed net usage, and others should be undertaken.

Psychopathological intersection between obsessive-compulsive disorder and post-traumatic stress disorder: scoping review of similarities and differences.

INTRODUCTION: Although post-traumatic stress disorder and obsessive-compulsive disorder have distinct diagnostic criteria, some psychopathological phenomena seem to be shared, which may lead to misdiagnosis and erroneous treatment decisions. This scoping review explores the psychopathological similarities and differences between these two disorders. METHOD: The review complies with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and included articles published in Portuguese, English, or Spanish in the last 50 years indexed in the PubMed database. Case-reports were excluded. RESULTS: Fifty-three studies with different designs were included (30 [56.5%] were cross-sectional studies; eight [15.1%] were case-control studies; one [1.9%] was a cohort study; three [5.7%] were clinical trials; nine [17%] were reviews/systematic reviews; and two [3.8%] were meta-analyses). The main psychopathological aspects described by the studies included were flashbacks x obsessions; avoidant behavior (AB); depressive, anxious, and somatic symptoms; sexuality, sleep, and appetite; psychiatric comorbidities; and suicidality. The intersection between clinical features seems to occur in the extrinsic psychopathological dimension. CONCLUSION: The disorders' core psychopathological symptoms (intrinsic characteristics) are distinctly different, since flashbacks and obsessions are consequences of different predominant defective mental functions: the former derives from defective memory, the latter from defective thought. Along the same lines, the ABs observed in the two disorders are products of different purposes and inner necessities.

Long-lasting household damage from Cyclone Idai increases malaria risk in rural western Mozambique.

Cyclone Idai in 2019 was one of the worst tropical cyclones recorded in the Southern Hemisphere. The storm caused catastrophic damage and led to a humanitarian crisis in Mozambique. The affected population suffered a cholera epidemic on top of housing and infrastructure damage and loss of life. The housing and infrastructure damage sustained during Cyclone Idai still has not been addressed in all affected communities. This is of grave concern because storm damage results in poor housing conditions which are known to increase the risk of malaria. Mozambique has the 4th highest malaria prevalence in sub-Saharan Africa and is struggling to control malaria in most of the country. We conducted a community-based cross-sectional survey in Sussundenga Village, Manica Province, Mozambique in December 2019-February 2020. We found that most participants (64%) lived in households that sustained damage during Cyclone Idai. The overall malaria prevalence was 31% measured by rapid diagnostic test (RDT). When controlling for confounding variables, the odds of malaria infection was nearly threefold higher in participants who lived in households damaged by Cyclone Idai nearly a year after the storm. This highlights the need for long-term disaster response to improve the efficiency and success of malaria control efforts.

Household structure is independently associated with malaria risk in rural Sussundenga, Mozambique.

Introduction: Mozambique has the fourth highest malaria cases and malaria mortality globally. Locally, malaria incidence increases from low in the southern region to high in the central and northern regions. Manica Province in central Mozambique has the fourth highest prevalence of malaria out of the 11 provinces, and the highest in the central region of the country. In this area where coverage of interventions has been limited, household level risk factors can be important for understanding the natural history of infection, as well as the implementation of current and future interventions. There has been indication that the relationship between household structure and malaria risk is actually a mediating one between the true relationship between household income and education and Plasmodium falciparum infection. The objective of this study was to determine and quantify these complex relationships. Methods: We conducted a community-based cross-sectional study in Sussundenga village. Sussundenga is a rural village, located in Sussundenga District, Manica Province, Mozambique. We enrolled 303 participants from 83 randomly selected households. We collected information on demographics, household construction, and administered a P. falciparum rapid diagnostic test (RDT). We constructed several generalized estimating equations logistic regression models to determine the independent effects of housing construction on malaria risk. We also constructed models separate from generalized estimating equations logistic mediation models to determine the proportion of effects mediated by household construction material in the relationship between head of household occupation and education and malaria risk. Results: The overall malaria prevalence among the study population by RDT was 30.8%. In the multivariable model adjusting for all individual and household factors as potential confounders, rudimentary roof structure was the only household structural variable that was statistically significantly associated with increased malaria risk [OR 2.41 (1.03-5.63)]. We found no evidence that household structure mediated the relationship between head of household education or employment and malaria risk in our study population. Discussion: Household structure was a significant risk factor for malaria infection in our study population. These findings are consistent with malaria being a disease of poverty and an area that could be targeted for future interventions that could have long-term impacts.

Association of anthelmintic treatment with malaria prevalence in Rural Sussundenga, Mozambique.

Background: Mozambique has the 4 th highest malaria incidence and mortality globally. Despite the existing malaria control strategies, malaria prevalence remains stagnant. These challenges have increased calls for innovative strategies in areas with the highest disease burden. Community mass treatment with anthelmintic agents have been used as an effective tool for the control of major helminth infections and has emerged as a potential tool for vector control in the fight against malaria. Methods: This was an analysis of data from a cross-sectional community-based survey designed to study malaria risk, prevention, and health seeking behaviors in Sussundenga, Mozambique. Using logistic regression models, we quantified the association between ever receiving anthelmintic treatment and P. falciparum infection. We also fit models to determine the association between recent anthelmintic treatment and malaria infection. Results: Two-hundred, seventy-seven (277) participants from 83 households were included in this analysis. The prevalence of P. falciparum infection measured by rapid diagnostic test (RDT) was 30%. 77% of participants reported having ever received anthelmintics. The prevalence of malaria was slightly higher among participants who reported ever taking anthelmintics. There was no statistically significant association between prior receipt of anthelmintic and P. falciparum malaria infection after adjusting for age, ITN use and head of household full-time employment (OR = 1.37, 95% CI, 0.70-2.70, p = 0.36). However, recent intake of anthelmintics was associated with lower odds of testing positive for in the adjusted models (OR = 0.35, 95% CI, 0.07-1.80, p = 0.21), but this was not statistically significant. Conclusions: Our findings show that the benefit of anthelmintics treatment as a control tool for P. falciparum malaria infection is likely tied to when it is administered rather than if it was ever administered. These findings offer evidence for making decisions in planning mass community deworming in sub-Saharan Africa.

Modelling sociodemographic factors that affect malaria prevalence in Sussundenga, Mozambique: a cross-sectional study.

Background: Malaria is still one of the leading causes of mortality and morbidity in Mozambique with little progress in malaria control over the past 20 years. Sussundenga is one of most affected areas. Malaria transmission has a strong association with environmental and sociodemographic factors. The knowledge of sociodemographic factors that affects malaria, may be used to improve the strategic planning for its control. Currently such studies have not been performed in Sussundenga. Thus, the objective of this study is to model the relationship between malaria and sociodemographic factors in Sussundenga, Mozambique. Methods: Houses in the study area were digitalized and enumerated using Google Earth Pro version 7.3. In this study 100 houses were randomly selected to conduct a community survey of Plasmodiumfalciparum parasite prevalence using rapid diagnostic test (RDT). During the survey, a questionnaire was conducted to assess the sociodemographic factors of the participants. Descriptive statistics were analyzed and backward stepwise logistic regression was performed establishing a relationship between positive cases and the factors. The analysis was carried out using SPSS version 20 package. Results: The overall P. falciparum prevalence was 31.6%. Half of the malaria positive cases occurred in age group 5 to 14 years. Previous malaria treatment, population density and age group were significant predictors for the model. The model explained 13.5% of the variance in malaria positive cases and sensitivity of the final model was 73.3%. Conclusion: In this area the highest burden of P. falciparum infection was among those aged 5-14 years old. Malaria infection was related to sociodemographic factors. Targeting malaria control at community level can combat the disease more effectively than waiting for cases at health centers. These finding can be used to guide more effective interventions in this region.

The evaluation of citizen participation in policymaking: Insights from Portugal.

While citizen participation in policymaking is on the rise worldwide, the scholarly debate centring around its evaluation has not developed to the same extent. The article discusses the methodology and findings of the evaluation of the project "Portugal Participa: Caminhos para a Inovação Societal" which started at the end of 2014, and was implemented in 2015 and 2016, in Portugal. As the project promoted actions at both national and local levels, the evaluation accounted for both layers with a major focus on the analysis of procedures and outputs to examine its success. Through the application of a multi-method approach - data collection and analysis, cost-effectiveness assessment, interviews, pre-post surveys, and counterfactual focus groups - involving a wide array of agents - political representatives, civil servants, NGOs, citizens, national academia, and the funding sponsor - findings have helped retrieve three main insights that aim to contribute to future research on the evaluation of citizen participation in policymaking, which should shed light on: the (re)connection of multiple agents; the role within the governance systems; and the pursuit of social inclusion.

Malaria Temporal Variation and Modelling Using Time-Series in Sussundenga District, Mozambique.

Malaria is one of the leading causes of morbidity and mortality in Mozambique, which has the fifth highest prevalence in the world. Sussundenga District in Manica Province has documented high P. falciparum incidence at the local rural health center (RHC). This study's objective was to analyze the P. falciparum temporal variation and model its pattern in Sussundenga District, Mozambique. Data from weekly epidemiological bulletins (BES) was collected from 2015 to 2019 and a time-series analysis was applied. For temporal modeling, a Box-Jenkins method was used with an autoregressive integrated moving average (ARIMA). Over the study period, 372,498 cases of P. falciparum were recorded in Sussundenga. There were weekly and yearly variations in incidence overall (p < 0.001). Children under five years had decreased malaria tendency, while patients over five years had an increased tendency. The ARIMA (2,2,1) (1,1,1) 52 model presented the least Root Mean Square being the most appropriate for forecasting. The goodness of fit was 68.15% for malaria patients less than five years old and 73.2% for malaria patients over five years old. The findings indicate that cases are decreasing among individuals less than five years and are increasing slightly in those older than five years. The P. falciparum case occurrence has a weekly temporal pattern peaking during the wet season. Based on the spatial and temporal distribution using ARIMA modelling, more efficient strategies that target this seasonality can be implemented to reduce the overall malaria burden in both Sussundenga District and regionally.

Mapping Risk of Malaria as a Function of Anthropic and Environmental Conditions in Sussundenga Village, Mozambique.

Mozambique is a country in Southern Africa with around 30 million inhabitants. Malaria is the leading cause of mortality in the country. According to the WHO, Mozambique has the third highest number of malaria cases in the world, representing approximately 5% of the world total cases. Sussundenga District has the highest incidence in the Manica province and environmental conditions are the major contributor to malaria transmission. There is a lack of malaria risk maps to inform transmission dynamics in Sussundenga village. This study develops a malaria risk map for Sussundenga Village in Mozambique and identifies high risk areas to inform on appropriate malaria control and eradication efforts. One hundred houses were randomly sampled and tested for malaria in Sussundenga Rural Municipality. To construct the map, a spatial conceptual model was used to estimate risk areas using ten environmental and anthropic factors. Data from Worldclim, 30 × 30 Landsat images were used, and layers were produced in a raster data set. Layers between class values were compared by assigning numerical values to the classes within each layer of the map with equal rank. Data set input was classified, using diverse weights depending on their appropriateness. The reclassified data outputs were combined after reclassification. The map indicated a high risk for malaria in the northeast and southeast, that is, the neighborhoods of Nhamazara, Nhamarenza, and Unidade. The central eastern areas, that is, 25 de Junho, 1 and 2, 7 de Abril, and Chicueu presented a moderate risk. In Sussundenga village there was 92% moderate and 8% high risk. High malaria risk areas are most often located in densely populated areas and areas close to water bodies. The relevant findings of this study can inform on effective malaria interventions.

Paper-Based In-Situ Gold Nanoparticle Synthesis for Colorimetric, Non-Enzymatic Glucose Level Determination.

Due to its properties, paper represents an alternative to perform point-of-care tests for colorimetric determination of glucose levels, providing simple, rapid, and inexpensive means of diagnosis. In this work, we report the development of a novel, rapid, disposable, inexpensive, enzyme-free, and colorimetric paper-based assay for glucose level determination. This sensing strategy is based on the synthesis of gold nanoparticles (AuNPs) by reduction of a gold salt precursor, in which glucose acts simultaneously as reducing and capping agent. This leads to a direct measurement of glucose without any enzymes or depending on the detection of intermediate products as in conventional enzymatic colorimetric methods. Firstly, we modelled the synthesis reaction of AuNPs to determine the optical, morphological, and kinetic properties and their manipulation for glucose sensing, by determining the influence of each of the reaction precursors towards the produced AuNPs, providing a guide for the manipulation of nucleation and growth. The adaptation of this synthesis into the developed paper platform was tested and calibrated using different standard solutions with physiological concentrations of glucose. The response of the colorimetric signals obtained with this paper-based platform showed a linear behavior until 20 mM, required for glycemic control in diabetes, using the Red × Value/Grey feature combination as a calibration metric, to describe the variations in color intensity and hue in the spot test zone. The colorimetric sensor revealed a detection limit of 0.65 mM, depending on calibration metric and sensitivity of 0.013 AU/mM for a linear sensitivity range from 1.25 to 20 mM, with high specificity for the determination of glucose in complex standards with other common reducing interferents and human serum.

Solutions to tackle the mental health consequences of the economic recession: A qualitative study integrating primary health care users and professionals' perspectives.

This qualitative study explores solutions proposed by primary health care users and professionals to address the consequences of the economic recession and austerity measures on populations' mental health and delivery of care in Portugal. Qualitative data were collected in three primary health care centres in the Lisbon Metropolitan Area. Five focus groups with 26 users and semistructured interviews with 27 health professionals were conducted. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. Solutions proposed by users focused on improvements in accessibility and management of services, socioeconomic and living conditions, human resources for health, and investment in mental health. Health professionals focused on improvements in integration and articulation of services, infrastructure and structural barriers to primary care, recruitment and retention of human resources, and socioeconomic and living conditions. The themes from both groups were integrated and organized into three axes for action: 1) increasing investment and reversing austerity measures in health and social sectors; 2) coordination and integration of mental health care; and 3) tackling the social determinants of mental health. The findings provide an assessment of the needs and priorities set by primary health care users and professionals, reflecting their contextspecific experiences. These complementary perspectives highlight the need for inter-sectoral efforts in policy-making to improve delivery of care and to mitigate social inequalities in health across the Portuguese population.

Mapping and Modelling Malaria Risk Areas Using Climate, Socio-Demographic and Clinical Variables in Chimoio, Mozambique.

Background: Malaria continues to be a major public health concern in Africa. Approximately 3.2 billion people worldwide are still at risk of contracting malaria, and 80% of deaths caused by malaria are concentrated in only 15 countries, most of which are in Africa. These high-burden countries have achieved a lower than average reduction of malaria incidence and mortality, and Mozambique is among these countries. Malaria eradication is therefore one of Mozambique’s main priorities. Few studies on malaria have been carried out in Chimoio, and there is no malaria map risk of the area. This map is important to identify areas at risk for application of Public Precision Health approaches. By using GIS-based spatial modelling techniques, the research goal of this article was to map and model malaria risk areas using climate, socio-demographic and clinical variables in Chimoio, Mozambique. Methods: A 30 m × 30 m Landsat image, ArcGIS 10.2 and BioclimData were used. A conceptual model for spatial problems was used to create the final risk map. The risks factors used were: the mean temperature, precipitation, altitude, slope, distance to water bodies, distance to roads, NDVI, land use and land cover, malaria prevalence and population density. Layers were created in a raster dataset. For class value comparisons between layers, numeric values were assigned to classes within each map layer, giving them the same importance. The input dataset were ranked, with different weights according to their suitability. The reclassified outputs of the data were combined. Results: Chimoio presented 96% moderate risk and 4% high-risk areas. The map showed that the central and south-west “Residential areas”, namely, Centro Hipico, Trangapsso, Bairro 5 and 1° de Maio, had a high risk of malaria, while the rest of the residential areas had a moderate risk. Conclusions: The entire Chimoio population is at risk of contracting malaria, and the precise estimation of malaria risk, therefore, has important precision public health implications and for the planning of effective control measures, such as the proper time and place to spray to combat vectors, distribution of bed nets and other control measures.

Psychopathological intersection between obsessive-compulsive disorder and post-traumatic stress disorder: scoping review of similarities and differences

Abstract Introduction Although post-traumatic stress disorder and obsessive-compulsive disorder have distinct diagnostic criteria, some psychopathological phenomena seem to be shared, which may lead to misdiagnosis and erroneous treatment decisions. This scoping review explores the psychopathological similarities and differences between these two disorders. Method The review complies with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and included articles published in Portuguese, English, or Spanish in the last 50 years indexed in the PubMed database. Case-reports were excluded. Results Fifty-three studies with different designs were included (30 [56.5%] were cross-sectional studies; eight [15.1%] were case-control studies; one [1.9%] was a cohort study; three [5.7%] were clinical trials; nine [17%] were reviews/systematic reviews; and two [3.8%] were meta-analyses). The main psychopathological aspects described by the studies included were flashbacks x obsessions; avoidant behavior (AB); depressive, anxious, and somatic symptoms; sexuality, sleep, and appetite; psychiatric comorbidities; and suicidality. The intersection between clinical features seems to occur in the extrinsic psychopathological dimension. Conclusion The disorders' core psychopathological symptoms (intrinsic characteristics) are distinctly different, since flashbacks and obsessions are consequences of different predominant defective mental functions: the former derives from defective memory, the latter from defective thought. Along the same lines, the ABs observed in the two disorders are products of different purposes and inner necessities.

Modelling the influence of climate on malaria occurrence in Chimoio Municipality, Mozambique.

BACKGROUND: Mozambique was recently ranked fifth in the African continent for the number of cases of malaria. In Chimoio municipality cases of malaria are increasing annually, contrary to the decreasing trend in Africa. As malaria transmission is influenced to a large extent by climatic conditions, modelling this relationship can provide useful insights for designing precision health measures for malaria control. There is a scarcity of information on the association between climatic variability and malaria transmission risk in Mozambique in general, and in Chimoio in particular. Therefore, the aim of this study is to model the association between climatic variables and malaria cases on a weekly basis, to help policy makers find adequate measures for malaria control and eradication. METHODS: Time series analysis was conducted using data on weekly climatic variables and weekly malaria cases (counts) in Chimoio municipality, from 2006 to 2014. All data were analysed using SPSS-20, R 3.3.2 and BioEstat 5.0. Cross-correlation analysis, linear processes, namely ARIMA models and regression modelling, were used to develop the final model. RESULTS: Between 2006 and 2014, 490,561 cases of malaria were recorded in Chimoio. Both malaria and climatic data exhibit weekly and yearly systematic fluctuations. Cross-correlation analysis showed that mean temperature and precipitation present significantly lagged correlations with malaria cases. An ARIMA model (2,1,0) (2,1,1)52, and a regression model for a Box-Cox transformed number of malaria cases with lags 1, 2 and 3 of weekly malaria cases and lags 6 and 7 of weekly mean temperature and lags 12 of precipitation were fitted. Although, both produced similar widths for prediction intervals, the last was able to anticipate malaria outbreak more accurately. CONCLUSION: The Chimoio climate seems ideal for malaria occurrence. Malaria occurrence peaks during January to March in Chimoio. As the lag effect between climatic events and malaria occurrence is important for the prediction of malaria cases, this can be used for designing public precision health measures. The model can be used for planning specific measures for Chimoio municipality. Prospective and multidisciplinary research involving researchers from different fields is welcomed to improve the effect of climatic factors and other factors in malaria cases.

Perceived effects of the economic recession on population mental health, well-being and provision of care by primary care users and professionals: a qualitative study protocol in Portugal.

INTRODUCTION: Economic recession periods can pose accentuated risks to population's mental health and well-being as well as additional threats to health systems. Users and health professionals are key stakeholders in care delivery; however, little attention has been given to their experiences of the crisis. This paper presents a qualitative study protocol to assess users' and health professionals' perceptions about the effects of the post-2008 economic recession on mental health and care delivery in the Lisbon Metropolitan Area, Portugal. METHODS AND ANALYSIS: The methodology to assess perceived effects of the economic recession by primary care users and professionals on population mental health, well-being and provision of care is presented. Focus groups with users and semistructured interviews with health professionals will be carried out in three primary healthcare units in Lisbon areas especially affected by the crisis. Thematic analysis of full-transcribed interviews will be conducted using an iterative and reflexive approach. ETHICS AND DISSEMINATION: The study protocol was approved by the Ethics Committee of NOVA Medical School, NOVA University of Lisbon. The findings will be useful for other researchers and policy-makers to develop and implement the assessment of prevailing experiences of users and health professionals on the effects of the economic recession on mental health and quality of care in primary health context, promoting their involvement and contribution to services responsiveness.

Suicide in Portugal: Spatial determinants in a context of economic crisis.

This study compares the existing statistical association between suicide mortality and the characteristics of places of residence (municipalities), before and during the current economic crisis, in Portugal. We found that (1) the traditional culture-based North/South pattern of suicidal behaviour has faded away, while the socioeconomic urban/rural divide has become more pronounced; (2) suicide is associated with higher levels of rurality and material deprivation; and (3) recent shifts in suicidal trends may result from the current period of crisis. Strategies targeting rural areas combined with public policies that address area deprivation may have important implications for tackling suicide.