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Introduction With improved access to anti-retroviral therapy (ART) the focus of HIV treatment is changing to reducing chronic co-morbidities and their effects, but guidelines for HIV care in many African countries do not include screening for cardiac disease. Our study aimed to determine the pattern of cardiac abnormalities in HIV-positive patients on ART. Methods We implemented a prospective, observational study for 24 months on a random sample of adult patients seen at a dedicated HIV clinic in Mozambique. Demographic, clinical and full cardiovascular evaluations were performed on all participants. Results We enrolled 264 HIVvpositive patients (mean age 39.3 years; 186 female, 70.5%). The mean time on ART was 46 (SD 36) months and most had low viral load (174, 65%). Obesity (45, 17%), overweight (65, 24.6%), hypertension (54, 20.5%) and severe anaemia (21, 8.3%) were frequent. Diabetes was present in four patients (1.5%). The most important conditions in 252 patients submitted to echocardiography (88, 34.9% had cardiac abnormalities) were: severe rheumatic heart valve disease (six), severe dilated cardiomyopathy (five), aortic degenerative disease and congenital heart disease (in three patients each). At 24-month follow up, six of the 252 patients had died; of the 196 reviewed on echocardiography 29 had progressed and two had improved ventricular systolic function. Conclusion This young cohort of HIV-positive patients on ART showed lower occurrence of tuberculous pericarditis and dilated cardiomyopathy but high cardiovascular risk, as assessed by the presence of obesity, hypertension and anaemia. Cardiac abnormalities needing multidisciplinary care were also found. There is a need for tailored cardiovascular risk stratification and screening for cardiovascular disease in HIV-positive patients on ART in Africa.

IntroductionAsthma and allergic disorders are of global concern and risk for their development results from the interplay of genetic and environmental factors. Among numerous environmental factors identified to influence the disease risk, the role of exposure to a farming environment has gained interest in recent times, but the underlying evidence is conflicting. The review aims to comprehensively identify, critically appraise and synthesise evidence from studies investigating the association between farm living and risk of asthma and allergic diseases in children and adults.Methods and analysisWe will identify relevant analytical observational epidemiological studies, including cross-sectional, case-control and cohort studies, by searching PubMed, Cochrane Library, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), WHO Global Health Library, Web of Science, Scopus and Embase. Screening of identified records, data extraction from eligible studies and risk of bias assssment of eligible studies will be independently undertaken by two reviewers, with arbitration by a third reviewer. The Effective Public Health Practice Project will be employed for the risk of bias assessment. Estimates from studies judged to be clinically, methodologically and statistically homogeneous will be synthesised using random-effects meta-analysis. Heterogeneity will be assessed using the I-squared statistic. We will consider objectively measured or self-reported asthma, atopic dermatitis/eczema, allergic rhinitis, wheeze, and food allergy as primary outcomes.Ethics and disseminationAs this study is based solely on the published literature, no ethics approval is required. The study findings will be presented at scientific meetings related to the field of asthma and allergy and will be published in an international peer-reviewed scientific journal.PROSPERO registration numberCRD42020208805.

Huge efforts have been made to make society aware of the concerns of violence against women (VAW). Hiding this phenomenon creates obstacles to quantify and clearly understand related aspects as well as leads to barriers to undertake actions for the reduction or elimination of VAW. The aim of this study is to estimate costs associated with VAW and produce data that will help in the design of strategies for the reduction or elimination of VAW. The economic cost of VAW was calculated for the cities of Maputo, Matola, Beira, and Nampula, for a time horizon of 4 years (2005–2008). Calculation of economic costs of VAW considered costs for health care, judicial costs, the assistance provided by the justice services, and support from civil society organizations offering services to women subjected to violence. The economic cost of VAW in Maputo, Matola, Beira, and Nampula, for a time horizon of 4 years (2005–2008), was US$1,473,828.7, with the health sector absorbing about 81% of the amount, justice 17%, and organizations working in the area of prevention with 2%. Although calculated costs represent an estimate, it is clear that VAW consumes a significant amount of the state budget. Estimated value is much higher than the budget allocated to the National Action Plan for Prevention and Combat of Violence Against Women. The improvement of collection of statistical data may lead to producing more robust estimates and have more absolute and comparable data.

Background During their medical training, medical students aim to master communication skills and professionalism competencies to foster the best possible patient-physician relationship. This is especially evident when dealing with sensitive topics. This study describes and analyses the outcomes of a simulation-based training module on clinical communication competency through interacting with simulated intimate partner violence (IPV) survivors. The training was set up as part of a broader IPV module within a Gynaecology and Obstetrics Bachelor of Medicine and Bachelor of Surgery of Medicine (MBBS). Methods In total, 34 (59%) of all fourth-year medical students from one medical school in Mozambique were involved. A mixed-method approach was adopted. First, a quasi-experimental pre-test/post-test design was adopted to study the impact of the intervention to tackle critical IPV knowledge, skills, and attitudes, underlying a patient communication script. Second, a qualitative analysis of student perceptions was carried out. Results The results of the paired sample t-tests point at a significant and positive change in post-test values when looking at the general IPV self-efficacy (IPV SE) score and the subscales mainly in attitudes. Participants expressed a desire for additional IPV communication competency and suggested enhancements to the module. Conclusion We conclude that due to IPV being a sensitive issue, simulation activities are a good method to be used in a safe environment to develop clinical skills. The results of this study are a good complement of the analysis of the competencies learned by the medical students in Mozambique with the current curriculum.

Purpose: The researchers aimed to identify the gaps in competencies designed to help medical students to deal with Intimate Partner Violence (IPV) in key Mozambican medical schools curricula. Method: A survey was administered to 3rd and 6th-year medical students (N387), enrolled in five medical schools in Mozambique. The instrument focused on mapping students' perceived mastery of their knowledge, skills, and attitudes related to IPV. Results: In total, 387 medical students (RR 66%) participated in the survey. The overall mean perceived mastery of IPV competence was 36.18 (SD = 24.52) for knowledge, 32.01 (SD = 27.37) for skills, and 43.47 (SD = 27.58) for attitudes. Though 6th-year students reported a significantly higher mastery level, it is still below a mastery-learning benchmark of 80%. Conclusions: Medical students report critically low levels in their mastery of IPV- related competencies. This implies a need for a more comprehensive approach to developing knowledge, skills, and attitudes to deal with the victims of IPV.

Contains fulltext : 175752.pdf (Publisher’s version ) (Closed access) BACKGROUND: Medical education in Sub-Saharan Africa is in need of reform to promote the number and quality of physicians trained. Curriculum change and innovation in this region, however, face a challenging context that may affect curriculum outcomes. Research on outcomes of curriculum innovation in Sub-Saharan Africa is scarce. We investigated curriculum outcomes in a Sub-Saharan African context by comparing students' perceived preparedness for practice within three curricula in Mozambique: a conventional curriculum and two innovative curricula. Both innovative curricula used problem-based learning and community-based education. METHODS: We conducted a comparative mixed methods study. We adapted a validated questionnaire on perceived professional competencies and administered it to 5th year students of the three curricula (n = 140). We conducted semi-structured interviews with 5th year students from these curricula (n = 12). Additional contextual information was collected. Statistical and thematic analyses were conducted. RESULTS: Perceived preparedness for practice of students from the conventional curriculum was significantly lower than for students from one innovative curriculum, but significantly higher than for students from the other innovative curriculum. Major human and material resource issues and disorganization impeded the latter's sense of preparedness. Both innovative curricula, however, stimulated a more holistic approach among students toward patients, as well an inquiring and independent attitude, which is valuable preparation for Sub-Saharan African healthcare. DISCUSSION: In Sub-Saharan Africa, risks and benefits of curriculum innovation are high. Positive outcomes add value to local healthcare in terms of doctors' meaningful preparedness for practice, but instead outcomes can be negative due to the implementation challenges sometimes found in Sub-Saharan African contexts. Before embarking on innovative curriculum reform, medical schools need to assess their capability and motivation for innovation.

O oceano é um tema de interesse e de descoberta infinito. O seu estudo é fundamental, não só no meio onde nos inserimos mas também para a população em geral. Este trabalho debruça-se sobre uma ínfima parte do oceano, que são as fontes hidrotermais. Estas, são descargas de água a alta temperatura que se desenvolvem a partir do fundo do oceano. São uma grande fonte de biodiversidade e interesse, no entanto são ainda um pouco desconhecidas. Baseados em estudos anteriores, optámos por aprofundar o nosso estudo no comportamento da trajetória do raio sonoro no interior destas fontes. Numa primeira parte deste trabalho, fizemos uma revisão que nos ajudou a entender melhor, não só as fontes hidrotermais, como também o comportamento do som no oceano. De seguida, introduzimos duas equações da velocidade do som já conhecidas, para avaliar o comportamento do raio sonoro no interior das fontes, tendo em conta as alterações nos parâmetros da água. Os parâmetros estudados no presente trabalho foram: a temperatura, a profundidade e a salinidade, sendo que parece poder afirmar-se, que aquele que apresenta maior influência é a temperatura. De acordo com os estudos iniciais, foram construídos alguns modelos com o objetivo de obtermos uma visão inicial dos resultados pretendidos. Importa referir, que após a leitura aprofundada sobre esta matéria, baseada em investigações anteriores, considerámos a tomografia acústica, ou seja definimos que não só estudaríamos a trajetória do raio sonoro ao longo da fonte mas, também, os tempos efetuados pelo mesmo. Com isto, sugerimos a colocação de emissores e recetores ao redor da fonte, o que nos permitiu observar o comportamento das trajetórias. Isto porque são introduzidos parâmetros iniciais como por exemplo, a posição do emissor e o ângulo de emissão do mesmo. Os resultados deste trabalho são efetuados através da ferramenta MATLAB e apresentados em gráficos que contêm os desenhos das trajetórias e os tempos calculados das mesmas. The study of the ocean is a theme of infinite interest and discovery. Not only for navy officials but also for the population in general. This work focuses on a tiny part of the ocean, that which concerns the recently discovered hydrothermal vents. These are discharges of very hot water that escape through crevices from the bottom of the ocean. They are a great source of biodiversity and interest, but still largely unstudied as regards their morphology, composition, possible economic interest and so on. Having reviewed some previous recent studies, we choose to deepen our study on the behaviour of the sound ray trajectories through these vents. In a first part of this work, we did a review that helped us to understand better, the propagation of sound, with ray approximation, through pre-defined temperature field modelling simple deep water hydrothermal vent. Next, we introduce some known sound velocity equations in order to be able to evaluate the behaviour of the sound rays due to changes in the water parameters. Such as temperature, depth and salinity. The one that has greater influence in this case is the temperature. With these initial studies, some models were constructed so that we had an initial assessment of what one should observe in the field experiments. We also considered besides the trajectory of the sound ray through the vents, the times of their propagation between emitter and receiver properly placed around the source. The different trajectories and propagation times, vary as we choose different initial positions of the emitter and of the angle of emission of the ray relative to the vent, but always in a horizontal plane. The results of this work are obtained by solving a nonlinear ODE (ordinary differential equation) with MATLAB and are shown in various graphs containing drawings of the trajectories and their calculated times.

Item does not contain fulltext BACKGROUND: Evidence tailored to sub-Saharan Africa on outcomes of innovations in medical education is needed to encourage and advance their implementation in this region. AIM: To investigate preparedness for practice of students and graduates from an innovative and a conventional medical curriculum in a sub-Saharan African context. METHODS: Using mixed methods we compared junior doctors and fifth-year students from two Mozambican medical schools: one with an innovative problem- and community-based curriculum and one with a conventional lecture- and discipline-based curriculum. A questionnaire on professional competencies was administered, semi-structured interviews were conducted, and work diaries were collected. The findings were integrated in a conceptual model. RESULTS: Six areas of tension between global health care ideals and local health care practice emerged from the data that challenged doctors' motivation and preparedness for practice. Four elements of the innovative curriculum equipped students and graduates with skills, attitudes and competencies to better cope with these tensions. Students and graduates from the innovative curriculum rated significantly higher levels on various competencies and expressed more satisfaction with the curriculum and its usefulness for their work. CONCLUSION: An innovative problem- and community-based curriculum can improve sub-Saharan African doctors' motivation and preparedness to tackle the challenges of health care practice in this region.

A wealth of evidence for the effectiveness of progress testing in problem-based learning curricula has been collected in the Western academic world, but whether the progress testing can be equally effective in problem-based medical schools in resource-poor countries is a question that remains to be answered. In order to provide an initial answer to this question, we describe our experiences with progress testing in a medical school in Mozambique since its establishment in 2001, specifically focusing on test acceptability, formative educational impact, test validity and test reliability. After 7 years of experience, we think that the conclusion is justified that the progress testing can be a feasible and effective assessment instrument even in a resource poor setting. Institutional collaboration is important to guarantee test quality and sustainability.