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In the last decade (2010–2020), more than half of European countries have improved their health policies within the primary care for type 2 diabetes mellitus. Community pharmacies have been and could continue to be essential actors in this evolution of fighting the disease by providing a set of pharmacotherapeutic follow-up services for the person with diabetes. These services, designated by the Pharmaceutical Group of the European Union as “diabetes management” and “glucose measurement”, have aimed to optimize adherence to therapy and improve health outcomes. However, to follow the European guidelines of Good Pharmacy Practice, providing these services implies having a normative framework or a legal basis. Thus, this study sought to analyze the normative and regulatory framework on which community pharmacies in 28 European countries were based on providing this health care over the last decade.

PurposeThe CRIAS (Health trajectories of Immigrant Children in Amadora) cohort study was created to explore whether children exposed to a migratory process experience different health risks over time, including physical health, cognitive, socioemotional and behavioural challenges and different healthcare utilisation patterns.ParticipantsThe original CRIAS was set up to include 604 children born in 2015, of whom 50% were immigrants, and their parents. Recruitment of 420 children took place between June 2019 and March 2020 at age 4/5 years, with follow-up carried out at age 5/6 years, at age 6/7 years currently under way.Findings to dateBaseline data at age 4/5 years (2019–2020) suggested immigrant children to be more likely to belong to families with less income, compared with non-immigrant children. Being a first-generation immigrant child increased the odds of emotional and behavioural difficulties (adjusted OR 2.2; 95% CI: 1.06 to 4.76); more immigrant children required monitoring of items in the psychomotor development test (38.5% vs 28.3%). The prevalence of primary care utilisation was slightly higher among immigrant children (78.0% vs 73.8%), yet they received less health monitoring assessments for age 4 years. Utilisation of the hospital emergency department was higher among immigrants (53.2% vs 40.6%). Age 5 years follow-up (2020–2021) confirmed more immigrant children requiring monitoring of psychomotor development, compared with non-immigrant children (33.9% vs 21.6%). Economic inequalities exacerbated by post-COVID-19 pandemic confinement with parents of immigrant children 3.2 times more likely to have their household income decreased.Future plansFurther follow-up will take place at 8, 10, 12/13 and 15 years of age. Funds awarded by the National Science Foundation will allow 900 more children from four other Lisbon area municipalities to be included in the cohort (cohort-sequential design).

Background: The analysis of the European Union (EU28) health systems’ intervention for type 2 diabetes mellitus (T2DM) reports an insufficient combination of legal support, prevention, and early diagnosis. This fact compromises the patient’s health outcomes. The inclusion of pharmacy services oriented to T2DM (PS-T2DM) in strategic primary care network’s programs could be a solution. However, the different regulatory frameworks that include good pharmaceutical practices and clinical guidelines for T2DM in each EU28 country may be a limitation. Health systems need to know the evolution of these community services and to analyze their operational and regulatory base, both in time and space. Methods: A systematic review was carried out on a qualitative and quantitative approach to the expansion and upgrading of PS-T2DM provided in EU28 pharmacies between 2008 and 2018. Results: The implementation of PST2DM in EU28 has increased sharply since 2009 and 2010. Diabetes mellitus (DM) is regulated in 5 countries (Bulgaria, Spain, Italy, Lithuania, and Portugal) and T2DM in 3 (Austria, Latvia, and Romania). Also, in 3 countries (Latvia, Poland, and Spain), pharmacists are involved in implementing guidelines for DM and T2DM, but there is no evidence on the regulation of PS-T2DM. Twenty-two countries showed detailed studies for the PS-T2DM’s provision. The type of PS-T2DM implemented in the highest number of EU28 countries was “promoting the rational use of medicines,” and the specific subtype T2DM-related more commonly reported was the “glucose measurement.” Discussion/Conclusion: Pharmacy disease-oriented services contributed to improving the accessibility, proximity, and equity of primary care for T2DM provided in community pharmacies across the EU28 in recent decades. This promising strategy for improving health outcome sets may be a call to the action of health systems due to its impact consistent with some objectives of universal health coverage for the eradication of DM and T2DM. RESUMO - Introdução: A análise da intervenção dos sistemas de saúde da União Europeia (UE28) para a diabetes mellitus tipo 2 (T2DM) relata uma combinação insuficiente em termos de apoio jurídico, prevenção e diagnóstico precoce da doença, o que compromete os resultados de saúde. A inclusão de serviços de cuidados farmacêuticos orientados para a T2DM (PS-T2DM) nos programas estratégicos da rede de cuidados de saúde primários pode ser uma solução. No entanto, a diferente estrutura reguladora, que inclui as boas práticas farmacêuticas e as diretrizes clínicas para T2DM de cada país da UE28 podem ser uma limitação. Os sistemas de saúde devem conhecer a evolução conjunta desses serviços e analisar a sua base operacional e regulatória, tanto no tempo quanto no espaço. Métodos: Foi realizada uma revisão sistemática, numa abordagem qualitativa e quantitativa, da expansão e atualização da prestação de PS-T2DM nas farmácias comunitárias da UE28 entre 2008 e 2018. Resultados: Houve um aumento do número e tipo de PS-T2DM na UE28 desde 2009-2010. A diabetes mellitus (DM) encontra-se regulada em 5 países (Bulgária, Espanha, Itália, Lituânia e Portugal) e a T2DM em 3 (Áustria, Letônia e Romênia). Além disso, em 3 países (Letônia, Polônia e Espanha) os farmacêuticos estão envolvidos na implementação das guidelines para a DM e T2DM, embora não haja evidências sobre a regulamentação dos PS-T2DM. Vinte e dois países mostraram estudos concretos para a prestação de PST2DM. O tipo de PS-T2DM implementado num maior número de países da UE28 foi “promoção do uso racional de medicamentos” e o subtipo específico para a T2DM mais comumente relatado foi a “medição de glicose”. Discussão / Conclusão: A crescente contribuição para a melhoria da acessibilidade, proximidade e equidade dos cuidados primários para T2DM prestados em farmácias comunitárias em toda a UE28 nas últimas décadas deve-se à disponibilidade crescente de serviços orientados para a doença. Essa estratégia promissora do melhoramento dos resultados de saúde mostrou a possibilidade de ter um impacto positivo e consistente com alguns objetivos da cobertura universal de saúde para a erradicação da DM e da T2DM, assim como atuar como um apelo à ação dos sistemas de saúde. info:eu-repo/semantics/publishedVersion

ObjectiveTo describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks.MethodsClinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses.ResultsIn Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (pfor–trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G.ConclusionOur molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.