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“O Meu Coração Bate Saudável” – Results From a Pilot Project for Health Education in Portuguese Children
No full textIntroduction and objectives: Childhood offers an excellent window of opportunity to start interventions to promote behavioral changes before unhealthy lifestyles become established, leading to cardiovascular diseases. The goal of this pilot educational project for children is the promotion of healthy lifestyles and cardiovascular health.
Methods: This project was implemented in 4th grade children and included teacher-led classroom activities, a lesson given by a cardiologist and a practical lesson with dietitians. The teacher received a manual containing information on the topics to be discussed in class with the pupils and the children received a book that addresses cardiovascular risk factors and prevention. The components included were diet (D), physical activity (PA) and human body and heart awareness (BH). At the beginning and at the end of the schoolyear, a questionnaire was applied to the children to assess knowledge (K), attitudes (A) and habits (H) on these topics.
Results: A total of 73 children from two schools from an urban district public school in Lisbon, in a low to medium income area, participated in the project. Following the intervention, there was a 9.5% increase in the overall KAH score, mainly driven by the PA component (14.5%) followed by the BH component (12.3%). No improvement was observed for component D. The benefits were also more significant in children from a lower income area, suggesting that socioeconomic status is a determinant in the response obtained.
Conclusions: An educational project for cardiovascular health can be implemented successfully in children aged 9 years, but longer and larger studies are necessary.info:eu-repo/semantics/publishedVersio
Broncho-Esophageal Fistula: When Surgery and Endoscopy Fail, Consider Physiological Lung Exclusion
No full textWe discuss the case of an esophageal cancer patient treated by chemo and radiotherapy complicated by an esophageal stenosis and an iatrogenic broncho-esophageal fistula. This latter was managed with multiple palliative stenting procedures and colonic surgical bypass. Despite a long disease free survival but decreased quality of life and frailty, we came to the proposal of an extremely unusual form of treatment - physiological lung exclusion, with clinical benefit and so far without any drawbacks related to the procedure.info:eu-repo/semantics/publishedVersio
Higher Risk of Preterm Twin Delivery Among Shorter Nulliparous Women
No full textObjective: To determine if maternal height in nulliparous women influences pregnancy results in twin pregnancies.
Material and methods: Retrospective cohort analysis evaluating twin pregnancies followed at Centro Hospitalar Universitário Lisboa Central, between 1995 and 2020. Of the 2900 pregnancies followed in that period, 886 nulliparous women with dichorionic twin pregnancies were selected. Two groups were considered: A - maternal height <163 cm (<Q2) (n = 436) and B - maternal height ≥167 cm (≥Q3) (n = 234), The following results were compared: Age, body mass index (BMI), premature contractions, premature rupture of membranes (PROM), hypertensive disorders, gestational diabetes, gestational age at birth, delivery <28, <32, <34, < 36, ≥37 weeks (wks), average weight of newborns, very low birth weight, low birth weight, cesarean section rate, stillbirths, five minute Apgar score, neonatal death and perinatal death.
Result(s): PTB rates decreased along increasing maternal height. The comparison between group A and group B revealed no statistically significant differences in maternal characteristics (age, mode of conception - spontaneous or ART pregnancies, or BMI). Statistically significant differences were found in mean gestational age at birth (35.1 ± 1.8 vs. 36.0 ± 2.6 wks), PTB rates < 32, 34 and 36 wks, OR: 3.2, 2.3 and 2.4 respectively, p < 0.01. Shorter women had a 1.7× and 2.6× increased risk for significantly low (<2500 g) and very low (<1500 g) newborn birth weight (BW), respectively, and a 40 % increased risk of Cesarian delivery. No significant differences were shown with respect to stillbirths, neonatal and perinatal deaths, which had a low incidence in this study. In ART pregnancies we found the same results regarding PTB rates and newborn birthweight in shorter women. In Logistic Regression analysis, maternal height <Q2 is an independent risk factor for PTB under 32, 34 and 36 wks, adjusted OR: 2.0. 2.2 and 2.4, respectively, 95 % CI 1.1-3.7, p = 0.021.
Conclusion: Increased pregnancy risk in nulliparous shorter women should be taken into consideration in double embryo transfers.info:eu-repo/semantics/publishedVersio
Suplementos Multivitamínicos na Gravidez: Qual a Evidência?
No full textO período da gravidez constitui uma etapa chave na qual se deve apostar na promoção de estilos de vida saudáveis. Durante esta fase, as necessidades energéticas e de alguns nutrientes estão aumentadas para dar resposta às alterações metabólicas que ocorrem. Apesar de só haver indicação por parte da Organização Mundial da Saúde e Direção-Geral da Saúde para suplementar a mulher grávida com ácido fólico, ferro e iodo, a utilização de suplementos alimentares com vitaminas e minerais destinados para mulheres grávidas, é muitas vezes recomendada. Pretende-se neste artigo, apresentar a evidência que existe relativamente à toma destes suplementos na gravidez.info:eu-repo/semantics/publishedVersio
Cyto-Histological Profile of MicroRNAs as Diagnostic Biomarkers in Differentiated Thyroid Carcinomas
No full textIntroduction: The repertoire of microRNAs (miRNAs) in thyroid carcinomas starts to be elucidated. Among differentiated thyroid carcinomas (DTCs), papillary thyroid carcinoma (PTC) is the most frequent. The assessment of miRNAs expression may contribute to refine the pre-surgical diagnosis in order to obtain a personalized and more effective treatment for patients.
Aims: This study aims to evaluate (1) the miRNAs in a series of DTCs, and their association with the presence of selected genetic mutations in order to improve diagnosis and predict the biologic behavior of DTC/PTC. (2) The reliability of molecular tests in Ultrasound-guided Fine Needle Aspiration Cytology (US-FNAC) for a more precise preoperative diagnosis.
Material and methods: This series includes 176 samples (98 cytology and 78 histology samples) obtained from 106 patients submitted to surgery, including 13 benign lesions (controls) and 93 DTCs (cases). The microRNA expression was assessed for miR-146b, miR-221, miR-222, and miR-15a through quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). The results were analyzed by the 2-ΔΔCT method, using miR16 as an endogenous control. Regarding PTC diagnosis, the discriminative ability of miRNAs expression was assessed by the area under the Receiver Operating Characteristic Curve (AUC). In PTCs, the association of miRNAs expression, clinicopathological features, and genetic mutations (BRAF, RAS, and TERTp) was evaluated.
Results/discussion: All the analyzed miRNAs presented a tendency to be overexpressed in DTCs/PTCs when compared with benign lesions, both in cytology and histology samples. In cytology, miRNAs expression levels were higher in malignant tumors than in benign tumors. In histology, the discriminative abilities regarding PTC diagnosis were as follows: miR-146b (AUC 0.94, 95% CI 0.87-1), miR-221 (AUC 0.79, 95% CI 0.68-0.9), miR-222 (AUC 0.76, 95% CI 0.63-0.89), and miR-15a (AUC 0.85, 95% CI 0.74-0.97). miR-146b showed 89% sensitivity (se) and 87% specificity (sp); miR-221 se = 68.4, sp = 90; miR-222 se = 73, sp = 70; and mi-R15a se = 72, sp = 80. MicroRNAs were associated with worst-prognosis clinicopathological characteristics in PTCs (p < 0.05), particularly for miR-222. Our data reveal a significant association between higher expression levels of miR-146b, miR-221, and miR-222 in the presence of the BRAF mutation (p < 0.001) and miR-146b (p = 0.016) and miR-221 (p = 0.010) with the RAS mutation, suggesting an interplay of these mutations with miRNAs expression. Despite this study having a relatively small sample size, overexpression of miRNAs in cytology may contribute to a more precise preoperative diagnosis. The miRNAs presented a good discriminative ability in PTC diagnosis. The association between the miRNAs expression profile and genetic alterations can be advantageous for an accurate diagnosis of DTCs/PTCs in FNAC.info:eu-repo/semantics/publishedVersio
Estratégias para a Promoção da Investigação nos Cuidados de Saúde Primários em Portugal: Um Estudo Qualitativo
No full textIntroduction: There are several barriers discouraging clinicians from undertaking research, including insufficient funding, lack of time, organizational issues and lack of support. The strengthening of research capacity is perceived from three levels: characteristics of the researcher, the environment, and organizational issues. To date, Portugal is lacking studies on this subject. The aim of this study was to identify the best practices to promote research in Portuguese Primary Health Care.
Methods: We conducted a qualitative study using semi-structured interviews with family doctors with broadly recognized research work and other stakeholders. We selected a sample by convenience and snowball sampling. From a total of 14 doctors invited by email, 12 responded positively, and we subsequently included two other stakeholders. We conducted the interviews in digital or face-to-face formats. Two team members handled the coding of interviews independently. We kept all recordings and transcripts confidential, only accessible to researchers.
Results: We identified 16 strategies: 1) increasing institutional support; 2) creating support structures; 3) redefining the residency program; 4) investing in research training; 5) redefining curriculum evaluation; 6) establishing dedicated time for research; 7) increasing funding; 8) improving access to research data; 9) being a research driver; 10) establishing a research culture; 11) working in collaboration; 12) creating formally organized research groups; 13) creating autonomous research centers; 14) improving the definition of the research subjects and study designs; 15) reviewing procedures for ethics' committees; and 16) reviewing the current selection of articles for publication.
Conclusion: Overall, a greater proportion of interviewees identified the following as the most relevant strategies for research promotion: institutional support, including technical and scientific support from public institutions, private entities and academic centers; the reorganization of working hours with protected time for research; increased funding directed towards research and breaking isolation in research, promoting teamwork with clinicians within the same area or from different professional backgrounds.info:eu-repo/semantics/publishedVersio
Eating Disorders: Case Series of the Child and Adolescent Psychiatry Inpatient Unit of Hospital Dona Estefânia in 2022
No full textINTRODUÇÃO: As perturbações do comportamento alimentar (PCA) são patologias com alta morbilidade e significativo impacto na vida de crianças e adolescentes. Trata-se de doenças biopsicossociais, envolvendo fatores de natureza individual, familiar e sociocultural. Apresentam elevada comorbilidade com outras perturbações psiquiátricas. As complicações orgânicas são comuns.
O nosso objetivo foi caracterização dos doentes internados com diagnóstico principal de Perturbação do Comportamento Alimentar na Unidade de Internamento de Pedopsiquiatria do HDE durante o ano de 2022. Descrição das características dos doentes do ponto de vista familiar, social e médico e dos respetivos internamentos e seguimentos.
MÉTODOS: Estudo retrospetivo, descritivo, a partir da consulta do processo clínico dos doentes internados na Unidade de Internamento de Pedopsiquiatria do HDE com o diagnóstico de PCA de janeiro a dezembro de 2022 (inclusive). Posteriormente foi realizada uma análise descritiva dos dados e tratamento com recurso ao programa SPSS.
RESULTADOS: De um total de 48 doentes, a média de idades foi de 14 anos e 4 meses, sendo a maioria (95,8%, n=46) do sexo feminino. A maioria (77,1%, n=37) correspondia a uma anorexia nervosa tipo restritivo, 20,8% (n=10) a uma anorexia tipo ingestão compulsiva/purgativo e um caso de perturbação de ingestão alimentar evitante/restritiva. As perturbações depressivas foram a comorbilidade mais frequente (25%, n=12).
CONCLUSÃO: O tratamento das PCA deve ser feito a partir de uma abordagem multidisciplinar. Será importante, no futuro, uma reflexão sobre os principais motivos que conduzem à necessidade de reinternamento.info:eu-repo/semantics/publishedVersio
Coração com Moçambique: a Contribuição Portuguesa para a Erradicação da Doença Cardíaca Reumática
No full textinfo:eu-repo/semantics/publishedVersio
Disforia de Género: Conceitos, Diagnóstico e Abordagem Clínica
No full textGender dysphoria is defined as a condition characterized by mental suffering associated with the incongruence between one's experienced gender and their birth-assigned sex. Gender as a construct and gender dysphoria as a condition in need of multidisciplinary intervention have developed as swiftly as their visibility in society, making it mandatory to promote the literacy and education of all healthcare professionals in this area. This article aims to review information based on scientific evidence on people with gender dysphoria and its clinical approach, while contributing to a safe, inclusive, and non-discriminatory practice of healthcare.info:eu-repo/semantics/publishedVersio
Analysis of the Relationship Between Performance and Commitment in Health Professionals: a Systematic Review
No full textIntrodução – O desempenho dos profissionais de saúde refere-se às competências clínicas, conhecimentos e habilidades técnicas, enquanto o seu comprometimento está relacionado com o vínculo psicológico e emocional com o trabalho e a organização. A compreensão da interação entre estes conceitos é importante para otimizar os resultados em saúde. Objetivos – Explorar a extensão e a natureza da relação entre desempenho e comprometimento nos profissionais de saúde, identificando os fatores que influenciam esta relação e quais as metodologias utilizadas para o seu estudo. Métodos – Foi realizada uma revisão sistemática da literatura seguindo o protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Resultados – Foram identificados 847 artigos, dos quais 14 foram incluídos para análise.
Destaca-se a atualidade e universalidade do tema devido à profunda interação entre os constructos estudados. Alguns estudos apontam para correlações positivas diretas, enquanto outros evidenciam relações de influência mútua ou identificam o comprometimento como mediador em várias interações. Além disso, fatores como a satisfação no trabalho, o burnout, a liderança e a motivação também impactam a relação entre desempenho e comprometimento nos profissionais de saúde. Discussão – A relação entre desempenho e comprometimento nos profissionais de saúde é complexa e suscetível a diferentes influências. Conclusão – É pertinente a continuação de investigações para aprofundar o conhecimento nesta área, já que as organizações de saúde enfrentam o desafio contínuo de proporcionar uma assistência de qualidade aos pacientes, ao
mesmo tempo que tentam gerir de forma eficiente recursos limitados.Introduction – Healthcare professionals’ performance refers to their clinical skills, knowledge, and technical abilities, while their commitment refers to their psychological and emotional attachment to the work and the organization. Understanding the interaction between these concepts is important for optimizing health outcomes. Aims – To explore the extent and nature of the relationship between performance and commitment in healthcare professionals, to identify the factors that influence this relationship and the methods used to study it. Methods – A systematic review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol. Results – 847 articles were identified, of
which 14 were included in the analysis. The timeliness and universality of the topic is highlighted by the strong interaction between the constructs studied. Some studies suggest direct positive correlations, while others highlight relationships of mutual influence or identify commitment as a mediator in multiple interactions. In addition, factors such as job satisfaction, burnout, leadership, and motivation also influence the relationship between performance and commitment in healthcare professionals. Discussion – The relationship between performance and commitment in healthcare professionals is complex and susceptible to multiple influences. Conclusion – It is pertinent to continue research to deepen knowledge in this area, as healthcare organizations
face the ongoing challenge of providing quality care to patients while trying to manage limited resources efficiently.info:eu-repo/semantics/publishedVersio