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Journal Cover Acta Médica Portuguesa
  [SJR: 0.148]   [H-I: 15]   [0 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 0870-399X - ISSN (Online) 1646-0758
   Published by Ordem dos Médicos Homepage  [1 journal]
  • Thank You, Reviewers of Acta Médica Portuguesa

    • Authors: Miguel Guimarães, Tiago Villanueva
      Pages: 1 - 4
      Abstract: -/-
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • 2018: It is Time to Move Forward

    • Authors: Tiago Villanueva
      Pages: 5 - 6
      Abstract: - / -
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Gone with the Fire: How Family Physicians in Central Portugal Experienced
           the Aftermath of the Great Fire of October 15, 2017

    • Authors: Ana Sofia Carvalho, Sara Marques, Frederico Rosário
      Pages: 7 - 8
      Abstract: - / -
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • A Perspective on the OECD Report “Health at a Glance 2017”

    • Authors: Luís Campos
      Pages: 9 - 11
      Abstract: - / -
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Clinical Guidelines and Implementation into Daily Dental Practice

    • Authors: Guliz Nigar Guncu, Secil Karakoca Nemli, Eunice Carrilho, Nermin Yamalık, Elena Volodina, Paulo Melo, Vladimer Margvelashvili, Alessandra Rossi
      Pages: 12 - 21
      Abstract: Introduction: The purpose of this study is to assess the extent of the familiarity, attitude and perceptions of dental professionals regarding clinical dental guidelines and their implementation into daily dental practice.Material and Methods: For this purpose, a questionnaire which was developed by the members of the World Dental Federation, European Regional Organization Working Group − ‘Relation Between Dental Practitioner and Universities’, was implemented by the National Dental Associations of six European Regional Organization-zone countries (Georgian Stomatological Association - Georgia, Associazione Nazionale Dentisti Italiani - Italy, Portuguese Dental Association - Portugal, Russian Dental Association - Russia, Swiss Dental Association - Switzerland, and Turkish Dental Association - Turkey. The questionnaire was filled by a total of 910 dental professionals who are members of one of these national dental associations and who voluntarily wanted to participate to this survey.
      Results: Most of the survey participants were familiar with clinical dental guidelines (68%), claimed that they implemented them into daily practice (61.7%), and generally acknowledged their benefits (81.8%). Many participants believed that clinical dental guidelines could help to improve the clinical treatment plan (50.6 %) and the accuracy of diagnosis (39.4%); which increased with age and years of practice (p < 0.05). The most frequently perceived barrier to the effective implementation of clinical dental guidelines was expressed as ‘lack of awareness’, while participants suggested a role for national dental associations in spreading clinical dental guidelines.
      Discussion: A better understanding of the perceptions and attitudes of dentists towards clinical dental guidelines and the potential impact of factors affecting such perceptions and attitudes may be of particular importance for attempts aiming at overcoming the barriers for effective implementation of clinical dental guidelines into daily practice.
      Conclusion: Despite a significant familiarity and a common positive attitude, dental professionals are likely to have different perceptions towards clinical dental guidelines, especially regarding their effective implementation into daily practice, benefits and barriers. 
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Risk Factors for the Development of Postembolization Syndrome after
           Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

    • Authors: Mariana Lima, Sofia Dutra, Filipe Veloso Gomes, Tiago Bilhim, Élia Coimbra
      Pages: 22 - 29
      Abstract: Introduction: Hepatic transarterial chemoembolization is a widely used technique for the treatment of hepatocellular carcinoma. The most common complication of this procedure is postembolization syndrome. The main objective of this study was to assess risk factors for the development of postembolization syndrome.
      Material and Methods: Single-centre retrospective analysis of 563 hepatic transarterial chemoembolization procedures from January 1st, 2014 – December 31st, 2015. Hepatic transarterial chemoembolization was performed with ½ - 2 vials of 100 - 300 μm microspheres loaded with doxorubicin. Patients who experienced postembolization syndrome were identified based on prolongation of hospitalization due to pain, fever, nausea and/or vomiting. A control group with the patients who did not have postembolization syndrome was randomly created (three controls for one case). Descriptive analysis and multivariate logistic regression were performed.
      Results: The overall prevalence of postembolization syndrome was 6.2%. Hepatic transarterial chemoembolization with doxorubicin dosage above 75 mg (more than one vial), the size of the largest nodule and female gender had statistically significant relation with development of postembolization syndrome (p = 0.030, p = 0.046 and p = 0.037, respectively).
      Discussion: Doxorrubicin dosage above 75 mg is associated with a higher risk of postembolization syndrome. This result can be helpful for decision-making in clinical practice, whenever it is possible to avoid a higher dose without compromising the efficacy of the treatment. The size of the largest nodule and female gender also constitute risk factors for postembolization syndrome. The other variables studied were not related to the development of postembolization syndrome.
      Conclusion: The dose of doxorrubicin, the size of the largest nodule treated and female gender are potential risk factors for the development of postembolization syndrome after hepatic transarterial chemoembolization for hepatocellular carcinoma.
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Quality of Life of Children with Otitis Media and Impact of Insertion of
           Transtympanic Ventilation Tubes in a Portuguese Population

    • Authors: Ana Rita Lameiras, Deodato Silva, Assunção O´Neill, Pedro Escada
      Pages: 30 - 37
      Abstract: Introduction: Quality of life is an important measure for health-outcome evaluation. Although otitis media is one of the most common childhood diseases, its impact on Portuguese children’s quality of life is unknown. The aim of this study is to determine the quality of life of Portuguese children with chronic otitis media with effusion and/or recurrent acute otitis media and the short-term impact of transtympanic ventilation tubes, using the Portuguese version of the OM-6 questionnaire, a valid, reliable and sensitive instrument to evaluate the health-related quality of life in children with otitis media.

      Material and Methods: This study was conducted in a tertiary referral center, to where children are referred from primary care and hospital pediatric consultations. The Portuguese version of the OM-6 questionnaire was applied to children with chronic otitis media with effusion and/or recurrent acute otitis media. The instrument was re-administered at two months postoperatively to a group of children who underwent tympanostomy tube placement, to evaluate the change in quality of life with the surgical procedure.

      Results: The study involved a sample of 169 children, aged between 6 months and 12 years (mean: 4.20 ± 2.05 years). The average score in the survey was 3.3 ± 1.47, of a maximum of 7 (worst quality of life). The domains ‘caregiver concerns’, ‘hearing loss’ and ‘physical suffering’ had the highest scores. The domain ‘hearing loss’ was correlated with the domain ‘speech impairment’ (rs = 0.41; p < 0.001) and the domain ‘physical suffering’ correlated with the domain ‘activity limitation’ (rs = 0.47; p < 0.001). There was a correlation between the score on ‘hearing loss’ and the presence of conduction hearing loss (χ2 (6) = 24.662; p = 0.022). Children with chronic otitis media with effusion had lower scores on the domain ‘physical suffering’, while children with recurrent acute otitis media had lower scores in the domain ‘hearing loss’ and higher scores in the domain ‘emotional distress’. There was an improvement in the quality of life in all the dimensions studied by the questionnaire after surgery. The improvement was large in 55%, moderate in 15% and small in 10% of the cases. The presence of otorrhea postoperatively did not decrease the quality of life improvement achieved with surgery.

      Conclusion: Otitis media has a negative impact on Portuguese children quality of life. Tympanostomy tubes improve quality of life related to the middle ear in most children. The application of validated disease-specific questionnaires allows an enhanced understanding of the impact of otitis media on Portuguese children quality of life and of the success of therapeutic measures.
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Mortality from Suicide in the Municipalities of Mainland Portugal:
           Spatio-Temporal Evolution between 1980 and 2015

    • Authors: Adriana Loureiro, Ricardo Almendra, Cláudia Costa, Paula Santana
      Pages: 38 - 44
      Abstract: Introduction: Suicide is considered a public health priority. It is a complex phenomenon resulting from the interaction of several factors, which do not depend solely on individual conditions. This study analyzes the spatio-temporal evolution of suicide mortality between 1980 and 2015, identifying areas of high risk, and their variation, in the 278 municipalities of Continental Portugal.

      Material and Methods: Based on the number of self-inflicted injuries and deaths from suicide and the resident population, the spatio-temporal evolution of the suicide mortality rate was assessed via: i) a Poisson joinpoint regression model, and ii) spatio-temporal clustering methods.

      Results: The suicide mortality rate evolution showed statistically significant increases over three periods (1980 - 1984; 1999 - 2002 and 2006 - 2015) and two statistically significant periods of decrease (1984 - 1995 and 1995 - 1999). The spatio-temporal analysis identified five clusters of high suicide risk (relative risk >1) and four clusters of low suicide risk (relative risk < 1).

      Discussion: The periods when suicide mortality increases seem to overlap with times of economic and financial instability. The geographical pattern of suicide risk has changed: presently, the suicide rates from the municipalities in the Center and North are showing more similarity with those seen in the South, thus increasing the ruralization of the phenomenon of suicide.

      Conclusion: Between 1980 and 2015 the spacio-temporal pattern of mortality from suicide has been changing and is a phenomenon that is currently experiencing a growing trend (since 2006) and is of higher risk in rural areas. 
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Factors Influencing the Implementation of Screening and Brief
           Interventions for Alcohol Use in Primary Care Practices: A Systematic
           Review Protocol

    • Authors: Frederico Rosário, Maria Inês Santos, Kathryn Angus, Leo Pas, Niamh Fitzgerald
      Pages: 45 - 50
      Abstract: Introduction: Alcohol is a leading risk factor contributing to the global burden of disease. National and international agencies recommend evidence-based screening and brief interventions in primary care settings in order to reduce alcohol consumption. However, the majority of primary care professionals do not routinely deliver such interventions.

      Objective: To identify factors influencing general practitioners/family physicians’ and primary care nurses’ routine delivery of alcohol screening and brief intervention in adults.

      Material and Methods: A systematic literature search will be carried out in the following electronic databases: Medline, CINAHL, CENTRAL, and PsycINFO. Two authors will independently abstract data and assess study quality using the NIH National Heart, Lung, and Blood Institute quality assessment tools for quantitative studies, and the CASP checklist for qualitative studies. A narrative synthesis of the findings will be provided, structured around the barriers and facilitators identified. Identified barriers and facilitators will be further analysed using the Behavioural Change Wheel/Theoretical Domains Framework.

      Discussion: This review will describe the barriers to, and facilitators for, the implementation of alcohol screening and brief interventions by general practitioners/family physicians and nurses at primary care practices. By mapping the barriers and facilitators to the domains of the Behavioural Change Wheel/Theoretical Domains Framework, this review will also provide implementation researchers with a useful tool for selecting promising practitioner-oriented behavioural interventions for improving alcohol screening and brief intervention delivery in primary care.

      Conclusion: This review will provide important information for implementing alcohol screening and brief intervention in primary health care.

      Systematic Review Registration: PROSPERO CRD42016052681 
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Delirium: The 7th Vital Sign'

    • Authors: Rita Prayce, Filipa Quaresma, Isabel Galriça Neto
      Pages: 51 - 58
      Abstract: Introduction: Delirium is an acute, transient and fluctuating neuropsychiatric syndrome that is common in medical wards, particularly in the geriatric and palliative care population.

      Material and Methods: We present a brief literature review of the definition, pathophysiology, aetiology, diagnosis, prevention and treatment of delirium and its social and economic impact.

      Results and Discussion: Delirium is under-recognized, especially by health professionals, and is associated with higher morbidity, mortality and economic burden. Moreover, the presence of delirium interferes with the evaluation and approach to other symptoms. Furthermore, it causes significant distress in patient’s families and health professionals. The best treatment for delirium is prevention which is based on multidisciplinary interventions that addresses the main risk factors. The scientific evidence for the treatment of delirium is scarce. Non-pharmacological approaches are usually the first choice, and includes environmental, behavioural and social strategies. Pharmacological options, mainly antipsychotics, are a second-line treatment used essentially to prevent self harm.

      Conclusion: The recognition and prevention of delirium are crucial. Health professional education and training, patient clinical monitoring and families support are mandatory. Considering the impact of delirium on patients, relatives, health services and professionals we must be more aware of delirium and, why not, make it the 7th vital sign.
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Hidradenitis Suppurativa: Combined Treatment with Dermal Template, Skin
           Graft and Negative Pressure Wound Therapy, a Case Study

    • Authors: Luís Mata Ribeiro, Ana Silva Guerra
      Pages: 59 - 62
      Abstract: Hidrosadenitis supurativa is a chronic inflammatory disease with great physical and psychological impact. Although conservative treatments may be effective in mild forms of the disease, extensive surgical resection and reconstruction are necessary in more severe forms of the disease. The purpose of this paper is to describe our two-stage reconstructive procedure regarding this kind of disease. We present a clinical case of a patient with severe, bilateral axillary hidrosadenitis. In the first surgical step we excised the lesions and applied the artificial dermis secured with negative pressure wound therapy. In the second step we used a split thickness skin graft to close the wound and again applied negative pressure wound therapy. The graft take was very good, without complications. The cosmetic outcome is acceptable and shoulder mobility was not compromised. No recurrence was detected (nine months follow up).
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Radiofrequency for Treatment of Refractory Epistaxis in Hereditary
           Hemorrhagic Telangiectasia

    • Authors: Mariana Donato, João Pimentel, Rui Cabral, Pedro Escada
      Pages: 63 - 66
      Abstract: Hereditary hemorrhagic telangiectasia is a rare multi-systemic autosomal dominant disorder characterized by dysplasia of the vascular connective tissue and recurrent bleeding tendency. Epistaxis is the most common and earliest symptom. It is usually mild to moderate, however, in some patients it can be severe with significant interference in quality of life. We report a case of a patient with hereditary hemorrhagic telangiectasia, in which an episode of refractory epistaxis was treated with radiofrequency and fibrin sealant. Control of acute bleeding and elimination of telangiectasia was possible with this technique. After six months follow-up, there was no epistaxis recurrence. Various treatments for epistaxis in this disease have been described in the literature, but there is no consensus about the gold-standard procedure. Radiofrequency ablation of telangiectasia is a recent technique that has shown to be safe, effective and well tolerated, even in patients who underwent other previous treatments.
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Pneumatocele, Pneumocephalus or Aerocele

    • Authors: Jana Zelinova, Marta Custódio, Anabela Salgueiro Marques
      Pages: 67 - 67
      Abstract: - / -
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Congenital Hip Dislocation: A Rare Case in Adulthood

    • Authors: Natália Ferreira, Marcelo Abreu, Armando Abreu
      Pages: 68 - 68
      Abstract: - / -
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Letter to the Editor: Infectious Mononucleosis and Cholestatic Hepatitis

    • Authors: Vitorino Modesto Santos
      Pages: 69 - 69
      Abstract: N/A
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
  • Letter to the Editor. Use of Vitamin K Antagonists in Patients on
           Hemodialysis: Is Benefit Greater than the Risk'

    • Authors: Iolanda Godinho, André Weigert
      Pages: 69 - 70
      Abstract: - / -
      PubDate: 2018-01-31
      Issue No: Vol. 31, No. 1 (2018)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
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