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Journal Cover Acta Médica Portuguesa
  [SJR: 0.155]   [H-I: 11]   [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

    • Pages: 1 - 4
      Abstract: N/a
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • General Practitioner Sentinel Network as a Tool of [Public] Health

    • Authors: Ana Paula Rodrigues, Rita Carvalho Fonseca, Carlos Matias-Dias
      Pages: 5 - 9
      Abstract: Current strategies of European health advocate the strengthening of the role of public health, requiring from decision-makers the ability to defend and enhance the health of individuals and populations in all policies. In the pursuit of this objective, public health should be evidence-based and so public health surveillance, seen as an important tool of public health since the nineteenth century, plays a central role in public health practice through the production and dissemination of the health information necessary for health planning and for evaluation of public health actions. Within the practice of public health estimations of disease frequency are important for outbreak control, health assessment, health needs assessment and estimation of health gains, but unfortunately these estimations are not always available for the entire population. In those cases and for diseases with high prevalence sentinel surveillance based in sentinel networks have some advantages for specific groups, namely needed of scarce resources and obtainment of quick results.
      The central role of family doctors in chronic disease management, their knowledge on individuals and families and their responsibilities in the management of a clear defined patients list are characteristics that make general practice an appropriate context to develop a sentinel network. In fact, in Portugal there is a general practitioner sentinel network named Rede Médicos-Sentinela working since 1989 which estimated, for the last 25 years, incidence rates of several chronic diseases, some of them targeted on national priority health programs. Thus, we consider that Rede Médicos-Sentinela can be integrated in a national surveillance system for chronic diseases in Portugal.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • Heart Failure: A New Epidemic of Cardiovascular Disease

    • Authors: Doroteia Silva, Miguel Angel Gomez-Sanchez
      Pages: 10 - 11
      Abstract: Keywords: Cardiovascular Diseases; Heart Failure.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • Analysis of the Cochrane Review: Incentives for Smoking Cessation.
           Cochrane Database Syst Rev. 2015;5:CD004307.

    • Pages: 12 - 14
      Abstract: Material incentives for alteration or reinforcement of healthy behaviours have been widely used in several health systems. These incentives, which are used in various contexts such as workplaces, health facilities or community programs, have been successfully implemented in smoking cessation programs. This systematic review - a third updated version of two published previously - sought to determine if a given set of incentives increased abstinence rates in smokers of medium and high risk (pregnant women). The authors searched several databases until December 2014: the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, CINAHL and PsycINFO. Two trials published in 2105 were included. The main results were:
      - In mixed populations (medium risk) six months after the onset there is a greater probability of withdrawal in patients subject to incentives. Direct payments to smokers - through different forms - were particularly effective (North American studies);
      - In populations of pregnant women (high risk), incentives caused a higher abstinence rate either during pregnancy or in the long term (up to 24 weeks postpartum).
      The authors conclude that the incentives appear to be effective in increasing the rate of smoking cessation in medium-risk as well as high-risk populations (e.g. pregnant women).
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • Oncology Referral Concerning Paediatric Neurosurgery' Analysis of the
           Situation between 2008-2013 in the North of Portugal

    • Pages: 15 - 23
      Abstract: Introduction: Primary central nervous system tumours represent the second most frequent neoplasm and are the leading cause of death from solid tumours in children. Our study aimed to provide the most up-to-date epidemiological analysis of primary central nervous system tumours in children living in the north of Portugal and to explore a possible effect of the centralisation of care on outcomes.
      Material and Methods: This population-based study included all newly diagnosed and histologically confirmed primary central nervous system tumours in people below 18 years old, living in the north of Portugal, from January 2008 to December 2013. Data were collected through access to clinical files. We described children and tumour characteristics, and analysed patient: paediatric neurosurgeon and histological tumour type: paediatric neurosurgeon ratios.
      Results: A total of 147 cases was recorded. Mean age at diagnosis of primary central nervous system tumours was 8.0 ± 5.2 years. Astrocytomas were the most common histological type (34%). We found that World Health Organization Tumour Grade was the only variable of statistically significant influence in mortality (p = 0.001). 1-, 3- and 5-year survivals related to 2008-2013 period were statistically higher than 2005 - 2007. Astrocytomas have the highest survival rate, with statistically significant difference from other tumours (p = 0.015). We estimated a mean of 12.25 treated cases per year by each paediatric neurosurgeon at our institution.
      Discussion: Our results are globally consistent with those published all over the world, but we reported the highest survival rates. The number of cases treated per year by each neurosurgeon is accordant to the recommended.
      Conclusion: We showed an improvement when comparing to data previous to 2008 and better results than those from previous studies, namely higher survival at 1-, 3- and 5-years from the diagnosis, with low complication and relapsing rates. Therefore, the referral of primary central nervous system tumours cases to centres with larger experience can be invaluable for the achievement of the best outcomes.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • Burnout in Portuguese Healthcare Professionals: An Analysis at the
           National Level

    • Pages: 24 - 30
      Abstract: Introduction: Burnout is a psychological syndrome, characterized by a state of high emotional exhaustion, high depersonalization and low personal accomplishment, which leads to erosion of personal, professional and health values. This study reports the incidence of burnout in Portuguese Healthcare professionals.
      Material and Methods: Burnout in Portugal’s health professionals was assessed with the Maslach Burnout Inventory - Human Services Survey, using a zero (never) to six (always) ordinal scale, on a sample of 1 262 nurses and 466 physicians with mean age of 36.8 year (SD = 12.2) and 38.7 (SD = 11.0), respectively. Participants came from all national districts (35% Lisbon, 18% Oporto, 6% Aveiro, 6% Setúbal, 5% Coimbra, 5% Azores and Madeira), working in hospitals (54%), Families’ Health Units (30%), Personalized Health Units (8%) and other public or private institutions (8%).
      Results: Analysis of MBI-HSS scores, stratified by district, revealed that both types of professionals had moderate to high levels of burnout (M = 3.0, SD = 1.7) with no significant differences between the two groups. Vila Real (M = 3.8, SD = 1.7) and Madeira (M = 2.5, SD = 1.5) were the regions where burnout levels were higher and lower, respectively. Burnout levels did not differ significantly between Hospital, Personalized Health Units and Families’ Health Centers. Professionals with more years in the function were less affected by Burnout (r = -0.15). No significant association was observed with the duration of the working day (r = 0.04). The strongest predictor of burnout was the perceived quality of working conditions (r = -0.35).
      Discussion: The occurrence of the burnout syndrome in Portuguese health professionals is frequent, being associated with a poor working conditions perception and reduced professional experience. The incidence of the burnout syndrome shows regional differences which may be associated with different and suboptimal conditions for health care delivery. Results suggest the need for interventions aimed at improving working conditions and initial job training of health professionals, as requisites for a good professional practice and personal well-being.
      Conclusions: At the national level, between 2011 and 2013, 21.6% of healthcare professionals showed moderate burnout and 47.8% showed high burnout. The perception of poor working conditions was the main predictor of burnout occurrence among the Portuguese health professionals.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • Prevalence of Pre-Obesity/Obesity in Pre and Basic School Children at Vila
           Nova de Gaia, Portugal

    • Pages: 31 - 40
      Abstract: Introduction: Over 30% of Portuguese children present overweight. Being a serious public health problem with multiple causes, only a cross-sectorial and concerted action could contribute to their resolution. Municipalities have a set of skills that make them ideal for effective intervention in the fight against this problem. For this action to be effective there must be a local assessment of the extent of the problem and their spatial distribution. The aim of this study was to characterize, from the point of view of the prevalence of overweight, the population of pre-school and first cycle basic education under the responsibility of the municipality of Vila Nova de Gaia, the third most populous municipality in the country.
      Material and Methods: Were evaluated 8 974 pre and basic-school children, in school year 2013/14. The assessment of the nutritional status of the sample was made using anthropometric measures height and weight. In the classification of nutritional status was considered z-scores or percentiles of body mass index for age according to the World Health Organization, Centers for Disease Control and Prevention and International Obesity Task Force.
      Results: The prevalence of overweight by the World Health Organization requirements was 37.4%. There were some disparities in the distribution of overweight in schools of the municipality.
      Discussion: The results were slightly higher than those of other national and international studies, being the sampling size the possible justification for the differences founded.
      Conclusion: The prevalence found is high and with irregular geographical distribution, which could help identifying the main causes of the problem at the local level.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • β-Tricalcium Phosphate in the Surgical Treatment of Proximal Humeral

    • Authors: Marco Sarmento, Samuel Martins, Jacinto Monteiro
      Pages: 41 - 45
      Abstract: Introduction: The proximal humeral fractures are becoming more frequent, with a greater tendency for its surgical treatment by osteosynthesis with plate and locked screws. The mechanical and biological failure in these fractures and devices, despite the evolution of this type of implants, highlighted the synthetic bone grafts became an option.
      Material and Methods: Over a period of 96 months, patients considered were those with proximal humeral fractures treated surgically with a plate and locked screws, and in which β-tricalcium phosphate bone graft had been used. Functional results were evaluated by the shoulder range of motion as the radiological results.
      Results: In 19 patients, with a medial follow up of 53 months, we obtained an average shoulder range of motion of 140º in abduction, 142º in forward flexion, 37º in external rotation and L3 hand position in internal rotation for a cefalo-diaphyseal angle of 136º.
      Discussion: The β-tricalcium phosphate synthetic bone graft allows the maintenance of reduction after fixation of proximal humeral fractures stabilized with plate and locked screws. This reduction which means the maintenance of cefalo-diaphyseal angle is in close relationship with functional results as shown by shoulder range of motion in all planes.
      Conclusion: The β-tricalcium phosphate synthetic bone graft should be seen as an adjuvant therapy in extramedullary fixation of proximal humeral fractures, especially those with greater comminution of the medial calcar.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • A Neurologist’s Hard Day’s Work: Impact of Inpatient Neurology
           Consultation in a Tertiary Hospital

    • Authors: Helena Rocha, Ana Monteiro, Tiago Gomes, Miguel Grilo, Marta Carvalho
      Pages: 46 - 51
      Abstract: Introduction: Consultation of hospitalized patients under the responsibility of other specialties is a very demanding work. However, it is often under-recognized and poorly documented. The aim of the present study was to assess the burden of the inpatient neurology consultation in a Portuguese hospital and to evaluate the performance of our Neurology department regarding this issue.
      Material and Methods: A retrospective study was conducted during 2013, reviewing clinical and demographic data.
      Results: Over one year, the neurologists of our department evaluated 632 inpatients. The commonest reasons for consultation were altered mental state/behavior, focal neurological deficit and seizures. Requests came mainly from medical departments but also from Intermediate and Intensive Care Units. Neurologists suggested further investigation in almost one half of patients and management changes in a similar proportion of patients. A new diagnosis could be established in 63% of cases and the most frequent diagnosis were neurological manifestations of systemic disorders, epilepsy and cerebrovascular disease. Our intervention had impact on the care of 68% of patients.
      Discussion and Conclusion: Different studies in the literature support our findings and highlight the economic and patient care benefits of this activity. Our results suggest that neurological inpatient observation generates useful interventions for the clinical management of these patients.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • Syphilis: Prevalence in a Hospital in Lisbon

    • Pages: 52 - 55
      Abstract: Introduction: Syphilis is a sexual and vertical transmitted disease. Its incidence is increasing in Europe, particularly, in Portugal.
      Material and Methods: A descriptive, retrospective study was performed based on positive treponemal tests from January to December 2013, at the Santa Maria Hospital, Lisbon. In-patients and out-patients evaluated in medical appointments and at the emergency department were included. We proceeded to epidemiological characterization, disease classification and definition of risk factors.
      Results: We obtained a sample of 580 patients, of whom 51 with no clinical data and 45 with false positive serologies were excluded. There was a predominance of male patients (75%) and a mean age of 47 years. Most (59%) had syphilis successfully treated in the past and 3.7% were in follow-up. We recorded 13 primaries syphilis, 71 cases of secondary syphilis, 40 cases of early latent syphilis, 49 unknown duration syphilis and five cases of late latent syphilis. In the early syphilis group, 42% (n = 124) were HIV-positive and, in 8% both diagnosis were done simultaneously.
      Discussion: We emphasize the high prevalence of syphilis/HIV co-infection in patients with early syphilis, reinforcing the importance of promoting the use of preventive measures. We obtained 11% of patients with late clinical forms, which are notifiable since June 2014, in Portugal. All serological tests for the diagnosis of syphilis have limitations which emphasizes the importance of clinical-laboratory correlation.
      Conclusion: Syphilis remains an important public health problem. It is necessary to establish education programs, screening and follow-up strategies to reduce their prevalence and to perform more efficient screening of the partners.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • Are Amyotrophic Lateral Sclerosis Caregivers at Higher Risk for Health

    • Pages: 56 - 62
      Abstract: Introduction: Amyotrophic lateral sclerosis is a rare neurodegenerative disease affecting motor neurons. Patients present with progressive physical impairment, respiratory failure being the main cause of death. A significant portion of patients presents neurobehavioral problems as well. As severe impairment occurs, patients become highly dependent and in general, their families assume the role of primary caregivers, exposing them to stress and other potential causes of disease like insomnia, physical strain from patients’ mobilization and changes on eating habits. The aim of this work is to understand if taking care of patients with amyotrophic lateral sclerosis increases disease and health problems on caregivers.
      Material and Methods: Comprehensive review of the literature published on the electronic databases PubMed and Scopus between 2010 and 2014.
      Results: Eighteen studies met the inclusion criteria. We found that amyotrophic lateral sclerosis caregivers have higher levels of burden, depression and anxiety with lower quality of life. This is associated to age and gender of caregivers, time spent caring, patients’ disability and neurobehavioral changes. Higher sense of support and spirituality on family seem to promote wellbeing.
      Discussion: On our work, we were able to understand that several factors have influenced caregivers’ quality of life and affect their health. Besides, we could understand that the outcomes studied are related between themselves and, as seen in some of the studies, related to patients’ quality of life itself. Consequently, it has become essential to adopt a holistic approach of these patients and their families, fighting the deteriorating risk factors and investing on health promoters.
      Conclusion: Despite the large body of research on family caregiving for amyotrophic lateral sclerosis patients, little has changed and the outcomes measured remain almost the same before and after 2010. The work indicates that caregivers have lower levels of health than the general population. Still additional research is required, in order to better understand and characterized the changes on caregivers’ health. It is nevertheless clear that health care professionals cannot ignore these health changes and need an approach focused not only on patients but also on caregivers.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • Ectopic Decidualization: A Forgotten Entity

    • Pages: 63 - 72
      Abstract: Introduction: Although ectopic decidualization is an entity often underdiagnosed, it may have adverse clinical impact on maternal-fetal morbimortality. The objective of this study was to review the scientific evidence regarding the etiology, clinical features, diagnosis and therapeutic approach on this issue.
      Material and Methods: The search for this literature review was conducted in PubMed, Web of Science and Scopus, through the query (‘deciduosis’ OR ‘ectopic decidualization’ OR ‘ectopic decidua’ OR ‘ectopic decidua reaction’), considering articles of all evidence levels published up to 31/06/2014.
      Results: Ectopic decidualization is, usually, a benign condition, asymptomatic and does not require therapeutic intervention. It occurs mostly during pregnancy, with complete regression in the postpartum period. The frequency of the diagnosis depends on the clinical suspicion and its location, being the omentum and the ovary the most common sites. When symptomatic, the main clinical manifestations are genital bleeding and hemoperitoneum. Differential diagnosis includes malignant disease and histopathological confirmation is essential in these situations. The low index of suspicion may lead to a biopsy, which can have serious adverse outcomes due to the high friability of these lesions.
      Discussion and Conclusion: The recognition of this entity and its clinical features are essential for the management of these patients. On one side this allows an early and proper medical approach in severe cases, on the other side (the majority of cases) maintaining an expectant attitude avoiding iatrogeny, does not compromise, in most cases, the favorable outcome of ectopic decidualization.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • Assisted Reproductive Technology in Female Transplant Recipients:
           Experience of a Reproductive Medicine Unit and Literature Review

    • Pages: 73 - 78
      Abstract: Diseases in end stage typically occur with hypothalamic-pituitary-ovarian axis disorders, with consequent anovulation and infertility. The solid organ transplantation increased survival of patients with end-stage organs disease and the vast majority of women improve their reproductive capacity after transplantation. Although adoption can always be a possibility, the transplanted infertile woman has the right to self-reproductive determination using assisted reproductive techniques. While it is known that pregnancies in transplanted
      women are at high risk, there is no evidence of differences in pregnancy outcome in pregnant transplanted subject to technical, compared with spontaneous pregnancies. The use of assisted reproductive techniques in transplanted women is a medical, ethical and psychosocial challenge, whose approach must be multidisciplinary, to ensure reproductive success without compromising the function of the transplanted organ or maternal health, allowing the birth of a healthy child. The literature remains scarce. Three clinical cases are presented.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • Ainhum or Dactylolysis Spontanea: a Missing Toe

    • Pages: 79 - 79
      Abstract: Keywords: Ainhum; Toes.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
  • Thirty Six Views of Mount Fuji and the First Oncology Appointment

    • Authors: Margarida Dantas de Brito
      Pages: 80 - 81
      Abstract: Keywords: Appointments and Schedules; Medicine in Art; Neoplasms; Paintings.
      PubDate: 2016-01-29
      Issue No: Vol. 29, No. 1 (2016)
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