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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]
  • Fifteen Years of Experience from a Medical School’ Clinical Skills

    • Authors: José Miguel Pêgo, João José Cerqueira, João Bessa, Vitor Hugo Pereira, Sara Gomes, José Mariz, Rita Sousa, Pedro Morgado, Nuno Sousa
      Pages: 85 - 92
      Abstract: Introduction: Medical Education has evolved being defined as a continuum of the medical training from the pre- to the post-graduate period and through a lifetime of medical practice that is mirrored in the competencies framework that several international institutions have established. This creates a challenge to educational institutions (pre- and post-graduate) that traditionally take separate pathways.
      Material and Methods: The present report is a description of the efforts carried by the School of Medicine of the University of Minho to implement a strategy of teaching/learning methods that follows modern standards towards constructive alignment of the medical curriculum, from the pre- to the post-graduate. The faculty members responsible for these activities make a narrative self-report of the activities developed and where available quantitative data from participant surveys are presented.
      Results: In order to achieve a constructive alignment of educational/assessment strategies several steps were taken that focused on the revision of the learning goals, teaching methodologies and assessment strategies. This implicated the investment in the training/
      certification of faculty, acquisition of simulation tools and a dedicated infrastructure. Alumni were a fundamental cornerstone as voluntary faculty contributing to pre-graduate training, but also training their own scholar skills. Overall, courses are rate with a high rate of satisfaction among course participants.
      Discussion: Setting up the present teaching/learning environment of the School of Medicine of the University of Minho required a collective effort of the faculty, as well a progressive investment in both acquisition of equipment and training of staff. These human and material efforts, however, lead to an excellent return in learning outcomes.
      Conclusion: The main conclusion is that the constructive alignment of educational and assessment strategies towards the medical education continuum needs reflective thinking on the learners’ needs. The secondary gain of these initiatives is to provide opportunities for junior doctors to practice teaching.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • The OXIMAPA Study: Hypertension Control by ABPM and Association with Sleep
           Apnea Syndrome by Pulse Oximetry

    • Authors: Tiago Maricoto, Eurico Alves Rrodrigues Silva, Pedro Damião, José Mesquita Bastos
      Pages: 93 - 99
      Abstract: Introduction: Ambulatory blood pressure monitoring by automatic device is the best blood pressure evaluation method and sleep apnea syndrome is the leading cause of poor control. Oximetry allows screening these individuals but its usefulness has been poorly explored in Primary Health Care. The aim was to evaluate the blood pressure control at the office and with ambulatory blood pressure monitoring by automatic device and to relate it to sleep apnea syndrome.
      Material and Methods: We selected a sample of 50 participants, representative of 3036 hypertensive patients. The variables were: blood pressure value at the office and blood pressure with ambulatory blood pressure monitoring by automatic device; presence of criteria of sleep apnea syndrome in oximetry.
      Results: The prevalence of uncontrolled blood pressure was 56% on office evaluation and 68% on ambulatory blood pressure monitoring by automatic device. It was found: 36% of daytime hypertension, 52% nocturnal hypertension, 40% non-dipper profile, 16% of white coat hypertension and 28% masked hypertension. The prevalence of sleep apnea syndrome was 16%. Blood pressure in ambulatory blood pressure monitoring by automatic device and blood pressure in office showed no statistically significant association (p = 0.761). We found a statistically significant association between sleep apnea syndrome and daytime hypertension (p = 0.019) and non-dipper profile (p = 0.005).
      Discussion and Conclusion: Ambulatory blood pressure monitoring by automatic device detected more 12% of uncontrolled hypertension than office blood pressure. Sleep apnea syndrome is strongly associated with uncontrolled hypertension and oximetry may be a good screening method, but should be studied further.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • Forensic Medicine and the Military Population: International Dental
           Records and Personal Identification Concerns

    • Authors: Maria Inês Guimarães, Augusta Silveira, Teresa Sequeira, Joaquim Gonçalves, Maria José Carneiro Sousa, Aurora Valenzuela
      Pages: 100 - 107
      Abstract: Introduction: The first goal of this research was to perceive the global commitment towards the organization and archiving of dental records and to compare it with each country’s security risk rating. The second one was to study dental records in a sample of the Portuguese military population, using the available national dental records.
      Material and Methods: An e-mail was sent to representative dentistry associations in several countries, requesting some information concerning the professionals’ awareness of this issue. After obtaining permission from the Ethics Committee, the information was collected through the Forensic Dental Symbols® system into the Dental Encoder®, as an extension of a Spanish study, and a generic codification was used (unrestored, restored, missing and crowned teeth).
      Results: The most common dental record retention period is ten years after treatment. Observing the samples’ dental records (595 files), we found a total of 19 040 analyzed teeth, with the following frequencies: unrestored (89.6%), restored (7.0%), missing (2.2%) and crowned (1.1%).
      Discussion: There is a wide range of guidelines on how long dentists should keep dental records. Especially for the military population, dental records must include detailed information concerning each tooth situation, in order to support the process of human identification.
      Conclusion: This article reinforces the need for mandatory quality dental records in all countries, which must be efficiently stored and easily accessible in case dental identification is necessary. For the military population, these requirements are especially important, due to the added risks to which this group is subject.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • Secular Trends in Anthropometrics and Physical Fitness of Young Portuguese
           School-Aged Children

    • Authors: Aldo Matos Costa, Mário Jorge Costa, António Antunes Reis, Sandra Ferreira, Júlio Martins, Ana Pereira
      Pages: 108 - 114
      Abstract: Introduction: The purpose of this study was to analyze secular trends in anthropometrics and physical fitness of Portuguese children.
      Material and Methods: A group of 1819 students (881 boys and 938 girls) between 10 and 11 years old was assessed in their 5th and 6th scholar grade throughout a 20 years’ time-frame. ANCOVA models were used to analyze variations in anthropometrics (height, weight and body mass index) and physical fitness (sit and reach, curl-up, horizontal jump and sprint time) across four quinquennials (1993 - 1998; 1998 - 2003; 2003 - 2008; 2008 - 2013).
      Results: Secular trends showed the presence of heavier boys and girls with higher body mass index in the 5th and 6th grade throughout the last 20 years. There was also a presence of taller girls but just until the 3rd quinquennial. Both boys and girls were able to perform better on the core strength test and sprint time but become less flexible over the years. Mean jumping performance remained unchanged for both genders.
      Discussion: The present study provides novel data on anthropometrics and physical fitness trends over the last two decades in young Portuguese children, consistent with the results reported in other developed countries.
      Conclusion: Evidence for the start of a positive secular trend in body mass index and in some physical fitness components over the last two decades among the Portuguese youth.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • Translation, Cultural Adaptation and Validation of the Satisfaction with
           Amplification in Daily Life Scale for European Portuguese

    • Authors: Luis Roque dos Reis, Mariana Donato, Rita Sousa, Pedro Alberto Escada
      Pages: 115 - 121
      Abstract: Introduction: The scale Satisfaction with Amplification in Daily Life uses a simple and easily administered questionnaire to evaluate the adaptation of individuals to their hearing aids. The objective of this study is to validate the scale for European Portuguese speakers, by means of translation and cultural adaptation of the questionnaire. The study includes an evaluation of reproducibility and a description of the results of the administration of the questionnaire to patients fitted with hearing aids.
      Material and Methods: We invited 147 individuals fitted with hearing aids (uni- or bilateral) to participate in the study. Participants had used a hearing aid for at least six weeks and were patients of the Department of Otolaryngology at the Egas Moniz Hospital (Lisbon). The consent as well the guidelines for translation from and into the English language were obtained from the author of the scale, and the translation from and into, and cultural adaptation were carried out, along with an evaluation of reproducibility and internal consistency.
      Results: The participants were 54% male and 46% female, aged between 16 and 93 (66.09 ± 17.41 years). The results of the study showed an overall level of satisfaction of 5.4 among hearing aids users. The sub-scale satisfaction levels were: positive effects 5.88, service and cost 5.25, negative effects 4.24, and self-image 5.57. The Cronbach α score was 0.75 which indicates good internal consistency. Furthermore, the questionnaire’s overall and sub-scale average scores did not differ significantly from the results obtained under the American scale. The inter-examiner reproducibility was also good.
      Discussion: This study provides reliable results of the scale for the Portuguese of Portugal and adequate internal consistency, with significant age variability in the sample.
      Conclusion: This adaptation of the Satisfaction with Amplification in Daily Life questionnaire for European Portuguese speakers should be considered a good tool for evaluation of the level of satisfaction of hearing aid users, and until now, is the only available scale for speakers of European Portuguese.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • Biliary Anastomosis in Liver Transplantation: With or Without T-Tube'

    • Authors: Janine Carmelino, Susana Rodrigues, Hugo Pinto Marques, Vasco Ribeiro, Daniel Virella, Marta Alves, Américo Martins, Eduardo Barroso
      Pages: 122 - 126
      Abstract: Introduction: Biliary complications occur in 10-30% of liver transplants. The aim of this study was to compare the incidence of these complications in liver transplants when the T-tube was or was not used during the biliary anastomosis.
      Material and Methods: Analysis of 2 groups of patients undergoing liver transplantation between 2008 and 2012. Patients were divided considering if the T-tube was used (G1) or if it was not (G2). We sought explanatory models of the occurrence of biliary complications by logistic regression, including the variables identified in the univariate analysis.
      Results: We reviewed 506 consecutive patients who underwent a first liver transplant (G1 = 363, G2 = 143). The overall incidence of biliary complications was 24.7% (95% CI 21.1 to 28.6): 27.0% in G1 and 18.9% in G2 (p = 0.057). The incidences of stenosis and biliary fistula tended to be higher in G1: 19.6% (95% CI 15.7 to 23.8) vs 15.4% (95% CI 10.1 to 22.0) (p = 0.275) and 6.6% (95% CI 4.4 to 9.5) vs 2.8% (95% CI 0.9 to 6.6) (p = 0.091). We did not find statistically significant differences in the rates of endoscopic retrograde cholangiopancreatography, reoperation and retransplantation. There were two deaths in G1. There was no association between the occurrence of biliary complications and the diameters of the biliary tract nor the time of cold ischemia. The explanatory model, adjusted to the recipient and the donor age’s and to the initial diagnosis, identifies the use of the T-tube as increasing the possibility of the occurrence of biliary complications (AdjOR 1.71, 95% CI 1.04 to 2.80; p = 0.034).
      Discussion and Conclusion: The use of the T-tube should be a decision taken on a case-based intraoperative judgment of experienced surgeons
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • Safety and Effectiveness of Cataract Surgery with Simultaneous
           Intravitreal Anti-VEGF in Patients with Previously Treated Exudative
           Age-Related Macular Degeneration

    • Authors: Manuel Sousa Falcão, Paulo Freitas-Costa, João Nuno Beato, João Pinheiro-Costa, Amândio Rocha-Sousa, Ângela Carneiro, Elisete Maria Brandão, Fernando Falcão-Reis
      Pages: 127 - 133
      Abstract: Introduction: To evaluate the safety and impact on visual acuity, retinal and choroidal morphology of simultaneous cataract surgery and intravitreal anti-vascular endothelial growth factor on patients with visually significant cataracts and previously treated exudative age-related macular degeneration.
      Material and Methods: Prospective study, which included 21 eyes of 20 patients with exudative age-related macular degeneration submitted to simultaneous phacoemulsification and intravitreal ranibizumab or bevacizumab. The patients were followed for 12 months after surgery using a pro re nata strategy. Visual acuity, foveal and choroidal thickness changes were evaluated 1, 6 and 12 months post-operatively.
      Results: There was a statistically significant increase in mean visual acuity at one (13.4 letters, p < 0.05), six (11.5 letters, p < 0.05) and twelve months (11.3 letters, p < 0.05) without significant changes in retinal or choroidal morphology. At 12 months, 86% of eyes were able to maintain visual acuity improvement. There were no significant differences between the two anti-vascular endothelial growth factor drugs and no complications developed during follow-up.
      Discussion: Simultaneous phacoemulsification and intravitreal anti- vascular endothelial growth factor is safe and allows improvement in visual acuity in patients with visually significant cataracts and exudative age-related macular degeneration. Visual acuity gains were maintained with a pro re nata strategy showing that in this subset of patients, phacoemulsification may be beneficial.
      Conclusion: Cataract surgery and simultaneous anti-vascular endothelial growth factor therapy improves visual acuity in patients with exudative age-related macular degeneration.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • Rethinking Anatomy: How to Overcome Challenges of Medical
           Education’s Evolution

    • Authors: Bruno Guimarães, Luís Dourado, Stanislav Tsisar, José Miguel Diniz, Maria Dulce Madeira, Maria Amélia Ferreira
      Pages: 134 - 140
      Abstract: Introduction: Due to scientific and technological development, Medical Education has been readjusting its focus and strategies. Medical curriculum has been adopting a vertical integration model, in which basic and clinical sciences coexist during medical instruction. This context favours the introduction of new complementary technology-based pedagogical approaches. Thus, even traditional core sciences of medical curriculum, like Anatomy, are refocusing their teaching/learning paradigm.
      Material and Methods: We performed a bibliographic review aiming to reflect on Medical Education’s current pedagogical trend, by analysing the advantages of the introduction and diversification of pedagogical approaches in Anatomy Education.
      Results: Anatomy Education’s status quo is characterized by: less available teaching time, increasing demands from radiology and endoscopy imaging and other invasive and non-invasive medical techniques, increasing number of medical students and other logistical restrains exposed by the current Medical Education scenario. The traditional learning approach, mainly based on cadaveric dissection, is drifting to complementary newer technologies - such as 3D models or 2D/3D digital imaging - to examine the anatomy of the human body. Also, knowledge transfer is taking different channels, as learning management systems, social networks and computer-assisted learning and assessment are assuming relevant roles.
      Discussion: The future holds promising approaches for education models. The development of Artificial Intelligence, Virtual Reality and Learning Analytics could provide analytic tools towards a real-time and personalized learning process.
      Conclusion: A reflection on Anatomy Education, as a comprehensive model, allows us to understand Medical Education’s complexity. Therefore, the present Medical Education context favours a blended learning approach, in which multi-modality pedagogical strategies may become the landmark.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • Scientific Research Policy for Health in Portugal: I - European and
           National Environment

    • Authors: Cátia Sá Guerreiro, Zulmira Hartz, Luís Sambo, Cláudia Conceição, Gilles Dussault, Giuliano Russo, Miguel Viveiros, Henrique Silveira, Pedro Pita Barros, Paulo Ferrinho
      Pages: 141 - 147
      Abstract: The global debate on scientific research policy for human health has been led by World Health Organisation with important contributions from other stakeholders such as Council on Health Research for Development, the World Bank and the Global Forum for Health Research. Recently it has been dominated by the thematic agendas of major global financiers. There is a growing interest worldwide in making better use of the evidence resulting from scientific research in health, in the decision-making process regarding health policies, which is fraught with difficulties, as it is the case in Europe. After more than 40 years of democracy and 30 years of European integration, Portugal has bridged the research gap it had previously. However, when compared to global and European research policies, Portugal still has a long way to go regarding investment in research and development.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • Single Fetal Death in Monochorionic Twin Pregnancy: Co-Twin Prognosis and
           Neonatal Outcome

    • Authors: Emídio Vale-Fernandes, Joana Dias, Belandina Gil, Alexandra Cadilhe
      Pages: 148 - 151
      Abstract: The incidence of single fetal death in twin pregnancy varies from 0.5% - 6.8%, leaving the surviving fetus with increased morbi-mortality. The prognosis is worse in monochorionic pregnancies. In addressing these cases it should be noted referral to tertiary center with differentiated perinatal support, induction of fetal lung maturation and termination of pregnancy if there’s loss of fetal well-being or possibility of maternal complications and suspected neurological sequelae in the surviving fetus. The risk of iatrogenic prematurity should always be weighed with the possible consequences arising from the fetus staying in a hostile uterine environment. The authors describe a case of a 32-year-old pregnant woman with monochorionic/diamniotic twin pregnancy diagnosed with death of one of the fetuses due to fetal growth restriction and velamentous insertion of the umbilical cord at 30 weeks of gestation. The couple opted for termination of pregnancy at 33 weeks after documentation of brain changes in the surviving fetus.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • Syndrome of Irreversible Lithium-Effectuated NeuroToxicity

    • Authors: Ana Luísa Silva, Carolina Ourique, Filipe Martins, Fernando Friões
      Pages: 151 - 153
      Abstract: Lithium has a narrow therapeutic window. Frequent monitoring of both serum levels and clinical signs of toxicity is warranted because toxicity may be present even when concentrations are within the therapeutic range. We report the case of a man with lithium poisoning, with persistent neurologic signs and symptoms even after removal of lithium from circulation – a diagnosis of syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) was made.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • Delayed-Onset Striatal Hands Following Basal Ganglia Anoxic Insult

    • Authors: Sandra Sousa, Fernando Pita
      Pages: 154 - 154
      Abstract: N/A.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • ‘Secret’ Self-Inflicted Skin Lesions: A Challenge in

    • Authors: Bárbara Roque Ferreira, José Pedro Reis, Américo Figueiredo
      Pages: 155 - 155
      Abstract: N/A.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
  • Letter to the Editor: Therapies for Osteogenesis Imperfecta

    • Authors: Sandra Sousa, Fátima Godinho, Maria José Santos
      Pages: 156 - 157
      Abstract: N/A.
      PubDate: 2017-02-27
      Issue No: Vol. 30, No. 2 (2017)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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