Journal Cover Acta Médica Portuguesa
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  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]
  • Coimbra Telemedicine Service Improves Access to Pediatric Cardiology in
           Cape Verde

    • Authors: Eduardo Castela
      Pages: 253 - 254
      Abstract: N/a.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Implementation of Telemedicine in Cape Verde: Influencing Factors

    • Authors: Artur Correia, Vanda Azevedo, Luís Velez Lapão
      Pages: 255 - 262
      Abstract: Introduction: Telemedicine is the provision of health services, where distance is a critical factor, using information and communication technologies. Cape Verde has bet on using this tool to increase access of the population of its islands to specialized care.
      Material and Methods: Qualitative study, covering the period between 2013 and 2014. It uses document analysis, semi-structured interviews and focus groups to collect data and analysis of content for their analysis. The participant population includes doctors, nurses and professionals from some institutions related to telemedicine.
      Results: The priorities of the National Telemedicine Program are set, the cores and reference centers are operational, with trained personnel and equipment installed. Several other policy instruments and conditioning factors and facilitators of the program have been identified.
      Discussion: Telemedicine is contributing to the reduction of inequalities in access to health, in Cape Verde. However, the full adoption of a service based on a new technology depends on conditioning factors and facilitators, and several success factors of telemedicine, identified in the literature, are not observed and in conjunction with other existing weaknesses affect the overall development of the National Telemedicine Program. However the strengths and capabilities are highlighted opportunities to act.
      Conclusion: Despite the progress, some telemedicine success factors highlighted on the literature are not seen in the country.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Economic Crisis and Portuguese National Health Service Physicians:
           Findings from a Descriptive Study of Their Perceptions and Reactions from
           Health Care Units in the Greater Lisbon Area

    • Authors: Inês Rego, Giuliano Russo, Luzia Gonçalves, Julian Perelman, Pedro Pita Barros
      Pages: 263 - 272
      Abstract: Introduction: In Europe, scant scientific evidence exists on the impact of economic crisis on physicians. This study aims at understanding the adjustments made by public sector physicians to the changing conditions, and their perceptions on the market for medical services in the Lisbon metropolitan area.
      Material and Methods: A random sample of 484 physicians from São José Hospital and health center groups in Cascais and Amadora, to explore their perceptions of the economic crisis, and the changes brought to their workload. This paper provides a descriptive statistical analysis of physicians’ responses.
      Results: In connection to the crisis, our surveyed physicians perceived an increase in demand but a decrease of supply of public health services, as well as an increase in the supply of health services by the private sector. Damaging government policies for the public sector, and the rise of private services and insurance providers were identified as game changers for the sector. Physicians reported a decrease in public remuneration (- 30.5%) and a small increase of public sector hours. A general reduction in living standard was identified as the main adaptation strategy to the crisis. Passion for the profession, its independence and flexibility, were the most frequently mentioned compensating factors. A percentage of 15% of physicians declared considering migration as a possibility for the near future.
      Discussion: The crisis has brought non-negligible changes to physicians’ working conditions and to the wider market for medical services in Portugal.
      Conclusion: The physicians’ intrinsic motivation for the professions helped counterbalance salary cuts and deteriorating working conditions.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Anxiety, Family Functioning and Neuroendocrine Biomarkers in Obese

    • Authors: Inês Pinto, Simon Wilkinson, Daniel Virella, Marta Alves, Conceição Calhau, Rui Coelho
      Pages: 273 - 280
      Abstract: Introduction: This observational study explores potential links between obese children’s cortisol, and parental mental state, family functioning, and the children’s symptoms of anxiety and depression.
      Material and Methods: A non-random sample of 104 obese children (55 boys), mean age 10.9 years (standard deviation 1.76), was recruited from a childhood obesity clinic. Obesity was defined as body mass index above the 95th age- and gender-specific percentiles. Neuroendocrine biomarkers were measured. Symptoms of anxiety and depression were assessed with self and parent-reported questionnaires (Anxiety, Depression and Stress Scales; Child Behaviour Checklist). Family functioning was assessed with parent-reported questionnaires (Family Adaptation and Cohesion Scales-III).
      Results: A significant, negative correlation (rs = -0.779; p = 0.003) between girls’ cortisol and their parents’ anxiety symptoms was found, limited to high functioning families. Boys scored significantly higher than girls on parent-reported internalizing symptoms but not on self-report. No association was found between cortisol in children and parental depressive symptoms.
      Discussion: Whether the association between cortisol levels in obese children and parental mental health is effectively restricted to girls from high functioning families or is due to study limitations, requires further research. The lack of associations between cortisol in children and parental depressive symptoms, suggests a specific association between cortisol and parental anxiety symptoms.
      Conclusion: These results highlight the importance of taking into account family functioning, parental mental state and gender, when investigating neuroendocrine biomarkers in obese children associated with symptoms of anxiety and depression.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Efficacy and Safety of Foley Catheter Balloon for Cervix Priming in Term

    • Authors: Catarina Policiano, Mariana Pimenta, Diana Martins, Nuno Clode
      Pages: 281 - 284
      Abstract: Introduction: Foley catheter promotes cervix priming by a direct mechanical effect of distension.
      Material and Methods: A prospective observational study was conducted at a tertiary hospital, including all cases of induction of labor with Foley catheter between September 1, 2013 and November 30, 2015. Women were eligible if they had a singleton pregnancy with a Bishop score < 6 and a gestational age ≥ 41 weeks or a medical indication for induction of labor. The primary outcome was the Bishop score variation (difference between Bishop score before and after insertion of Foley catheter). Mode of delivery, induction-to-delivery time, uterine tachysystole with fetal decelerations, peripartum fever ≥ 38º C, maternal pain and mortality were also analyzed.
      Results: Within 201 inductions with Foley catheter, average increase in Bishop score after catheter placement was three (1 - 7), with only 5% (11/201) of unmodified cervix after catheter removal/extrusion. Vaginal delivery rate was 71% (142/201) and in women with a previous cesarean section (n = 40) was 37% (15/40). Average induction-to-delivery time was 38 hours (4 - 120). Uterine infection rate was 3% (6/201). There was only one case of significant vaginal bleeding which required immediate catheter removal. There has been no significative maternal or neonatal morbidity.
      Discussion/Conclusion: Foley catheter is a safe and effective method of cervical priming for women with an unfavorable cervix, even in the case of a previous cesarean delivery.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Graduate Students in Medicine Course: Motivation, Socialization and
           Academic Recognition

    • Authors: Cristina Magalhães-Alves, Joselina Barbosa, Laura Ribeiro, Maria Amélia Ferreira
      Pages: 285 - 292
      Abstract: Introduction: Students with a previous degree have personal and professional experiences that can contribute to a different academic path during the medical course. This study aims to: 1) analyze both satisfaction and impact of academic recognition; 2) investigate whether motivations and expectations at entrance are maintained along the course; 3) to evaluate socialization after regress to higher education.
      Material and Methods: To accomplish the first objective a questionnaire was administered to 82 students who entered the medical school from 2011/2012 to 2013/2014. For the second and third goals a focus group was run (three groups with five students each, representing the three academic years).
      Results and Discussion: Students felt satisfied with the recognition, and 50% of them believe that accreditations replace knowledge acquired with the curricular units, and 47% preferred to obtain accreditation. Academic achievement was negatively associated with the satisfaction of recognition and positively with age, background and registration cycle. Socialization of these students is distinct from the younger ones, their motivations at entrance are intrinsic and, contrary to expectations, are maintained along the course.
      Conclusion: Students prefer recognition instead of attending the curricular units. The most satisfied with the recognition accomplish less credits and the younger ones, from health area and enrolled in the clinical cycle, accomplish more. Along the course, motivations become more solid, expectations change and socialization is carried out with greater responsibility.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Relevant Factors on Cognitive Evaluation of the Portuguese Population

    • Authors: Catarina Resende de Oliveira, Anabela Mota-Pinto, Vítor Rodrigues, Catarina Alves
      Pages: 293 - 301
      Abstract: Introduction: Aging is an inevitable process that has a social impact in the forecoming decades, and it will present a great challenge regarding public health. An efficient health system requires a reflection on the preventive measures to be implemented.
      Material and Methods: The study population comprised a total number of 2672 individuals of both genders, aged 55 years and over, residents in continental Portugal, to whom a questionnaire was applied that included the following sections: Social network; Locomotion; Physical autonomy; Instrumental autonomy; Cognitive assessment; Physical activity.
      Results: The study of aging in the Portuguese population found that physical autonomy for tasks related to daily life are associated with better cognitive evaluation. A statistically significant association was found between performance in cognitive assessment and gender, age, schooling, the fact of living alone, the number of hours being alone, autonomy to walk in the street, washing, dressing, eating, preparing meals, doing shopping, managing money and taking medications and washer / treat clothing.
      Discussion: Cognitive evaluation is negatively influenced by the number of hours that an individual is alone.
      Conclusion: Activities of daily life must be valued, since they require the ability to plan and carry out tasks and their preservation is a key component in successful aging.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Playing-Related Musculoskeletal Disorders of Professional Orchestra

    • Authors: Cláudia Maria Sousa, Jorge Pereira Machado, Henry Johannes Greten, Daniela Coimbra
      Pages: 302 - 306
      Abstract: Introduction: It is well known that musicians are a group prone to suffer from playing-related musculoskeletal disorders. Professional orchestra musicians play for several hours a week and have to fight against pain caused by their profession. The aim of this study was to explore and describe self-reported complaints among professional orchestra musicians and to compare its intensity and the prevalence between string and wind instruments.
      Material and Methods: Hundred and twelve professional orchestra musicians from the three main professional orchestras from the North of Portugal were individually interviewed about the prevalence and the intensity (measured by verbal numerical scale for pain) of their playing-related musculoskeletal disorders.
      Results: About two third (62.5%) of the interviewed musicians presented playing-related musculoskeletal disorders during the time of the interview. Despite there are no significant statistic values between groups, results suggested that playing-related musculoskeletal disorders are more common in string players and more intense in wind players.
      Discussion: Referring to the prevalence of playing-related musculoskeletal disorders, our data is in line with other studies from different countries. More than half of professional orchestra musicians in the North of Portugal are playing with a mild to moderate pain.
      Conclusion: Future studies focusing on working-related problems among professional orchestra musicians in Portugal would be useful to better describe the problem of occupational diseases among performing artist.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Psychological Treatments for Borderline Personality Disorder: A Review of
           Cognitive-Behavioral Oriented Therapies

    • Authors: Sofia Marques, Daniel Barrocas, Daniel Rijo
      Pages: 307 - 319
      Abstract: Introduction: Borderline personality disorder is the most common personality disorder, with a global prevalence rate between 1.6% and 6%. It is characterized by affective disturbance and impulsivity, which lead to a high number of self-harm behaviors and great amount of health services use. International guidelines recommend psychotherapy as the primary treatment for borderline personality disorder. This paper reviews evidence about the effects and efficacy of cognitive-behavioral oriented psychological treatments for borderline personality disorder.
      Material and Methods: A literature review was conducted in Medline and PubMed databases, using the following keywords: borderline personality disorder, cognitive-behavioral psychotherapy and efficacy.
      Results: Sixteen randomized clinical trials were evaluate in this review, which analyzed the effects of several cognitive-behavioral oriented psychotherapeutic interventions, namely dialectical behavioral therapy, cognitive behavioral therapy, schema-focused therapy and manual-assisted cognitive therapy. All above stated treatments showed clinical beneficial effects, by reducing borderline personality disorder core pathology and associated general psychopathology, as well as by reducing the severity and frequency of self-harm behaviors, and by improving the overall social, interpersonal and global adjustment. Dialectical behavioral therapy and schema-focused therapy also caused a soaring remission rate of diagnostic borderline personality disorder criteria of 57% and 94%, respectively.
      Discussion: Although there were differences between the psychotherapeutic interventions analysed in this review, all showed clinical benefits in the treatment of borderline personality disorder. Dialectical behavioral therapy and schema-focused therapy presented the strongest scientific data documenting their efficacy, but both interventions are integrative cognitive-behavioral therapies which deviate from the traditional cognitive-behavioral model.
      Conclusion: In summary, the available studies support cognitive-behavioral psychological treatments as an efficacious intervention in borderline personality disorder. However, the existing scientific literature on this topic is still scarce and there is need for more studies, with higher methodological rigor, that should validate these results.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Surgical Treatment of Rotator Cuff Tears After 65 Years of Age: A
           Systematic Review

    • Authors: Bruno Mota Silva, António Cartucho, Marco Sarmento, Nuno Moura
      Pages: 320 - 329
      Abstract: Introduction: The objective of this study was to analyze current evidence regarding surgical management of rotator cuff tears in patients of 65 years of age and above. Our hypothesis was that surgical repair of rotator cuff tears, in patients older than 65 years, conveys good outcome scores. We have not found a similar systematic review in current literature.
      Material and Methods: Medline®, PubMed, Scopus, and the Cochrane Register of Controlled Trials were searched from January 1999 unto December 2015 for studies, regardless of language, including the words ‘rotator cuff’ and ‘65 years’ or ‘70 years’. Inclusion criteria were studies (level I to IV) that reported clinical outcomes in patients older than 65 years, having undertaken surgical repair of a symptomatic rotator cuff tears. Arthroscopic, mini open and open techniques were included. Exclusion criteria were: studies with patients younger than 65 years, studies that did not use validated outcome evaluation scores as primary assessment tools and those with follow up under one year. This work followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA guidelines. Data abstracted included patient demographics, tear pattern, surgical procedures, clinical and repair results. Outcome scores were converted to percentages, allowing comparison of data between studies.
      Results: After deep analysis, 14 studies met the inclusion criteria: 11 level IV studies, 1 level III study and 2 level II studies. Seven studies found statistically significant outcome improvements between pre and postoperative evaluations. All studies reported good or excellent surgical outcomes.
      Discussion: Better results would probably be achieved if all studies had rigorous and homogeneous patient selection criteria, but the fact is, that even though this was not the case, the clinical scores remained favorable, and with statistically significant outcome improvement in all studies with prospectively collected data.
      Conclusion: Based on current literature, rotator cuff repair in patients older than 65 years imparts favorable improvement in clinical outcome scores and overall patient satisfaction.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Bisalbuminemia: A Rare Variant of Albumin

    • Authors: Carla Garcez, Susana Carvalho
      Pages: 330 - 333
      Abstract: Introduction: Bisalbuminemia is a qualitative disorder of albumin and it is defined by the coexistence in the same individual of two types of serum albumin with different electrophoretic mobility. There are two forms: hereditary and permanent, or acquired and transient.
      Case Report: Girl, 17-years-old, referenced to the hospital consult after incidental finding of bisalbuminemia detected in plasma protein electrophoresis performed within the investigation of diminished muscular tone in the lower limbs. Physical examination was normal. Secondary causes of bisalbuminemia were excluded. Later, it was confirmed the same disorder in plasma protein electrophoresis performed to her 14-years-old brother and mother.
      Discussion: We describe a rare case of hereditary bisalbuminemia in a portuguese family. In general, this condition shows no pathological significance, however it is of interest to the clinicians the knowledge of this analytic change for better orientation of their patients.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Bilateral Deep Vein Thrombosis Associated with Inferior Vena Cava Agenesis
           in a Young Patient Manifesting as Low Back Pain

    • Authors: Felipe Langer, Daiane dos Santos, Gustavo Suertegaray, Carlos Jesus Pereira Haygert
      Pages: 333 - 337
      Abstract: Congenital absence of the inferior vena cava is a rare vascular anomaly, and most cases are asymptomatic. Nevertheless, patients with inferior vena cava malformations may have increased risk of deep venous thrombosis. Particularly, cases of bilateral deep venous thrombosis may arise owing to an insufficient collateral venous drainage from the lower limbs. We hereby describe a case of a previously healthy young male patient presenting with bilateral lower limb deep venous thrombosis as the initial clinical manifestation of congenital inferior vena cava agenesis. We conclude that in young patients presenting with deep venous thrombosis, especially when thrombosis occurs spontaneously, bilaterally, or recurrently, inferior vena cava anomalies should be thoroughly investigated and ruled out as appropriate.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Intragastric Penetration of the Connecting Tube After Laparoscopic
           Adjustable Gastric Banding

    • Authors: Samuel Costa, Artur Machado, Bruno Gonçalves, José Maia da Costa, Raquel Gonçalves
      Pages: 338 - 338
      Abstract: N/a.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Diplopia as Rare Initial Manifestation of Gastric Cancer

    • Authors: Helena Temido, Filipe Vilão, Francisco Parente
      Pages: 339 - 339
      Abstract: N/a.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Genetic Study of Primary Dystonias: Recommendations from the Centro
           Hospitalar São João Neurogenetics Group

    • Authors: Ana Monteiro, João Massano, Miguel Leão, Carolina Garrett, Em nome do Grupo de Neurogenética do Centro Hospitalar São João
      Pages: 340 - 346
      Abstract: The primary dystonias are a particular group of dystonias of presumed genetic origin, with a wide age of onset and variable progression. The diagnosis is, therefore, a challenge and the issue of the genetic investigation presents frequently in clinical practice. In the past few years several gene mutations have been identified as causative of primary dystonias. The choice of molecular testing is complex, given the clinical specificities and low frequency of these entities and the cost of genetic testing. It must follow observation by specialized clinicians highly differentiated in this area and be supported by a rational plan of investigation. The Centro Hospitalar São João Neurogenetics Group, a multidisciplinary team of Neurologists and Geneticists with special interest in neurogenetic disorders, devised consensus recommendations for the investigation of the genetic etiology of the primary dystonias, based on international consensus documents and recent published scientific evidence. This manuscript adopts the new classification system for genetic movement disorders, allowing for its systematic and standardized use in clinical practice.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
  • Letter to the Editor. Urticaria in the Emergency Room: Recommendations for
           Diagnostic and Therapeutic Approach

    • Authors: Célia Costa, Margarida Gonçalo, Em nome do GPEU – Grupo Português de Estudos de Urticária
      Pages: 347 - 349
      Abstract: N/a.
      PubDate: 2017-04-28
      Issue No: Vol. 30, No. 4 (2017)
School of Mathematical and Computer Sciences
Heriot-Watt University
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