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Abstract Hormone Therapy (HT) is the most effective treatment for symptom control during menopause due to hypoestrogenism. Studies that linked HT to the risk of breast cancer led to a decrease in its prescription. This article seeks to review the risk of breast and gynecologic cancer associated with HT use. It is concluded that it’s a safe and effective option in symptomatic menopausal woman up to the age of 60, without contraindications, in the first 10 years post-menopause. The main concern prescribing it is the risk of breast cancer, which is only significant with a prolonged use over 5 years.

Resumo A Terapia Hormonal (TH) é o tratamento mais eficaz para controlar os sintomas de hipoestrogenismo da menopausa. Estudos que associaram a TH ao risco de cancro da mama levaram à diminuição da sua prescrição. Este artigo procura rever o risco de cancro da mama e ginecológico associado ao uso de TH. Conclui-se que é uma opção segura e eficaz em mulheres menopáusicas sintomáticas, sem contraindicações, até aos 60 anos e nos primeiros 10 anos pós-menopausa. O principal receio na sua prescrição é o risco de cancro de mama, que é significativo apenas com uso superior a 5 anos.

Perceções de produtores de castanha do concelho de Sabugal acerca dos serviços de ecossistema providenciados pelos soutos
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Marques, Filipa

; Paula, Anabela

; Cação, Andreia

; Castro, Paula

Revista de Ciências Agrárias

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mar 2023, Volume 46 N. 1 Pages 21 - 30

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract In Portugal, the chestnut tree is a species used essentially for chestnut production. The chestnut groves are multifunctional ecosystems that provide, besides food, essential ecosystem services (ES). As agents managing these ecosystems, farmers assume an essential role in implementing solutions that valorise the several goods and services that the chestnut groves provide. This study aimed to analyse and understand how these agents perceive the services and disservices associated with the chestnut production activity through an inquiry by questionnaire carried out with 14 producers in the municipality of Sabugal. The sample surveyed is characterised by conventional agriculture, with small and medium-sized farms, with low incomes. The agriculture they practice is perceived as an activity with a positive impact on ES. The main provisioning services perceived provided by the chestnut groves are the Production of Plants for Human Food and the Production of Materials (e.g.wood); in the regulating and supporting services, the majority consider that all of them can be provided; in the cultural services, the Beauty of the Landscape stands out. Farmers' perceptions are essential to guarantee an effective promotion of the services and multifunctionality of the chestnut groves.

Resumo Em Portugal, o castanheiro é uma espécie utilizada essencialmente para a produção de castanha. Os soutos são ecossistemas multifuncionais que providenciam, para além de alimento, importantes serviços de ecossistemas (SE). Os produtores, como agentes que gerem estes ecossistemas, assumem um papel essencial na implementação de soluções que valorizem os diversos bens e serviços que os soutos fornecem. O objetivo deste trabalho consistiu em analisar e compreender como estes agentes percecionam os serviços e desserviços associados à atividade de produção de castanha, através de um inquérito por questionário realizado a 14 produtores, no concelho do Sabugal. A amostra inquirida carateriza-se por uma agricultura convencional, com pequenas e médias explorações, de baixos rendimentos. O tipo de agricultura que fazem é percecionada como sendo uma atividade com impacte positivo nos SE. Os principais serviços de aprovisionamento percecionados como fornecidos pelos soutos são a Produção de Plantas para Alimentação Humana e a Produção de Materiais (ex. madeira); nos serviços de regulação e suporte, a maioria considera que todos podem ser fornecidos; nos serviços culturais, destaca-se a Beleza da Paisagem. As perceções dos agricultores são essenciais para garantir uma efetiva promoção dos serviços e multifuncionalidade dos soutos.

https://doi.org/10.19084/rca.27783

COVID-19 in kidney transplant recipients: what have we learned one year later? A cohort study from a tertiary center COVID19 COVID 19 COVID-1 recipients later COVID1 1 COVID-
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Tavares, Joana

; Oliveira, João Pedro

; Reis, Pedro

; Ribeiro, Bárbara

; Silva, Filipa

; Malheiro, Jorge

; Almeida, Manuela

; Martins, La Salete

; Cabrita, António

; Henriques, António Castro

; Dias, Leonídio

Brazilian Journal of Nephrology

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dec 2022, Volume 44 N. 4 Pages 533 - 542

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: Os receptores de transplante renal (TR) apresentam um alto risco para desfechos adversos de infecções, tais como a COVID-19. Métodos: Revisamos retrospectivamente todos os receptores de TR com COVID-19 documentada entre 1º de Março de 2020 e 15 de Março de 2021, e analisamos as características, curso clínico, tratamento e desfechos dos pacientes. Resultados: Identificamos 123 pacientes, 72% do sexo masculino, com uma média de idade de 54,5±13,0 anos. Vinte por cento eram assintomáticos, 7% apresentaram transmissão nosocomial, e 36% do restante necessitaram de internação. Quase todos os pacientes internados receberam oxigênio, 30% necessitaram de ventilação mecânica invasiva (VMI), mais da metade apresentou lesão renal aguda, com 10% necessitando de diálise, e 20% foram a óbito. A incidência foi comparável à da população portuguesa, mas a taxa de mortalidade foi quase quatro vezes superior (TMP de 3,768 (IC 95%: 1,723-7,154). Maior índice de massa corporal (OR 1,275; P=0,001), menor função do enxerto basal (OR 0,968; P=0,015), e transmissão nosocomial (OR 13,836; P=0,019) foram associados à demanda de oxigênio, enquanto sexo feminino (OR 3,801; P=0,031) e menor função do enxerto renal basal (OR 0,955; P=0,005), mas não índice de massa corporal, foram associados à VMI e/ou óbito. Conclusão: A taxa de mortalidade em pacientes com TR foi mais elevada do que na população em geral e a função renal basal mais baixa foi o marcador mais consistente para desfechos adversos. Introdução (TR infecções COVID19. COVID19 COVID 19. 19 Métodos COVID-1 º 202 1 2021 características clínico Resultados 12 72 masculino 545130 54 5 13 0 54,5±13, anos assintomáticos 7 36 internação oxigênio 30 VMI, , (VMI) aguda 10 diálise 20 óbito portuguesa TMP 3768 3 768 3,76 IC 95% 95 1,7237,154. 17237154 1,723 7,154 . 723 154 1,723-7,154) OR 1,275 1275 275 P=0,001, P0001 P P=0,001 001 P=0,001) 0,968 0968 968 P=0,015, P0015 P=0,015 015 P=0,015) 13,836 13836 836 P=0,019 P0019 019 3,801 3801 801 P=0,031 P0031 031 0,955 0955 955 P=0,005, P0005 P=0,005 005 P=0,005) eou ou Conclusão COVID1 COVID- 54513 54,5±13 (VMI 2 376 76 3,7 9 7237 1,7237,154 1723715 1723 1,72 7154 7,15 1,723-7,154 1,27 127 27 P000 P=0,00 00 0,96 096 96 P001 P=0,01 01 13,83 1383 83 3,80 380 80 P=0,03 P003 03 0,95 095 5451 54,5±1 37 3, 1,7237,15 172371 172 1,7 715 7,1 1,723-7,15 1,2 P00 P=0,0 0,9 09 13,8 138 8 3,8 38 545 54,5± 1,7237,1 17237 17 1, 71 7, 1,723-7,1 P0 P=0, 0, 13, 54,5 1,7237, 1,723-7, P=0 54, 1,7237 1,723-7 P= 1,723-

Abstract Introduction: Kidney transplant (KT) recipients have a high risk for adverse outcomes from infections, such as COVID-19. Methods: We have retrospectively reviewed all KT recipients with documented COVID-19 between March 1, 2020, and March 15, 2021, and analyzed patients’ characteristics, clinical course, treatment, and outcomes. Results: We identified 123 patients, 72% were male, with a mean age of 54.5±13.0 years. Twenty percent were asymptomatic, 7% had a nosocomial transmission, and 36% of the remainder required hospitalization. Almost all admitted patients received oxygen, 30% required invasive mechanical ventilation (IMV), more than a half had acute kidney injury, with 10% requiring dialysis, and 20% died. Incidence was comparable to that of the Portuguese population, but the mortality rate was almost four times higher (SMR of 3.768 (95% CI:1.723-7.154). Higher body mass index (OR 1.275, P=0.001), lower baseline graft function (OR 0.968, P=0.015), and nosocomial transmission (OR 13.836, P=0.019) were associated with oxygen demand, whereas female gender (OR 3.801, P=0.031) and lower baseline kidney graft function (OR 0.955, P=0.005), but not body mass index, were associated with IMV and/or death. Conclusion: Mortality rate in KT patients was higher than in the general population and lower baseline kidney function was the most consistent marker for adverse outcomes. Introduction (KT infections COVID19. COVID19 COVID 19. 19 Methods COVID-1 1 2020 15 2021 characteristics course treatment Results 12 72 male 545130 54 5 13 0 54.5±13. years asymptomatic 7 36 hospitalization 30 IMV, , (IMV) injury 10 dialysis 20 died SMR 3768 3 768 3.76 95% 95 (95 CI1.7237.154. CI17237154 CI 1.723 7.154 . 723 154 CI:1.723-7.154) OR 1275 275 1.275 P=0.001, P0001 P P=0.001 001 P=0.001) 0968 968 0.968 P=0.015, P0015 P=0.015 015 P=0.015) 13836 836 13.836 P=0.019 P0019 019 demand 3801 801 3.801 P=0.031 P0031 031 0955 955 0.955 P=0.005, P0005 P=0.005 005 P=0.005) andor or death Conclusion COVID1 COVID- 202 54513 54.5±13 (IMV 2 376 76 3.7 9 (9 CI1 7237 CI1.7237.154 CI1723715 1723 1.72 7154 7.15 CI:1.723-7.154 127 27 1.27 P000 P=0.00 00 096 96 0.96 P001 P=0.01 01 1383 83 13.83 380 80 3.80 P=0.03 P003 03 095 0.95 5451 54.5±1 37 3. ( CI1.7237.15 CI172371 172 1.7 715 7.1 CI:1.723-7.15 1.2 P00 P=0.0 09 0.9 138 8 13.8 38 3.8 545 54.5± CI1.7237.1 CI17237 17 1. 71 7. CI:1.723-7.1 P0 P=0. 0. 13. 54.5 CI1.7237. CI1723 CI:1.723-7. P=0 54. CI1.7237 CI172 CI:1.723-7 P= CI1.723 CI17 CI:1.723- CI1.72 CI:1.723 CI1.7 CI:1.72 CI1. CI:1.7 CI:1. CI:1 CI:

https://doi.org/10.1590/2175-8239-jbn-2021-0257en

Surpresa! O Que Você é? O Desafio Diagnóstico de uma Massa Cardíaca
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Tinoco, Mariana

; Castro, Filipa

; Leite, Sérgio

; Sousa, Francisco

; Lourenço, António

Arquivos Brasileiros de Cardiologia

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oct 2022, Volume 119 N. 4 Pages 616 - 618

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20211033

Differences in hormonal levels between heterozygous CYP21A2 pathogenic variant carriers, non-carriers, and females with non-classic congenital hyperplasia
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Silva, Rita Santos

; Carvalho, Berta

; Pedro, Jorge

; Castro-Correia, Cíntia

; Carvalho, Davide

; Carvalho, Filipa

; Fontoura, Manuel

Archives of Endocrinology and Metabolism

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apr 2022, Volume 66 N. 2 Pages 168 - 175

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: CYP21A2 mutation heterozygote carriers seem to have an increased risk of hyperandrogenism. However, the clinical relevance of the heterozygote carrier status and the reliability of hormonal testing in discriminating a carrier from a non-carrier are puzzling questions. We aimed to characterize a population of Portuguese females suspected of having non-classic congenital adrenal hyperplasia (NC-CAH) due to clinical and biochemical criteria and who have undergone CYP21A2 molecular analysis. Subjects and methods: Retrospectively, we have analyzed the clinical records of 131 females (32 girls aged 3-9 and 99 adolescents and premenopausal women aged 13-49) who underwent complete CYP21A2 molecular analysis due to suspicion of NC-CAH. We divided included participants into three groups according to the CYP21A2 molecular analysis: NC-CAH females (46), heterozygous carriers (49), and wild type (36). We then compared clinical signs and symptoms as well as biochemical and molecular data between carriers and NC-CAH individuals and between carriers and wild type females. We measured 17OHP by electrochemiluminescence immunoassay. Results: Clinical features were similar between groups. Heterozygous carriers presented higher basal and post-cosyntropin 17-hydroxyprogesterone (17OHP) than wild type individuals (p < 0.05) and lower basal and stimulated 17OHP levels than NC-CAH patients (p < 0.05). We discovered a considerable overlap between 17OHP levels among groups. The most common pathogenic variant we identified was p.Val282Leu. Conclusion: In this population of hyperandrogenic women and children, heterozygous carriers showed higher basal and stimulated 17OHP than non-carriers although normal basal and stimulated 17OHP responses do not exclude heterozygosity for CYP21A2 pathogenic variants. In this study, only the molecular analysis presented good sensitivity in identifying heterozygotes.

https://doi.org/10.20945/2359-3997000000437

Relationships between type and duration of training and well-being status of volleyball athletes
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Lima, Ricardo Franco

; Silva, Ana Filipa

; Afonso, José

; Silva, Rui

; Castro, Henrique de Oliveira

; Clemente, Filipe Manuel

Revista Brasileira de Cineantropometria & Desempenho Humano

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2022, Volume 24 elocation e75672

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O objetivo deste estudo foi descrever as variações semanais no tipo e duração do treinamento, bem como parâmetros relacionados ao bem-estar, em jogadores de elite de voleibol. Vinte e quarto jovens jogadores de elite de voleibol da seleção Francesa (idade: 17,8 ± 1,0 anos) foram monitorados diariamente, e o tipo de treinamento, a duração do treinamento, a participação em partidas e o status de bem-estar foram medidos durante 22 semanas. A duração do treinamento de voleibol variou de 100 a 510 minutos por semana, enquanto a duração do treinamento de força e condicionamento variou de 97 a 262 minutos por semana. Os níveis de fadiga variaram de 1,5 a 2,8 A.U., e a dor muscular tardia (DMT) variou de 1,5 a 2,5 A.U. Correlação positiva grande foi encontrada entre sono e duração do jogo (r = 0,64) e entre estresse e volume semanal (r = 0,52). Além disso, uma correlação positiva moderada foi encontrada entre fadiga e duração da partida (r = 0,36), entre sono e volume semanal (r = 0,35), entre DMT e duração da partida (r = 0,43), entre estresse e treinamento de força (r = 0,42), treinamento de voleibol (r = 0,35), e duração da partida (r = 0,47). O presente estudo revelou variações naturais no volume de treinamento ao longo da temporada e dependência moderada entre treinamento semanal/duração da partida e status de bem-estar.

ABSTRACT The purpose of this study was to describe weekly variations in the type and duration of training, as well as wellness-related parameters, in elite volleyball players. Twenty-four youth elite volleyball players from the French national team (age: 17.8 ± 1.0 y.o.) were monitored daily, and the type of training, training duration, participation in matches, and wellness status were measured over 22 weeks. Volleyball training duration varied from 100 to 510 minutes per week, while strength and conditioning training duration varied from 97 to 262 minutes per week. Fatigue levels varied from 1.5 to 2.8 A.U., and delayed onset muscle soreness (DOMS) varied from 1.5 to 2.5 A.U. Large positive correlation were found between sleep and match duration (r = 0.64) and between stress and weekly volume (r = 0.52). Additionally, moderate positive correlation were found between fatigue and match duration (r = 0.36); between sleep and weekly volume (r = 0.35); between DOMS and match duration (r = 0.43); between stress and strength training (r = 0.42), volleyball training (r = 0.35), and match duration (r = 0.47). The present study revealed natural variations in training volume across the season and moderate dependency between weekly training/match durations and wellness status.

https://doi.org/10.1590/1980-0037.2022v24e75672

Acute hyperammonemic encephalopathy - an indication for an extracorporeal depuration technique A case report and literature review
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Silva, Filipa

; Tavares, Joana

; Castro, Ana

; Guimas, Arlindo

; Freitas, Cristina

; Pimentel, João Pedro

; Cabrita, António

Portuguese Journal of Nephrology & Hypertension

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mar 2021, Volume 35 N. 1 Pages 43 - 46

Abstract: En | Text: En | PDF: En

ABSTRACT Introduction: Ammonia is a resultant molecule from the protein metabolism that can be neurotoxic when present in high concentrations, causing brain edema and encephalopathy. Extracorporeal blood purification technique (EBPT) can play a role in reducing both ammonia and urea blood levels. However, there are no specific guidelines for its use in hyperammonemia, due to its low incidence and scarce literature on this subject, particularly in adults. Case report: The authors describe a case of a 22‑year‑old previously healthy woman. She presented with polyuria, polydipsia, anorexia, vomiting and significant (>10%) weight loss over a month. Laboratory data revealed hypoglycemia and a high anion gap metabolic acidosis with severe acidemia with normal lactate, serum creatinine of 1.12 mg/dl and 260 (reference value 26‑74)umol/l of ammonia. Urine analysis showed ketone bodies. She evolved with progressive encephalopathy and neurological deterioration. The hypothesis of hyperammonemic encephalopathy secondary to a hereditary metabolic disease was suspected. Medical supportive therapy was initiated. An EBPT for ammonia removal and acid‑base correction was initiated using continuous venovenous hemodiafiltration (CVVHDF) with a drastic neurologic improvement. A fatty acid beta‑oxidation deficit was discovered. The patient was discharged with no neurological changes, with a strict diet free of fat, animal protein and high‑protein vegetables, plus supplementation with benzoate, carnitine, riboflavin, maltodextrine and essential amino acids. Discussion and conclusion: In adults, hyperammonemia related to metabolic disorders is rare, and in the presence of encephalopathy, ECDT should be considered. Ammonia is easily dialysable either by intermittent or continuous techniques. CVVHDF provides a continuous clearance with less rebound effect.

https://doi.org/10.32932/pjnh.2021.04.117 67 downloads

10.

Impacte da reabilitação respiratória, prescrita por enfermeiros, na capacidade para o autocuidado, na pessoa com DPOC
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Pereira, Marlene Andreia dos Santos

; Moreira, Ana Filipa Braga

; Machado, Paulo Alexandre Puga

; Padilha, José Miguel dos Santos Castro

Revista Portuguesa de Enfermagem de Reabilitação

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dec 2020, Volume 3 N. 2 Pages 80 - 85

Abstract: Es Pt En | Text: Es Pt En | PDF: Es | PDF: Pt | PDF: En

RESUMEN Introducción: La rehabilitación respiratoria (RR) es una componente central del tratamiento no farmacológico de la EPOC. El entrenamiento físico es un elemento primario de RR. Sin embargo, se sabe poco sobre la efectividad de estos programas prescritos por enfermeros. Objetivos: Identificar el impacto de un programa de RR, prescrito por enfermeras, sobre la capacidad de autocuidado de la persona con EPOC. Métodos: Hemos realizado una revisión sistemática de la literatura hasta el 4 de febrero de 2019, utilizando MEDLINE, EMBASE, Web of Science Core Collection, Scopus y CINAHL. Resultados: Este estudio, demostró que las personas con EPOC, que participan en un programa de RR, prescrito por enfermeros, demostraron una reducción en los niveles de fatiga, una mejora en la calidad de vida y en la capacidad de realizar actividades de la vida diaria. Conclusión: El estudio permitió identificar que los programas de RR de enfermería tienen un impacto positivo en la reducción de la fatiga, aumentando la capacidad de las personas para participar en actividades de la vida diaria y mejorando su calidad de vida.

RESUMO Introdução: A Reabilitação Respiratória (RR) é uma componente central do tratamento não farmacológico da DPOC. O treino de exercício é um elemento primordial da RR. Porém, pouco se sabe sobre a efetividade destes programas prescritos por enfermeiros. Objetivos: Identificar o impacte de um programa de RR, prescrito por enfermeiros, na capacidade para o autocuidado, da pessoa com DPOC. Métodos: Revisão sistemática de literatura até ao dia 4 de fevereiro de 2019, com recurso à MEDLINE, EMBASE, Web of Science Core Collection, Scopus, and CINAHL. Resultados: Incluímos um estudo que comprovou que as pessoas com DPOC, que participaram num programa de RR, prescrito por enfermeiros, revelaram uma redução nos níveis de fadiga, melhoria na qualidade de vida e na capacidade para executar as atividades de vida diária. Conclusão: O estudo permitiu identificar melhorias nos níveis de fadiga, na qualidade de vida e na execução das atividades de vida diária resultantes da reabilitação respiratória prescrita por enfermeiros.

ABSTRACT Introduction: Pulmonary Rehabilitation (PR) is a central component in the non-pharmacological treatment of COPD. One of the primary elements of PR is exercise training. However, little is known about the effectiveness of conducting these programs by nurses. Objectives: Identify the impact of an PR program, prescribed by nurses, on the capacity for self-care of the person with COPD. Methods:: Systematic literature review until February 4, 2019, using MEDLINE, EMBASE, Web of Science Core Collection, Scopus, and CINAHL. Results: The systematic literature review included 1 article which showed that people undergoing PR programmes, supervised by nurses, revealed a decrease in fatigue levels, an improvement in their life quality and in the daily routine tasks/activities execution. Conclusion: This review allowed to identify that nurse-led interventions has positive impact over fatigue, health related quality of life and in daily living activity performance of COPD patients.

https://doi.org/10.33194/rper.2020.v3.n2.12.5823 65 downloads

11.

Identification of clusters of asthma control: A preliminary analysis of the Inspirers studies
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Jácome, Cristina

; Amaral, Rita

; Almeida, Rute

; Pereira, Ana Margarida

; Couto, Mariana

; Araújo, Luís

; Alves-Correia, Magna

; Pereira, Mariana

; Ferreira-Magalhães, Manuel

; Loureiro, Cláudia Chaves

; Catarata, Maria Joana

; Santos, Lília Maia

; Cabral, Sara

; Pereira, João

; Ramos, Bárbara

; Lopes, Cristina

; Mendes, Ana

; Lopes, Anabela

; Rodrigues, José Carlos Cidrais

; Oliveira, Georgeta

; Aguiar, Ana Paula

; Afonso, Ivete

; Carvalho, Joana

; Arrobas, Ana Maria

; Costa, José

; Valério, Margarida

; Pereira, Marta

; Almeida, Teresa

; Dias, Joana

; Bom, Ana Todo

; Azevedo, João

; Ribeiro, Carmelita

; Alves, Marta

; Pinto, Paula Leiria

; Neuparth, Nuno

; Neves, Ana Castro

; Palhinha, Ana

; Marques, João Gaspar

; Martins, Pedro

; Trincão, David Pina

; Todo-Bom, Filipa

; Santos, Maria Alvarenga

; Branco, Joana

; Costa, Alberto

; Neto, Armandina Silva

; Santalha, Marta

; Lozoya, Carlos

; Santos, Natacha

; Silva, Diana

; Vasconcelos, Maria João

; Barata, Luís Taborda

; Teixeira, Maria Fernanda

; Pinto, Diana

; Alves, Rodrigo Rodrigues

; Moreira, Ana Sofia

; Pinto, Cláudia Sofia

; Silva, Pedro Morais

; Alves, Carlos

; Câmara, Raquel

; Coelho, Didina

; Bordalo, Diana

; Carvalho, Fernanda

; Fernandes, Ricardo

; Ferreira, Rosário

; Oliveira, José Ferraz de

; Menezes, Fernando

; Gomes, Ricardo

; Calix, Maria José

; Marques, Ana

; Cardoso, João

; Emiliano, Madalena

; Gerardo, Rita

; Nunes, Carlos

; Ferreira, José Alberto

; Lopes, Inês

; Alves, Adelaide

; Fonseca, João Almeida

Revista Portuguesa de Imunoalergologia

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dec 2020, Volume 28 N. 4 Pages 231 - 240

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Objetivos: Identificar clusters de controlo da asma baseados no Teste de Controlo da Asma e Rinite Alérgica (CARAT) e comparar as características dos doentes nos diferentes clusters. Métodos: Adultos e adolescentes (≥13 anos) com asma persistente foram recrutados em 29 centros no contexto de 2 estudos observacionais do projeto INSPIRERS. Foram recolhidos dados relativos a características demográficas e clínicas, adesão ao inalador, crenças sobre a medicação, sintomas de ansiedade e depressão, qualidade de vida e controlo da asma (CARAT, >24 bom controlo). Foi efetuada uma análise hierárquica de clusters usando a pontuação total do CARAT (CARAT-T).Resultados: Foram analisados 410 doentes (68% adultos), com uma idade mediana (percentil 25-percentil 75) de 28 (16-46) anos. Foram identificados três clusters [média CARAT-T(min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] e cluster 3 [10(2-13)]. Os doentes no cluster 1 (34%) apresentavam melhor controlo da asma, melhor qualidade de vida, maior adesão aos inaladores e usavam um único inalador. Os doentes nos clusters 2 (50%) e 3 (16%) tinham a asma não controlada, menor adesão aos inaladores, mais sintomas de ansiedade e depressão e mais de metade reportavam pelo menos uma exacerbação no último ano. Adicionalmente, os doentes no cluster 3 eram predominantemente mulheres, tinham mais consultas médicas não agendadas, apresentavam mais sintomas de ansiedade, percebiam uma maior necessidade dos inaladores, mas também uma maior preocupação associada ao seu uso. Não se verificaram diferenças na idade, índice de massa corporal, função pulmonar, hábitos tabágicos, hospitalizações ou tempo de seguimento pelo médico especialista. Conclusões: Um método não supervisionado baseado no CARAT-T, identificou 3 clusters de doentes com diferentes características clínicas. O cluster com melhor controlo apresenta um ponto de corte semelhante ao estabelecido no estudo de validação do CARAT. Este estudo sugere ainda a existência de um ponto de corte adicional para distinguir doença mais grave. Mais investigação é necessária para validar os clusters identificados

Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25-percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Furthermore, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symptoms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT-T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.

https://doi.org/10.32932/rpia.2020.12.046 633 downloads

12.

Curso masivo en línea “Salud sexual y reproductiva”: cambios en conocimientos, deserción, reprobación y satisfacción
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Castro, Filipa De

; Rodríguez-Hernández, José Alejandro

; Hubert-López, Celia

; Sánchez-Pájaro, Andrés

; Rosas-Magallanes, Cynthia

; Villalobos, Aremis

; Barrientos-Gutiérrez, Tonatiuh

Salud Pública de México

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oct 2020, Volume 62 N. 5 Pages 559 - 568

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Objetivo: Presentar resultados globales de la deserción, reprobación y satisfacción de los usuarios del Curso Masivo en Línea Abierto (MOOC, por sus siglas en inglés), así como los cambios en conocimientos y prácticas del personal de salud inscrito al MOOC “Salud sexual y reproductiva y prevención del embarazo en adolescentes”. Material y métodos: Se analizaron 45 549 registros y se ajustaron modelos de regresión logística para la deserción y reprobación del curso. Resultados: Finalizó el curso 57.8% de los usuarios, mientras que 15.1% reprobó. Los modelos logísticos muestran que la edad y el cargo ocupado se asocian tanto con la deserción como con la reprobación. Conclusiones: El MOOC es una herramienta útil para generar mejoras en conocimientos y competencias. Es necesario ampliar la cobertura a profesionales que tienen trato con población adolescente, con el fin de mejorar la salud sexual y reproductiva y prevenir embarazos en la adolescencia.

Abstract Objective: To present global results of the dropout and failure and satisfaction of the Massive Open Online Course (MOOC) users, as well as changes in knowledge and practices of personnel registered in “Sexual and Reproductive Health and Prevention of adolescent pregnancy”. Materials and methods: Using 45 549 records, we adjust logistic regression models to find associations between variables of dropout and failure. Results: 57.8% of people completed the course and 15.1% failure. Logistic models show that age and position are associated with both dropout and failure. Conclusions: The MOOC is useful to improve knowledge and skills of health personnel. It is necessary to expand the coverage to professionals who deal with adolescent population, in order to improve sexual and reproductive health and prevent teenage pregnancies.

https://doi.org/10.21149/11183 51 downloads

13.

Bases metodológicas de la medición de desarrollo infantil temprano en la Ensanut 100k
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Castro, Filipa de

; Rojas-Martínez, Rosalba

; Villalobos, Aremis

; Shamah, Teresa

; Vázquez-Salas, Ruth Argelia

; Armendares, Nathalie

; Allen-Leigh, Betania

; Escamilla, Alberto

; Romero, Martin

Salud Pública de México

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oct 2020, Volume 62 N. 5 Pages 532 - 539

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Objetivo: Presentar los métodos realizados para la inclusión del módulo de Desarrollo Infantil Temprano (DIT) en la Ensanut 100k. Material y métodos: Con dicho módulo y el cuestionario de menores de cinco años, se obtuvieron indicadores del estado de salud, desarrollo y bienestar de niñas/os en los primeros cinco años de vida. De noviembre a diciembre de 2017, se definió el diseño de la muestra, instrumentos y manuales, y se realizó una prueba piloto. Se capacitó y estandarizó al personal de campo. El levantamiento de información se realizó entre enero y junio de 2018. Resultados: Se estudió en el módulo DIT de la encuesta a 3 892 niños/as de 0 a 59 meses de edad. Conclusiones: La capacitación y estandarización del personal de campo, por parte de personal capacitado y estandarizado, minimiza los sesgos de información.

Abstract Objective: The methods that were carried out for the inclusion of the early childhood development module in the Ensanut 100k are presented. Materials and methods: With this module and the questionnaire for children under five years-old, indicators of the state of health, development and well-being of children in the first five years of life are obtained. From November to December 2017, the sample design, instruments and manuals were defined and a test was carried out. Field staff were trained and standardized. The information was collected between January and June 2018. Results: 3 892 children from 0 to 59 months of age were studied in the DIT Module of the Survey. Conclusions: Training and standardization of field personnel, by trained and standardized personnel, minimizes information biases.

https://doi.org/10.21149/11067 28 downloads

14.

Pneumonia por Chlamydia psittaci: Um Caso Clínico
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Castro, José Luís

; Xavier, Filipa Castro

; Valente, Joana

; Rodrigues, Marina

; Rollo, Ana Castro

Gazeta Médica

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sep 2020, Volume 7 N. 3 Pages 282 - 285

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo A psitacose, também conhecida como ornitose, é geralmente uma doença com manifestações sistémicas proeminentes e alguns sintomas respiratórios, causada por Chlamydia psittaci. Os pássaros psitacinos são o principal reservatório e meio de transmissão da doença para os humanos. Descreve-se o caso clínico de uma doente de 50 anos, trabalhadora num armazém agro-avícola, que foi observada três vezes em contexto de urgência por quadro de dispneia, tosse seca, toracalgia, cansaço generalizado e febre. Relata-se o seu percurso e evolução até ao diagnóstico de pneumonia a Chlamydia psittaci. Este relato de caso reforça a importância de realizar sempre uma adequada anamnese, revelando-se preponderante para o sucesso diagnóstico e terapêutica dirigida.

Abstract Psittacosis, also known as ornithosis, is a condition, caused by Chlamydia psittaci, which usually causes both prominente systemic manifestations and respiratory symptoms. This condition is transmitted to the vast majority of humans by psitaciformes birds. In this article, we describe a clinical case of a 50-year-old patient, working in an agro-poultry warehouse, who was observed three times due to dyspnea, dry cough, chest pain, general tiredness and fever. Only after she have been submitted to additional tests, the diagnosis of pneumonia to Chlamydia psittaci was revealed. With this case we aim to stress the fundamental role played by an adequate anamnesis and her importance for a successful diagnosis and concomitant targeted therapy.

https://doi.org/10.29315/gm.v7i3.314 43 downloads

15.

SARS-CoV-2 infection in hemodialysis patients: Preliminary data from a Portuguese hospital center
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Tavares, Joana

; Dias, Bruno Fraga

; Oliveira, João Pedro

; Sala, Inês

; Silva, Filipa

; Castro, Ana

; Freitas, Cristina

; Fonseca, Tomás

; Pimentel, João Pedro

; Cabrita, António

; Castro, Rui Sarmento e

Portuguese Journal of Nephrology & Hypertension

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sep 2020, Volume 34 N. 3 Pages 142 - 146

Abstract: En | Text: En | PDF: En

Background: In December 2019, a new form of coronavirus was identified (COVID-19) and quickly became a worldwide pandemic. Previous data reported a more severe disease in older patients, with high comorbidities, which are common features in hemodialysis patients. Scarce data is available about the clinical presentation and outcomes in this population. For this reason, we aim to report the characteristics of COVID-19 disease in hemodialysis patients admitted to our center. Methods: We retrospectively reviewed all patients on chronic hemodialysis admitted with a laboratory-confirmed COVID-19 infection from March 2nd to May 20th of 2020. Baseline characteristics, clinical, laboratory and radiological presentation were registered and treatment and outcomes Results: Fourteen patients were included, 57% female, with a median age of 81 years old and a high number of comorbidities. Cough and fever were the most common symptoms and lymphocytopenia, increased inflammatory parameters and coagulation dysregulation were frequently registered. Ground-glass opacities were present in each thorax computerized tomography performed. Five patients developed respiratory insufficiency, but none needed invasive ventilation or ICU admission. In a significant proportion, discharge was postponed due to the impossibility of ensuring social isolation. Median viral shedding was 38 days. Discussion and conclusion: Hemodialysis patients who required hospitalization were very old and had multiple comorbidities. Even so, the impaired immune response of this population seems to cause a less severe course of the disease and a longer time of viral shedding. HD units have required a reformulation of their circuits in order to avoid disease spreading.

https://doi.org/10.32932/pjnh.2020.10.083 382 downloads

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