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Since the detection of the first cases of COVID-19, reported by the People's Republic of China on the 31st December 2019, up to the confirmation of the first cases in Portugal, on the 2nd March, countries like Italy and Spain faced the collapse of their healthcare systems. Anticipating this possibility, the Portuguese National Health Service carried out measures to prepare for this reality. This paper describes the changes implemented in the Anesthesiology department of a tertiary hospital center in Portugal, aiming to ensure the safety of both patients and healthcare professionals. The measures implemented had to do mostly with scientific preparation and team reorganization; management of personal protective equipment; redesigning the department's clinical common areas, separation of patient circuits with creation of a designated COVID Operating Room, Post-Anesthetic Care Unit; rescheduling of elective surgery and testing all patients before anesthesia procedures and consulting other hospital departments. The reported data covers the period between the 2nd March and the 30th April of 2020. In this period, 64 cases with COVID-19 or with high clinical suspicion were approached. To date, there have been no cases of in-hospital spread to other patients or to professionals in this department. With this paper we intend to start a reflection that will end up with the optimization of strategies that allows health systems to deal better with COVID-19, keeping patients and health providers safe.

Introduction: Our neonatal service is part of a differentiated perinatal hospital and has contributed to the Vermont Oxford Network for more than 15 years. This data base includes data on the morbidity and mortality of newborns born in the member hospitals with birth weight between 401 and 1500 g and/ or from 22 to 29 weeks and six days of gestation, or those admitted to these hospitals with up to 28 days of age. It thus allows the analysis of clinical practice and its comparison with similar units. The goal of the present paper is to disclose some of our data from the past 15 years and to compare it with the Vermont Oxford Network data trying to identify areas of possible improvement and permitting other neonatal units to compare their data with our in a benchmarking process., Material and Methods: Observational, retrospective study. It included newborns with birth weight ≤ 1500 g (very low birth weight newborns) born and treated at our hospital from 2001 to 2015. Descriptive data analysis, chi-square test and ANOVA, significance when p < 0.05., Results: A total of 869 very low birth weight newborns were studied, median weight 1100 g and gestational age 29 weeks. Twinning was found in 37.6%. In the delivery room, 23% did not require any resuscitation, 52.2% of the newborns required invasive intubation, 78.3% had surfactant, and, since 2011, 29.7% have started noninvasive ventilation. Of the total very low birth weight newborns, 12.9% had oxygen therapy at 36 weeks of corrected age, 23% patent ductus arteriosus and late sepsis in 17.1%. There was higher neurological morbidity compared to the Vermont Oxford Network except in the case of retinopathy of prematurity. Overall mortality was 14% (122 newborns). The time of hospitalization was on average 52.7 ± 34.4 days. The 629 newborns that were discharged home had equivalent length of stay and head circumference measure but a lower weight than those in the Vermont Oxford Network, and 14.3% went home with exclusive breastfeeding., Discussion: This work allowed us to study our very low birth weight newborns data and compare it with one of the largest neonatal world networks. Our population is similar from the point of view of gestational age, somatometric data, pregnancy surveillance rates and cesarean section with the most noticeable difference being the percentage of low birthweight for gestational age babies, twin pregnancies and antenatal corticosteroid treatment, superior in our center. Cardio-pulmonary and gastrointestinal disorders were overlapping. It is urgent to improve our rate of sepsis, neurologic sequelae, post-partum hypothermia control and neuroprotection with magnesium sulphate. The mortality rate and the length of stay at discharge was similar., Conclusion: This study allowed us to compare our population of very low birth weight newborns with those registered in the network. We have verified that we have been accompanying the evolution of Neonatology over the past years and we have identified areas for improvement.

Introduction: Diabetes Mellitus is a public health problem that is on the increase throughout the world, including in Portugal. This paper aims to identify the changing geographic pattern of this cause of death in Portugal and its association with sociomaterial deprivation., Material and Methods: This is a transversal ecological study of the deaths by Diabetes Mellitus in Portuguese municipalities in three periods (1989-1993, 1999-2003 and 2006-2010). It uses a Bayesian hierarchical model in order to obtain a smooth standardized mortality ratio and the relative risk of death by Diabetes Mellitus associated to sociomaterial deprivation., Results: In 1989-1993, the highest smooth standardized mortality ratio values were found in coastal urban municipalities (80% of municipalities with smooth standardized mortality ratio ≥ 161, of which 60% are urban); in 2006-2010, the opposite was found, with the highest smooth standardized mortality ratio values occurring in rural areas in southern inland regions (76.9% of municipalities with smooth standardized mortality ratio ≥ 161, of which 69.2% are rural), particularly the Alentejo. The relative risk of death by Diabetes Mellitus increases with vulnerability associated to social and economic conditions in the area of residence, and is significant in the last two periods (relative risk: 1.00; IC95%: 0.98-1.02)., Discussion: Diabetes Mellitus presents a geographic pattern marked by coastal-inland and urban-rural asymmetry. However, this has been altering over the last twenty years. 48% of the population reside in municipalities where the smooth standardized mortality ratio has increased in the last twenty years, particularly in the rural areas of inland Portugal., Conclusion: The highest smooth standardized mortality ratio are currently found in rural municipalities with the highest index of sociomaterial deprivation.

Objective: The aim of the present study was to evaluate iodine intake in portuguese school children in order to inform health authorities of eventual measures to be implemented., Introduction: Iodine is the key element for thyroid hormone synthesis and its deficiency even mild, as found in other European countries, may have deleterious effects in pregnancy resulting in cognitive problems of offsprings. In Portugal there are no recent data on iodine intake in schoolchildren., Population and Methods: 3680 children aged 6-12 years of both sexes, from 78 different schools were studied. Iodine intake was evaluated trough urine iodine (UI) determinations using a colorimetic method., Results: The global median UI value was 105.5 µg/L; the percentage of children with UI <100 µg/L was 47.1%, corresponding to 41% of the studied schools. The percentage of values <50 µg/L was 11.8%. The male gender, the south region of the country and the distribution of milk in school were significantly linked with a higher iodine elimination., Discussion: Our global results point to a borderline/ mildly insufficient iodine intake in the portuguese school population. However 47% of the children had UI under 100 µg /L. The comparison of our results with the available data from 30 years ago, point to a considerable improvement, due to silent prophylaxis. Male gender, geographical area and milk distribution influenced positively iodine intake.The importance of milk has been referred in numerous papers., Conclusions: The study of UI in the Portuguese school population points to a borderline iodine intake. However, in 47% of children iodine intake was inadequate. Compared with data from the eighties, a considerable increase in iodine elimination was found. Taking into account the potencial deleterious effects of inadequate iodine intake, a global prophylaxis with salt iodization has to be considered.

Allogeneic haematopoietic stem cell transplantation (HSCT) has been used to treat a variety of malignant and non-malignant diseases, particularly of the blood and immune system. However, as no more than 30% of patients will have HLA-identical sibling, much effort has been devoted to the establishment of bone marrow registries for HSCT. In 2010, there are more than 15 million bone marrow donors and cord blood units in the in the Bone Marrow Donors Worldwide (BMDW) database. Participants are 64 stem cell donor registries from 44 countries, and 44 cord blood banks from 26 countries. The North Center of Histocompatibility (CHN) is one of the three Histocompatibility Centers which made the Portuguese Registry of bone marrow donors--National Center of Bone Marrow, Stem Cells and Cord Blood Donors (CEDACE). The aim of this paper is to present the first 110000 donors recruited by the CHN to the CEDACE. In 2010, the recruited donors throw the CHN distribution by age are 14.6%, 38.7%, 37.8% and 8.9%, for the age groups [18;25], [25;35], [35;45] and = 45, respectively. The 110000 bone marrow donors recruited in the North of Portugal by the CHN are a contribution to the worldwide effort that is the BMDW. Young, preferably male donors, should be targeted as replacement of the donors who retire because of old age or for other reasons. Also, the quest for donors with the so-called unique phenotypes is a challenge for all registries. Portuguese areas which show particularly high levels of phenotype diversity or those in which alleles of haplotypes underrepresented in the registry are identified can and should be targeted for the optimization of recruitment strategies.

Background: The need to teach evidence-based public health to undergraduate medical students is clearly established. Following the Bologna reforms under way in many European universities and their medical schools, there is a recognised need to monitor teaching methods and their results (learning objectives). Within this framework, a new Public Health study unit was introduced in the fifth year of the Master in Medicine in a Portuguese Medical School (Instituto de Ciências Biomédicas Abel Salazar), in 2007., Methods: At the end of the final written exam, a specifically developed questionnaire was given to all students to be completed anonymously. The questionnaire covered the areas of learning objectives and teaching methods and formats., Results: After an account of the contents and teaching methods used in the course unit, this paper will focus on the description and discussion of the results of a questionnaire, used in the academic years of 2008/2009 and 2009/2010. All students attending the final exams (n = 268) in these two years, succeeded in the study unit. From the 213 valid questionnaires it can be concluded that initially proposed learning objectives were successfully achieved. Moreover, final reported levels of competency were high for most objectives. The students preferred active teaching methods, such as group presentation and discussion, compared with passive approaches (eg classical lecture)., Discussion: This study has methodological limitations, most of which derive from the use of a self-completed questionnaire that has not been previously validated. Nevertheless, results seem to show the success of the study unit, pointing to needed studies in the future. Teaching evidence-based public health to undergraduate medical students can be further assessed in the future.

This paper aims to demonstrate that with Marck Athias, the Portuguese medicine inaugurated a new chapter in its history, in the Republic period, characterized by the experimental training at the laboratory. Thus, book-based knowledge gave way to a more clinically based approach favouring laboratory practice and basic research within several scientific domains. This new perspective operated important changes in the Portuguese medical community in the first half of century XX. Marck Athias (1857-1946), a Portuguese, was a physician trained at the University of Paris under Mathias Duval (a former student of Santiago Rámon y Cajal). It was in his laboratory that Athias began his career as researcher. Returning to Portugal, Athias founded a research school in physiology and histology which stressed a new approach in medicine based on experimental research. At the beginning of the twentieth century, scientific research in Portugal was virtually devoid of any of the practical clinic aspects. It is in fact Athias who introduced a new scientific perspective in Portuguese scientific community as well as influenced generations of graduate students in several national higher education and scientific research centres associated with Medicine. His influence and impact was due in great part to the underlying ideology of a positivist nature which succeeded in attracting several generations of followers, promoting a new step for the modernization of Portuguese medicine.

Unlabelled: Local and national scientific journals have been widely criticized by some authors. Additionally, they are quite rarely indexed at international databases, which results in a reduced visibility of their articles., Objective: To analyze international scientific productions of authors publishing in Acta Medica Portuguesa during 2008., Methods: A database with all the authors publishing in Acta Medica Portuguesa in 2008 was built. In July 2009, production of all those authors from the previous five years (2003-2007) was retrieved from Science Citation Index. Journals where they published, Impact Factors of those journals, articles' references, and times cited were analyzed., Results: The 78 articles published by Acta Medica Portuguesa in 2008 were produced by 259 different authors. Ninety four (36.3%) of those authors wrote 420 articles from 2003 to 2007 indexed at Science Citation Index. These articles were published in 249 different journals, with an average Impact Factor of 2.973 (SD = 2.92). Journal with highest Impact Factor was The Lancet (IF2008 = 28.409) with two papers published. Eighty seven of those authors received some citation to their articles, with a total amount of 5001 cites. Out of the 14035 references on those 420 articles, only 10 cited any article published in Acta Médica Portuguesa., Conclusion: Authors publishing in Acta Médica Portuguesa produce a good amount of international publications in journals with an acceptable Impact Factor and they receive quite a good number of citations. Conversely, these authors when publishing in international journals have an extremely low citation of articles published in Acta Médica Portuguesa.

This paper reports on some important findings of a study conducted in Covilhã/Portugal on appropriateness of hospital admission and in-hospital days in a Portuguese hospital using an adapted version of the Appropriateness Evaluation Protocol--a review tool for hospital utilization. This analysis showed a significant rate of inappropriateness in admission (24.6%) and days of stay (37.4%) and it also suggested a low rate of use of the override options. It was possible to identify the conservative attitude as the most common cause of inappropriate admissions and days of stay. This study demonstrates that a high proportion of admissions and days of stay are related to patients who could have been attended at other levels of the health care system such as outpatient consultations. The analysis made it possible to identify and to explore some variables correlated to the levels of inappropriateness and to the causes of inappropriateness or levels of health care required by the patients.

Introduction and Objectives: The bibliometric analysis of the Portuguese scientific production in the field of breast pathology since 1995 to date (July 2005) provides an overview on the developed scientific activity on this subject and allows the characterisation of some relevant features as well as its evolution along the studied period., Material and Methods: Documents collected, reflecting the national scientific production in the field of breast pathology between 1995 and July 2005 in 3 databases, Medline (with search interface PubMed), Science Citation Index and Index of the Portuguese medical journals were studied. We applied quantitative and qualitative bibliometric indicators to the found number of articles and the journals where they were published. The quantitative indicators based on the number of published articles illustrate Portugal's position in the area of breast pathology within the international scientific community; further, it also allows the identification of the participation of the different institutions and national bodies, allocated by geographic areas, in scientific production as well as the establishment of international collaboration. Qualitative indicators were used to investigate the influence, and the impact of the scientific production. These are indicators based on the journal classification where the articles were published and also the citations they received. The number of citations obtained by the articles collected in the performed search, was determined, based on the Science Citation Index and the Impact Factor (IF) of the journals, which is annually published in the Journal Citation Reports (JCR). In spite of all its constraints, it is difficult not to accept the opinion that the Impact Factor is today one of the few means (if not the sole one) which enables an assessment of the influence of a journal in the international scientific community., Results: During the evaluated period, the Portuguese scientific production in the selected area showed an increase of 200%. We analysed 348 documents (232 published in the selected international Databases and 16 in the national Database. We noticed that articles published by one single author are very rare, n=6 and that co-authorship is the most common way of publishing. The distribution of article production is as follows: 59% in the North Zone, 26% in the South Zone and 15% in the Central Zone of the country. The national institutions with a higher rate of publishing in renowned international journals are IPATIMUP, IPO Porto and IPO Lisboa. The institutions which publish the larger number of papers in Portuguese journals are Hospitals and Health Centres. The international journals selected by the national scientists present a high impact factor. In the whole of the 232 articles selected in the international databases, 81 have not received any citation and 120 obtained a total of 1.856 citations. It should be noted that the more recent articles have not yet received citations. The articles resulting from international collaboration, were those receiving an higher rate of citations., Conclusions: An increase of the investigation in breast pathology is observed, this being illustrated by the increase in the number of articles published in well-recognized international journals. It is also noticed a trend to publish in journals with a higher impact factor as well as an increasing role of co-authorship and international collaboration.

In the field of pychoeducational interventions in schizophrenia, terminology is sometimes misleading and further efforts are needed to specify and operationalise terms such as psychoeducation or family intervention, especially wherever they are adapted, for example, for use in non-English speaking countries. On the other hand, in spite of growing evidence of their clinical effectiveness, family interventions for schizophrenia are still not routinely implemented in real life clinical settings. Furthermore, the current poverty of original literature or replication studies in Portugal in the field of family interventions is astonishing. Several high-quality review papers have been published in the last two decades, summarising or meta-analysing data concerning efficacy, effectiveness and efficiency of these family interventions worldwide, but mostly in Anglo-Saxon literature. These findings were indeed incorporated in several clinical guidelines, namely in the United Kingdom. But there seems to exist, in a considerable number of settings, a lack of will to implement scientific findings established for more than twenty years. In developed countries, this should be addressed as a true paradox.

Ticks are hematophagos arthropods that parasitize terrestrial vertebrates. They are world wide, living in almost all terrestrial regions. Although mainly associated to animals, there are several tick species that bite humans and transmit tick-borne agents causing important infectious disease. In this paper the authors revise the most outstanding aspects of those arthropods as vectors of infectious pathogens in Portugal, focusing biologic, ecologic and epidemiologic features with Public Health interest.

This paper deals with the cross-fire between the crimes, respectively, of violation of the professional confidentiality and of transmission of infection disease, by omission, under the Portuguese legal framework, in the case of HIV/AIDS. The conflict of interests and duties for the practitioner, and the difficulty of solving it. Shall the practitioner speak, or shall he/she keep silence when the HIV/AIDS patient refuses to say the truth to his/her sexual partner, with the consequent risk of transmission of infection disease? The point of view of the Human rights. The position of the World Health Organisation (WHO) and of the European Union (EU) in the fight against the discrimination of people affected by HIV/AIDS. The statements of the European Convention on Human Rights (ECHR) concerning the right to privacy and to non-discrimination (even for illness). Possibility of confrontation with the positions represented by: a) the opinion of the National Council of Ethics for the Sciences of Life (CNECV), of 23rd October 2000, required by the Order of the Practitioners; b) the opinion of the Portuguese legal experts; c) the Criminal Law and the Procedural Criminal Law; d) the cases of the English jurisprudence (High Courts). The ethics of responsibility, the crossing of the traditional principles of medicine, bioethics and law, as well as the reinforcing of the medical deontology and the implementing of a deontology of the patient as possible ways to be considered in order to find answers for the problems.

Background: The Toronto Alexithymia Scale, namely in its revised version (TAS-20), is nowadays widely used and certainly the most well validated measure of alexithymia; allowing to recognize three distinct aspects of the construct., Objective: The aim of the present study is to assess reliability and validity of a Portuguese translation; proceeding in this first part, to the semantic validation and confirmatory structural analysis of the questionnaire, as well as to the analysis of the internal coherence of this structure, and of its reliability in what concerns time stability. Just to later examine validity related aspects as described in a second paper., Methods: Fist of all translation and substantiation were properly made as described according with commonly used procedures. Thus resulting in a questionnaire subsequently applied to three distinct populations: university students (N = 468), outpatients attending a routine general practice consultation (N = 50), and patients with inflammatory bowel disease (N = 74)., Results: Despite some traceable instability while replicating the original model, confirmatory factorial analysis somehow allowed disclosing the three originally described factors. Nevertheless also resulted some differences susceptible to later being discerned among the factors in what concerns their internal coherence: the questionnaire as a whole is highly reliable, and the same goes for factor 1, in any of the studied samples; less steady results among different groups were found regarding factors 2 and 3. However the test-retest stability brought to evidence, in any of the considered groups, an excellent reliability in all aspects: global score and integrating factors., Conclusion: With these sound psychometric properties of the instrument under scrutiny, the observed cross-cultural variations result as minor, while also considering the aimed comparability in the context of a vast amount of alexithymia studies carried out all over the world.

This paper begins by discussing the influence of neurological diseases in the practice of general practitioners. A thorough review of the literature allows us to conclude that the frequency of neurological complaints in general practice varies between 7% and 15% and that complaints of sleep disorders reach about 26% in those cases. However, general practitioners do not refer all these neurological cases to a neurologist. They screen the cases and refer only 9% of all observed patients. Next, we briefly analyse the impact of telemedicine in general practice. Given this technique's novelty, we present a predictive model for the utility of teleconsultation, which we are currently developing and testing. We then summarise the current status of general practitioners' referrals to our hospital's neurological outpatient clinic, given previous measures that targeted waiting list reduction and adequate referral. After this overview, we present our methodology, which includes the development and implementation of the technologies needed for teleconsultation and the discussion and application of medical protocols for clinical data, benefits and costs. Simultaneously, we investigated the real need for teleconsultation in Neurology according to the literature and to several, more or less optimistic, models of acceptance. Based on this method, teleconsultation began its regular operation in July 1998. We discuss the result of the first 14 weeks of operation. We observed that referral developed according to calculated predictions and that there were clear advantages regarding diagnostics, medication, exam requests, cost avoidance and patient trips to the central hospital. The data collected predicts that this method is useful, efficient and able to substantially reduce costs.

This paper describes the study aimed at validating the Portuguese version of the MOS SF-36 instrument of assessment. It starts by presenting the results of the implementation of this instrument in a sample of 930 pregnant women and the results of scaling tests, including the values of internal consistency and reliability. However, since a reliable instrument is not necessarily a valid one, the results of several validity tests are also presented. Finally, this paper ends by recommending the use of the Portuguese version of the SF-36 instrument of assessment.

No one aims at applying generic measures as substitutes for other more traditional clinical procedures. The whole history of the evolution of these types of measures has been based on comparisons with clinical measures, always seen by researchers as ways to validate health outcome measures and as a process to be recognized by clinicians as a way to detect changes in time not always detected by the usual measures. The measurement instrument presented in this paper is the Portuguese version of the MOS SF-36, originally a result of the Medical Outcomes Study, a study carried out by Rand Corporation researchers in the 80's. One of the objectives of these researchers was precisely to develop instruments to be used in continuous monitoring of outcomes. This paper describes the first time MOS SF-36 was culturally adapted to Portuguese, validated and implemented. The first part mentions some of the foundations and developments of the original instrument as well as some results obtained from some specific applications. The second part introduces operational definitions for each of the eight scales and describes the SF-36 measurement model as well as the factor structure with two dimensions. Next, we present the design used by us to transform the data from the time they are collected from the respondents to the time they are ready to be further used. Finally, the methodology used to culturally adapt the MOS SF-36 and create a Portuguese version which is culturally equivalent are presented.

Psychiatric problems are common in general medical practice. This paper reviews information supporting the need to integrate psychiatry and general medical practice. The two year liaison between the psychiatric ward of Santa Maria Hospital and Sete Rios Medical Centre is described. A model of longitudinal case supervision analogous to that used in psychiatric residency training to provide knowledge and skills in mental health can respond to the needs of general practitioners.

Cost-containment in health care has become a major issue in today's practice of medicine. With its needs in advanced technologies and skilled personnel, intensive care is among the most expensive of all hospital activities. This fact makes the analysis of indications for intensive care unit admission, as well as early discharge, of paramount importance: patients who are not likely to benefit from intensive care are at the extremes of disease severity, since low-risk patients are not ill enough to need ICU admission and high-risk patients have a very high mortality, irrespective of intensive care treatment. In this paper we discuss, based on published evidence, the formulation of recommendations for admission and early discharge from ICUs, and also present the Society of Critical Care Medicine guidelines, on this subject.

An attempt is being made in several Portuguese Medical Schools to reduce the Medical Course to five academic years. It will be easier and much more rigorous to base these changes on a detailed list of Educational Objectives. The choice of Educational Objectives must take into account the professional and social context surrounding the non-specialist physician (family doctor, general practitioner, etc), the background and maturity of the students, the manpower and resources of the Medical School and the results of the evaluation of the medical graduates as they finish their undergraduate training. This paper is an attempt to produce a list of Educational Objectives for undergraduate training in urology. Since we lack adequate information in relation to Portugal, we relied on epidemiological data from other countries as well as the experience obtained in similar attempts carried out in the USA.

The Paediatric Cardiology Service in Santa Marta Hospital accomplished 25 years of existence at the end of 1994. The Conde de S. Januário Hospital, in Macau also celebrated its 120th anniversary at the same time. The Paediatric Cardiology a paper entitled collaborated in these festivities with Service of Santa Marta Hospital Paediatric Cardiology, 25 years. Hospital de Santa Marta-Lisbon-Past, Present, Future. This paper is now published.

Discussion on curriculum vitae is a highly valorized parameter in the final exam to obtain the degree of medical specialist in Portugal. However, the lack of guidelines for making up a curriculum causes difficulties for everyone involved: residents, juries and institutions which govern the equity of the process. This paper presents guidelines for a curriculum which can be applied to any surgical speciality. The proposal is based on the regulations which govern post-graduate medical training. A broad debate on this issue is also suggested in this article.

Non-insulin-dependent diabetics often have quantitative changes in plasma lipid profiles characterised by higher triglycerides and lower HDL-cholesterol than the average population. This paper summarises the cross-sectional data (reported by the general practitioners participating in Medicos-Sentinela) concerning total and HDL-cholesterol in a cohort of non-insulin-dependent diabetics treated at primary care settings in Portugal. Total cholesterol and High Density Lipoprotein (HDL) associated cholesterol were significantly higher in women. Total cholesterol increased significantly with age (in women), regular alcohol intake, body mass index, systolic blood pressure and diastolic blood pressure (in males). HDL-cholesterol showed significant increase with age (both sexes and males only), gender, and alcohol intake in males. The increase in total cholesterol found in patients with regular alcohol intake is an infrequently reported finding.

Cardiovascular diseases represent an important Public Health problem among us. It is known that the atherosclerotic process on which they are based is mostly dependent on hyperlipidemia, mainly of those characterized by hypercholesterolemia and starts early in childhood. In this paper some lipid parameters were evaluated in children and youngsters and the prevalence of those at risk was compared with the one found in a population sample of adult people, collected at random, using the same determinations and laboratory methods. The authors conclude that preventive measures should be implemented as early as possible in childhood as there are many children and youngsters with hypercholesterolemia and the latter may become lower; some ideas and recommendations for those measures are pointed out.

With the objective of contributing to the Reform of Medical Education, presently in progress in Portugal, this paper presents a short review of the main reasons to change, as well as international movements and pedagogical trends in Medical Education. Some specificities of medical education in Portugal are discussed and the main difficulties and strategies for change are addressed. The experience of the Karolinska Institute in Stockholm is reviewed and its potential correlations to the Portuguese situation are explored.

The authors consider the recently passed about the Portuguese health system reform, namely bills Laws 48/90 and 10/93 (the Bases for Health Law and the National Health Service Act) and they existing some contradictions between the two Laws. In this paper the authors try to adopt point out legislation, mainly the Bases for Health Law from August 24, 1990, as a standard for the conceptualization of a model. One of the proposals in this law, the Health Area, is examined according to the functional contents expressed therein. The authors then probe the concept further, suggesting a local health administration function, at in a Health Area and aimed based a population of about 30,000 inhabitants (from 10 to 50 thousand) and headed by a local Health Administration. The duties and the functional and organizational structure of this body are defined; suggestions for its composition are also advanced. Considering the organizational structure, the authors suggest some services to be supervised by the Local Health Administration: a Public Health Service, a Secretariat and Accounting Service, a Social Service and other. The new concept of Health Center, as the primary care providing unit, is introduced, as is the idea of a Family Medicine Unit, whose functions, definition and scope are proposed.

The authors discuss the indications for radiotherapy in late breast cancer, retrospectively analysing the experience of the Radiotherapy Department of the Portuguese Institute of Oncology in Lisbon. Treatment results of locally advanced cancer (T4a-b-c) with megavoltage machines (telecobalt therapy) using two different types of fractionation regimes are discussed. They conclude that conventional fractionation remains the best option. In elderly patients, those with ulcerated and bleeding lesions and those with socio-economic problems, it is acceptable to use non-conventional fractionation regimes with a high dose per fraction for the first part of the treatment. Advantages are overall shortening of treatment time without an increase in morbidity although survival is somewhat lower (30% versus 40% at 5 years). The authors also discuss the role of radiotherapy in disseminated disease which, in combination with systemic treatment, may be extremely useful in improving the patient's quality of life--as a way of stopping haemorrhage in bleeding lesions, for pain relief in secondary deposits, to treat superior vena cava syndrome and spinal cord compression, to prevent pathological fractures and last, but not least, to relieve or prevent symptoms such as those caused by brain metastases. The results presented in this paper are in agreement with current literature. Finally, the authors mention the most frequent complications of radiotherapy in late breast cancer as well as the guidelines for supportive care of the irradiated patient with the aim of a complete re-habilitation.

Adverse reactions to drugs, by their frequency and morbidity, constitute a very important problem in clinical practice today. However, it is not always possible to establish the definitive causal relationship between the drug and the clinico-laboratory situation. This is not only due to the variability of these findings and the inherent difficulties of the methodology used, but also the fact that most doctors show little sensitivity to such an important subject. In this paper we present a short review of the drug surveillance programme: basic concepts, objectives and the most important methodology, as well as the current situation in the EEC countries.