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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.

The World Health Organization's (WHO) 2002 Annual Report estimated that about 14% of the burden of disease in wealthier countries is attributable to smoking. Smoking related diseases include cardiovascular diseases, cancer and respiratory diseases. This paper presents an estimate of the burden of disease attributable to smoking in Portugal. The estimates are based on the Portuguese demographic and health statistics available for 2005. The most important conclusion of the analysis is that 11.7% of deaths in Portugal are attributable to smoking. If we use disability adjusted life years (DALYs) to measure the burden of disease, we find that 11.2% of death DALYs in Portugal is attributable to smoking. The gender distribution of this amount is very unequal; 15.4% of the male burden of disease and 17.7% of all male deaths can be attributed to smoking, but only 4.9% of the female burden of disease and 5.2% of all female deaths. These estimates are higher than death estimates previously available (Peto et al. 2006); 14% in men and only 0.9% in women. This paper also presents estimates of the burden of reducible disease, that is, the reduction in mortality and DALYs that would occur if all current smokers quit and thus experienced the mean risk of ex-smokers, which is lower than for current smokers but typically not as low as for never-smokers. Our estimates are that the burden of disease would decrease by 5.8% (7.8% in men and 2.8% in women), and that deaths would decrease by 5.8% as well (with an 8.5% and 2.9% decrease in men and women, respectively). The paper also includes estimates of the burden of disease generated by smoking related disability. Smoking related illnesses generated 121,643 DALYs, 72,126 (59%) of which are attributable to smoking and 12,417 would be reducible if all smokers were to quit.

The area of the parental paper has been studied in several perspectives. At present, the studies carried out in Portugal have been aiming at the need of support of hospitalized children parents, at International level the investigation centers in the perception of family-nurse interactions, both in the perspective of the family and in the perspective of nurses. There is a concern about the participation of parents in the care, (in the present study we focus in the participation of mothers in the care of their children when they are hospitalized in an oncology pediatric unit, as she stays twenty four hours with her child), namely if they are or not disposed to participate. Thus our question is: If they are really disposed to participate, what do they do? What reasons make them participate? In which way are mothers integrated in the care? These were some of the questions why we decided to draw up a work about the subject Nurses and mothers on the way ... the partnership to empowerment in the care. We carried an ethnographic, exploratory and descriptive study. We observed and described, which care mothers provided to the child, the reasons that took them to participate and how they are integrated in the care. From the obtained data through the participant observation and the semi-structured interviews, twelve Cultural Domains were indentified, translating the participation of mothers in the care of the hospitalized child. From the thematic analysis of cultural domains two cultural subjects merged that constitute the central axle of the study results: the partnership and the empowerment in the Care. Based in the results, the importance of nurses stands out, they develop strategies that can help mothers to acquire competences to take care of their children, promoting the adaptation when facing situations and lifestyles, often unthinkable unexpected.

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 this paper the author makes an analysis on the context and challenges lived presently by the Portuguese Cardiac Surgery and concludes that part of the response lies on the development of registries of surgical activity, either national or supranational. This necessity was felt by the Portuguese Society for Cardio-Thoracic and Vascular Surgery who took the initiative, in the year 2000, of the creation of National Registry dedicated to the Adult's Cardiac Surgery. Six years later, the aim of the project is still far from the expected, for several reasons that are analysed and lead to the conclusion that several urgent decisions are necessary to be undertaken, to save the project as well as the amount of work already done.

Objective: The aim of the present paper was to report trends in Portuguese interventional cardiology from 1992 to 2003 and to compare these data with other European countries., Methods: Based on questionnaires distributed to and completed by Portuguese interventional cardiology centers we give an overview of the development of coronary interventions since 1992, when data were first collected. In 2003, 24,834 diagnostic catheterization procedures were performed, representing an increase of 315% in comparison to 1992. In 2003 the population-adjusted rate was 2483 coronary angiograms per million population. Coronary interventions increased by 1193% in comparison to 1992, with a total of 8465 procedures and a rate of coronary interventions of 848 per million population in 2003. Coronary stents were the most frequently used devices, with an increase from 53% in 1996 to 89% in 2003. The present rate of stent implantation in Portugal is similar to that in Europe and Spain, but the rate of use of drug-eluting stents in Portugal is one of the highest in Europe (55%). In 2003, multivessel percutaneous coronary interventions were performed in 24% of cases, with no significant increase during the last 10 years, and ad hoc interventions were performed in the course of diagnostic coronary angiography in 73 % of patients; glycoprotein IIb-IIIa inhibitors were used in 30% of procedures; percutaneous coronary interventions in patients with acute myocardial infarction accounted for 16% of all procedures; of the noncoronary interventions recorded, 49 percutaneous mitral valvuloplasties, 37 atrial septal defect closures and 15 patent foramen ovale closures were reported. The PCI rate per million population in Portugal was lower than the mean European rate (848 vs. 1194)., Conclusion: Interventional cardiology in Portugal and other European countries has been expanding since 1992. We would emphasize the high rate of reporting by laboratories, which enables the Registry to compile data that are highly representative of activity in Portugal since 1992.

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 is aimed at to demonstrate and enhance the importance of anesthetic protocols in general sense, and for the lung transplantation in particular, as markers of "process" in the perioperative anesthetic care. The authors describe and discuss the main steps of the organization of a specific protocol dedicated to lung transplantation and put particular emphasis on the need of a good integration of the different specialties and professional groups directly involved in this demanding field of activity.

Respiratory diseases are an important cause of morbidity and mortality and their importance is expected to increase in the near future. The Pneumology speciality in Portugal must accompany the natural evolution of Medicine and contribute to creating competent experts, adapted to new challenges within the European Community. Some changes are currently in the process of implementation, directed at improving the learning experience of future Pneumology specialists in order to obtain the Common Certificate of Pneumology. A survey related to the training in this speciality was conducted to ascertain the opinions and suggestions of Residents, Tutors and Directors of Pneumology departments in Portugal. This paper will present and discuss the results of this survey.

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.

Cardiovascular diseases are the main cause of death in Portugal, in developed countries and, indeed, worldwide. Hypercholesterolemia is a major risk factor for these diseases, including ischemic heart disease, cerebrovascular disease, and peripheral vascular disease. This paper reports the results of a study of the cost of illness associated with hypercholesterolemia and the costs directly attributable to hypercholesterolemia in Portugal, estimated from data for the year 2000. The results indicate that the cost of the health care provided to deal with illnesses associated with hypercholesterolemia was Euros 735.9 million (direct costs) and the costs of lost production due to disability of patients of working age was Euros 74.82 million (indirect costs). The costs attributable to hypercholesterolemia, those that would be avoided if hypercholesterolemia were completely eliminated, amount to Euros 358.84 million in direct costs and Euros 28.31 million in indirect costs. These results confirm that hypercholesterolemia is a source of major health costs. This means that hypercholesterolemia deserves special attention from those who formulate health policy and should be given priority in implementing such policies.

Cardiovascular diseases are the main cause of death in Portugal, in developed countries and indeed, worldwide. Hypercholesterolemia is a major risk factor for these diseases. What are the potential health gains to be obtained by reducing the prevalence of hypercholesterolemia in the Portuguese population? How are they to be estimated and quantified? Studies of the burden of disease aim to measure and evaluate the impact of a disease or group of diseases on overall levels of health. Although they do not strictly speaking constitute an economic evaluation, since no specific interventions are analyzed, burden of disease studies do provide an accurate picture of a specific health problem and its magnitude, as well as an indication of changes in health policy and in preventive or corrective measures that might lead to improvement. This paper reports the results of a study of the disease burden of hypercholesterolemia in Portugal, calibrated for data from the year 2000. In this study, the disease burden is estimated as the component attributable to hypercholesterolemia in DALYs (disability-adjusted life years). DALYs are a measure used by international organizations such as the World Health Organization and the World Bank.

This paper will explore the role and practices of magic-using folk healers - curandeiros and saludadores - in early modern Portuguese society. The article will examine the ambivalent place of the folk healer as a figure both central to and marginal in Portuguese popular culture. In considering some of the services offered by unlicensed popular healers and their recourse to the unorthodox magical means inherent in popular curing, the paper will investigate curandeiros and saludadores illicit sources of power. Further, this work will examine the prominence of men as folk healers in southern Portugal during the seventeenth and eighteenth centuries. Finally, by looking at the notoriety of Luso-African folk healers, the paper will assess the importance of race as a factor in the culture of Portuguese magical curing.

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.

The safety profile of a drug is not a static concept. It progresses and can change on the basis of scientific data gathered before and after it is marketed. Therefore, it is now considered fundamental that all countries have the capacity to continuously monitor the safety of medicines authorized for sale. Based on the resulting and appropriate data, this allows them to alter the previously authorized conditions for use of a given drug as a public health safeguard. This paper describes how a pharmacovigilance system is being developed in Portugal in the 1990s. The system is being implemented based on our national characteristics and positions within the European Union. The article includes some results from the initial implementation of these methods. Many similarities allow one to extrapolate some of the procedures from one country to another. When we began we borrowed and adapted extensively from experiences already tested by others.

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.

This paper discusses works on chemical analyses of mineral waters in late 18th Century Portugal and the way these results were used by physicians when prescribing treatment with such waters. Furthermore, this research sheds some light on the application in Portugal of theories on composition and transformation of mater.

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.

The support offered by the ICN to the african countries of portuguese language, is described in this paper. The countries that participated of the ICN' Project were Angola, Cabo Verde, Guiné-Bissau, Moçambique, São Tomé and Principe. The purposes of the project are: analyse development of nursing in these countries; identify the needs of the nurses of the these countries; to evaluate the health systems and work to introduce the nurse in these systems; to identify the strughts and issues of the nursing associations; to promote the relationship among nurses and to establish plan to reinforce the national Nursing Association. We don't think that nursing is ready and well structured now, but this Project will be the first step in this direction. We have results an had some example of this is affiliation to the ICN of some African countries that have been made.

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.