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Introdução: O cumprimento do Programa Nacional de Vacinação associa-se a ganhos em saúde pública. A atualização dos que trabalham na área da vacinação deve ser uma preocupação dos serviços de saúde. Objetivos: Avaliar o conhecimento sobre as falsas contraindicações à vacinação pediátrica e caracterizar práticas de aconselhamento, comparando os resultados em função da categoria profissional, da atividade clínica, dos anos de carreira e do local de trabalho. Métodos: Estudo quantitativo, transversal, descritivo e correlacional, aprovado por comissão de ética. Dados recolhidos em questionário online anónimo, validado, com questões relativas a contraindicações à vacinação expressas no Programa Nacional de Vacinação e outras variáveis sociodemográficas, como a categoria profissional: M (médicos), E (enfermeiros); atividade clínica: PA (prescreve/administra vacinas em idade pediátrica), NPA (não prescreve/não administra); anos de carreira: A1 (

INTRODUCTION: Transition in care (TC): Planned and structured transfer of pediatric care to adult. OBJECTIVE: to compare the transfer process (PCA) of patients with type 1 diabetes (DM1) with (Group A) and without (Group B) TC. MATERIAL AND METHODS: Cross-sectional study. Patients with DM1, 18-25 years, followed on the pediatric service of a district hospital. A questionnaire with a likert scale was used: 1 (totally disagree) to 5 (totally agree). Adequate TC: onset 14 years; promotion of autonomy; user participated; understanding the difference in services; multidisciplinary and transmission of information between professionals. RESULTS: Total 29, 14 from Group A. The following medians were obtained for Group A and B: "age at onset of PCA": 17 vs 18 years; "promotion of autonomy": 5 vs 5; "explanation of differences between services": 4 vs 4; "participation in the process": 5 vs 3; "transmission of information between professionals": 4.5 vs 4; "multidisciplinary team": 4 vs 3. In group A 36% responded affirmatively to all items defined for adequate TC. DISCUSSION: On the group with TC, the median age of onset of PCA was lower, although higher than proper. In the remaining items, the response medians were higher in group A, except for promotion of autonomy and explanation of service differences, with a statistical difference in user participation in the process and the involvement of a multidisciplinary team. TC is implemented, but needs to be systematized to improve care provided.

ABSTRACT Objective To characterize adolescents referred to medical consultation based on the screening tool “Perfil de Saúde do Utente Adolescente”, and to compare to information gathered from a questionnaire and data assessed during the visit. Methods A retrospective and descriptive study, with analysis of the questionnaires filled out by adolescents and their respective medical records, in the period from January 2013 to June 2016. Results A total of 54 adolescents were seen, 57% male and mean age of 12±1.7 years. In the questionnaire, 37% stated that they had some kind of health problem; 35% would like to change the relationship with their parents; 18% had some concern about safety at school; and 39% made dietary mistakes. Approximately 31% had consumed alcohol, 13% had tried smoking, and 4% had used other drugs. At the first medical appointment, 38% stated they had chronic disease, 11% reported poor family environment, 39% had school problems and 39% made dietary mistakes. About 13% had tried smoking, 24% had tried to consume alcohol, and 2% had tried other drugs. Thirty seven percent of adolescents were referred to adolescent medicine consultation, and 39% to another hospital consultation. Conclusion Many of the biopsychosocial risk items identified through the questionnaire were confirmed during consultation, indicating that it could be a useful screening method for problems linked to the adolescence period.

Maturity Onset Diabetes of the Young (MODY) includes a clinically and genetically heterogeneous group of diabetes subtypes with MODY-2 being the second most prevalent form. We report 2 cases of MODY-2 identified during the investigation of asymptomatic hyperglycemia. A 12-year-old girl with a familiar history of diabetes (mother, maternal aunt, and maternal grandfather) was referred due to hypercholesterolemia, abnormal fasting glucose (114 mg/dL), and increased levels of glycated haemoglobin (HbA1c) (6%) presenting with negative β-cell antibodies. A glucokinase (GCK) heterozygous missense mutation c.364C>T (p.Leu122Phe) in exon 4 was identified in the index patient and in the 3 family members. An obese 9-year-old boy was investigated for elevated fasting glycemic levels (99–126 mg/dL), HbA1c rise (6.6%–7.6%), and negative β-cell antibodies. The patient’s father, paternal aunt, and paternal grandfather had a history of diabetes during their childhood. A GCK heterozygous missense mutation c.698G>A (p.Cys233Tyr) in exon 7 was identified in the index patient. This variant was only described in another family strongly affected by both MODY and classic autoimmune mediated diabetes, contrary to our case. MODY-2 should be suspected in the presence of early onset of persistent mild fasting hyperglycemia and negative β-cell antibodies associated with a positive family history of diabetes. These cases illustrate the challenging aspects of MODY diagnosis due to possible phenotypic overlap with other types of diabetes. The diagnosis requires a high level of suspicion and GCK genetic screening should be performed in the presence of compatible features. An early diagnosis allows for appropriate management, genetic counselling, and the identification of affected family members.

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ABSTRACT Objective: To construct a scale of adolescents' attitudes towards sexuality and to determine their psychometric characteristics. Methods: Methodological study conducted with 394 students from the 8th to 12th grades of a school in central Portugal. They answered a questionnaire consisting of the Adolescent Students' Attitude Scale for Sexuality (E3AS) and socio-demographic and academic data. The project received a favorable opinion from the National Data Protection Commission (authorization No. 10421/2017). Construct validity analysis was performed through exploratory factor analysis and internal consistency was performed through Cronbach's alpha. A maximum error probability of 5% was considered. Results: The mean age of the sample was 14.9±1.4 years, with 53.3% being female. The instrument consisted of 34 items distributed into five factors: F1. Family planning and sex education (α=0.826); F2. First sexual relationship (α=0.819); F3. Violation of sexual rights and who to turn to in the event of unplanned pregnancies (α=0.695); F4. Gender expression and identity (α=0.542), and F5. Unplanned pregnancy and parenting (α= 0.761), with a total alpha value of 0.766, accounting for 45.3% of total variance. Conclusions: The psychometric adequacy of the E3AS for the Portuguese population allows us to affirm that it is a valid and reliable instrument that can be used in future studies to assess the attitudes of adolescent students towards sexuality.

ABSTRACT Objective: To evaluate serum biochemical parameters’ evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. Methods: Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. Results: A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). Conclusions: Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.

Introdução: Os adolescentes são um grupo de intervenção prioritária em saúde reprodutiva. Os médicos de medicina geral e familiar, ginecologistas e pediatras são os principais responsáveis pelo aconselhamento contracetivo. Material e Métodos: Estudo transversal, correlacional, de natureza quantitativa, aprovado pela comissão de ética do Centro Hospitalar de Leiria. Dados colhidos em questionário online validado (alfa de Cronbach e Análise Fatorial Exploratória), constituído por itens de tipo diferencial semântico, com cinco pontos (“Discordo totalmente — 1” e “Concordo totalmente — 5”). Pontuações mais elevadas conotam-se com maior conhecimento ou adequabilidade na questão. Análise por género, especialidade, anos de carreira e grau de formação: especialista, interno de formação específica. Resultados: Obtiveram-se 338 respostas (51% médicos de medicina geral e familiar, 29% pediatras, 20% ginecologistas). Do total, 66% eram especialistas, 36% tinham menos de cinco anos de carreira e 17% tinham mais de 20 anos de carreira. O conhecimento das recomendações foi superior entre os ginecologistas [4,38 (1,09); p < 0,001] e no género feminino [3,65 (1,41); p = 0,039] com diferença estatisticamente significativa. Os ginecologistas receberam mais formação recentemente [3,79 (1,42)] e consideram estar atualizados [4,41 (0,70), p < 0,001]. Discussão: O questionário revelou validade e fiabilidade. Os ginecologistas estão mais familiarizados com a contraceção na adolescência, enquanto pediatras e clínicos mais novos referem maior necessidade de atualização. Os ginecologistas receberam formação recentemente e consideram estar atualizados, pelo que a formação na área parece ter impacto positivo. Conclusão: O conhecimento acerca do aconselhamento contracetivo ainda não é ótimo, pelo que é fundamental investir na formação dos profissionais de saúde.

Increase in the incidence and prevalence of Eating Disorders have made it increasingly important that Health Care Professionals be familiar with the early detection and appropriate management of this group of disorders.To characterize an adolescent population followed in Adolescent Medicine office visit of Pediatric Department in Leiria's Hospital with Eating Disorders for type of disorder, presence of alert signs and symptoms and risk factors for an early detection of disease.Retrospective analytic study conducted by consulting clinical processes and first office visit questionnaires of adolescent population followed for Eating Disorders, between August 2005 and April 2008. Criteria of Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition were considered to define Eating Disorder type.Twenty two adolescents were included, with 20 girls. Five adolescents met all Anorexia Nervosa criteria and two met all Bulimia Nervosa criteria. The other 15 were included in Eating Disorder Not Otherwise Specified. All samples showed intense fear of gaining weight and 20 adolescents a disturbed body image. All adolescents confessed having restrictive eating attitudes, half had compensatory behaviors and four assume having recurrent episodes of binge eating. Almost all revealed some type of somatic complaint and 19 showed psychological symptoms. One third of this population had personal history of obesity/overweight. Most adolescents presented weight lost when observed in the first office visit. Six adolescents showed body weight under 85% of that expected. One third of postmenarche adolescents suffered from secondary amenorrhea. Half of adolescents reported dysfunctional family and one quarter had separate parents; eight adolescents had family history of mental illness.Most adolescents were included in the diagnosis of Eating Disorder Not Otherwise Specified, according with other studies in this age. This fact implies that in practice the suspicion of an Eating Disorder in an adolescent should not be restricted to the meeting of other categories criteria. For an early detection, relevance should be given to aspects like a weight loss even without an abnormal body mass index, an inappropriate eating attitude, a dissatisfaction with body image, associated with a multiplicity of psychosomatic complaints, in a dysfunctional family environment.

In the context of the National Health Youth Program, Department of Pediatrics of Santo André Hospital (SAH) has as one of its objectives to extend its age limit up to 18 years of age.To evaluate adolescents' health needs followed up at SAH and to determine the impact of the proposed new age limit policy.Retrospective descriptive study that included adolescents (10-18 years old) seen at the emergency department (ED), outpatients or admitted to the pediatric ward between 2000 and 2004.Adolescents represented 7.3% (average) of all the patients seen at SAH during this period. Approximately 11130 adolescents were seen yearly in the ED, 57% of these in the pediatric ED, 39.5% in general ED, and 3.5% in obstetrics/gynecology ED (the majority of these patients were between the ages of 15 and 18). Medical causes represented 53% of the final diagnosis and 43% were surgical related. The average number of outpatients consultations was 7657 per year and of these, 25% were seen by pediatricians (87% were 10 to 14 years of age). The specialties with the greatest number of consultations were: dentistry (13.3%), orthopedics (13.1%), ear, and nose and throat specialist (8.3%), ophthalmology (7.7%), dermatology (7.2%), psychiatric (5.3%) and obstetrics (5.2%). General medicine and other medical specialties were responsible for 6.4% of the consultations. Yearly about 590 adolescents were admitted, 60.3% in the pediatric ward regardless of the underlying cause. The remaining were admitted to the surgical ward, orthopedics ward and obstetrics/gynecology ward.With the proposed new age limit policy we expect a 10% overall increase in the numbers of patients in the pediatric ED, 6.4% in the pediatric outpatients and 15.5 as inpatients. Adolescents will represent 33.7 of the pediatrics total inpatients population. Management of the patients will require the development of new installations, the training of medical professionals, both pediatric and adult health careers, that will in the future deal with this patient group.

Objective To analyse the progression of body mass index in eating disorders and to determine the percentile for establishment and resolution of the disease.Methods A retrospective descriptive cross-sectional study. Review of clinical files of adolescents with eating disorders.Results Of the 62 female adolescents studied with eating disorders, 51 presented with eating disorder not otherwise specified, 10 anorexia nervosa, and 1 bulimia nervosa. Twenty-one of these adolescents had menstrual disorders; in that, 14 secondary amenorrhea and 7 menstrual irregularities (6 eating disorder not otherwise specified, and 1 bulimia nervosa). In average, in anorectic adolescents, the initial body mass index was in 75thpercentile; secondary amenorrhea was established 1 month after onset of the disease; minimum weight was 76.6% of ideal body mass index (at 4th percentile) at 10.2 months of disease; and resolution of amenorrhea occurred at 24 months, with average weight recovery of 93.4% of the ideal. In eating disorder not otherwise specified with menstrual disorder (n=10), the mean initial body mass index was at 85thpercentile; minimal weight was in average 97.7% of the ideal value (minimum body mass index was in 52nd percentile) at 14.9 months of disease; body mass index stabilization occured at 1.6 year of disease; and mean body mass index was in 73rd percentile. Considering eating disorder not otherwise specified with secondary amenorrhea (n=4); secondary amenorrhea occurred at 4 months, with resolution at 12 months of disease (mean 65th percentile body mass index).Conclusion One-third of the eating disorder group had menstrual disorder − two-thirds presented with amenorrhea. This study indicated that for the resolution of their menstrual disturbance the body mass index percentiles to be achieved by female adolescents with eating disorders was 25-50 in anorexia nervosa, and 50-75, in eating disorder not otherwise specified.

ABSTRACT Objective To characterize the care flow and the primary diagnoses of an Adolescent Medicine Clinic. Methods A retrospective descriptive study, with analysis of clinical processes of adolescents (10-18 years) seen at the Adolescent Medicine Clinic, from January 2006 to December 2013. The following variables were analyzed: sex, age, number of visits, referring service and primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. As to the variable age, the adolescents were divided into two groups: Group I comprised those aged 10-14 years, and Group II, 15-18 years. Results A total of 7,692 visits were carried out, in that, 1,659 first visits (22%), with an annual growth rate of 6%. The mean age was 14.2 years, and 55% of patients were female. The group of endocrine, nutritional and metabolic diseases was the most representative in our sample (34%), with obesity being the most frequent diagnosis in both sexes and age groups (23%), with a higher prevalence in males (13% male versus 10% female, p

ABSTRACT Objective: To characterize sexual behaviors in a sample of adolescents and youth. Methods: An analytical descriptive study using a questionnaire about sexual behaviors, adapted from the World Health Organization. It was distributed to students from a Portuguese city aged 14-24 years, during two months. Two age groups were defined: G1 - students aged 14-19 years; G2 - aged 20-24 years. Results: The sample included 2,369 students, 61% females and 70% in G1. The mean age of first sexual intercourse was 16.4±1.8 years; 93% used some contraceptive method in the first sexual intercourse. Out of those who did not use contraception in the first sexual intercourse, 83% were in G1 (p

Hiatal hernias are common in the elderly and in most cases asymptomatic and no intervention is needed. Hiatal hernias can range from asymptomatic to an intrathoracic stomach, a rare but potentially life-threatening condition, characterized by the migration of the stomach into the thoracic cavity. Its need for urgent intervention presents a major concern for the anesthesiologist because it is associated with a high risk of aspiration. This case report discusses the clinical presentation and anesthetic management of an intrathoracic full stomach proposed for urgent surgery. By presenting this case, we hope to enhance the understanding of preoperative management in patients with intrathoracic full stomach and the role of awake fiberoptic guided intubation as a valuable technique in emergency surgical settings. This case reinforces the importance of existing healthcare professionals with practice in managing similar clinical scenarios effectively., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Carreira et al.)

Context: Tumor volume doubling time (TVDT) is emerging as a useful tool in predicting oncologic outcomes. There is limited data on the prognostic role of TVDT in metastatic medullary thyroid cancer (MTC)., Purpose: The goal of this study was to assess the value of TVDT in predicting disease-specific survival (DSS) in patients with hereditary and sporadic MTC., Methods: This was an Institutional Review Board-approved cohort study including patients with metastatic MTC having at least 3 consecutive imaging studies. TVDT of up to the five largest lesions per organ was calculated using a standardized formula. The association between TVDT and DSS was analyzed using Kaplan-Meier survival curves. Cox proportional regression model was used to account for confounding factors., Results: The study sample consisted of 51 patients presenting with 286 metastatic lesions measured with 457 scans during the follow-up of 51 (IQR 25-102) months. Median age was 19 years (IQR 15-41), 53% female patients. Cumulative volumes of all metastatic lesions and proportion of patients with TVDT of <1 year were higher in patients with sporadic as compared with hereditary MTC (p<0.01). Factors independently associated with shorter DSS were TVDT of <1 year based on 3 initial and 3 last scans as well as lung, brain and prostate as the organs with the fastest growing tumor. TVDT based on 2-dimentional and 3-dimentional measurements showed strong correlation (r=0.94, p<0.05)., Conclusions: Three baseline and three most recent scans preceding follow-up visit enable calculation of TVDT and can be used as predictors of mortality from MTC., (Published by Oxford University Press on behalf of the Endocrine Society 2024.)

Unlabelled: The sleep disorders are quite common in hospitalized patients, but are also undervalued by health professionals. The identification of factors that interfere with sleep patients has been the subject of numerous studies., Objective: To identify factors that interfere with the patient's sleep in the hospital., Methodology: We performed a research on EBSCO (CINAHL with Full Text; MEDLINE with Full Text; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; Database of Abstracts of Reviews of Effects; Medlatina), LILACS (full text available) andSCIELO (Brazil, Spain andPortugal), andsearch full-text articles, publishedfrom 1 January 2007 to 31 December2012. The PI[C]O method was used, and selected six articles from a total of thirty-six., Results: We identify 20 factors that interfere with the patient's sleep in the hospital and describe particular aspects relevant to each of these factors., Conclusion: The factors that interfere with the patient's sleep in the hospital were grouped into External (Environmental and Associated to care) and Internal (Physiological and Psychological). The results allow us to realize that these factors are identified, but they still persist in services, interfering with the patient's sleep. Awareness of health professionals is the first step to adopt the measures suggested in this article, in order to reduce the impact of these factors on the patient's sleep in the hospital.