Search

Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association.Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy.Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units’ factors, and little by maternal and fetal characteristics.Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.

Abstract The end of the Middle Pleistocene Transition (MPT, ~ 800-670 thousand years before present, ka) was characterised by the emergence of large glacial ice-sheets associated with anomalously warm North Atlantic sea surface temperatures enhancing moisture production. Still, the direction and intensity of moisture transport across Eurasia towards potential ice-sheets is poorly constrained. To reconstruct late MPT moisture production and dispersal, we combine records of upper ocean temperature and pollen-based Mediterranean forest cover, a tracer of westerlies and precipitation, from a subtropical drill-core collected off South-West Iberia, with records of East Asia summer monsoon (EASM) strength and West Pacific surface temperatures, and model simulations. Here we show that south-western European winter precipitation and EASM strength reached high levels during the Marine Isotope Stage 18 glacial. This anomalous situation was caused by nearly-continuous moisture supply from both oceans and its transport to higher latitudes through the westerlies, likely fuelling the accelerated expansion of northern hemisphere ice-sheets during the late MPT.

Introdução: A literacia em saúde mental remete para o conhecimento e crenças sobre transtornos mentais, o seu reconhecimento, gestão e prevenção. Para os professores do ensino superior é crucial visando a promoção da saúde mental dos estudantes e a prevenção / gestão da doença. Objetivo: Sintetizar a evidência sobre a literacia em saúde mental dos professores do ensino superior. Material e Métodos: Revisão integrativa, através: 1) elaboração da questão de pesquisa; 2) pesquisa e extração dos dados; 3) categorização; 4) avaliação dos estudos incluídos; 5) interpretação dos resultados; 6) síntese. Questão de investigação (mnemónica PCC: Participantes, Conceito, Contexto) - Qual a literacia em saúde mental dos professores do ensino superior? A pesquisa (janeiro de 2023) realizada na: MEDLINE (via PubMed) e CINAHL Complete (via EBSCO), adotou a metodologia PRISMA. Dados extraídos por dois revisores independentes, utilizando um instrumento desenvolvido pelos pesquisadores, a partir do modelo do JBI para extração de detalhes, características e resultados. Critérios de inclusão: estudos escritos em inglês e português, entre 2013 – 2023; conteúdo sobre literacia em saúde mental dos professores do ensino superior. Resultados: Identificaram-se 15 registos, e incluíram-se dois estudos na revisão (Gulliver et al., 2018; Gulliver et al., 2019). Maioritariamente os professores consideraram não estar suficientemente informados para responder a problemas de saúde mental dos estudantes, sobretudo com pensamentos suicidas e, quase metade não tinha acesso a treino formal (Gulliver et al., 2018). Gulliver et al. (2019) constataram que os professores demonstraram uma literacia relativamente alta e sentiam-se suficientemente informados para ajudar estudantes com problemas de saúde mental. Contudo, consideraram necessário mais formação para aumentar a confiança pessoal em lidar com os mesmos e como aprender com essas experiências. Conclusões: A maioria dos professores não tem suficiente literacia em saúde mental para responder adequadamente a problemas dos estudantes universitários, sendo necessário alterar políticas de atuação, pois mesmo os que demonstram uma literacia relativamente alta consideram necessário mais formação e treino de procedimentos para aumentarem a confiança pessoal em lidar com esses problemas e garantir que os estudantes tenham acesso a cuidados apropriados.

Wound dressings based on graphene sheets are expected to play a crucial role in wound treatment. The good conductivity and charge mobility of graphene as an electronic material makes graphene-based field effect transistors well-adapted for sensing of wound biomarkers. In this work, an aptamer-based field effect transistor using graphene as sensing channel material was developed and evaluated for the selective and sensitive monitoring of matrix metalloproteinase 9 (MMP-9), a wound biomarker upregulated in non-healing wounds. Concentration-dependent measurements performed with wound fluid spiked with MMP-9 on GFET-MMP/PEG sensors exhibited real-time detection of MMP-9 with a detection limit of 97 pM in 1x MOPS/1 mM CaCl2. The sensor was tested on swab samples from non-healing wounds and compared to results of antibody-based ELISA analysis. In contrast to ELISA, the GFET sensor was only sensing the active MMP-9 form and not the mixture of active and inactive forms, as evidenced by the analysis performed in the presence of EDTA as inactivation medium.

Leaf wax n-alkane biomarkers are widely used to infer past vegetation dynamics and hydroclimate changes. The use of these compounds strongly relies on the characterization of modern plants. However, few studies have explored leaf waxes of modern plants and their application to reconstructing climate and environmental changes in the Iberian Peninsula, a region known for its high vulnerability to climate change. In this study, we characterize the distributions and compound-specific isotopic compositions of the leaf waxes of dominant plants in the vegetation cover, soil, and surface sediment of the Lake Peixão area, a high-mountain glacial lake in Serra da Estrela (central Portugal). Our results show that the modern oro-Mediterranean (subalpine) vegetation of the study area is dominated by C3 grasses/herbs and shrubs that preferentially produce long-chain leaf waxes (≥C27). The C31n-alkane display the overall highest concentration, produced by some grasses and shrubs, but especially Erica sp (heather), which is highlighted as a major source for the total n-alkane pool in the lake sediments. C29 is the second-most abundant and the most equally produced n-alkane of the vegetation cover; C25 and C27 homologs are mainly associated with aquatic-related grasses/herbs, while C33 and C35 are particularly linked to cold-drought tolerant Juniperus sp. shrubs. Shrubs show higher but proportional values than grasses/herbs in the isotopic space, suggesting a directly proportional physiological adaptation of the two ecological forms to the prevailing climatic and environmental factors of the study area. C29 is pointed as the most representative (or less plant-biased) leaf wax n-alkane in the lake sediments. Thus, δD of C29n-alkane is interpreted as a robust terrestrial hydrological indicator (δDterr), which signal is believed to be strongly influenced by the mean air temperature and/or precipitation amount. Despite the sparse vegetation and small catchment area, the apparent hydrogen fractionation factor, determined from δDterr of the lake surface sediment, is in line with the modeled global mean values for the latitude of the study area. The different molecular and compound-specific signatures of the studied oro-Mediterranean species have the potential to support future interpretations of leaf wax biomarkers in the Iberian Peninsula.

Abstract Reduced graphene oxide has shown great potential for the fabrication of different electronic devices, especially biosensors and electric circuits. It allows the usage of simple deposition techniques such as drop casting or spin coating of graphene oxide solutions with a subsequent chemical, electrochemical, and/or thermal reduction to reduced graphene oxide. However, the utilized deposition strategy requires a defined protocol that ensures reproducibility. A study on a range of concentrations of GO and spin coating parameters is presented, aiming at the most uniform layers consisting of only single and double sheets for the application in electronic devices. The effect of film deposition on morphological parameters like the number of layers, overlaps, and surface coverage as well as the influence on electronic properties such as baseline stability and the transfer characteristics for the application as an electrolyte gated field‐effect transistor (EG‐FET) are shown. Best film characteristics and electronic properties are achieved by using a GO concentration of 214 μg/mL applied via spin coating with 1800 rpm, after surface modification with adhesive layer.

Psychiatric disorders are the number one cause of disability in adolescents worldwide. Yet, in low- and middle-income countries (LMIC), where 90% of adolescents reside, mental health services are extremely limited, and the majority do not have access to treatment. Integration of mental health services within primary care of LMICs has been proposed as an efficient and sustainable way to close the adolescent mental health treatment gap. However, there is limited research on how to effectively implement integrated mental health care in LMIC. In the present study, we employed Implementation Mapping to develop a multilevel strategy for integrating adolescent depression services within primary care clinics of Maputo, Mozambique. Both in-person and virtual approaches for Implementation Mapping activities were used to support an international implementation planning partnership and promote the engagement of multilevel stakeholders. We identified determinants to implementation of mental health services for adolescents in LMIC across all levels of the Consolidated Framework for Implementation Research, of which of 25% were unique to adolescent-specific services. Through a series of stakeholder workshops focused on implementation strategy selection, prioritization, and specification, we then developed an implementation plan comprising 33 unique strategies that target determinants at the intervention, patient, provider, policy, and community levels. The implementation plan developed in this study will be evaluated for delivering adolescent depression services in Mozambican primary care and may serve as a model for other low-resource settings.

In order to better understand interglacial climate variability within the 41 kyr world, we produced high-resolution climate records for interglacial Marine Isotope Stage (MIS) 47 (1424–1452 ka) at IODP Site U1387 (36°48′ N, 7°43′ W) on the southern Portuguese margin. Using benthic and planktonic foraminifera stable isotope records, Uk’37 sea-surface temperature (SST), and plankton assemblage data we investigated Mediterranean Outflow Water (MOW) and surface water conditions. The MOW-level records indicate a poorly ventilated and sluggish bottom current during the MIS 48/MIS 47 transition in association with the insolation maximum, whereas a well-ventilated MOW formed a contourite layer during the second insolation maximum. The benthic δ18O record shows a fairly abrupt change during the deglaciation of MIS 48, while the surface waters experienced a terminal stadial event that was associated with initial cooling and freshening followed by stepwise warming until interglacial SST was reached at 1450 ka. Interglacial conditions with SST of 24 °C or higher persisted until 1427 ka, although warm SST prevailed into MIS 46. The persistent and prolonged warmth is attributed to a northward expansion of the subtropical gyre during MIS 47 as reflected by the dominance of subtropical-tropical planktonic foraminifera species and the presence of warm water coccolithophores taxa.

Introduction: Cardiovascular (CV) risk is known to be increased in HIV-infected individuals. Our aim was to assess CV risk in HIV-infected adults. Methods: CV risk was estimated for each patient using three different risk algorithms: SCORE, the Framingham risk score (FRS), and DAD. Patients were classified as at low, moderate or high CV risk. Clinical and anthropometric data were collected. Results: We included 571 HIV-infected individuals, mostly male (67.1%; n=383). Patients were divided into two groups according to antiretroviral therapy (ART): naïve (7.5%; n=43) or under ART (92.5%; n=528). The mean time since HIV diagnosis was 6.7±6.5 years in the naive group and 13.3±6.1 years in the ART group. Metabolic syndrome (MS) was identified in 33.9% (n=179) and 16.3% (n=7) of participants in the ART and naïve groups, respectively. MS was associated with ART (OR=2.7; p=0.018). Triglycerides ≥150 mg/dl (OR=13.643, p

Introdução: A forma como as organizações são geridas e o modo como é organizado o trabalho e os sistemas de trabalho, pode causar stresse e/ou outra exposição a factores de risco psicossocial nos profissionais. Os Serviços de Saúde são dos sectores de atividade mais expostos, sendo o stresse e a violência alguns dos mais importantes. Estes factores de risco acarretam importantes consequências tanto ao nível individual, como institucional e social, afetando de forma direta a saúde física e mental dos profissionais atingidos e prejudicando o seu desempenho e a qualidade dos cuidados prestados. Objectivos: Caracterizar a presença de factores de risco psicossocial, determinar o risco e correlacioná-lo com variáveis sócio-demográficas em trabalhadores de uma Unidade Local de Saúde do Alentejo. Métodos: Neste trabalho, o Copenhagen Psychosocial Questionnaire, versão II (COPSOQ-II) foi utilizado para avaliar os riscos psicossociais de um universo geral de profissionais de saúde de uma unidade de saúde de média dimensão, na região do Alentejo, que abrange cuidados de saúde primários e hospitalares. O COPSOQ é baseado num modelo de exigência e controlo que tenta explicar o stresse como consequência das elevadas exigências no trabalho e de um baixo apoio social. Resultados e Conclusões: Neste estudo foi encontrado risco elevado para a saúde dos trabalhadores, no sub-grupo dos médicos, na dimensão “insegurança no trabalho”. No caso dos restantes trabalhadores, a estratificação do risco para a saúde resultou numa situação intermédia para enfermeiros, assistentes técnicos e outros técnicos superiores. Os assistentes operacionais e os trabalhadores da gestão foram as categorias onde o risco foi considerado mais favorável. Observaram-se também diferenças estatisticamente significativas, e merecedoras de replicação, o maior risco para a saúde dos trabalhadores dos cuidados hospitalares na dimensão ritmo de trabalho (t(124)=2,71), exigências emocionais (t(124=2,18) e confiança vertical (t(116)=2,36); o maior risco nos trabalhadores do sexo masculino na dimensão exigências cognitivas (t(136)=2,71), influência no trabalho (t(136)=2,32), previsibilidade (t(132)=2,08), transparência t(132)=2,74), conflitos no trabalho (t(132)=2,73), significado do trabalho (t(134)=3,31), compromisso com o trabalho (t(134)=2,44) e comportamentos ofensivos (t(132)=2,16); e o maior risco nas trabalhadoras na dimensão burnout (t(132)=2,16). Estes resultados devem merecer a nossa preocupação se desejamos diminuir a exposição dos trabalhadores desta instituição a estes factores de risco, sendo desejável o seu estudo sistematizado no universo das unidades de saúde do nosso país.

Introduction: Birth weight is a major contributor to neonatal morbidity and mortality and is associated with chronic diseases in adulthood. This study aimed to evaluate the use of Intergrowth 21st instead of the Fenton & Kim 2013 growth charts in the diagnosis of small and large for gestational age in a group of Portuguese newborns. Material and Methods: We conducted an analytical and retrospective study to evaluate birth weight of term and preterm newborns using both growth charts. Groups studied: ‘Term-weeks’ and ‘Term-days’ (term newborns with gestational age in weeks and days, respectively), ‘Preterm-weeks’ and ‘Preterm-days’ (preterm newborns with gestational age in weeks and days, respectively). Results: A total of 14 056 newborns were included, 6% preterm. Using the Intergrowth 21st growth charts, the groups ‘Term-weeks’ (n = 12 081), ‘Term-days’ (n = 1118), ‘Preterm-weeks’ (n = 617) and ‘Preterm-days’ (n = 240), classified as small for gestational age according to the Fenton & Kim 2013 growth charts were adequate for gestational age in 52.8%, 57.8%, 37.7% and 9.3% respectively; and 9.2%, 9.2%, 5.9% and 0.6% of adequate for gestational age newborns were large for gestational age, respectively. In the ‘Pretermdays’ group, 7.9% of adequate for gestational age newborns were small for gestational age and 22.2% of large for gestational age newborns were adequate for gestational age, all with gestational age below 231 days. Discussion: The use of the Intergrowth 21st growth charts in this sample resulted in a lower number of newborns being classified as small for gestational age, except in very preterm newborns. Conclusion: Considering the results obtained, we suggest that Portuguese maternity hospitals use the Intergrowth 21st instead of the Fenton & Kim 2013 growth charts. However, more studies are needed to confirm these results.

Resumo: A insuficiência cardíaca é uma síndrome com elevada prevalência, morbilidade e mortalidade, sendo, no entanto, pouco reconhecida junto dos cidadãos e decisores políticos. O presente documento foi elaborado por um conjunto de peritos constituído por médicos especialistas em cardiologia, medicina interna e medicina geral e familiar, e pretende expor detalhadamente o problema da insuficiência cardíaca em Portugal a vários níveis: peso da síndrome, diagnóstico, tratamento e acompanhamento dos doentes. Para tal, são identificados e discutidos em detalhe os diferentes aspetos inerentes ao manejo da síndrome durante o processo assistencial, nas várias fases da doença e que incluem doentes hospitalizados e em ambulatório. De modo a otimizar a assistência médica prestada a estes doentes, são apontadas diversas soluções e estratégias a curto, médio e longo prazo com potencial para melhorarem a articulação e utilização dos recursos disponíveis. Pretendeu‐se desta forma destacar estratégias que, não se traduzindo num modelo único de melhoria, poderão ser adaptadas às diferentes especificidades regionais, de modo a aumentar o reconhecimento e a atenção prestada à insuficiência cardíaca em Portugal. Abstract: Heart failure is a syndrome with high prevalence, morbidity and mortality, but awareness of the disease is poor among the general public and policy makers. This document, which was prepared by a group of experts consisting of cardiologists, internists and general practitioners, aims to set out in detail the problem of heart failure in Portugal at several levels: burden of the disease, diagnosis, treatment and monitoring. To this aim, different aspects of the management of the various stages of the disease are identified and discussed in detail, covering both outpatients and hospitalized patients. In order to optimize the medical care provided to these patients, various short‐, medium‐ and long‐term solutions and strategies are put forward that have the potential to improve the integration and use of available resources. The intention is to highlight strategies that are not based on a single model but can be adapted to different regional circumstances, in order to increase awareness and improve management of heart failure in Portugal. Palavras‐chave: Insuficiência cardíaca, Documento de consensos, Prevalência, Tratamento multidisciplinar integrado, Impacto socioeconómico, Keywords: Heart failure, Consensus statement, Prevalence, Integrated multidisciplinary treatment, Socioeconomic impact

Introduction: Despite advances in the knowledge of the circumstances surrounding preterm delivery, in a considerable number of cases there are still some unknown aspects. Aims: The objective of the current work is to characterize and analyze data relating to familial antecedents and the gestation of preterm newborns with 32 or less weeks of gestational age at birth admitted to the neonatal intensive care unit of a differentiated perinatal hospital in Portugal. Material and methods: Through the use of a prospective, descriptive and opportunistic questionnaire and by reviewing the mother’s and newborn’s case notes, data was collected focusing on information relating to the newborn, pregnancy, mother, household and family history, based on a sample of 51 mothers and 65 newborns. Results: The sample included more than 50% of the preterm newborns born in the period of time studied. The main results showed that 52.9% of the mothers were aged 18-34 years, most of them had a favorable socioeconomic position, and 49% suffered from congenital/chronic disease. About 25.4% of pregnancies were the result of medically assisted reproduction and 25.5% involved invasive prenatal diagnosis. About 60.8% of the women needed hospitalization during pregnancy and the main reason for hospitalization in the delivery room was labor induction (45.1%). With regards to newborns, 2 had congenital malformations, a minority had fetal growth restriction and 3 died. Conclusions: In this descriptive study we registered the fact that preterm mothers had important pre-existing chronic conditions and many needed hospitalization during pregnancy. The preterm birth was medically induced in about 45% of cases due to maternal/fetal pathology. This data can be the starting point for a case-control study.

Introduction: Hepatobiliary disease is becoming a major public health problem, and recent data suggest that the burden of liver disease is higher than previously thought. Our aim was to quantify the mortality from hepatobiliary disease in Portugal and to compare this with the mortality related to other causes over a 7-year period (2006-2012). Materials and Methods: A statistical analysis of mortality data according to cause, sex, age, and region from the National Statistics Institute in Portugal was carried out. The data related to 14 causes of death, the most frequent of which were alcoholic liver disease (ALD) (International Classification of Diseases code K70), unspecified cirrhosis of liver (UCL) (K74.6), hepatocellular carcinoma (HCC) (C22.0), unspecified malignant neoplasm of liver (C22.9), and cholangiocarcinoma (C22.1). Results: Between 2006 and 2012, 18,279 deaths (24.5/100,000) from hepatobiliary disease were registered in Portugal, constituting the 8th leading cause of death. The main causes of death from hepatobiliary disease were ALD (7.1/100,000), UCL (5.5/100,000), and HCC (4.3/100,000), with a male predominance (72%). ALD was the main aetiology in younger age groups (40-65 years), while primary neoplasms of the liver and the intrahepatic bile ducts were predominant in the elderly (>80 years). The mortality related to HCC increased by 66% between 2006 and 2012. Conclusion: These data outline the burden of hepatobiliary disease in Portugal (8th cause of death) and highlight a potential impact on economic productivity.

Objectives: To evaluate the respiratory support strategy and its association with morbidity and mortality in preterm infants with Gestational Age (GA) ≤ 32 weeks, admitted between 2000 and 2008. Methods: Chart data from newborns with GA ≤ 32 weeks admitted to a tertiary Neonatal Intensive Care Unit between 2000-2008, were reviewed retrospectively. Newborns were divided into two groups according to the year of birth: Group 1 (2000-2004) and Group 2 (2005-2008). Each group of newborns was subdivided in subgroups according to their GA: 23-28 gestational weeks and 29-32 gestational weeks. Each group was compared in terms of ventilation and surfactant strategy, morbility and mortality. The statistical analysis was carried out with SPSS 21.0. Results: We included 499 newborns, 224 in Group 1 and 275 in Group 2. The mean GA, sex and birth weight were similar in both groups. The comparison of the two groups showed a statistically significant difference in the rate of invasive ventilation and surfactant strategy. The mortality before discharge rate was 17.4% for Group 1 and 13.5% for Group 2. The comparison of the subgroups, revealed a statistically higher incidence of INSURE strategy and noninvasive ventilation in newborns born after 2004, with reduction of the mortality rate in newborns with GA comprised between 29-32 weeks and reduction of pneumothorax, severe chronic lung disease and intraventricular hemorrhage in newborns with GA comprised between 23-28 weeks. Conclusion: There was a tendency towards non-invasive strategy and INSURE administration of surfactant over the years. Mortality and major morbidity decreased along with these changes in the therapeutic approach of the respiratory distress syndrome in preterm newborns.

The pathogenesis of bronchopulmonary dysplasia (BPD) is clearly multifactorial. Specific pathogenic risk factors are prematurity, respiratory distress, oxygen supplementation, mechanical ventilation (MV), inflammation, patent ductus arteriosus (PDA), etc. Aim: To evaluate BPD prevalence and to identify risk factors for BPD in five Portuguese Neonatal Intensive Care Units in order to develop better practices the management of these newborns. Material and methods: 256 very low birth weight infants with gestational age (GA) 0.30 (85 vs 5 days, respectively in BPD and no BPD patients, pA displasia broncopulmonar (DBP) é multifactorial. Prematuridade, doença da membrana hialina, oxigénio, ventilação mecânica, inflamação e canal arterial são alguns dos factores na sua patogénese. Objectivo: Avaliar a prevalência da DBP e seus factores de risco em cinco unidades portuguesas, para implementar boas práticas no tratamento deste doentes. Material e métodos: 256 recém-nascidos (RN) com idade gestacional (IG) 0,30 (85 vs 5 dias, respectivamente nos doentes com e sem DBP, p

Resumo: A displasia broncopulmonar (DBP) é multifactorial. Prematuridade, doença da membrana hialina, oxigénio, ventilação mecânica, inflamação e canal arterial são alguns dos factores na sua patogéneseObjectivo: Avaliar a prevalência da DBP e seus factores de risco em cinco unidades portuguesas, para implementar boas práticas no tratamento deste doentes.Material e métodos: 256 recém-nascidos (RN) com idade gestacional (IG) ;0,30 (85 vs 5 dias, respectivamente nos doentes com e sem DBP, p;0.30 (85 vs 5 days, respectively in BPD and no BPD patients, p

This study aimed to quantify the association between adequacy of prenatal care and prevalence of folic acid, iron, and multivitamin intake during pregnancy. Data were obtained on socio-demographics, prenatal care, pregnancy complications, and use of vitamin/mineral supplements for 836 women, using a postpartum interview. Associations with the use of vitamin/mineral supplements were quantified with risk ratios (RR), computed by generalized binomial regression. A high proportion of women reported the use of folic acid (81.9%), iron (55.4%), and multivitamins (76.2%) as supplements during pregnancy. Use of supplements was independently associated with adequacy of prenatal care (adequate vs. inadequate: folic acid, RR = 2.28; 95%CI: 1.58-3.29; iron, RR = 1.99; 95%CI: 1.57-2.52, multivitamins, RR = 1.97; 95%CI: 1.54-2.51). Higher schooling was also associated with increased use of folic acid (RR = 1.42; 95%CI: 1.18-1.70), but not multivitamins (RR = 0.87; 95%CI: 0.77-0.98). Use of folic acid was less prevalent in single women (RR = 0.67; 95%CI: 0.48-0.95) and during unplanned pregnancies (RR = 0.81; 95%CI: 0.71-0.92). Adequacy of prenatal care is a major determinant of vitamin/mineral intake during pregnancy.Quantificar a associação entre a adequação dos cuidados pré-natais e a prevalência de utilização de ácido fólico, ferro e vitaminas durante a gravidez. Após o parto, 836 mulheres foram questionadas relativamente a características sócio-demográficas, utilização dos cuidados pré-natais, complicações durante a gravidez e utilização de suplementos vitamínicos/minerais. A associação entre as variáveis foi quantificada por meio de riscos relativos (RR) calculados por regressão binomial generalizada. Uma elevada proporção de mulheres reportou ter tomado ácido fólico (81,9%), ferro (55,4%) e multivitaminas (76,2%) durante a gravidez. A utilização de suplementos esteve independentemente associada à adequação dos cuidados pré-natais (adequado vs. inadequado: ácido fólico, RR = 2,28; IC95%: 1,58-3,29; ferro, RR = 1,99; IC95%: 1,57-2,52; multivitaminas, RR = 1,97; IC95%: 1,54-2,51). O elevado nível de escolaridade associou-se ao uso de ácido fólico (RR = 1,42; IC95%: 1,18-1,70), mas não de multivitaminas (RR = 0,87; IC95%: 0,77-0,98). A utilização de ácido fólico foi menos prevalente em mulheres que viviam sozinhas (RR = 0,67; IC95%: 0,48-0,95) e cuja gravidez não foi planeada (RR = 0,81; IC95%: 0,71-0,92). A adequação dos cuidados pré-natais é um determinante importante da utilização de vitaminas/minerais durante a gravidez.

Some experimental work suggests that exposure to intrauterine infection is associated, not only, with lung maturation and a reduced risk of respiratory distress syndrome, but also, with delayed alveolarization and increased risk of bronchopulmonary dysplasia. Aim: To evaluate the association between histological chorioamnionitis and lung disease in extremely low birth weight preterm infants. Methods: A retrospective chart review of 63 less than 1000 g birthweight, appropriated for gestational age neonates, delivered at three tertiary medical centers in the north of Portugal, between 2001 and 2002. The association between histological chorioamnionitis and lung damage (respiratory distress syndrome and bronchopulmonary dysplasia) was evaluated through the calculation of crude and adjusted odds ratio. Results: There were 32 newborns from mothers with histological chorioamnionitis and 31 without the condition. The association between histological chorioamnionitis and respiratory distress syndrome was OR 0.23 (95% CI 0.01 - 2.51). The association between chorioamnionitis and bronchopulmonary dysplasia was OR 1.61 (95% CI 0.38 - 6.97). The association between histological chorioamnionitis and bronchopulmonary dysplasia when adjusted for gestational age, multiple birth and C-section revealed no statistical significance: OR 2.66 (95% CI 0.36 - 19.60) for chorioamnionitis without funisitis or vasculitis and OR 1.68 (95% CI 0.25 - 11.18) for funisitis and/or vasculitis. Conclusion: In this study we could not confirm a decreased risk of respiratory distress syndrome nor an increased risk of bronchopulmonary dysplasia in extremely low birth weight preterm neonates with histological chorioamnionitis.Alguns estudos experimentais sugerem que a exposição a infecção intra-uterina associa-se, não só, a maturação pulmonar e menor risco de doença das membranas hialinas, mas também a atraso na formação alveolar e maior risco de displasia broncopulmonar. Objectivo: Avaliar a associação entre corioamnionite histológica e lesão pulmonar no recém-nascido pré-termo de extremo baixo peso. Métodos: Estudo retrospectivo em 63 recém-nascidos com peso ao nascimento inferior a 1000 g, apropriados à idade gestacional, nascidos em três centros hospitalares do Norte de Portugal, entre 2001 e 2002. A associação entre corioamnionite histológica e lesão pulmonar (doença das membranas hialinas e displasia broncopulmonar) foi avaliada através do cálculo de odds ratio. Resultados: Em 32 recém-nascidos as mães apresentaram corioamnionite histológica e em 31 a condição não estava presente. A associação entre corioamnionite histológica e doença das membranas hialinas foi OR 0,23 (IC 95% 0,01 - 2,51). A associação entre corioamnionite histológica e displasia broncopulmonar foi OR 1,61 (IC 95% 0,38 - 6,97). A associação entre corioamnionite histológica e displasia broncopulmonar ajustada para a idade gestacional, gestação múltipla e parto por cesariana não foi estatisticamente significativa: OR 2,66 (IC 95% 0,36 - 19,60) para orioamnionite sem funisite ou vasculite e OR 1,68 (IC 95% 0,25 - 11,18) para corioamnionite com funisite e/ou vasculite. Conclusão: Este estudo não nos permitiu confirmar a existência de menor risco de doença das membranas hialinas ou de maior risco de displasia broncopulmonar no recém-nascido pré-termo de extremo baixo peso com corioamnionite histológica.

Introdução: A técnica do gânglio sentinela constitui uma ferramenta importante para o estadiamento dos doentes com melanoma, permitindo identificar metástases ganglionares regionais ocultas e evitar linfadenectomias desnecessárias. Objectivo: Analisar os padrões de recidiva do melanoma em doentes com um resultado negativo na técnica do gânglio sentinela e identificar as características clínicas e histopatológicas potencialmente preditivas de recidiva após técnica do gânglio sentinela negativa. Material e métodos: Foi realizado um estudo retrospectivo em doentes com melanoma cutâneo submetidos a técnica do gânglio sentinela no Serviço de Dermatologia do Hospital Distrital de Santarém, entre 2005 e 2011. Resultados: Foram avaliados 96 doentes submetidos a técnica do gânglio sentinela. Destes, 29 doentes obtiveram resultado positivo, 66 tiveram resultado negativo e um doente obteve resultado inconclusivo. Dos 66 doentes com técnica do gânglio sentinela negativa, 11 (16,7% do total de resultados negativos) desenvolveram recidiva do melanoma aos 21,7 meses de mediana de seguimento (intervalo, 8-51 meses). Comparativamente ao grupo de doentes sem recidiva, estes doentes tinham idade mais avançada ao diagnóstico (média de idade de 71,8 vs 62,9 anos; p=0,021), eram predominantemente do sexo masculino (54,5% vs 29,1%: p=0,159) e apresentavam lesões primárias mais espessas (espessura mediana de 2,92 vs 1,80 mm; p=0,087), mais frequentemente ulceradas (63,6% vs 38,1%; p=0,177) e com invasão vascular/perineural (40% vs 13%; p=0,207). O melanoma nodular foi a variante clínica mais prevalente neste grupo (54,5%), enquanto no grupo sem recidiva predominou o tipo extensão superficial (50,9%). Conclusões: Globalmente, a recidiva de melanoma após um resultado negativo na técnica do gânglio sentinela (16,7%) foi semelhante à dos estudos previamente publicados. Identificámos como possíveis factores preditivos de recidiva, apesar de um resultado negativo na técnica do gânglio sentinela: idade mais avançada no diagnóstico, sexo masculino, espessura de Breslow superior, presença de ulceração, presença de invasão vascular/perineural e variante nodular.

To determine the prevalence of infertility in Porto and to assess the association between infertility and women's year of birth and socioeconomic status.In a cross-sectional study were evaluated in Porto, in 1999-2003, 1540 women aged 18-90 years. Structured face-to-face interviews comprising information on social, demographic, personal and family history, gynaecological and obstetric history, cognitive capacity and behavioural characteristics were performed. Gynaecological history included lifetime infertility. Primary infertility was defined as never being able to achieve a pregnancy after more than one year trying to conceive. Secondary infertility means that the woman has already conceived, but subsequently was unable, for at least a period of one year. Socioeconomic status was evaluated by education and job.The prevalence of lifetime infertility was 12.0% (95% confidence interval: 10.4%-13.7%). The prevalence of primary infertility was 7.7% and secondary infertility was 3.8%. The prevalence of infertility was not significantly different according to women's year of birth, education or job. Infertility was significantly more frequent among married/cohabiting/widow/divorced women (13.9%) compared to single women (1.7%).These findings do not confirm the increase of infertility with more recent birth cohorts. There appeared no association between infertility and socioeconomic status. It was found higher prevalence on married/cohabiting/widow/divorced women comparative to single group women, and these differences were statistically significant.

Plasma brain-type natriuretic peptide (BNP) is secreted by cardiac myocytes in response to pressure or volume overload. Recently, an assay to measure the N-terminal segment of the pro-hormone (NT-pro-BNP) was developed.(1) To determine the plasma levels of NT-pro-BNP in premature neonates without congenital heart disease; (2) to determine the relationship between the severity of respiratory distress syndrome (RDS) and plasma levels of NT-pro-BNP.Plasma levels of NT-pro-BNP were measured in premature neonates (

Introdução: O termo «crise hipertensiva» corresponde a uma variedade de situações clínicas que diferem entre si, pela gravidade dos valores da pressão arterial e pela necessidade de redução mais ou menos rápida dos mesmos. Esta entidade é arbitrariamente definida como qualquer elevação da pressão arterial diastólica acima de 120 mmHg e sintomas acompanhantes relacionados. Dependendo da existência de lesão de órgão-alvo aguda ou rapidamente progressiva, a «crise hipertensiva» pode manifestar-se como urgência ou emergência hipertensiva. Objectivos: Pretende-se apresentar uma breve revisão de conceitos básicos sobre o que é, e como diferenciar, uma verdadeira crise hipertensiva (urgência ou emergência hipertensiva) de uma «pseudocrise», qual a marcha diagnóstica desta patologia e qual a terapêutica mais adequada a implementar. Métodos: Revisão bibliográfica incluindo tratados de referência e artigos recentemente publicados na área de hipertensão arterial, nomeadamente referentes a urgências e emergências hipertensivas. Conclusão: As urgências hipertensivas e as emergências hipertensivas são igualmente denominadas «crises hipertensivas» e ambas se caracterizam por uma elevação súbita e sintomática da pressão arterial que pode ou não associar-se a uma lesão de órgão-alvo e/ou envolver risco de morte imediato ou potencial. O doente que se encontra numa situação de emergência hipertensiva, se considerado em estado grave e/ou agudo, deve ser internado numa unidade de cuidados intensivos, com monitorização da pressão arterial de forma contínua e cuidadosa, sendo necessária uma redução imediata da pressão arterial em minutos ou horas. A redução não necessita de atingir valores «normais» mas sim valores que possam afastar o risco de morte e impedir o agravamento ou deterioração de órgão-alvo. As urgências hipertensivas definem-se como elevações da pressão arterial sistólica e/ou diastólica sem evidência de lesão de órgão-alvo a curto prazo, sendo necessária uma redução gradual da pressão arterial em 24-48 horas para que ocorra a recuperação e a readaptação do doente.

Several studies highlight the association between perinatal infection/inflammation and neonatal morbidity, mainly bronchopulmonary dysplasia and periventricular leukomalacia.To evaluate the role of histological chorioamnionitis on the overall morbidity of preterm newborns.A retrospective study on preterm newborns less than 34 weeks gestational age at birth, and respective mothers, at three tertiary medical centers (Hospital de São João, Maternidade Júlio Dinis and Centro Hospitalar de Vila Nova de Gaia) in the north of Portugal, between January 2001 and December 2002. We evaluated the association between histological chorioamnionitis and the overall neonatal morbidity. The association between histological chorioamnionitis and acute (respiratory distress syndrome) and chronic (bronchopulmonary dysplasia) lung damage was also evaluated in the subgroup of less than 1000 g birthweight preterm neonates.452 [ M 253 / F 217; birthweight 1440 (515-2620) g; gestational age 31 (23-33) weeks] preterm newborns were included. The association between histological chorioamnionitis and the overall neonatal morbidity was: respiratory distress syndrome OR 1.5 (95% CI 0.94-2.31); bronchopulmonary dysplasia OR 2.6 (95% CI 1.16-6.03); patent ductus arteriosus OR 2.5 (95% CI 1.17-5.44); sepsis OR 1.2 (95% CI 0.9-2.13); necrotizing enterocolitis OR 1.4 (95% CI 0.9-1.76); intraventricular hemorrhage grades III-IV OR 2.5 (1.20-5.11); cystic periventricular leukomalacia OR 3.0 (1.5-6.07); retinopathy of prematurity OR 1.4 (95% CI 0.8-1.35). The association adjusted to birthweight and gestational age was: bronchopulmonary dysplasia OR 1.2 (95% CI 0.51-2.95); patent ductus arteriosus OR 0.9 (95% CI 0.4-2.35); intraventricular hemorrhage grades III-IV OR 0.9 (95% CI 0.39-2.28); cystic periventricular leukomalacia OR 2.2 (95% CI 1.03-4.61). The association between histological chorioamnionitis and lung damage in the subgroup of less than 1000 g birthweight preterm neonates was: respiratory distress syndrome OR 0.23 (95% CI 0.01-2.51); bronchopulmonary dysplasia OR 1.61 (95% CI 0.38-6.97).This study confirms the association between histological chorioamnionitis and cystic periventricular leukomalacia of the preterm newborn.