Para uma cartografia do termo

UID/ELT/04097/2013publishersversionpublishe

Contribuição para uma resenha bio-bibliográfica do Prof. João Inácio Ferreira Lapa (1823-1892)

info:eu-repo/semantics/publishedVersio

PCV141 Atherosclerosis : real-world insights from a Portuguese primary care database

Copyright © 2019 Published by Elsevier Inc.Objectives: Cardiovascular disease remains the leading cause of death in Portugal and across the world. Atherosclerosis is the most common pathophysiologic process underlying CVD. Its clinical manifestations include coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral artery disease (PAD). This study aims to determine the clinical and demographic characteristics of adult patients with atherosclerosis in a Portuguese primary care comprehensive administrative database.info:eu-repo/semantics/publishedVersio

Total and attuned multiple autonomy support and the social development of early adolescents

The effects of Multiple Autonomy Support (MAS), meaning the autonomy support provided by two or more sources, is an overlooked topic in social development literature. The aim of this study is to understand how two types of MAS, Total Multiple Autonomy Support (TMAS) and Multiple Autonomy Support Attunement (MASA), are related to early adolescents’ social development indicators (prosocial behavior, self-regulation, antisocial behavior, alcohol use, and 1-year substance use intention). TMAS pertains to the general amount of autonomy support perceived by a MAS recipient, irrespectively of each provider’s contribution to that score. MASA refers to the interindividual patterns of perceived coordination among MAS providers, based on each provider’s autonomy scores. The participants were 818 early adolescent Portuguese (M?=?12.15; SD?=?.81; 54.2% girls) surveyed in a cross-sectional exploratory study about MAS provided by parents, teachers, and mentors. Descriptive analyses revealed levels of low (n? =?81; 10.00%), moderate (n? =?432; 52.82%), and high (n? =?302; 36.91%) TMAS. A k-cluster analysis revealed four MASA groups: low attuned MAS (n? =?128; 15.65), misattuned MAS/low attuned parent autonomy support (n? =?225; 27.51%), misattuned MAS/low attuned teacher autonomy support (n? =?177; 21.64%), and high attuned MAS (n? =?288; 32.21%). Ordinal regressions show that, after controlling for age, a pattern of high attuned MAS predicts better prospects of prosocial behavior and self-regulation, as opposed to high levels of TMAS. In addition, MASA involving low teacher autonomy support predicts the worst results on the selected indicators of social development.info:eu-repo/semantics/acceptedVersio

A aterosclerose nos cuidados de saúde primários: estudo da vida real

Introduction and Objectives: To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. Methods: A cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. Results: A total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p<0.001). Mean blood pressure, LDL-C and glycated hemoglobin values were lower in the subpopulation with manifestations (142/74 vs. 146/76 mmHg, 101 vs. 108 mg/dl, and 6.80 vs. 6.84%, respectively; p<0.001). Each user with atherosclerosis attended 4.1±2.9 face-to-face medical consultations and underwent 8.6±10.0 laboratory test panels, with differences in subpopulations with and without clinical manifestations (4.4±3.2 vs. 4.0±2.8 and 8.3±10.3 vs. 8.7±9.8, respectively; p<0.001). Conclusions: About one in three adult primary health care users with atherosclerosis have clinical manifestations. The results suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis.Introdução e objetivos: caracterizar os doentes com aterosclerose, uma doença com elevado impacto socioeconómico, na Região de Saúde de Lisboa e Vale do Tejo. Métodos: Estudo observacional transversal, recorrendo ao Sistema de Informação desta Administração Regional de Saúde, com extração de dados clínico-demográficos e de consumo de recursos dos utilizadores adultos com aterosclerose em 2016. A aterosclerose foi definida pela presença de manifestações clínicas, fatores de risco aterotrombóticos e/ou consumo de medicamentos marcadores de aterosclerose. Foram comparados os resultados para a população com e sem manifestações clínicas (testes paramétricos). Resultados: Identificámos 318 692 utilizadores, a maioria (n=224 845 doentes; 71%) sem registo de manifestações clínicas. A subpopulação com manifestações clínicas era mais idosa (72,0±11,5 versus 71,3±11,0 anos), com maior proporção de homens (58,0% versus 45,9%), registo de hipertensão arterial (78,3% versus 73,5%), dislipidemia (55,8% versus 53,5%) e menor proporção de registo de obesidade (18,2% versus 20,8%), em comparação com a população sem manifestações clínicas (p<0,001). Os valores médios de pressão arterial sistólica/diastólica, C-C-LDL e hemoglobina glicada foram inferiores na subpopulação com manifestações (142/74 versus 146/76 mmHg, 101 versus 108 mg/dL, 6,80 versus 6,84%, respetivamente; p<0,001). Cada utilizador com aterosclerose realizou 4,1±2,9 consultas médicas presenciais e 8,6±10,0 painéis de análises clínicas, com diferenças nas subpopulações com e sem manifestações clínicas (4,4 ± 3,2 versus 4,0 ± 2,8 e 8,3 ± 10,3 versus 8,7±9,8, respetivamente; p<0,001). Conclusões: Cerca de um em cada três utilizadores adultos de cuidados de saúde primários com aterosclerose têm manifestações clínicas. Os resultados sugerem que o controlo dos factores de risco cardiovascular é sub-óptimo em doentes com aterosclerose.info:eu-repo/semantics/acceptedVersio

A Aterosclerose nos Cuidados de Saúde Primários: Estudo da Vida Real

Introduction and objectives: To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. Methods: A cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. Results: A total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p<0.001). Mean blood pressure, LDL-C and glycated hemoglobin values were lower in the subpopulation with manifestations (142/74 vs. 146/76 mmHg, 101 vs. 108 mg/dl, and 6.80 vs. 6.84%, respectively; p<0.001). Each user with atherosclerosis attended 4.1±2.9 face-to-face medical consultations and underwent 8.6±10.0 laboratory test panels, with differences in subpopulations with and without clinical manifestations (4.4±3.2 vs. 4.0±2.8 and 8.3±10.3 vs. 8.7±9.8, respectively; p<0.001). Conclusions: About one in three adult primary health care users with atherosclerosis have clinical manifestations. The results suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis.info:eu-repo/semantics/publishedVersio

MAternal Mental Health in the WORKplace (MAMH@WORK): a protocol for promoting perinatal maternal mental health and wellbeing

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Women are exposed to increased burden of mental disorders during the perinatal period: 13–19% experience postpartum depression. Perinatal psychological suffering affects early mother-child relationship, impacting child’s emotional and cognitive development. Return-to-work brings additional vulnerability given the required balance between parenting and job demands. The MAternal Mental Health in the WORKplace (MAMH@WORK) project aims to develop and evaluate the effectiveness of a brief and sustainable intervention, promoting (a) maternal mental health throughout pregnancy and first 12 months after delivery, and (b) quality of mother–child interactions, child emotional self-regulation, and cognitive self-control, while (c) reducing perinatal absenteeism and presenteeism. MAMH@WORK is a three-arm randomized controlled trial. A short-term cognitive-behavioral therapy-based (CBT-based) psychoeducation plus biofeedback intervention will be implemented by psychiatrists and psychologists, following a standardized procedure manual developed after consensus (Delphi method). Participants (n = 225, primiparous, singleton pregnant women at 28–30 weeks gestational age, aged 18–40 years, employed) will be randomly allocated to arms: CBT-based psychoeducation intervention (including mindfulness); psychoeducation plus biofeedback intervention; and control. Assessments will take place before and after delivery. Main outcomes (and main tools): mental health literacy (MHLS), psychological wellbeing (HADS, EPDS, KBS, CD-RISC, BRIEF COPE), quality of mother–child interaction, child–mother attachment, child emotional self-regulation and cognitive self-control (including PBQ, Strange Situation Procedure, QDIBRB, SGS-II, CARE-Index), job engagement (UWES), and presenteeism. Intention-to-treat and per-protocol analyses will be conducted; Cohen’s d coefficient, Cramer’s V and odds ratio will be used to assess the effect size of the intervention. MAMH@WORK is expected to contribute to mental health promotion during the perinatal period and beyond. Its results have the potential to inform health policies regarding work–life balance and maternal mental health and wellbeing promotion in the workplace.The development of this protocol has benefited from the funding from FCT, under the grants UIDB/04295/2020 and UIDP/04295/2020.info:eu-repo/semantics/publishedVersio

The burden of atherosclerosis in Portugal

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please [email protected]: This paper sought to estimate the burden of disease attributable to atherosclerosis in mainland Portugal in 2016. Methods and results: The burden of atherosclerosis was measured in disability-adjusted life years (DALY) following the latest 2010 Global Burden of Disease (GBD) methodology. DALYs were estimated as the sum of years of life lost (YLL) with years lived with disability (YLD). The following clinical manifestations of atherosclerosis were included: ischemic heart disease (IHD) (including acute myocardial infarction (AMI), stable angina, and ischemic heart failure (IHF)), ischemic cerebrovascular disease (ICVD) and peripheral arterial disease (PAD). YLL were estimated based on all-cause mortality data for the Portuguese population and mortality due to IHD, ICVD and PAD for the year 2016 sourced from national statistics. Standard life expectancy was sourced from the GBD study. YLD corresponded to the product of the number of prevalent cases by an average disability weight (DW) for all possible combinations of disease. Prevalence data for the different clinical manifestations of atherosclerosis were sourced from epidemiological studies. DW were sourced from the published literature. In 2016, 15,123 deaths were attributable to atherosclerosis, which corresponded to 14.3% of overall mortality in mainland Portugal. DALYs totaled 260,943, 75% due to premature death (196,438 YLL) and 25% due to disability (64,505 YLD). Conclusion: Atherosclerosis entails a high disease burden to society. A large part of this burden would be avoidable if evidence-based effective and cost-effective interventions targeting known risk factors, from prevention to treatment, were implemented.This study was funded by Bayer Portugal, Lda. Funding was independent of the study outcomes.info:eu-repo/semantics/publishedVersio

Os custos da aterosclerose em Portugal

Copyright © 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved.© 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espa ̃na, S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Introduction and objectives: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease-related costs. Methods: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real-world data from primary care, the 2014 National Health Interview Survey, and expert opinion. Results: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). Conclusions: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.info:eu-repo/semantics/publishedVersio