Narrative medicine: an optative course at the Faculty of Medicine of Lisbon

Copyright © Ordem dos Médicos 2016A chamada ‘Medicina Narrativa’ surgiu nos anos 90, na educação e na prática médica americana com o objetivo de desenvolver a aptidão dos estudantes para reconhecer o sofrimento, interpretar e ser sensibilizado pela história da doença. Os métodos propostos incluíam a leitura de textos literários, colheita da história clínica tutorada e escrita reflexiva que facilitem e estimulem uma relação de empatia e respeito entre o médico e o doente e daquele com os outros profissionais de saúde.info:eu-repo/semantics/publishedVersio

Adolescent pregnancy in Sao Tome and Principe: a cross-sectional hospital-based study

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: Pregnancy starts early in Sao Tome and Principe (STP) and rates of adolescent pregnancy increased 16% in recent years reaching a 27.3% prevalence. This study aimed to understand the pregnant adolescents' characteristics and factors associated to early childbearing in STP. Methods: A cross-sectional hospital-based study was undertaken in Hospital Dr. Ayres de Menezes between 2016 and 2018 with a randomly selected total sample size of 518 mothers. Mothers' clinical records and interviews were used to collect relevant data. The results among adolescent girls 19 years of age and younger (n=104) were compared to adult mothers (n=414). A subgroup analysis of adolescent pregnant girls was also conducted. Statistically significance was considered at a p-value ≤0.05. Data were analysed using SPSS software. Results: The study revealed that 20.1% were adolescent mothers. Pregnancy at a very early age (≤15) was experienced by 7.7%. The characteristics founded to be positively associated with adolescent pregnancy were: 1) being single (OR 0.39, 95% CI=0.2-0.6, p≤0.001); 2) having a relationship with the baby´s father for a period of less than one year (OR 0.16, 95% CI=0.09-0.3, p≤0.001); 3) lack of the baby´s father support (OR 0.41, 95% CI=0.2-0.7, p=0.002); 4) not using a contraceptive method (OR 0.33, 95% CI=0.2-0.5, p≤0.001), and 5) inappropriate knowledge concerning the identification of the newborn's danger signs (OR 15.7, 95% CI= 9-26, p≤0.001). Comparing pregnancy at very early age (≤15) to late (>18 and ≤19) adolescents, main differences were that previous contraceptives were not used at all in girls ≤15 years compared to 9.8% of late childbearing subgroup. Conclusions: Unfavourable factors linked to adolescent pregnancies were absence of a contraceptive method, getting pregnant in the early first months of one relationship and to be single. Gap age difference between adolescents' partners, polygamous sexual relationships, previous abortion and having already other living children were also identified. Adolescents also had inappropriate knowledge of the identification of the newborns' danger signs. Before being sexually active, adolescents critically need sexual and reproductive health information provided by a healthy community and through school programmes on sexual education. Schools should promote girl's empowerment and awareness and, at the same time, reinforce boy's role in fatherhood and shared responsibilities. The government should work on the prevention of early sexual initiation, as well as on improving family planning programmes to protect them from pregnancy with special focus for the very early adolescent girls. None of these goals can be achieved if the government doesn't, simultaneously, improve educational and economic opportunities for girls.AV was supported by the Fundação para a Ciência e Tecnologia (FCT) (https://www.fct.pt/index.phtml.pt/), grant number SFRH/BD/117037/2016.info:eu-repo/semantics/publishedVersio

Psychological well-being and chronic condition in portuguese adolescents

© 2015 The Author(s). Published by Taylor & Francis. This is an OpenAccess article distributed under the terms of theCreative CommonsAttribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the originalwork is properly cited. The moral rights of the named author(s) have been asserted.Objective: To examine the differences in the psychological well-being of Portuguese adolescents' (1) living with a chronic condition (CC) and (2) living with a CC and feeling it affects/not affects school participation. Methods: There were 5050 Portuguese adolescents as participants of the Health Behaviour in School-aged Children/WHO. Results: Adolescents without CC often feel rarely or never ‘sad/depressed’, ‘irritated/bad humour’, ‘nervous’, ‘fearful’ or ‘so sad that it seems I can't take it’, compared with their healthy peers. Young people living with CC and feeling that it does not affect participation in school, often feel rarely or never ‘sad/depressed’, ‘fearful’ or ‘so sad that it seems I can't take it’, comparing with the ones with CC and feeling it affects school. All of these symptoms were higher in adolescents living with a CC. Conclusions: Adolescents living with a CC and feeling that it affects participation in school can be at a higher risk for a healthy psychological well-being. Future early interventions based on a ‘health assets’ approach should be implemented.This work (HBSC/WHO in Portugal) was supported by “Aventura Social” team members on data collection/management and was co-financed by Alto Comissariado da Saúde, Ministério da Saúde (High Commission for Health, Health Ministry) and Coordenação Nacional para a Infecção VIH/SIDA (National Coordination for HIV/AIDS). Santos, T. receives a PhD grant from the Portuguese Foundation for Science and Technology (FCT),reference SFRH/BD/82066/2011. None of the authors reported any further financial interests or potential conflicts of interest.info:eu-repo/semantics/publishedVersio

Do clinical and psychosocial factors affect health-related quality of life in adolescents with chronic diseases?

Copyright © 2006 - 2018 The Canadian Center of Science and Education. All Rights Reserved. Copyright for this article is retained by the author(s), with first publication rights granted to the journal. This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).Living with a chronic disease in adolescence can have an impact on the perception of Health-related Quality of Life (HRQoL). Facing the increasing relevance of psychosocial dimensions and also considering the interaction with clinical variables, this study aimed to measure the impact of clinical and psychosocial factors (separated and combined) on adolescent’s reported HRQoL. A cross-sectional study was conducted in a clinical population of 135 adolescents with chronic diseases (n=70 boys), average age: 14±1.5 years old. Through a self-reported questionnaire, HRQoL (KIDSCREEN-10), socio-demographic, clinical variables (diagnostic; time of diagnosis; self-perceived pain; disease severity proxy; disease-related medication intake/use of special equipment), and psychosocial variables (psychosomatic health; resilience; self-regulation; social support) were assessed. Separately, clinical and psychosocial variables showed a significant impact in HRQoL, 27.9% and 62.4%, respectively. Once combined, the previously identified variables had a significant impact (64.2%), but a different contribution from clinical and psychosocial variables was revealed: when first entering the clinical variables (model 1) the variance only reaches 30%, and much more from psychosocial variables seems to explain the total (64.2%); inversely, when first integrating psychosocial variables (model 2), the clinical ones added a small significance to the model (0.6%). The present study underlined the association of clinical (“disease-related”) and psychosocial (“non-disease-related”) factors on HRQoL. Furthermore, it reinforced the need to focus more on psychosocial dimensions, highlighted the potential role of psychosomatic health, resilience, self-regulation and social support. It can be suggested that the identification of impaired psychosocial domains may help professionals to better plan, and achieve effective interventions of psychosocial care.Santos, T. was supported by a PhD grant from the Portuguese Foundation for Science and Technology (FCT) (Grant Number: reference SFRH/BD/82066/2011). The William James Center for Research, ISPA - Instituto Universitário is supported by a grant from the Portuguese Foundation for Science and Technology (FCT) (Grant Number: UID/PSI/04810/2013). The present study is grateful to all youngsters and parents who participated in this project, also to the health care professionals who collaborated, as well as to the Pediatrics Department of Hospital Santa Maria, CAML (Lisbon Academic Medical Center) for their assistance in this investigation. The authors are also grateful to Prof. Paula Ravasco, MD, PhD (University Hospital of Santa Maria, Portugal) for her assistance in proof-reading and revising the document.info:eu-repo/semantics/publishedVersio

Do clinical and psychosocial factors affect health-related quality of life in adolescents with chronic diseases?

publishersversionpublishe

Determinants of antenatal care utilization – contacts and screenings – in São Tome e Principe: a hospital-based cross-sectional study

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: Sao Tome & Principe (STP) has a high peri-neonatal mortality rate and access to high-quality care before childbirth has been described as one of the most effective means of reducing it. The country has a gap in the coverage-content of antenatal care (ANC) services that must be addressed to better allocate resources to ultimately improve maternal and neonatal health. Therefore, this study aimed to identify the determinants for adequate ANC utilization considering the number and timing of ANC contacts and screening completion. Methods: A hospital based cross-sectional study was undertaken among women admitted for delivery at Hospital Dr. Ayres de Menezes (HAM). Data were abstracted from ANC pregnancy cards and from a structured face-to-face interviewer-administered questionnaire. ANC utilization was classified as partial vs adequate. Adequate ANC utilization was defined as having ANC 4 or more contacts, first trimester enrolment plus one or more hemoglobin tests, urine, and ultrasound. The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Multivariable logistic regression was used to identify determinants of adequate ANC utilization at P-value < 0.05. Results: A total of 445 mothers were included with a mean age of 26.6 ± 7.1, an adequate ANC utilization was identified in 213 (47.9%; 95% CI: 43.3-52.5) and a partial ANC utilization in 232 (52.1%; 95% CI: 47.5-56.7). Age 20-34 [AOR 2.27 (95% CI: 1.28-4.04), p = 0.005] and age above 35 [AOR 2.5 (95% CI: 1.21-5.20), p = 0.013] when comparing with women aged 14-19 years, urban residence [AOR 1.98 (95% CI: 1.28-3.06), p < 0.002], and planned pregnancy [AOR 2.67 (95% CI: 1.6-4.2), p < 0.001] were the determinants of adequate ANC utilization. Conclusion: Less than half of the pregnant women had adequate ANC utilization. Maternal age, residence and type of pregnancy planning were the determinants for adequate ANC utilization. Stakeholders should focus on raising awareness of the importance of ANC screening and engaging more vulnerable women in earlier utilization of family planning services and choosing a pregnancy plan, as a key strategy to improve neonatal health outcomes in STP.AV was supported by the Fundação para a Ciência e Tecnologia (FCT) (https://www.fct.pt/index.phtml.pt/), grant number SFRH/BD/117037/2016.info:eu-repo/semantics/publishedVersio

Influence of individual and contextual characteristics on the weight of newborn (from immigrant and Portuguese mothers) in Lisbon Metropolitan Area

RESUMO - Objetivo: Avaliar a influência dos fatores biológicos, socioeconómicos e comportamentais no peso dos recém-nascidos (RN), considerando RN de mães imigrantes (MI) e mães portuguesas (MP). Método: Wilcox e Russel e modelos de regressão linear múltipla. Resultados: Observaram-se pesos mais baixos em RN do sexo feminino, idades gestacionais inferiores, mães adolescentes, não casadas ou em união de facto, escolaridade ≤ 12 anos, trabalhadoras manuais, residentes em «barracas», consumidoras de tabaco (MP), consumidoras de álcool (MI), paridade = 1, partos por cesariana (MI) ou eutócicos (MP) e não diabéticas. Conclusão: A distribuição residual de prematuridade revela maior vulnerabilidade nos RN de MI.ABSTRACT - Aim: Assess the influence of biological, socioeconomic and behavioural factors on the weight of newborn (NB) infants born from immigrant and Portuguese mothers (IM and PM respectively). Methods: Wilcox and Russell and multiple linear regression models. Results: Lower birthweights in NBs that were female and of lower gestational age, and whose mothers were adolescent, unmarried or in de facto marriages, had ≤ 12 years schooling, manual workers, lived in shanties, consumed tobacco (PM), consumed alcohol (IM), parity = 1, had Caesarian (IM) or normal (PM) deliveries and were not diabetic. Conclusion: Residual distribution of prematurity shows higher vulnerability in babies born from IM.info:eu-repo/semantics/publishedVersio

A Cross-Sectional Study

Publisher Copyright: © 2022 Alexandra Vasconcelos et al.Background. Intestinal parasitic infections (IPIs) are a public health problem in developing countries such as Sao Tome and Principe (STP) although the pregnancy burden of IPIs is unknown in this endemic country. Thus, the aim of this study was to determine the prevalence of IPIs, prescribed anthelmintics, and associated factors among pregnant women admitted to Hospital Dr. Ayres de Menezes (HAM). Methods. A hospital-based cross-sectional study was conducted among pregnant women admitted to the HAM who had undergone antenatal copro-parasitological screening. Data were abstracted from antenatal care (ANC) cards regarding parasitological results and anthelmintic prescriptions. A structured questionnaire face-to-face interview was also applied. Pregnant women with an IPI (210) were compared to noninfected women (151). Data analysis was performed using SPSS version 25.0. Odds ratios (ORs) with 95% confidence intervals (CIs) for factors associated with IPIs were estimated using multiple logistic regression models. A p value <0.05 was considered statistically significant. Results. A total of 361 participants (210 IPI and 151 no-IPI) with a mean age of 26.96 (SD: 7.00) were included. The overall prevalence of IPI was 58.2% (95% CI 52.9 to 63.3), mainly due to helminthiasis, with a 55.9% (95% CI 50.7-61.2%) rate. Ascaris lumbricoides (90.9%) was the most predominant parasite species identified followed by Trichuris trichiura (13.8%). Polyparasitism was observed in 25 cases (11.9%). Anthelmintics were prescribed to 23% of pregnant women. S intercalatum (11) and E histolytica (7) infections were not adequately treated. IPI was significantly associated with primary education (AOR 1.73 (95% CI: 1.10-2.71)), unemployment (AOR 1.94 (95% CI: 1.20-3.13)), and parity of five or above (AOR 3.82 (95% CI: 1.32-11.08)). Conclusion. This study highlights the IPI burden, associated factors, and missing treatment opportunities among pregnant women with STP. This study is a useful tool for policymakers in STP to enhance the health of women and their unborn babies.publishersversionpublishe