Modalidades de execução de rastreio do cancro do colón e recto

Trabalho final de mestrado integrado em Medicina área cientifica de Economia e Gestão da Saúde, apresentada á Faculdade de Medicina da Universidade de CoimbraIntrodução: O Cancro Colo-Rectal representa um grande problema de saúde pública responsável por um milhão de novos casos todos os anos. A maioria dos Cancros Colo-Rectais tem origem em pólipos adenomatosos através da sequência adenoma-carcinoma, com um tempo de progressão de aproximadamente dez anos, sendo causa de significativa morbi-mortalidade, onde o tratamento da doença desempenha um enorme encargo financeiro para a sociedade. Vários estudos têm mostrado que o rastreio do Cancro Colo-Rectal reduz a mortalidade, a incidência e melhora a sobrevivência. Os métodos actualmente disponíveis para rastreio são, a pesquisa de sangue oculto nas fezes, existindo para tal, o teste do guaiaco e testes imunoquímicos, a colonoscopia, a sigmoidoscopia flexível, a colonografia por tomografia computorizada, a cápsula endoscópica, os testes de ácido desoxirribonucleico fecal e os biomarcadores serológicos. Objectivos: Analisar e comparar o impacto financeiro, estimando o custo da implementação de um programa de rastreio de base populacional pelas técnicas de pesquisa de sangue oculto nas fezes e por colonoscopia total na região Autónoma dos Açores. Métodos: Utilizadas quatro taxas de participação, 25; 50; 65 e 75%, para comparar as três técnicas de rastreio. Com base nos custos totais, foram calculados os custos por participante para as mesmas taxas de participação. Resultados: Para taxa de participação de 25%, o total de custos estimados para a implementação de um rastreio de base populacional foi de 910.497,29€ para o método guaiaco, de 1.830.374,69€ para o método imunoquímico e 2.186.494,30€ para a colonoscopia, com custos por participante de 75,01€; 150,79€ e de 180,13€ respectivamente. 4 Para a taxa de 50%, o total de custos estimados foi de 1.501.115,60€ para o método guaiaco; 3.308.980,92€ para o método imunoquímico e de 4.186.914,68€ para a colonoscopia, com custos por participante de 61,83€; 136,30€ e 172,47€ respectivamente. Para a taxa de 65%, o total de custos estimados foi de 1.852.857,87€ para o guaiaco; 4.180.811,30€ para o método imunoquímico e de 5.387.166,91€ para a colonoscopia, com custos por participante de 58,71€, 132,47€ e 170,70€, respectivamente. Para a taxa de 75%, o total de custos estimados foi de 2.086.262,45€ para o guaiaco; 4755711,99€ para o imunoquímico e 6187335,06€ para a colonoscopia, com custos por participante de 57,29€, 130,60€ e 169,91€ respectivamente. Conclusão: Quando a taxa de participação é semelhante para as três técnicas, os custos totais e os custos por participante são consideravelmente maiores para a colonoscopia total, seguida do método imunoquímico e por fim o método guaiaco.Introduction: Colo-Rectal Cancer is a major public health problem responsible for one million new cases, every year. Most Colo-Rectal Cancers develop from adenomatous polyps through the adenoma-carcinoma sequence, with a time of progression of approximately 10 years, being responsible for significant morbility and mortality. The treatment for this disease plays a huge financial burden to society. Several studies have shown that screening tests reduce Colo-Rectal Cancer mortality and incidence, improving survival rates. The methods currently available for screening are the fecal occult blood test, which includes the guaiac test and immunochemical tests; colonoscopy, flexible sigmoidoscopy, colonoscopy, colonography, the capsule endoscopy, fecal deoxyribonucleic acid testing and serological biomarkers. Objectives: To analyze and compare the financial impact, estimating the cost of the implementation of a population-based screening program using the fecal occult blood test and total colonoscopy, in Azores. Methods: Four participation rates (25, 50, 65 and 75%) were used, to compare the three screening techniques. Based on total costs, the cost per participant was calculated, for the same participation rates. Results: For participation rate of 25%, the total estimated costs for implementing a population-based screening was 910.497,29€ for the guaiac method; 1.830.374,69€ for immunochemical method and 2.186.494,30 for colonoscopy, with a cost per participant of 75,01€, 150,79€ and 180,13€ respectively. For participation rate of 50%, the total estimated costs for implementing a population-based screening was 1.501.115,60€ for the guaiac method; 3.308.980,92€ for immunochemical method and 4.186.914,68€ for colonoscopy, with a cost per participant of 75,01€, 150,79€ and 180,13€ respectively. 6 For participation rate of 65%, the total estimated costs for implementing a population-based screening was 1.852.857,87€ for the guaiac method; 4.180.811,30€ for immunochemical method and 5.387.166,91€ for colonoscopy, with a cost per participant of 58,71€, 132,47€ e 170,70€ respectively. For participation rate of 75%, the total estimated costs for implementing a population-based screening was 2.086.262,45€ € for the guaiac method; 4.755.711,99€ for immunochemical method and 6.187.335,06€ for colonoscopy, with a cost per participant of 57,29€, 130,60€ e 169,91€ respectively. Conclusion: When the participation rate is similar for the three techniques, the total costs and costs per participant are considerably higher for total colonoscopy, followed by immunochemical test and finally the guaiac test

Estudo in vivo da reparação óssea guiada pela membrana biológica de poliestireno com colágeno e norbixina

Bone tissue has an enormous regenerative capacity, but several factors can lead to a bone defect with “abnormality”, without spontaneous regeneration capacity. In this regard, the use of biomaterials has been employed in the perspective of improving bone healing. Polymers membranes associated with other compounds, such as norbixin is an example of researched and used biomaterial in these pathologies. In this context, the objective of this study was to evaluate, in vivo, the effects of a collagen and norbixin polystyrene membrane on calvary bone fractures involving the sagittal suture of Bregma rats at 15 and 30 days of treatment. Inflammatory alterations (presence of edema, vascular alterations and inflammatory inflitates) and the degree of repair (fibrosis process, neovascularization and fibroblastic proliferation) of tissues developed around the polystyrene, collagen and norbixin composite were evaluated by histological tests. Twenty adult male rats underwent fractures in the calvary bone involving the sagittal suture, which were divided into two groups, G1 (control, bone fracture without membrane application) and G2 (fracture with membrane application), which were evaluated at 15 and 30 days of treatment, without and with the application of the membrane. After 15 days of membrane application, Group G2 had a lower inflammatory infiltrate and rapid blood vessel formation, which were not observed in Group G1. At 30 days of membrane application, the presence of immature and lamellar bone tissue was observed in both groups. Therefore, the membrane was effective in decreasing the inflammatory process and initiated bone remodeling in fractures caused in rats within a relatively short period of treatment.O tecido ósseo possui uma enorme capacidade regenerativa, porém diversos fatores podem levar a um defeito ósseo com “anormalidade”, sem capacidade de regeneração espontânea. Nesse aspecto, o uso de biomaterias tem sido empregado na perspectiva de melhorar a cicatrização óssea. As membranas de polímeros associadas a outros compostos, como a norbixina é um exemplo de biomaterial bastante pesquisado e empregado nestas patologias. Nesse contexto, o objetivo desse trabalho foi avaliar, in vivo, os efeitos de uma membrana de poliestireno com colágeno e norbixina em fraturas no osso da calvária, envolvendo a sutura sagital Bregma de ratos aos 15 e 30 dias de tratamento. Foram avaliados as alterações inflamatórias (presença de edema, alterações vasculares e inflitrado inflamatório) e o grau de reparação (processo de fibrose, neovascularização e proliferação fibroblástica) dos tecidos desenvolvidos em torno do compósito de poliestireno, colágeno e norbixina por meio de testes histológicos. Vinte ratos machos, adultos foram submetidos a fraturas no osso da calvária, envolvendo a sutura sagital, que foram divididos em dois grupos, G1 (controle, fratura óssea, sem aplicação da membrana) e G2 (fratura com aplicação da membrana), os quais foram avaliados aos 15 e 30 dias de tratamento, sem e com a aplicação da membrana. Após 15 dias de aplicação da membrana, o Grupo G2 apresentou um menor infiltrado inflamatório e uma rápida formação de vasos sanguíneos, que não foram observados no grupo G1. Já aos 30 dias da aplicação da membrana foi observada a presença de tecido ósseo imaturo e lamelar em ambos os grupos. Portanto, a membrana foi efetiva na diminuição do processo inflamatório e iniciou a remodelação óssea nas fraturas provocadas em ratos em um período, relativamente, curto de tratamento

Both “illness and temptation of the enemy”: melancholy, the medieval patient and the writings of King Duarte of Portugal (r. 1433–38)

Recent historians have rehabilitated King Duarte of Portugal, previously maligned and neglected, as an astute ruler and philosopher. There is still a tendency, however, to view Duarte as a depressive or a hypochondriac, due to his own description of his melancholy in his advice book, the Loyal Counselor. This paper reassesses Duarte's writings, drawing on key approaches in the history of medicine, such as narrative medicine and the history of the patient. It is important to take Duarte's views on his condition seriously, placing them in the medical and theological contexts of his time and avoiding modern retrospective diagnosis. Duarte's writings can be used to explore the impact of plague, doubt and death on the life of a well-educated and conscientious late-medieval ruler

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2\ub75th percentile and 100 as the 97\ub75th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59\ub74 (IQR 35\ub74–67\ub73), ranging from a low of 11\ub76 (95% uncertainty interval 9\ub76–14\ub70) to a high of 84\ub79 (83\ub71–86\ub77). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of 'leaving no one behind', it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. METHODS: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Career satisfaction of medical residents in Portugal

Introdução: A satisfação com a profissão médica tem sido apontada como um fator essencial para a qualidade assistencial, o bemestar dos doentes e a estabilidade dos sistemas de saúde. Estudos recentes têm vindo a enfatizar um crescente descontentamento dos médicos, principalmente como consequência das alterações das relações laborais. Objetivos: Avaliar a perceção dos médicos de formação específica em Portugal, sobre as expectativas e grau de satisfação com a profissão, especialidade e local de formação; razões da insatisfação e intenção de emigrar. Material e Métodos: Estudo transversal. A colheita de dados foi efetuada entre Maio e Agosto de 2014 através de um Inquérito online sobre a “Satisfação com a Especialidade”. Resultados: De uma população total de 5788 médicos, foram obtidas 804 respostas (12,25% do total de médicos internos). Desta amostra, 77% das respostas correspondem a internos dos três primeiros anos de formação. Verificou-se que 90% dos médicos se encontram satisfeitos com a especialidade, tendo-se encontrado também níveis elevados de satisfação com a profissão (85%) e local de formação (86%). Por outro lado, constatou-se que estes diminuíam com a progressão ao longo dos anos de internato. A avaliação global sobre o panorama da prática médica foi negativa e 65% dos médicos responderam que consideram emigrar após conclusão do internato. Conclusão: Os médicos internos em Portugal apresentam níveis positivos de satisfação com a sua profissão. No entanto, a sua opinião sobre o panorama da Medicina e os resultados relativos à intenção de emigrar alertam para a necessidade de tomada de medidas para inverter este cenário.Introduction: The satisfaction with the medical profession has been identified as an essential factor for the quality of care, the wellbeing of patients and the healthcare systems’ stability. Recent studies have emphasized a growing discontent of physicians, mainly as a result of changes in labor relations. Objectives: To assess the perception of Portuguese medical residents about: correspondence of residency with previous expectations; degree of satisfaction with the specialty, profession and place of training; reasons for dissatisfaction; opinion regarding clinical practice in Portugal and emigration intents. Material and Methods: Cross-sectional study. Data collection was conducted through the “Satisfaction with Specialization Survey”, created in an online platform, designed for this purpose, between May and August 2014. Results: From a total population of 5788 medical residents, 804 (12.25 %) responses were obtained. From this sample, 77% of the responses were from residents in the first three years. Results showed that 90% of the residents are satisfied with their specialty, 85% with the medical profession and 86% with their place of training. Nevertheless, results showed a decrease in satisfaction over the final years of residency. The overall assessment of the clinical practice scenario in Portugal was negative and 65% of residents have plans to emigrate after completing their residency. Conclusion: Portuguese residents revealed high satisfaction levels regarding their profession. However, their views on Portuguese clinical practice and the results concerning the intent to emigrate highlight the need to take steps to reverse this scenario