Os idosos institucionalizados : estudo de algumas variáveis

Trabalho de Projeto apresentado à Escola Superior de Educação do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Gerontologia Social.Esta pesquisa debruçou-se sobre o estudo do risco de queda, da dor e da qualidade de vida em idosos institucionalizados. Através de uma metodologia descritiva objetivou-se avaliar a qualidade de vida dos idosos institucionalizados, e determinar a existência de relações entre esta variável, o risco de queda e a presença de dor, numa amostra aleatória e estratificada de 56 idosos institucionalizados. O estudo empírico recorreu a quatro instrumentos de avaliação: Mini Exame do Estado Mental, Escala de Morse para Risco de Queda, Escala Numérica da Intensidade da Dor e Instrumento Abreviado de Avaliação da Qualidade de Vida da Organização Mundial de Saúde. Os resultados permitiram confirmar que os sujeitos estudados estão globalmente satisfeitos com a sua qualidade de vida. A maioria da amostra (44,6%) apresenta risco de queda não elevado e uma dor moderada (média de 5,21). Constatou-se a existência de uma correlação moderadamente forte negativa entre qualidade de vida e dor, isto é, ao aumento da dor corresponde uma diminuição da qualidade de vida. Entre as restantes variáveis não se observou relação contudo, apesar de não se poder afirmar que existe uma associação entre idade e risco de queda, observou-se uma correlação muito fraca positiva, ou seja, ao aumento da idade corresponde um aumento do risco de queda. Os achados do estudo poderão ser significativos para a discussão e consequente melhoria dos cuidados de saúde dispensados aos idosos nas instituições.This research focused on the study of the risk of falling, pain and quality of life in institutionalized elderly. Through a descriptive analysis we aimed to evaluate the quality of life of institutionalized elderly, and determine the existence of relationships between this variable, the risk of falling and the presence of pain, on a random stratified sample of 56 institutionalized elderly. The empirical study employed four assessment instruments: Mini Mental State Examination, Morse Fall Scale, Numerical Scale of Pain Intensity and Abbreviated World Health Organization Quality of Life questionnaire. The results allowed to confirm that the subjects studied are globally satisfied with their quality of life. The majority of the sample (44.6 %) have no high risk of falling and moderate pain (mean 5.21). It was found that there was a moderately strong negative correlation between pain and quality of life, i.e., increased pain corresponds to a decreased quality of life. Among the remaining variables no relationship was observed however, although it can not be said that there is an association between age and fall risk, we observed a very weak positive correlation, i.e., the increase in age corresponds to an increased risk of falling. The study findings may be significant for the discussion and consequent improvement of health care provided to the elderly in institutions

A National Wide Collaborative Study

INTRODUCTION: Even though the risk of COVID-19 in pregnancy may be increased, large-scale studies are needed to better understand the impact of the infection in this population. The aim of this study is to describe obstetric complications and the rate of vertical transmission in pregnant women with SARS-CoV-2 infection. MATERIAL AND METHODS: Detected cases of SARS-CoV-2 infection in pregnancy were registered in Portuguese hospitals by obstetricians. Epidemiological, pregnancy and childbirth data were collected. RESULTS: There were 630 positive cases in 23 Portuguese maternity hospitals, most at term (87.9%) and asymptomatic (62.9%). The most frequent maternal comorbidity was obesity. The rates of preterm birth and small-to-gestational-age were 12.1% and 9.9%, respectively. In the third trimester, 2.9% of pregnant women required respiratory support. There were eight cases (1.5%) of fetal death, including two cases of vertical transmission. There were five cases of postpartum respiratory degradation, but no maternal deaths were recorded. The caesarean section rate was higher in the first than in the second wave (68.5% vs 31.5%). RT-PCR SARS-CoV-2 positivity among newborns was 1.3%. CONCLUSION: SARS-Cov-2 infection in pregnancy may carry increased risks for both pregnant women and the fetuses. Individualized surveillance and the prophylaxis of this population with vaccination. is recommended in these cases.publishersversionepub_ahead_of_prin

Relatório estágio profissional

Relatório final do estágio profissionalizante do 6.º an

Cotyledonoid Dissecting Leiomyoma of the Uterus: An Unexpected Diagnosis After Delivery

Cotyledonoid dissecting leiomyoma, also known as Sternberg tumor, is a rare benign uterine tumor with a gross and radiological appearance that may suggest the possibility of a malignancy. We report a case of a thirty-eight-year-old female patient who presented with menorrhagia and abdominal pain one month after delivery by cesarean section. An ultrasound scan showed a heterogeneous pelvic mass, near the isthmic region, with 25 x 24 x 23 mm without vascularization so the possibility of placenta accreta could not be excluded. During hysterectomy, we also removed a small grey mass in the right ovary. Microscopic examination revealed a proliferation of a sparsely cellular tissue with extensive hyalinization and coagulative necrosis, composed of spindle shaped muscle cells without cellular atypia or mitoses. The patient is without evidence of recurrence one year and six months post-surgery

The Portuguese version of “The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty”: validation and clinical application

Introduction: The evaluation of surgical outcomes measured by patient satisfaction or quality of life is very important, especially in plastic surgery. There is increasing interest in self-reporting outcomes evaluation in plastic surgery. Objective: The aim of this study was to perform the translation, cross-cultural adaptation and validation of “The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty” from English to Portuguese. Methods: Retrospective study involving 50 patients undergoing to rhinoplasty comparing the preoperative period with the current postoperative situation (minimum 6 months and maximum 24 months postoperatively). Statistical analysis was performed to assess internal consistency, test–retest reliability, validity and responsiveness. Results: No patients received a negative score on the visual analogue scale comparing preoperative and postoperative appearance. The postoperative improvement on the visual analogue scale revealed a Gaussian curve of normal distribution with a mean improvement of 4.44 points. The test–retest reliability showed a positive correlation between the postoperative response and the same questionnaire repeated ninety-six hours later. The internal consistency was high (Cronbach's alpha value: Preoperative = 0.88; Postoperative = 0.86). The authors observed a significant improvement in response for all individual questions in the postoperative phase as compared with preoperative situation (t-student test – p < 0.05). Conclusion: The Portuguese version of “The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty” is a valid instrument to assess patients’ outcomes following rhinoplasty surgery. Resumo: Introdução: A avaliação do resultado cirúrgico medido pela satisfação do paciente ou qualidade de vida é muito importante, especialmente na cirurgia plástica, uma especialidade na qual há um crescente interesse na avaliação de resultados por auto-relato. Objetivo: O objetivo deste estudo foi realizar a tradução, a adaptação transcultural e a validação do questionário “The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty”, do inglês para português. Método: Estudo retrospectivo envolvendo 50 pacientes submetidos a rinoplastia comparando o período pré-operatório com a situação atual (mínimo de 6 meses e máximo de 24 meses de pós-operatório). A análise estatística foi realizada para avaliar a consistência interna, confiabilidade teste-reteste, validade e capacidade de resposta. Resultados: Nenhum paciente recebeu pontuação negativa na escala visual analógica ao comparar a aparência pré- e pós-operatória. A melhora pós-operatória na escala visual analógica revelou uma curva gaussiana de distribuição normal, com melhora média de 4,44 pontos. A confiabilidade teste-reteste mostrou uma correlação positiva entre a resposta pós-operatória e o mesmo questionário repetido noventa e seis horas depois. A consistência interna foi alta (valor do alfa de Cronbach: pré-operatório = 0,88; pós-operatório = 0,86). Os autores observaram uma melhora significante nas respostas para todas as questões individuais na fase pós-operatória em comparação com a situação pré-operatória (teste t de Student – p < 0,05). Conclusão: A versão em português do “The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty é um instrumento válido para avaliar os resultados do paciente após a cirurgia de rinoplastia. Keywords: Surveys and questionnaires, Rhinoplasty, Quality of life, Plastic surgery, Patient satisfaction, Palavras-chave: Pesquisas e questionários, Rinoplastia, Qualidade de vida, Cirurgia plástica, Satisfação do pacient

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit