Proposta de um Core Set abreviado de avaliação da funcionalidade em cuidados pós-agudos geriátricos

Desenvolver um Core Set Geriátrico Abreviado para avaliação/intervenção da funcionalidade, em cuidados de reabilitação de contexto pós-agudo. Materiais e Métodos: Desenvolveu-se um estudo observacional do tipo analítico e longitudinal, que permitisse conhecer os domínios e as variáveis com maior valor preditivo e discriminativo relativamente à evolução da funcionalidade das condições de saúde observadas. Para a constituição da amostra consideraram-se os indivíduos com 65 ou mais anos, internados em unidades de Convalescença e Média Duração da Rede Nacional de Cuidados Continuados Integrados da região do Algarve.info:eu-repo/semantics/publishedVersio

Proposal of a brief Core Set of functioning assessment in post-acute geriatric care

RESUMO - Objetivo: Desenvolver um Core Set Geriátrico Abreviado para avaliação/intervenção da funcionalidade, em cuidados de reabilitação de contexto pós-agudo. Materiais e Métodos: Desenvolveu-se um estudo observacional do tipo analítico e longitudinal, que permitisse conhecer os domínios e as variáveis com maior valor preditivo e discriminativo relativamente à evolução da funcionalidade das condições de saúde observadas. Para a constituição da amostra consideraram- se os indivíduos com 65 ou mais anos, internados em unidades de Convalescença e Média Duração da Rede Nacional de Cuidados Continuados Integrados da região do Algarve. Resultados: A amostra foi constituída por 451 indivíduos, com uma média de idade 79,5 ± 7,5 anos, dos quais 62,1% eram mulheres. As condições de saúde com frequências mais elevadas como causa de admissão na Rede foram as fraturas da extremidade superior do fémur e os acidentes vasculares encefálicos que no seu conjunto equivaleram a 73,6% dos casos. Das 21 variáveis independentes que integraram os modelos explicativos da funcionalidade foi possível organizar uma listagem de 28 categorias: 5 Funções, 16 Atividades/Participação e 7 Fatores Ambientais. Conclusões: A presente proposta de Core Set Geriátrico Abreviado para os cuidados de reabilitação de contexto pós-agudo tem um enfoque sobretudo no componente Atividades/Participação, enquanto componente que materializa de forma concreta a interação do indivíduo com o meio e a sua vida real. A funcionalidade deve ser considerada uma variável incontornável da Saúde Pública pelo facto de permitir reproduzir as deficiências e limitações dos indivíduos, mas igualmente facilitar a alocação estruturada de equipamentos, serviços e sistemas, promotores da sua participação.ABSTRACT - Objective: Developing a brief geriatric core set for the assessment/ intervention of functioning in the post-acute context of rehabilitative care. Materials and Methods: We developed an observational study of analytical and longitudinal type that allows to know the domains and variables with greater predictive and discriminative value regarding the evolution of the functioning of the health conditions observed. For the selection of the sample individuals aged 65 years or older were considered, who were hospitalized in Convalescence Units and Rehabilitation and Average Duration Units of the National Network of Integrated Continuous Care of the Algarve region. Results: The sample consisted of 451 individuals with an average age of 79.5 ± 7.5 years, of which 62.1% were women. Health conditions at higher frequencies as a cause of admission to the network were fractures of the upper extremity of the femur and stroke, which together amounted to 73.6% of cases. Of the 21 independent variables that were part of the explanatory models of functioning, it was possible to organize 28 categories: 5 Functions, 16 Activities/ Participation, and 7 Environmental Factors. Conclusions: The proposed Brief Geriatric Core Set for the postacute context of rehabilitation care focuses primarily on the category Activities/Participation as a component that materialized in a concrete way the interaction of the individual with the environment and real life. The function should be considered an essential variable of public health in being able to reproduce the weaknesses and limitations of individuals, but also facilitate structured allocation of equipments, services, and systems, promoting their participation.info:eu-repo/semantics/publishedVersio

An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribing

Background: The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs, acid suppressive therapy, and antiplatelets. However, their effectiveness in changing actual practice is unknown. Methods: The study will compare the effectiveness of educational outreach visits regarding the improvement of compliance with clinical guidelines in primary care against usual dissemination strategies. A cost-benefit analysis will also be conducted. We will carry out a parallel, open, superiority, randomized trial directed to primary care physicians. Physicians will be recruited and allocated at a cluster-level (primary care unit) by minimization. Data will be analyzed at the physician level. Primary care units will be eligible if they use electronic prescribing and have at least four physicians willing to participate. Physicians in intervention units will be offered individual educational outreach visits (one for each guideline) at their workplace during a six-month period. Physicians in the control group will be offered a single unrelated group training session. Primary outcomes will be the proportion of cyclooxygenase-2 inhibitors prescribed in the anti-inflammatory class, and the proportion of omeprazole in the proton pump inhibitors class at 18 months post-intervention. Prescription data will be collected from the regional pharmacy claims database. We estimated a sample size of 110 physicians in each group, corresponding to 19 clusters with a mean size of 6 physicians. Outcome collection and data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and detailers cannot be blinded. Discussion: This trial will attempt to address unresolved issues in the literature, namely, long term persistence of effect, the importance of sequential visits in an outreach program, and cost issues. If successful, this trial may be the cornerstone for deploying large scale educational outreach programs within the Portuguese National Health Service.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

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

Need-Opportunity-Accessibility, how to engage them?

Funding Information: We thank Professor Helder Trindade to promote the study and investigation, Dr. Jo?o Paulo Almeida Sousa for supporting the research, and ONT ? Organizaci?n Nacional de Trasplantes for data supplementation. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Publisher Copyright: © 2021Background: Despite all efforts, the demand for organs increases. New and better strategies are still needed, critical in a crisis like pandemics. Methodology: A mathematical approach that integrates need, Opportunity, and Accessibility to kidney transplantation, was created. NOA method, corresponds to the lateral surface area of a trigonal pyramid with the need, Opportunity, and Accessibility as axis, resulting in an intuitional chart output (NOA chart) and a percentage score (NOA score). Higher NOA scores are associated with larger NOA chart areas. Method Application: We found some natural variability among the European Member States regarding Need, Opportunity, and Accessibility to kidney transplantation, concomitant with NOA scores. In 2019, in the European Union, 129 patients pmp on the waiting list for a kidney transplant were registered, 47 kidneys pmp were procured, and 36 kidneys pmp were transplanted, corresponding to 25% of kidney transplantation's response capacity. Conclusion: Transplantation is frequently the better treatment for end-stage kidney failure. NOA method may be, in the future, an indicator for evaluating the overall transplantation performance regarding the need for it and a tool for policy definition. With NOA method we seek to contribute for: • A transplantation overall performance normalizing score; • Transplantation response capacity evaluation.publishersversionpublishe

A Mixed-Cohort Study

Funding: This study was partially supported by the Portuguese Neonatal Society through the Grant ‘Nutricia Early Life Nutrition 2019’.The optimal method for human milk (HM) fortification has not yet been determined. This study assessed whether fortification relying on measured HM macronutrient content (Miris AB analyzer, Upsala, Sweden) composition is superior to fortification based on assumed HM macronutrient content, to optimize the nutrition support, growth, and body composition in infants born at <33 weeks' gestation. In a mixed-cohort study, 57 infants fed fortified HM based on its measured content were compared with 58 infants fed fortified HM based on its assumed content, for a median of 28 and 23 exposure days, respectively. The ESPGHAN 2010 guidelines for preterm enteral nutrition were followed. Growth assessment was based on body weight, length, and head circumference Δ z-scores, and the respective growth velocities until discharge. Body composition was assessed using air displacement plethysmography. Fortification based on measured HM content provided significantly higher energy, fat, and carbohydrate intakes, although with a lower protein intake in infants weighing ≥ 1 kg and lower protein-to-energy ratio in infants weighing < 1 kg. Infants fed fortified HM based on its measured content were discharged with significantly better weight gain, length, and head growth. These infants had significantly lower adiposity and greater lean mass near term-equivalent age, despite receiving higher in-hospital energy and fat intakes, with a mean fat intake higher than the maximum recommended and a median protein-to-energy ratio intake (in infants weighing < 1 kg) lower than the minimum recommended.publishersversionpublishe

O impacto do ambiente interior na saúde respiratória dos idosos: resultados preliminares do projeto GERIA

Projeto GERIA, financiado pela Fundação para a Ciência e Tecnologia (FTC) PTDC/SAU-SAP/116563/2010 e SFRH/BD/72399/2010, e pelo Programa Operacional Fatores de Competitividade (COMPETE) do Quadro de Referência Estratégico Nacional para Portugal 2007-2013

A multivariable prediction model to select colorectal surgical patients for co-management

Funding: The work of A.L. Papoila and C. Geraldes is partially sponsored by national funds through Fundação Nacional para a Ciência e Tecnologia, Portugal—FCT under the project PEst-OE/MAT/UI0006/2014. The work of Cátia Salgado was supported by the PhD Scholarship SFRH/BD/121875/2016 from Portuguese Foundation for Science & Technology. S. M. Vieira acknowledges the support by Program Investigador FCT (IF/00833/2014) from FCT, co-funded by the European Social Fund (ESF) through the Operational Program Human Potential (POPH).Introduction: Increased life expectancy leads to older and frailer surgical patients. Co-management between medical and surgical specialities has proven favourable in complex situations. Selection of patients for co-management is full of difficulties. The aim of this study was to develop a clinical decision support tool to select surgical patients for co-management. Material and Methods: Clinical data was collected from patient electronic health records with an ICD-9 code for colorectal surgery from January 2012 to December 2015 at a hospital in Lisbon. The outcome variable consists in co-management signalling. A dataset from 344 patients was used to develop the prediction model and a second data set from 168 patients was used for external validation. Results: Using logistic regression modelling the authors built a five variable (age, burden of comorbidities, ASA-PS status, surgical risk and recovery time) predictive referral model for co-management. This model has an area under the curve (AUC) of 0.86 (95% CI: 0.81 - 0.90), a predictive Brier score of 0.11, a sensitivity of 0.80, a specificity of 0.82 and an accuracy of 81.3%. Discussion: Early referral of high-risk patients may be valuable to guide the decision on the best level of post-operative clinical care. We developed a simple bedside decision tool with a good discriminatory and predictive performance in order to select patients for comanagement. Conclusion: A simple bed-side clinical decision support tool of patients for co-management is viable, leading to potential improvement in early recognition and management of postoperative complications and reducing the ‘failure to rescue’. Generalizability to other clinical settings requires adequate customization and validation.publishersversionpublishe

Factors associated with perinatal and neonatal deaths in Sao Tome & Principe: a prospective cohort study

BackgroundNeonatal mortality reduction is a global goal, but its factors are seldom studied in most resource-constrained settings. This is the first study conducted to identify the factors affecting perinatal and neonatal deaths in Sao Tome &amp; Principe (STP), the smallest Central Africa country.MethodsInstitution-based prospective cohort study conducted at Hospital Dr. Ayres Menezes. Maternal-neonate dyads enrolled were followed up after the 28th day of life (n = 194) for identification of neonatal death-outcome (n = 22) and alive-outcome groups (n = 172). Data were collected from pregnancy cards, hospital records and face-to-face interviews. After the 28th day of birth, a phone call was made to evaluate the newborn's health status. Crude odds ratios and corresponding 95% confidence intervals were obtained. A p value &lt;0.05 was considered statistically significant.ResultsThe mean gestational age of the death-outcome and alive-outcome groups was 36 (SD = 4.8) and 39 (SD = 1.4) weeks, respectively. Death-outcome group (n = 22) included sixteen stillbirths, four early and two late neonatal deaths. High-risk pregnancy score [cOR 2.91, 95% CI: 1.18–7.22], meconium-stained fluid [cOR 4.38, 95% CI: 1.74–10.98], prolonged rupture of membranes [cOR 4.84, 95% CI: 1.47–15.93], transfer from another unit [cOR 6.08, 95% CI:1.95–18.90], and instrumental vaginal delivery [cOR 8.90, 95% CI: 1.68–47.21], were factors significantly associated with deaths. The odds of experiencing death were higher for newborns with infectious risk, IUGR, resuscitation maneuvers, fetal distress at birth, birth asphyxia, and unit care admission. Female newborn [cOR 0.37, 95% CI: 0.14–1.00] and birth weight of more than 2,500 g [cOR 0.017, 95% CI: 0.002–0.162] were found to be protective factors.ConclusionFactors such as having a high-risk pregnancy score, meconium-stained amniotic fluid, prolonged rupture of membranes, being transferred from another unit, and an instrumental-assisted vaginal delivery increased 4– to 9–fold the risk of stillbirth and neonatal deaths. Thus, avoiding delays in prompt intrapartum care is a key strategy to implement in Sao Tome &amp; Principe