Tailgut cyst adenocarcinoma

Tailgut cysts (TGCs) are rare congenital entities arising from remnants of the embryological postanal primitive gut. Malignancy in TGCs is rare, with the majority being adenocarcinomas and carcinoid tumors. A search of the published literature yielded only 27 cases of adenocarcinoma developing in TGCs. We described the case of a 54-year-old female who presented with complaints of pelvic and perineal pain of several weeks. After the initial work-up, a mass in the right presacral location was diagnosed. She underwent radical resection of the tumor, using a posterior approach. The lesion was removed en bloc with the middle rectum, coccyx, and sacrum (S4–S5). The histopathologic examination revealed an adenocarcinoma arising in a TGC, and the patient received adjuvant chemoradiotherapy. Our case underlines that diagnosing a TGC is difficult as it is a rare congenital lesion. Clinical examination may be challenging as TGCs present with various symptoms, which can mimic other commonly proctologic disorders. Patients should be referred to a tertiary center with experience in pelvic surgery and must be managed by a multidisciplinary approach to maximize successful treatment. The recommended treatment is surgical excision given the malignant potential of TGCs and their risk of causing local complications

Systematic Review

Funding Information: MP received support from the Portuguese National Funds through FITEC – Programa Interface, with reference CIT INOV – INESC INOVAÇÃO. Funding was also provided from the PhD program in Industrial Management, NOVA Science and Technology Faculty. Funding Information: MP and LVL acknowledge Fundação para a Ciência e a Tecnologia (FCT-MCTES) for its financial support via the project UIDB/00667/2020 (UNIDEMI).Background: The digital age, with digital sensors, the Internet of Things (IoT), and big data tools, has opened new opportunities for improving the delivery of health care services, with remote monitoring systems playing a crucial role and improving access to patients. The versatility of these systems has been demonstrated during the current COVID-19 pandemic. Health remote monitoring systems (HRMS) present various advantages such as the reduction in patient load at hospitals and health centers. Patients that would most benefit from HRMS are those with chronic diseases, older adults, and patients that experience less severe symptoms recovering from SARS-CoV-2 viral infection. Objective: This paper aimed to perform a systematic review of the literature of HRMS in primary health care (PHC) settings, identifying the current status of the digitalization of health processes, remote data acquisition, and interactions between health care personnel and patients. Methods: A systematic literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify articles that explored interventions with HRMS in patients with chronic diseases in the PHC setting. Results: The literature review yielded 123 publications, 18 of which met the predefined inclusion criteria. The selected articles highlighted that sensors and wearables are already being used in multiple scenarios related to chronic disease management at the PHC level. The studies focused mostly on patients with diabetes (9/26, 35%) and cardiovascular diseases (7/26, 27%). During the evaluation of the implementation of these interventions, the major difficulty that stood out was the integration of information into already existing systems in the PHC infrastructure and in changing working processes of PHC professionals (83%). Conclusions: The PHC context integrates multidisciplinary teams and patients with often complex, chronic pathologies. Despite the theoretical framework, objective identification of problems, and involvement of stakeholders in the design and implementation processes, these interventions mostly fail to scale up. Despite the inherent limitations of conducting a systematic literature review, the small number of studies in the PHC context is a relevant limitation. This study aimed to demonstrate the importance of matching technological development to the working PHC processes in interventions regarding the use of sensors and wearables for remote monitoring as a source of information for chronic disease management, so that information with clinical value is not lost along the way.publishersversionpublishe

Os mortos na Gruta do Escoural (Montemor-o-Novo, Portugal): interações nas primeiras sociedades camponesas do sudoeste da Península Ibérica

The arrival of farmers to the south-western Iberian Peninsula was followed by a period of complex human interaction after 5500 BCE. This marked the arrival of new technologies and subsistence practices such as pottery, husbandry and domestication of plants, but also the co-existence of diverse social structures and world-views in a territory populated by hunter-gatherers. Biological and sociocultural interactions between local and migrant groups at the onset and establishment of the Neolithic in Atlantic Europe are poorly understood. The Neolithic funerary context in the Escoural cave, Montemor-o-Novo, Portugal, offers a research opportunity to examine these processes because it is uniquely well preserved and its use intersects key periods to understand multilayered human interaction. In this paper we present a synthesis of what is known about the Neolithic use of the cave complemented by new observations in the scope of a multidisciplinary project centred on the Escoural Cave started in 2018.A entrada dos primeiros agricultores no SO da Penísula Ibérica, c. 5500 BCE, foi acompanhada pela introdução de novas tecnologias e formas de subsistência. As interacções que se estabeleceram entre grupos locais e migrantes nesta etapa do processo histórico, que marca o advento e a consolidação do Neolítico na Europa Atlântica, são mal conhecidas. O contexto funerário da Gruta do Escoural (Montemor-o-Novo) constitui uma oportunidade para investigar estes processos, não só devido ao seu grau de preservação, mas porque a sua utilização intercepta períodos-chave para a compreensão de múltiplos aspectos dessa interacção humana. Os materiais arqueológicos escavados na década de 1960 incluem restos humanos, artefactos em pedra e osso, cerâmicas e adornos. Apesar de a cultura material sugerir uma afiliação ao Neolítico Médio (c. 4500-3500 BCE), a datação de restos humanos sugere um intervalo de tempo mais tardio (c. 3500-3000 BCE), marcado pela construção de monumentos megalíticos na região. O cruzamento de culturas de cronologia neolítica no Escoural é igualmente apoiado por cerâmicas cardiais e impressas, sugerindo uma utilização da cavidade no Neolítico Antigo (c. 5500-4700 BCE). Neste artigo apresentamos uma síntese dos dados conhecidos sobre a ocupação Neolítica da Gruta do Escoural, a par de novas observações realizadas no âmbito de um projeto iniciado em 2018 e centrado nesta cavidade. O objectivo deste projecto é implementar uma perspectiva interdisciplinar ao estudo da Arqueologia da Morte, investigando paralelamente as interacções humanas criadas com a introdução e consolidação de novas formas de vida na região (c. 5400-3000 BCE).info:eu-repo/semantics/publishedVersio

Design science approach

Funding Information: This project (PrimaryCare@COVID-19: Digital Platform for Supporting Chronic Patients and COVID-19 consultations and Monitoring in Primary Care) was funded by the Funda??o para a Ci?ncia e Tecnologia (Ministry of Science of Technology, Portugal) under the Research4COVID-19 program. Funding Information: This project (PrimaryCare@COVID-19: Digital Platform for Supporting Chronic Patients and COVID-19 consultations and Monitoring in Primary Care) was funded by the Fundação para a Ciência e Tecnologia (Ministry of Science of Technology, Portugal) under the Research4COVID-19 program. Publisher Copyright: © 2021 Luís Velez Lapão, Mariana Peyroteo, Melanie Maia, Jorge Seixas, João Gregório, Miguel Mira da Silva, Bruno Heleno, Jorge César Correia.Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. Objective: The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. Methods: For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. Results: The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. Conclusions: Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient's health related outcomes.publishersversionpublishe

Identifying barriers and finding solutions to implement best practices for cancer surgery at Maputo Central Hospital, Mozambique

Purpose: The aim of this study was to assess the surgical resources and surgical oncology team skills at the Surgical Department of Maputo Central Hospital (MCH) in Mozambique in order to define an educational program to support surgical oncology practice. Methods: From January 2017 to December 2017, a general evaluation of the resources of MCH was carried out, as well as its offerings in oncological care in different services. Data were obtained by reviewing documents, visiting surgical services and interviewing key informants and others informally. In addition, a group of seven surgeons of the Surgical Department of MCH answered a questionnaire about the quality of the cancer units (The Cancer Units Assessment Checklist for low- or middle-income African countries). Subsequently, surgical, anaesthesiology and intensive care facilities were evaluated according to the Portuguese-speaking African Countries Assessment of Surgical Oncology Capacity Survey (PSAC-Surgery). All the data were triangulated in order to identify gaps, develop an action plan and define an educational program. Results: Breast, oesophagus and colorectal cancers were the most commonly treated neoplasms in MCH. A range of technical and resource needs as well as the gaps in knowledge and skills were identified. All surgeons recognised the need to create a training program in oncology at the undergraduate level, specific training for residents and continuing oncological education for general surgeons to improve the practice of surgical oncology. It was evident that all these interventions needed to be formalised, appropriately certified and count for professional career progression. Based on the local epidemiological data and on these study findings, oncology education programs were developed for surgeons. Conclusions: The findings of this study contributed to the development of an educational program in surgical oncology, considered essential to the training of surgeons at MCH. The cancer educational programs and the mobilisation of adequate resources will ensure the provision of adequate surgical oncology treatments for MCH. The training requirements should be tailored to suit the local needs based on the most prevalent malignancies diagnosed in the region. In our view, this methodology may apply to other countries with similar realities in the formation of surgical oncologists.publishersversionpublishe

The role of climate, marine influence and sedimentation rates in late-Holocene estuarine evolution (SW Portugal)

Estuaries are sensitive to changes in global to regional sea level, to climate-driven variation in rainfall and to fluvial discharge. In this study, we use source and environmentally sensitive proxies together with radiocarbon dating to examine a 7-m-thick sedimentary record from the Sado estuary accumulated throughout the last 3.6 kyr. The lithofacies, geochemistry and diatom assemblages in the sediments accumulated between 3570 and 3240 cal. BP indicate a mixture between terrestrial and marine sources. The relative contribution of each source varied through time as sedimentation progressed in a low intertidal to high subtidal and low-energy accreting tidal flat. The sedimentation proceeded under a general pattern of drier and higher aridity conditions, punctuated by century-long changes of the rainfall regime that mirror an increase in storminess that affected SW Portugal and Europe. The sediment sequence contains evidence of two periods characterized by downstream displacement of the estuarine/freshwater transitional boundary, dated to 3570-3400 cal. BP and 3300-3240 cal. BP. These are intercalated by one episode where marine influence shifted upstream. All sedimentation episodes developed under high terrestrial sediment delivery to this transitional region, leading to exceptionally high sedimentation rates, independently of the relative expression of terrestrial/marine influences in sediment facies. Our data show that these disturbances are mainly climate-driven and related to variations in rainfall and only secondarily with regional sea-level oscillations. From 3240 cal. BP onwards, an abrupt change in sediment facies is noted, in which the silting estuarine bottom reaches mean sea level and continued accreting until present under prevailing freshwater conditions, the tidal flat changing to an alluvial plain. The environmental modification is accompanied by a pronounced change in sedimentation rate that decreased by two orders of magnitude, reflecting the loss of accommodation space rather than the influence of climate or regional sea-level drivers.FCT by Spanish Ministry of Science and Innovation [SFRH/BD/110270/2015, HAR2014-51830-P, HAR2011-29907-C03-00]FCTPortuguese Foundation for Science and Technology [PTDC/HISARQ/121592/2010]Instituto Dom Luiz-IDL [UID/GEO/50019/2013]info:eu-repo/semantics/publishedVersio

a review of methodological design choices

Publisher Copyright: © 2023 Cambridge University Press. All rights reserved.This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the Disability-Adjusted Life Years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3,053 studies of which 2,948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results.publishersversionepub_ahead_of_prin

Burden of disease attributable to risk factors in European countries: a scoping literature review

Objectives: Within the framework of the burden of disease (BoD) approach, disease, and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature review to: (1) map the BoD assessments including risk factors performed across Europe, and (2) identify the methodological choices in comparative risk assessment (CRA) and risk assessment methods. Methods: We searched multiple literature databases, including grey literature websites, and targeted public health agencies' websites. Results: A total of 113 studies were included in the synthesis and further divided into independent BoD assessments (54 studies) and studies linked to the Global Burden of Disease (59 papers). Our results showed that the methods used to perform CRA varied substantially across independent European BoD studies. While there were some methodological choices that were more common than others, we did not observe patterns in terms of country, year, or risk factor. Each methodological choice can affect the comparability of estimates between and within countries and/or risk factors since they might significantly influence the quantification of the attributable burden. From our analysis, we observed that the use of CRA was less common for some types of risk factors and outcomes. These included environmental and occupational risk factors, which are more likely to use bottom-up approaches for health outcomes where disease envelopes may not be available. Conclusions: Our review also highlighted misreporting, the lack of uncertainty analysis, and the under-investigation of causal relationships in BoD studies. Development and use of guidelines for performing and reporting BoD studies will help understand differences, and avoid misinterpretations thus improving comparability among estimates.info:eu-repo/semantics/publishedVersio

Burden of infectious disease studies in Europe and the United Kingdom: a review of methodological design choices.

This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results

As sequências didáticas como estratégia para a aprendizagem da escrita

Relatório de Estágio apresentado à Escola Superior de Educação de Lisboa para obtenção de grau de mestre em Ensino do 1.º Ciclo do Ensino Básico e de Português e História e Geografia de Portugal no 2.º Ciclo do Ensino BásicoO presente relatório tem como objetivo a descrição reflexiva do processo de intervenção pedagógica desenvolvido no âmbito da Unidade Curricular de Prática de Ensino Supervisionado II, inserida no plano de estudos do mestrado em Ensino do 1.º Ciclo do Ensino Básico e em Português e História e Geografia de Portugal no 2.º Ciclo do Ensino Básico. Do processo de intervenção, aplicado a uma turma do 2.º ano de escolaridade, surgiu o tema da investigação: o contributo da implementação de Sequências Didáticas para a melhoria de competências escritas dos alunos. O estudo assenta na metodologia de investigação-ação, tendo como amostra um total de 21 participantes. Foram utilizadas, como técnicas de recolha de dados, essencialmente, a observação participante, os testes, os questionários e a análise documental; e, como técnicas de análise e tratamento de dados, a combinação entre o paradigma quantitativo e o qualitativo. Os resultados da investigação comprovam que a implementação de Sequências Didáticas contribui para a melhoria das competências de escrita dos alunos. Assim, as conclusões do estudo apontam para a necessidade de (re)pensar o ensino e a aprendizagem da escrita na Escola, numa dimensão sociocultural, dialógica e amplamente processual, trabalho para o qual poderá concorrer a implementação de Sequências Didáticas.ABSTRACT The present report has as objective the reflexive description of the pedagogic intervention process developed for the curse unit “Supervised Teaching Practice II”, included in the master’s degree in Teaching Primary Education studies. From the intervention process, applied to a 2nd grade class, emerged the investigation theme: the contribution of the implementation of didactic sequences to the improvement of written competences of students. The study was carried out in the investigation-action methodology, having as sample a total of 21 participants. It has been used, as data collection technics, essentially, the participative observation, the tests, the questionnaires and the documental analysis; and, as data analysis and treatment technics, the combination between the quantitative and qualitative paradigm. The investigation results prove that the implementation of Didactic Sequences, indeed, improves the writing competences of students. Thus, the study conclusions point towards the need of (re)thinking the teaching and learning process of writing at school, in a sociocultural dimension, dialogical and extensively procedural, work for which may apply the implementation of didactic sequences.N/