Welfare and Trade Effects of International Environmental Agreements

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PERFIL EPIDEMIOLÓGICO DE PACIENTES COM DIABETES MELLITUS EM SALVADOR, BAHIA, BRASIL (2002-2012)

O Diabetes Mellitus (DM) representa atualmente uma epidemia mundial e uma das doenças mais prevalentes do Brasil. O conhecimento do perfil das pessoas com DM constitui-se em importante estratégia para o planejamento e a organização dos serviços de saúde. Com objetivo de descrever o perfil epidemiológico do DM no município de Salvador-Ba no período de 2002 a 2012, foi realizado um estudo descritivo retrospectivo com a utilização de dados secundários do Sistema Hiperdia disponíveis no DATASUS. No período estudado, registrou-se 4.279 casos de DM. Em todos os anos o maior número de casos foi no sexo feminino (61,8%) e na faixa etária de 40 a 59 anos (55,8%). Conclui-se que o DM é um agravo frequente na população estudada, principalmente o tipo 2, com grande possibilidade de desenvolver complicações crônicas e que é importante o conhecimento do perfil da população para o desenvolvimento de ações de prevenção e controle.

On the Protective Role of Identification with a Stigmatized Identity:Promoting Engagement and Discouraging Disengagement Coping Strategies

We examined the mechanisms by which identification with a stigmatized ingroup impacts well-being in stigmatized groups. The first three studies were conducted among gay men and lesbians in Europe and North America. Results support the idea that identification with homosexuals protects well-being by decreasing attempts at self-group distancing. Pursuit of self-group distancing was negatively related to well-being (studies 1 to 3a, N=1055). Other coping strategies were associated with identification but had no relationship with well-being. Identification was positively related to engagement coping strategies, namely, collective action, group affirmation and ingroup support, and negative related to disengagement strategies: ingroup blaming and avoidance of discrimination. A fourth study (study 3b) examined these mechanisms among Black North Americans (N=203). Again, identification was positively related to engagement strategies, and negatively related to disengagement; however, only collective action (positively) predicted well-being. Results are discussed in terms of how the effectiveness of different strategies for coping with stigma will differ depending on qualities of the identities in question and the specifics of the intergroup context

Comportamento Suicidário nos Internos de Psiquiatria em Portugal: Comparação com a Realidade Europeia

Introduction: The aim of this paper was to assess the prevalence of suicide ideation and attempts in Portuguese psychiatry trainees (adult and child and adolescence), and compare the data with the general population and other European countries.  Material and Methods: A structured and anonymous questionnaire was sent by email to 159 portuguese trainees of adult psychiatry and child and adolescence psychiatry with questions about personal history of suicidal ideation and suicide attempts, as well as family history of suicide attempts and completed suicides. This is part of the BoSS Study (Burnout Syndrome Study) performed in 21 countries worldwide. Data was analysed in SPSS v.19.  Results: From the inquired population, 62 trainees (40,3%) partially responded, and 46 (29%) were complete responders - these entered the final analysis. There was a ratio of 2:1 (female:male) and a mean age of 29 years. The suicidal ideation was present in passive form in 44% and in active form in 33%; also, 4.3% of respondents had previous suicide attempts. In first degree relatives, 22% had attempted suicide and 13% completed suicide.  Discussion: The results are worriying and may be associated with some factors to which this population is exposed.  Conclusion: It is necessary further research to better understand this phenomenon, its causes and potential modifiers

Enhance access to pulmonary rehabilitation with a structured and personalized home-based program—reabilitAR: protocol for real-world setting

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Home-based models represent one of the solutions to respond to the poor accessibility of pulmonary rehabilitation (PR) services in patients with chronic respiratory disease (CRD). The main goal of this protocol is to present the implementation of the first nationwide home-based PR program—reabilitAR—in Portugal and the strategies to assess its benefits in patients with CRD. The program consists of 2 phases: a 12-week intensive phase and a 40-week maintenance phase (total: 52 weeks, 1 year). The intervention in both phases is composed of presential home visits and phone-call follow ups, including exercise training and the self-management educational program Living Well with COPD. Dyspnea, impact of the disease, emotional status, and level of dyspnea during activities of daily living are used as patient-reported outcomes measures. A one-minute sit-to-stand test is used as a functional outcome, and the number of steps as a measure of physical activity. To ensure safety, fall risk and the cognitive function are assessed. Data are collected at baseline, at 12 weeks, at 26 weeks and at 52 weeks. This is the first nationwide protocol on enhancing access to PR, providing appropriate responses to CRD patients’ needs through a structured and personalized home-based program in Portugal.info:eu-repo/semantics/publishedVersio

Clinical Screening Prediction in the Portuguese National Health Service: Data Analysis, Machine Learning Models, Explainability and Meta-Evaluation

This paper presents an analysis of the calls made to the Portuguese National Health Contact Center (SNS24) during a three years period. The final goal was to develop a system to help nurse attendants select the appropriate clinical pathway (from 59 options) for each call. It examines several aspects of the calls distribution like age and gender of the user, date and time of the call and final referral, among others and presents comparative results for alternative classification models (SVM and CNN) and different data samples (three months, one and two years data models). For the task of selecting the appropriate pathway, the models, learned on the basis of the available data, achieved F1 values that range between 0.642 (3 months CNN model) and 0.783 (2 years CNN model), with SVM having a more stable performance (between 0.743 and 0.768 for the corresponding data samples). These results are discussed regarding error analysis and possibilities for explaining the system decisions. A final meta evaluation, based on a clinical expert overview, compares the different choices: the nurse attendants (reference ground truth), the expert and the automatic decisions (2 models), revealing a higher agreement between the ML models, followed by their agreement with the clinical expert, and minor agreement with the reference.This research work was funded by FCT—Fundação para a Ciência e a Tecnologia, I.P, within the project SNS24.Scout.IA—Aplicação de Metodologias de Inteligência Artificial e Processamento de Linguagem Natural no Serviço de Triagem, Aconselhamento e Encaminhamento do SNS24 (ref. DSAIPA/AI/0040/2019)

Prevalence of vaginal delivery after cesarean in a high-risk maternity / Prevalência de parto vaginal após cesárea em uma maternidade de alto risco

Objetivo: estimar a prevalência de parto vaginal após cesárea em uma maternidade de alto risco e identificar as complicações maternas e neonatais. Método: trata-se de um estudo transversal, quantitativo e retrospectivo, realizado com 44 mulheres que tiveram parto normal com cesárea prévia, por meio da análise dos prontuários realizou-se a análise descritiva com frequências absolutas e simples. Resultados: a prevalência de parto vaginal após cesárea foi de 13%. Ocorreu complicação em 13,6% das mulheres, porém não houve rotura uterina e em 4,5% dos neonatos. Conclusões: os desfechos favoráveis comprovam a segurança deste procedimento para a mãe e para neonato e servem de estímulo para que os profissionais incentivem as gestantes com cesárea anterior a considerarem a via vaginal como uma possibilidade segura para o próximo parto.

Portuguese multidisciplinary recommendations for non-pharmacological and non-surgical interventions in patients with rheumatoid arthritis

BACKGROUND: Patients with rheumatoid arthritis (RA) report significant levels of disease impact, which are improved, but not fully abrogated by immunosuppressive therapy, even when remission is achieved. This imposes the need for adjuvant interventions targeting the uncontrolled domains of disease impact. Non-pharmacological interventions are widely used for this purpose, but they have not been the object of professional recommendations or guidelines. OBJECTIVE: To propose multidisciplinary recommendations to inform clinical care providers regarding the employment of non-pharmacological and non-surgical interventions in the management of patients with RA. METHODS: The EULAR standardized operating procedures for the development of recommendations were followed. First, a systematic literature review was performed. Then, a multidisciplinary Technical Expert Panel (TEP) met to develop and discuss the recommendations and research agenda. For each developed recommendation i) the level of evidence and grade of recommendation were determined, and ii) the level of agreement among TEP members was set. A recommendation was adopted if approved by ≥75% of the TEP members, and the level of agreement was considered high when ≥8. All relevant national societies were included in this construction process to attain their endorsement. RESULTS: Based on evidence and expert opinion, the TEP developed and agreed on five overarching principles and 12 recommendations for non-pharmacological and non-surgical interventions in patients with RA. The mean level of agreement between the TEP members ranged between 8.5 and 9.9. The recommendations include a broad spectrum of intervention areas, such as exercise, hydrokinesiotherapy, psychological interventions, orthoses, education, general management of comorbidities, among others; and they set the requirements for their application. CONCLUSIONS: These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines and patients' representatives from Portugal. Given the evidence for effectiveness, feasibility and safety, non-pharmacological and non-surgical interventions should be an integral part of standard care for people with RA. It is hoped that these recommendations should be widely implemented in clinical practice. The target audience for these recommendations includes all health professionals involved in the care of patients with RA. The target patient population includes adult Portuguese people with RA.publishersversionpublishe

Syphilis in pregnancy: knowledge of pregnant and puerperous women / Sífilis na gestação: conhecimento de gestantes e puérperas

Objetivo: identificar o conhecimento de gestantes e puérperas acerca da sífilis. Método: pesquisa descritiva, com abordagem qualitativa. A coleta de dados ocorreu por meio de instrumento semiestruturado, entre abril a julho de 2021, com 18 gestantes/puérperas com diagnóstico de sífilis na gestação. As respostas foram gravadas e transcritas na íntegra, sendo utilizado para análise a técnica do Discurso do Sujeito Coletivo. Resultados: identificou-se três ideias centrais: 1) Conhecimento sobre a sífilis, 2) Buscando conhecimento sobre a sífilis e 3) Falsa prevenção. O conhecimento das participantes mostrou-se conflitante, pois algumas apresentaram algum conhecimento e outras nenhum, sendo que todas deveriam ter sido orientadas sobre a doença. Considerações finais: identificou-se uma falha no atendimento ofertado nos serviços de saúde. Assim, estratégias voltadas à educação em saúde devem ser incentivadas e implementadas no acompanhamento de pré-natal, ofertando a promoção e prevenção da saúde, a fim de reduzir os casos de sífilis na gestação.