Acta medica portuguesa最新文献

{"title":"[Guideline for Assessment and Management of Adolescents with Suicidal Ideation in Primary Health Care].","authors":"Joana Coelho Santos, Mariana Medeiros Neves, Inês Barroca, Graciete Carvalho","doi":"10.20344/amp.22367","DOIUrl":"https://doi.org/10.20344/amp.22367","url":null,"abstract":"<p><p>Suicide is one of the main causes of death in adolescence globally, and depression, the psychiatric disorder that most often accompanies suicidal ideation, is one of the biggest causes of illness and disability in this population. The detection, approach and referral of high-risk situations by family physicians helps to reduce the risk of suicide in this age group. This guideline was created as part of the coordination between the Department of Child and Adolescent Psychiatry and the primary health care units of the Unidade Local de Saúde de Lisboa Ocidental and aims to systematize and operationalize the approach to adolescents with suicidal ideation seen in primary health care, enhancing early detection and appropriate intervention at the level of risk. This guideline presents definitions of the concepts needed to correctly characterize suicidal ideation and proposes a suicide risk assessment approach, which includes assessing and characterizing suicidal ideation and assessing the risk of committing suicide. Suicide risk assessment culminates in a decision on the referral and treatment of the adolescent, which may consist of immediate referral to the emergency department, a request for a Child and Adolescent Psychiatry consultation or more frequent Family Medicine appointments for reassessment and referral to a Psychology clinic, depending on the level of risk observed. Recommendations for crisis intervention and treatment of identified comorbidities are presented. Early detection and treatment of psychiatric illnesses, intervention in risk factors and restricting access to suicide methods, especially access to medication, stand out as effective measures to prevent suicide in adolescence.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operationalization of Involuntary Treatment in a Prison Setting: A Perspective in Light of the New Mental Health Law in Portugal.","authors":"Susana Pinto Almeida, Sérgio M Martinho","doi":"10.20344/amp.22684","DOIUrl":"https://doi.org/10.20344/amp.22684","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Optimizing Hospital Referrals: From Overload to Solution].","authors":"Sara Santos Vale, Tânia Pessoa, Sara Batalha, Paula Kjollerström, Raquel Maia","doi":"10.20344/amp.22917","DOIUrl":"https://doi.org/10.20344/amp.22917","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"281-282"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Hesitancy and Refusal of the COVID-19 Vaccine Among Healthcare Professionals: A Cross-Sectional Study in a Portuguese Hospital].","authors":"Vanessa Teófilo, Joana Amaro, Pedro Matos, Paulo Pinho, Salomé Moreira, Rui Ribeiro, Mariana Miller, Sofia Pinelas, Filipa Silva, Catarina Azevedo, Pedro Norton","doi":"10.20344/amp.22540","DOIUrl":"https://doi.org/10.20344/amp.22540","url":null,"abstract":"<p><strong>Introduction: </strong>Vaccine hesitancy is recognized by the World Health Organization as a major global health threat. In the context of the COVID-19 pandemic, this issue has taken on unique dimensions. Healthcare professionals are considered one of the most reliable sources of information regarding vaccination. Their stance on immunization is a determining factor in their likelihood to recommend it to others, with potential repercussions for vaccination uptake rates in the general population. This study aimed to characterize the sociodemographic profile of healthcare professionals at a Portuguese tertiary hospital who declined COVID-19 vaccination and to analyze the reasons for hesitancy/refusal and future vaccination intentions.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in 2021, targeting healthcare professionals eligible for the completion of the primary COVID-19 vaccination schedule. Those who refused vaccination were asked to complete the \"COVID-19 Non-Vaccination Questionnaire\", which included a multiplechoice question and an open response field regarding reasons for hesitancy/refusal and future vaccination intentions. Variables analyzed included gender, age, and professional category.</p><p><strong>Results: </strong>Among the 6648 healthcare professionals in the sample, 2.3% (n = 153) declined to complete the vaccination schedule. The average age was 46 years (SD = 11), with the proportion in each age group being 1.2% aged ≤ 35 years, 2.5% aged 36 - 45 years, and 3.1% aged > 45 years. The vaccine refusal rate among all professionals of each gender was 2.3% for females and 2.4% for males. A higher proportion of refusals was observed among healthcare assistants (n = 53, 4.0%) and technical assistants (n = 13, 3.0%). Sixteen reasons for vaccine hesitancy/refusal were identified, with the most frequently reported being fear of adverse reactions (n = 31), insufficient research on vaccines (n = 22), and distrust in vaccine efficacy (n = 25). Only 28.1% (n = 43) expressed an intention to be vaccinated in the future.</p><p><strong>Conclusion: </strong>A high acceptance rate for the primary COVID-19 vaccination schedule was observed. The likelihood of vaccine refusal was similar between genders but higher among individuals over 45 years and operational support staff. The reasons for vaccine refusal that implied concerns about the vaccine's safety stood out. Further studies are needed to better understand the dynamics underlying vaccine hesitancy/refusal.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"217-227"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Safety Issues of Intravenous Iodinated Contrast Media Are Questionable.","authors":"Bernardo Vidal Pimentel, Pedro Caiado Ferreira, Mariana Barosa","doi":"10.20344/amp.22484","DOIUrl":"10.20344/amp.22484","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"205-207"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Unilateral Bertolotti's Syndrome.","authors":"Rita Moura de Gouveia, Janete Guimarães, Mariana Pinho Pereira, Gonçalo Costa, João Pedro Antunes","doi":"10.20344/amp.21840","DOIUrl":"https://doi.org/10.20344/amp.21840","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"264-265"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chronic Disease Medication Services and Comparison with the Portuguese Context].","authors":"Margarida Castel-Branco, Salomé Panta Baltazar, Hélder Mota-Filipe, Isabel Mota Figueiredo","doi":"10.20344/amp.22442","DOIUrl":"https://doi.org/10.20344/amp.22442","url":null,"abstract":"<p><p>Over the past few years, there has been a growing effort to integrate community pharmacists into managing chronic patients with chronic disease, to alleviate the pressure on healthcare systems. Pharmacists are not only experts in medicines but also have clinical skills to promote adherence to therapy and ensure monitoring of the health status of patients with chronic disease, especially in the period between medical appointments. Chronic disease medication renewal in community pharmacies is a pharmacy service that seeks to streamline patients' access to their medication while still receiving adequate healthcare. We conducted a review of the legislation in force in different countries regarding the chronic medication renewal service and compared it with Portuguese legislation, proposing a pharmacy intervention protocol that optimizes the provision of the service. Repeat Dispensing in the United Kingdom is the service that most resembles its counterpart in Portugal: both require a 12-month medical prescription, allow access to the prescribing history (without access to clinical information). In neither of them is notification of the prescriber mandatory, both require informed consent and lead to the creation of written records of the process. Canada's Adapt a Prescription is more comprehensive because it allows prescriptions valid for 24 months, enables access to clinical information, and requires notification of the prescriber within 24 hours. Ireland's Prescription Extension is more limited in that it does not allow for therapeutic substitution, nor does it enable access to prescribing history or clinical information, requiring notification of the prescriber within seven days. In turn, Australia's Continued Dispensing and the United States' Emergency Refills differ significantly in that they do not require a long-term medical prescription, namely in situations when it is not possible to obtain a valid prescription and refusal to dispense the medicine could be life-threatening to the patient. The Chronic Medication Renewal service in Portugal arises as a response to the needs of the healthcare system and has potential in the healthcare provided to the population, specifically in the therapeutic management of patients with chronic disease.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"250-259"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carcinoid Complexity: A Syndrome Revealing Lung Tumor and Heart Disease.","authors":"Sofia R Lopes, Juliana Barata, Maria Inês Marques Vicente Lopes, Salete Valente","doi":"10.20344/amp.21387","DOIUrl":"https://doi.org/10.20344/amp.21387","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"276-277"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Adjustment of the Fraction of Inspired Oxygen (FiO2) and the Time Spent in Normoxemia in Preterm Infants.","authors":"Gustavo Rocha, Paulo Soares, Filipa Flor-de-Lima, Rita Amaral","doi":"10.20344/amp.22397","DOIUrl":"https://doi.org/10.20344/amp.22397","url":null,"abstract":"<p><strong>Introduction: </strong>The challenge of maintaining normoxemia in preterm infants undergoing respiratory support and oxygen therapy has led to the development of closed-loop automatic control systems for FiO2. The aim of this study was to assess the effectiveness of these systems in maintaining SpO2 within a target range (90% - 94%) in preterm neonates receiving supplemental oxygen.</p><p><strong>Methods: </strong>We conducted a single-centre prospective study over a three-year period (2020 - 2023) including preterm infants with a gestational age < 33 weeks who received supplemental oxygen within the first 24 hours of life and either invasive or non-invasive respiratory support. The closed-loop automatic control of FiO2 used was the Predictive Intelligent Control of Oxygenation feature on Fabian® ventilators. Two groups were randomized and compared, one receiving automatic plus manual control of FiO2, and the other receiving routine manual control. Uni- and multivariable regression analyses (linear or Poisson) were used to evaluate the association between the use of closed-loop automatic control of FiO2 and the parameters of manual adjustments, hypoxemia, hyperoxemia, and normoxemia.</p><p><strong>Results: </strong>The study included 89 patients, of which 45 received automatic plus manual control of FiO2 and 44 received routine manual control. The first group required fewer manual adjustments of FiO2, experienced fewer episodes of hypoxemia and hyperoxemia (p < 0.002), and spent more time with SpO2 within the target range (p < 0.001), compared to the second group. After adjustment for confounding, the total time spent in normoxemia was higher when in automatic plus manual control of FiO2 (β = 81.5; 95%CI: 47.9 - 115.2, p < 0.001).</p><p><strong>Conclusion: </strong>The use of closed-loop automatic control of FiO2 seems feasible and was associated with fewer episodes of hypoxia and hyperoxia, thereby maintaining SpO2 within normal limits for longer periods. Additionally, it has been shown to be associated with a reduction in manual interventions.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"208-216"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symmetrical Neck Swelling After Percutaneous Coronary Intervention.","authors":"Liliana Pereira Dias, Ana Cristina Coelho, Cristina Mota, Maria João Sousa","doi":"10.20344/amp.22423","DOIUrl":"https://doi.org/10.20344/amp.22423","url":null,"abstract":"<p><p>Cervical edema after iodinated contrast media administration can raise the suspicion of a hypersensitivity reaction, but other diagnoses must be considered. The authors present a rare case of a man who, during the diagnostic investigation of a patient with thoracic pain developed severe submandibular swelling and local pain after a percutaneous coronary intervention with iodinated contrast media. The cervical computerized tomography revealed enlargement of the submandibular glands with adjacent fat stranding, suggesting contrast-induced sialadenitis. In the allergology department skin prick tests, intradermal tests and epicutaneous test with suspected iodinated contrast media and alternative were performed, which were negative. Drug provocation tests with alternative iodinated contrast media were negative. Different approaches can be considered when approaching these patients. Our algorithm includes the evaluation of a potential hypersensitivity reaction with a skin test and drug provocation test with alternative iodinated contrast media.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"260-263"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}