Acta medica portuguesa最新文献

{"title":"Invasive Cervical Cancer Detection After Transition to Primary Human Papillomavirus Screening: Population-Based Linkage Study in Portugal.","authors":"Rita Sousa, José Alberto Fonseca-Moutinho, Fábio Gomes, Fernanda Loureiro, Helena Nascimento, Helena Solheiro, Isabel Saavedra, Madalena Ponte, Mónica Barros, Sofia Pereira, Teresa Rebelo, Vítor Caeiro, Ana Rita Goes, Patrícia Soares","doi":"10.20344/amp.24709","DOIUrl":"https://doi.org/10.20344/amp.24709","url":null,"abstract":"<p><strong>Introduction: </strong>Invasive cervical cancer (ICC) is a key outcome for evaluating cervical cancer screening (CCS) programs. Monitoring ICC trends and distinguishing cancers detected within and outside the organized screening program are essential for assessing program impact, particularly during transitions such as the introduction of human papillomavirus (HPV) based primary screening.</p><p><strong>Methods: </strong>We conducted a retrospective population-based study in Portugal's Central Region (2014 - 2023). Deterministic linkage was performed between the organized CCS database and hospital morbidity records. Invasive cervical cancer cases were classified as screen-detected or non-screen-detected based on prior screening history. Incidence rates were calculated using population denominators. Poisson regression models with log link and log-transformed population offsets were fitted to estimate incidence rate ratios (IRR) comparing cytology-based (2014 - 2019) and HPV-based (2020 - 2023) periods, adjusting for temporal trends.</p><p><strong>Results: </strong>A total of 654 ICC cases were included. Screening participation remained broadly stable over time. The HPV-based period was associated with a significantly higher rate of screen-detected ICC (IRR = 1.94; 95% CI 1.11 - 3.40) compared with the cytology period. In contrast, ICC incidence outside the organized screening program did not differ significantly between periods (IRR = 0.94; 95% CI 0.65 - 1.35).</p><p><strong>Conclusion: </strong>The transition to HPV-based primary screening was associated with a shift in ICC detection towards the organized screening program, without evidence of a corresponding increase in incidence among women diagnosed outside the organized screening program. These findings should, however, be interpreted with caution in light of the early phase of implementation and potential external factors influencing access to diagnosis. Overall, the results support a shift in detection within the screening pathway rather than changes in underlying disease occurrence. Strengthening integration between screening, hospital, and cancer registry data remains essential for robust evaluation of cervical cancer screening policies.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 8","pages":"438-447"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676715","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":"Letter to the Editor Regarding the Article \"Addressing the Risks of the New Tobacco Product Wave in Portugal\".","authors":"Rute Neves Marques, Ana Cláudia Ramos","doi":"10.20344/amp.24539","DOIUrl":"https://doi.org/10.20344/amp.24539","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 8","pages":"492-493"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676662","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":"[Sexual Health in Oncology Patients and Cancer Survivors: A Structured Protocol to Address an Unmet Clinical Need at IPO-Porto].","authors":"Helena João Gomes, Ana Samico, Ana Dias Amaral, Susana Sousa Almeida","doi":"10.20344/amp.24789","DOIUrl":"10.20344/amp.24789","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"501-502"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148349971","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":"Hyperthermia in a Teenager: Is it Just a Heat Stroke?","authors":"Maria Limbert, Luzia Condessa, Carina Cardoso, Erica Torres, Sofia Deuchande","doi":"10.20344/amp.24465","DOIUrl":"10.20344/amp.24465","url":null,"abstract":"<p><p>An adolescent male with obesity and autism spectrum disorder presented to the emergency department with acute confusion, chills, muscle rigidity, and severe hyperthermia (tympanic temperature 41.9ºC) after physical exertion in extreme heat. His regular medication included antipsychotics. Laboratory evaluation showed multiorgan dysfunction, supporting a diagnosis of heat stroke with concurrent neuroleptic malignant syndrome. Prompt resuscitation and external cooling were initiated, and the patient was admitted to the pediatric intensive care unit. Management included discontinuation of antipsychotics, dantrolene and bromocriptine, active temperature control using Criticool®, benzodiazepines, and aggressive intravenous fluid therapy. The patient improved gradually and was discharged after four days in intensive care and 14 days in the ward, on aripiprazole and clonidine. This case highlights the diagnostic and therapeutic challenges posed by severe hyperthermia with overlapping features of heat stroke and neuroleptic malignant syndrome.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"481-483"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337216","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":"[Fibromyalgia: From Clinical Invisibility to Medico-Legal Recognition].","authors":"José António Pereira da Silva, Fernando Gonçalves de Oliveira, Duarte Nuno Vieira","doi":"10.20344/amp.24611","DOIUrl":"10.20344/amp.24611","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"435-437"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925379","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":"Cutaneous Polyarteritis Nodosa as the Inaugural Manifestation of Hairy Cell Leukemia.","authors":"Filipe Monteiro, Gustavo Almeida-Silva, Pedro De Vasconcelos, Sónia Fernandes, Joana Antunes","doi":"10.20344/amp.24696","DOIUrl":"10.20344/amp.24696","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"503-504"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306636","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":"[Implementing the AI Act in the Portuguese Health Sector: Implications, Challenges and the CPIA-OM Perspective].","authors":"João Frutuoso, Juan Pereira, Manuel Pereira, Helena Donato, António Vaz Carneiro","doi":"10.20344/amp.24588","DOIUrl":"10.20344/amp.24588","url":null,"abstract":"<p><p>The rapid expansion of artificial intelligence (AI) in the health sector has intensified the need for a robust regulatory framework capable of safeguarding patient safety, professional accountability, and public trust. We aimed to analyse the European Union Artificial Intelligence Act [AI Act, Regulation (EU) 2024/1689] and its implications for the healthcare sector in Portugal, presenting the institutional position of the Artificial Intelligence Committee of the Portuguese Medical Association (CPIA-OM). We conducted a narrative review based on official European legislation [AI Act, General Data Protection Regulation (GDPR), Medical Device Regulation (MDR) and In Vitro Diagnostic Medical Devices Regulation (IVDR)], institutional documents [including the 2025 White Paper on AI in Healthcare in Portugal, published by the Shared Services of the Ministry of Health (SPMS)], and peer-reviewed literature on artificial intelligence in medicine, ethics, and regulatory science. The AI Act introduces a risk-based classification of AI systems, ranging from prohibited \"unacceptable risk\" applications to minimal risk uses. Most medical AI applications, including diagnostic support, clinical monitoring, and therapeutic decision-making, are classified as \"high risk\" and are subject to stringent requirements regarding conformity assessment, technical documentation, human oversight, and data governance. The regulation interacts with existing frameworks such as the GDPR and MDR/IVDR, creating complex compliance obligations. Specific challenges include algorithmic bias, liability attribution, and the preservation of the physician-patient relationship. In Portugal, recent institutional initiatives within the National Health Service - including pilot projects in triage, frailty assessment, antibiotic stewardship, and medical imaging - illustrate opportunities for responsible AI integration, while academic reports highlight persistent concerns around transparency, trust, and professional substitution. The AI Act represents a landmark in European health regulation, balancing innovation with fundamental rights protection. For Portugal, its implementation requires coordinated action between the government, regulators, healthcare providers, and professional bodies. The CPIA-OM emphasises the need for continuous medical education in AI, the establishment of clinical oversight protocols, and the creation of observatories to monitor implementation and ensure ethical, safe, and patient-centred adoption.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 8","pages":"470-476"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676634","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":"Guideline Recommendations and Estimates of Excessive Screen Time in Children.","authors":"Daniela Rodrigues","doi":"10.20344/amp.24635","DOIUrl":"10.20344/amp.24635","url":null,"abstract":"<p><p>Even though digital media use in early childhood has increased, compliance estimates vary depending on the screen time guideline applied. This study compared Portuguese, World Health Organization, and American Academy of Pediatrics recommendations within the same population, and examined factors associated with exceeding age-specific limits. Baseline data from 940 children aged two to six years (mean 4.67 ± 1.03; 52.8% boys) were analyzed. The mean daily screen time was 126 minutes. The exceedance prevalence and severity were classified according to each framework. Most children exceeded recommendations across all systems, with highest prevalence and severity under the Portuguese Society of Neuropediatrics, followed by the American Academy of Pediatrics and the World Health Organization. Despite systematic reclassification across guidelines, consistent determinants emerged: earlier age at first exposure (ORs ranging between 0.93 - 0.98), child Internet use (non-use: ORs between 0.06 - 0.38), higher maternal screen time (ORs between 1.02 - 1.04), and bedroom device access (ORs between 0.17 - 0.50) were associated with higher odds of exceeding limits. Parental awareness of recommendations was generally high, but quantitative restrictions were less consistently implemented. The findings suggest that prevalence estimates strongly depend on the guideline framework applied, while family-level determinants of excessive exposure remain stable across classification systems.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"462-465"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148256915","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":"[When will a National Quality Program in Surgery be implemented?]","authors":"António Gomes, Vitor Nunes","doi":"10.20344/amp.24701","DOIUrl":"https://doi.org/10.20344/amp.24701","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 8","pages":"496-498"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676637","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":"[Orbital Myositis as a Rare Extra-Intestinal Manifestation of Ulcerative Colitis].","authors":"Madalena Pestana, Hugo Mota Dória, Tatiana Gregório, Ana Margarida Madureira, Nélia Abreu","doi":"10.20344/amp.24643","DOIUrl":"10.20344/amp.24643","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"499-500"},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238351","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}