Mental Health and Quality of Life in Alcoholic Liver Disease Patients After Liver Transplantation: a Prospective Controlled Study

OBJECTIVE: Alcoholic liver disease (ALD) is one of the most important indications for liver transplantation. Discordant conclusions have been found concerning quality of life and mental health after transplantation in this particular group. The aim of this work was to investigate improvements in mental health and quality of life among transplanted patients for ALD. METHODS: We studied 45 consecutive transplant candidates with ALD, attending the outpatient clinics. Among these patients we transplanted 24 with the control candidates remaining in wait for transplantation. RESULTS: There was a significant improvement in all mental health and quality of life dimensions among the transplanted ALD group. We also observed a favorable evolution of coping mechanisms (CM) in this group. CONCLUSION: There is a favorable adjustment of ALD patients after transplantation as shown in CM evolution, which might explain the improved mental health and quality-of-life dimensions.

Health survey on the Ilha da Conceição, state of Rio de Janeiro: I. Study design and report of selected demographic and environmental characteristics

During July and August of 1968, a Health survey was conducted on the Ilha da Conceição, an area of Niterói containing approximately one thousand households. The survey was conducted by students from the Universidade Federal Fluminense and the University of Maryland, and was under the supervision of faculty of the Department of Tropical Medicine at U.F.F. and from the Department of Preventive Medicine at the University of Maryland, Baltimore, Maryland, U.S.A. The survey was focused on a 25 percent random sample of the households on the island. Information was obtained from a responsible adult at each Household for completion of a Health questionnaire. Physical measurements, as well as laboratory study information were obtained from, all children in these households. A number of environmental sanitation problems were identified on the Ilha da Conceição. In addition, the survey indicated that approximately half the children had not been adequately immunized against diphteria, pertussis and typhoid. Preventable communicable diseases were the major cause of reported deaths which had occurred in infants ou Household members. The Health of the population on the Ilha da Conceição could well be enhanced by the development of an intelligence system indicating the immunization status of all children in the area. In addition a Health education program for the residents could well be beneficial for improvement of sanitary conditions on the island, as well as maternity and well baby care.

Health survey on the Ilha da Conceição, state of Rio de Janeiro, II: selected health characteristics in children

As part of the health survey on the Ilha da Conceição, a 25 percent random sample of households was identified and a health guestionnaire completed at 236 households. These households contained 536 children, of whom 239 were under age six. Prenatal care had been obtained by 70 percent of the mothers during the pregnancies of the youngest children and 83 percent of these children had been born in hospital. The use of available health facilities was reported more frequently for the younger children in comparison to the older children. Over 90 percent of the children had been vaccinated against one or more diseases but only 50 to 60 percent of the children had complete vaccination against pertussis, diphtheria and tetanus. Almost two-thirds of the stool specimens from the children revealed evidence of parasites and were most commonly found in children two to three years of age. Low hemoglobin values were found commonly under age three and hemoglobin leveis ábove 12 grams were not commonly found until age six. Compared with a North American standard for height and weight, proportionately more children on the Ilha da Conceição were found below the 25th and 3rd percentiles. These findings suggest that an improved health status for the children on the Ilha da Conceição would result from a household health record maintained at the island clinic including current information on vaccination status of all children, and a health education program focused on expectant mothers and the well baby clinic program.

Linked Data based Health Information Representation, Visualization and Retrieval System on the Semantic Web

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

Health-Related Quality of Life Impact of a Triple Combination of Olmesartan Medoxomil, Amlodipine Besylate and Hydrochlorotiazide in Subjects with Hypertension

BACKGROUND: A post-hoc analysis was performed on the data from a 54 weeks phase III study (ClinicalTrials.gov identifier: NCT00923091) to measure changes in the health-related quality of life (HRQoL) of 2,690 patients aged ≥18 with moderate-to-severe hypertension who received one of six doses of olmesartan/amlodipine/hydrochlorothiazide (OLM/AML/HCTZ), using the MINICHAL and EQ-5D instruments. METHODS: Descriptive statistics were used to assess blood pressure and HRQoL scores over the study period. Analysis of covariance (ANCOVA) was used to identify those factors that could possibly have influenced HRQoL. Linear regression was used to assess the relationship between changes in blood pressure and HRQoL scores. RESULTS: Patients' baseline MINICHAL mood and somatic domains scores were 5.5 and 2.6. Over the study period HRQoL improved as both MINICHAL scores decreased by 31-33%. Patients' baseline EQ-5D index and VAS scores were 0.9 and 73.4 respectively, increasing by 6% and 12% over the study period. Patients' QALY gain over the 54 weeks study period was estimated to be 0.029 QALYs. The ANCOVA showed that changes in patients' HRQoL was likely to have been influenced by patients' achievement of blood pressure control, the amount of concomitant medication and patients' last used dosage strength of antihypertensive. Linear regression showed that blood pressure improvement may have been associated with improved HRQoL. CONCLUSIONS: This study showed that OLM/AML/HCTZ reduced blood pressure and significantly increased blood pressure control whilst improving patients' HRQoL. Achieving blood pressure control, amount of concomitant medication and dosage strength of antihypertensive impacted on patients' HRQoL.

Web-application for gathering, analyzing, and processing health information about allergy data

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

How effective are brief interventions in smoking cessation: project of a cohort study in a family health care unit

ABSTRACT: Tobacco use remains the most significant modifiable cause of disability, death and illness1. In Portugal, 19,6% of the population aged ten years or more smoke3. A Cochrane review of 20087 concluded that a brief advice intervention (compared to usual care) can increase the likelihood of a smoker to quit and remain nonsmoker 12 months later by a further 1 to 3 %. Several studies have shown that Primary Care Physicians can play a key role in these interventions8,9,10. However we did not find studies about the effectiveness of brief interventions in routine consultations of Family Doctors in Portugal. For this reason we designed a Cohort Study to make an exploratory study about the effectiveness of brief interventions of less than three minutes in comparison with usual care in routine consultations. The study will be implemented in a Family Healthcare Unit in Beja, during six months. Family Doctors of the intervention group should be submitted for an educational and training program before the study begin. Quit smoking sustained rates will be estimated one year after the first intervention in each smoker. If, as we expect, quit smoking rates will be higher in the intervention group than in the control group, this may change Portuguese Family Doctors attitudes and increase the provision of brief interventions in routine consultations in Primary Healthcare Centers.

Custos diretos do tratamento do cancro do cólon no Algarve

RESUMO - O cancro colorretal é um dos tumores mais comuns nos países desenvolvidos e um grave problema de saúde pública. Em Portugal constitui a terceira causa de morte por cancro em ambos os sexos e a segunda para cada sexo separadamente. A sua importância tem vindo a aumentar devido aos custos pessoais e sociais, surgindo internacionalmente como a segunda doença oncológica com os custos económicos mais elevados. No contexto atual, onde os gastos continuam a aumentar e os recursos são limitados, é importante tornar acessível aos decisores políticos o valor dos custos do cancro do cólon, para comparar opções para a prevenção e tratamento desta doença, no momento de afetar os recursos e financiamento do cancro. O objetivo do estudo é medir os custos diretos do tratamento do cancro do cólon na região do Algarve no ano de 2007. Para além da caracterização sociodemográfica e clínica dos doentes, pretende-se relacionar os custos das diferentes tipologias de diagnóstico e tratamento com os estádios da doença, com a idade e com o sexo. Propõe-se um estudo retrospetivo, analítico, transversal, que segue a abordagem custos da doença baseada na prevalência, adotando a perspetiva dos serviços de saúde. A principal fonte dos dados é a plataforma do ROR-Sul, extraindo-se a população constituída por todos os doentes com diagnóstico de cancro do cólon entre 1 de janeiro de 2007 e 31 de dezembro de 2007, residentes no distrito de Faro (n=170). Para a valorização dos custos recorre-se às Portarias que regulam as tabelas de preços dos serviços do Sistema Nacional de Saúde, à contabilidade analítica dos hospitais e ao Infarmed. Os resultados serão analisados através do Statistical Program for Social Sciences (SPSS) versão 20. De forma a verificar a existência de diferenças estatísticas, em termos de médias e da existência de relações, entre as variáveis sociodemográficas e clínicas utilizaram-se vários testes. Consideramos que este estudo será um importante ponto de partida para posteriores análises económicas completas, em termos dos seus custos e suas consequências, nomeadamente a realização da análise custo-efetividade de programas de prevenção primária e secundária do cancro do cólon.

Incidência do cancro do estômago e do pulmão : um estudo espacio-temporal na região sul de Portugal Continental entre 2000-2008

RESUMO - Enquadramento/Objectivos: As doenças oncológicas constituem a segunda causa de morte em Portugal, e têm um profundo impacto psicossocial, não só pela sua elevada incidência e mortalidade mas também pelos enormes custos envolvidos na sua prevenção, tratamento e reabilitação. De acordo com estudos anteriores, existem disparidades geográficas na incidência da doença oncológica. É por isso indispensável caracterizar e analisar as diferentes distribuições espaciais no tempo e no espaço, para controlar a doença e promover a saúde, contribuindo ao mesmo tempo para uma melhor compreensão da etiologia da doença. Este projecto compreende 3 objectivos principais que são: a caracterização de distribuição espacio-temporal do cancro do pulmão e do cancro do estômago, separadamente e em conjunto, na região sul de Portugal Continental (abrangida pelo ROR-Sul) no espaço temporal de 2000 a 2008, procurando identificar potenciais áreas de risco no desenvolvimento destes tumores. Metodologia: Numa primeira fase realizou-se um estudo descritivo das taxas de incidência dos tumores aqui retratados por idades, por sexo, por ano e por distritos. Posteriormente com o objectivo de identificar a presença de áreas de elevada incidência, procedeu-se à análise de clustering espacio-temporal das taxas de incidência ao nível dos concelhos na região do estudo, em 2000-2008. Resultados: Os resultados da análise descritiva revelaram que ambos os tumores são mais incidentes nos homens do que nas mulheres e que estes são igualmente mais incidentes em pessoas com mais de 75 anos. A análise de clustering espacio temporal permitiu verificar a existência um padrão geográfico heterogéneo da incidência de ambos os tumores, da qual resultaram 3 clusters para o cancro do estômago e 2 clusters para o cancro do pulmão (p <0,001). Os clusters do estômago pertencem maioritariamente à região do Alentejo e os clusters do cancro do pulmão à região da grande Lisboa. Conclusões: Os resultados da análise de clustering demonstraram um padrão heterogéneo da distribuição da incidência dos dois cancros na região e período temporal do estudo. As zonas identificadas de elevado risco são diferentes para ambos o tumores. A região que apresenta maior risco para o desenvolvimento do cancro do estômago é o Alentejo e do pulmão é o distrito de Lisboa.

Knowledge and practices of general practitioners of district Peshawar about schizophrenia

ABSTRACT: Schizophrenia with its disabling features has been placed in the top ten of global burden of disease and is associated with long-term decline in functional ability. General Practitioners not only have an important role in treating patients with an established diagnosis of schizophrenia but they can also contribute significantly by identifying people in early stages of psychosis as they are the first hand medical help available and the duration of untreated psychosis is a good indicator of patient’s prognosis. This cross sectional survey, conducted at the clinics of General Practitioners, was designed to assess the knowledge and practices of general practitioners in Peshawar on diagnosis and treatment of schizophrenia. A semi structured questionnaire was used to assess their knowledge and practices regarding schizophrenia. The Knowledge/Practice was then categorized as good or poor based on their responses to the questions of the administered questionnaire. Overall, the results showed that the knowledge and practices of general practitioners of district Peshawar were poor regarding schizophrenia and may be responsible for delayed diagnosis, inadequate treatment and poor prognosis.

Logistics in the health sector

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Supplementary private health insurance: The characteristics of subscribers

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

Estimating demand for primary health care services

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

Clustering medical tourism in Algarve: setting the first steps for the the health authority

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Primary public health care and socioeconomic asymmetries in Portugal

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics