Cuidados de saúde primários em Portugal

RESUMO - A evolução dos cuidados de saúde primários em Portugal nos últimos trinta anos conheceu várias fases. A partir de 1971 foram criados os primeiros centros de saúde — os centros de saúde de primeira geração, associados ao que então se entendia por saúde pública —, incluindo actividades como a vacinação, vigilância de saúde da mulher, da grávida e da criança, saúde escolar e ambiental, entre outras. Em 1983 os primeiros centros de saúde foram integrados com os numerosos postos dos ex-Serviços Médico- -Sociais («caixas»). Este processo de fusão conduziu a uma maior racionalidade formal, mas não resultou numa melhoria naquilo que eram as principais virtudes dos componentes integrados — acessibilidade a consultas e a visitas domiciliárias, por um lado, e, por outro, a programação de actividades com objectivos de saúde. Em 1999 foi publicada a legislação sobre os «centros de saúde de terceira geração». Esta aparece na sequência de experiências sobre o terreno — «projectos Alfa» e outras iniciativas semelhantes, baseados numa filosofia de «prática de grupo» — e do início de um regime remuneratório experimental para a clínica geral. As unidades operativas dos novos centros de saúde pressupõem um processo de mudança organizacional que não pode ser implementada pela via normativa clássica tipo top down. Embora necessite de um enquadramento «de cima», a sua realização dependerá essencialmente da capacidade de despoletar uma dinâmica de mudança em cada centro de saúde e de proporcionar acompanhamento e apoio técnico a esses processos de mudança locais.

Evaluation of mechanical soft-abrasive blasting and chemical cleaning methods on alkyd-paint graffiti made on carbonate stones

In the context of this dissertation several studies were developed resulting in submission and publication “Evaluation of mechanical soft-abrasive blasting and chemical cleaning methods on alkyd-paint graffiti made on calcareous stones” to Journal of Cultural Heritage. (http://dx.doi.org/10.101 /j.culher.2014.10.004)

Demographic determinants of survival of people living with HIV attending an outpatient reference unit in the city of Três Lagoas, state of Mato Grosso do Sul, Brazil, in the period 1984-2009

INTRODUCTION: While the incidence of HIV infection and AIDS is increasing in small Brazilian cities, epidemiological studies are often conducted in large urban centers. METHODS: Our group conducted a retrospective analysis of survival determinants among 358 patients who attended a reference unit in a small city. RESULTS: Death risk was lower among men that had sex with men, patients with an HIV-seropositive partner, and those admitted after highly active antiretroviral therapy (HAART) was available. CONCLUSIONS: The study documents the striking beneficial effect of HAART. The finding of other groups with improved survival may aid in the development of programmatic strategies.

Soap bubble appearance in brain magnetic resonance imaging: cryptococcal meningoencephalitis

Although cryptococcal infections begin in the lungs, meningoencephalitis is the most frequently encountered manifestation of cryptococcosis among individuals with advanced immunosuppression. As the infection progresses along the Virchow-Robin spaces, these structures may become dilated with mucoid material produced by the capsule of the organism. We report a case of a 24-year-old man with cryptococcal meningoencephalitis in which magnetic resonance imaging showed clusters of gelatinous pseudocysts in the periventricular white matter, basal ganglia, mammillary bodies, midbrain peduncles and nucleus dentatus with a soap bubble appearance.

Biochemical and nutritional evaluation of patients with visceral leishmaniasis before and after treatment with leishmanicidal drugs

Introduction Visceral leishmaniasis (VL) is caused by the intracellular protozoan Leishmania donovani complex. VL may be asymptomatic or progressive and is characterized by fever, anemia, weight loss and the enlargement of the spleen and liver. The nutritional status of the patients with VL is a major determinant of the progression, severity and mortality of the disease, as it affects the clinical progression of the disease. Changes in lipoproteins and plasma proteins may have major impacts in the host during infection. Thus, our goal was evaluate the serum total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, glucose, albumin, globulin and total protein levels, as well as the body composition, of VL patients before and after treatment. Methods Nutritional evaluation was performed using the bioelectrical impedance analysis (BIA) to assess body composition. Biochemical data on the serum total cholesterol, HDL, LDL, triglycerides, glucose, albumin, globulin and total protein were collected from the medical charts of the patients. Results BIA indicated that both pre-treatment and post-treatment patients exhibited decreased phase angles compared to the controls, which is indicative of disease. Prior to treatment, the patients exhibited lower levels of total body water compared to the controls. Regarding the biochemical evaluation, patients with active VL exhibited lower levels of total cholesterol, HDL, LDL and albumin and higher triglyceride levels compared to patients after treatment and the controls. Treatment increased the levels of albumin and lipoproteins and decreased the triglyceride levels. Conclusions Our results suggest that patients with active VL present biochemical and nutritional changes that are reversed by treatment.

Dengue infection in children and adolescents: Clinical profile in a reference hospital in northeast Brazil

Introduction This study aimed to describe the clinical spectrum of dengue in children and adolescents from a hyperendemic region who were admitted for hospitalization. Methods A retrospective study was conducted on patients diagnosed with dengue infection upon admission to a reference center in Fortaleza, Brazil. Results Of the 84 patients included, 42 underwent confirmatory testing. The main symptoms were fever, abdominal pain and vomiting. The median level of serum aspartate aminotransferase was 143.5±128mg/dL. Conclusions A peculiar clinical profile was evident among children and adolescents with dengue infection in a reference center in northeast Brazil, including gastrointestinal symptoms and liver involvement.

Clinical and serological evolution in chronic Chagas disease patients in a 4-year pharmacotherapy follow-up: a preliminary study

Introduction The role of trypanocidal therapy in the chronic phase of Chagas disease remains controversial. Methods A total of 13 patients with chronic Chagas disease were treated with benznidazole (5mg/kg/day/60 days) and surveyed via antibody measurement and conventional electrocardiogram over the course of 4 years. Results The antibody titers were significantly reduced after 4 years (p<0.05). Most of the patients showed maintenance of the initial clinical picture (electrocardiographic), with the exception of 4 cases. Conclusions Although trypanocidal therapy in the chronic phase of Chagas disease was of limited effectiveness, we believe that it is beneficial in treating these patients.

Invenção latino-americana através da expressão audiovisual a partir da Oficina Popular de Audiovisual Latino-americano

Este projeto de tese traça uma percepção etnográfica sobre a Oficina Popular de Audiovisual Latino-americano, projeto de aproximação audiovisual a jovens imigrantes latino-americanos residentes na cidade de São Paulo, através do seu acompanhamento e da filmagem partilhada das suas sessões, ocorridas durante os meses de junho, julho, agosto e setembro de 2014, realizadas no espaço do Cineclube latino-americano, sediado no Memorial da América Latina. Parte-se das premissas de que a latinoamericanidade é um imaginário identitário integracionista continuamente inventado e reinventado por vários agentes, ressignificado ininterruptamente por outros imaginários transregionais e locais, e de que entre as muitas vias da sua contínua reinvenção o audiovisual se dá como expressão estética mediadora de impressões locais e transregionais e como potencializador da reflexão coletiva sobre a existência social de cada um e a partilhada. Descreve-se em forma de relatório e de ensaio audiovisual etnográfico, a intersecção de imaginários identitários migrantes e latino-americanos mediados pelo audiovisual, a envolvência dos jovens com os temários da deslocação e da latinoamericanidade através da Oficina, da recepção de filmes latino-americanos contemporâneos e da criação coletiva de dois curtas-metragens.

A saúde mental global, a depressão, a ansiedade e os comportamentos de risco nos estudantes do ensino superior : estudo de prevalência e correlação

RESUMO: A saúde mental é influenciada pelos comportamentos tanto como estes são influenciados pela saúde mental. Por isso é importante compreender quer a saúde mental quer os comportamentos adoptados pelo indivíduo em qualquer momento do seu ciclo vital para melhor poder actuar quando e sempre que necessário. Nos estudantes universitários, não sendo uma população de risco, a saúde mental e os comportamentos de risco afectam não só o próprio estudante e quem com ele convive mas também as próprias instituições que o acolhem. O presente estudo teve como objectivos: nos estudantes universitários 1) caracterizar a saúde mental global; 2) caracterizar os níveis de sintomatologia depressiva e ansiosa; 3) identificar os padrões de comportamentos de risco; 4) analisar a relação entre saúde mental global, depressão, ansiedade e comportamentos de risco. Para tal realizou-se um estudo quantitativo, descritivo, correlacional, transversal e exploratório com 1968 estudantes do 1º ciclo da Universidade da Beira Interior e dos Institutos Politécnicos da Guarda, Castelo Branco e Portalegre. Foram utilizados como instrumentos de investigação uma ficha de Caracterização Socio-Demográfica; o Mental Health Inventory-5; o Patient Health Questionnaire-9; Generalized Anxiety Disorder-7; e o Questionário de Comportamentos de Risco em Estudantes Universitários. Os principais resultados mostraram que 18,3% (n=360) apresentavam saúde mental negativa; 17,7% sintomatologia depressiva moderada a severa; 15,6% sintomatologia ansiosa moderada a severa; e que apenas 15% dos que apresentavam saúde mental global negativa recorreu a ajuda profissional. As mulheres, os alunos de 1ª e 4º ano, e os alunos dos cursos de Artes e Letras apresentavam níveis de saúde mental global inferiores. O Consumo de álcool foi superior nos homens, nos estudantes das áreas de Ciências e Ciências da Saúde e nos estudantes deslocados. Os estudantes com mais de 3 unidades curriculares em atraso apresentavam maior sintomatologia depressiva e ansiosa. Os resultados mostraram ainda que quanto mais positiva a saúde mental global maior o consumo de bebidas alcoólicas e menor a sintomatologia depressiva e ansiosa. As variáveis Curso e Sexo influenciam significativamente a saúde mental global, a depressão e a ansiedade. Apesar de a maioria dos estudantes inquiridos não revelar problemas de saúde mental nem apresentar comportamentos de risco, as principais conclusões apontam para a necessidade de programas de educação para a saúde assim como de programas de literacia de saúde mental para as instituições poderem identificar precocemente as situações problemáticas e ajudar os próprios estudantes a reconhecer em si o sofrimento psicológico e a necessidade de procurar apoio profissional.---------------------------------- ABSTRACT: Mental health is influenced by behaviours as much as behaviours are influenced by mental health. Thus, it is important to understand not only the mental health but also the behaviours adopted by an individual at any stage of its vital cycle in order to accurately intervene whenever and always deemed necessary. Regarding college students, despite not being deemed as a population at risk, mental health and risk behaviours affect not only the student itself and whoever interacts with him but also the institutions that host them. The main purposes of this study were regarding college students 1) characterize the overall mental health; 2) characterize the levels of depression and anxiety symptoms; 3) identify the risk behaviours patterns; and 4) analyse the relation between overall mental health, depression, anxiety and risk behaviours. With that scope a quantitative, descriptive, correlated, transversal and exploratory study has been conducted with 1968 students of the 1st cycle of the University of Beira Interior and of the Polytechnic Institutions of Guarda, Castelo Branco and Portalegre. The investigation instruments used were a chart of Socio-Demographic Characterization; the Mental Health Inventory-5; the Patient Health Questionnaire-9; the Generalized Anxiety Disorder-7; and one Questionnaire of Risk Behaviours in College Students. The main results showed that 18.3% (n=360) revealed negative mental health; 17.7% moderated to severe depression symptoms; 15.6% moderated to severe anxiety symptoms; and that only 15% of those revealing negative overall mental health have seek for professional help. Females, students of the 1st and 4th years and students of the Artes and Letras courses revealed inferior levels of overall mental health. Alcohol consumption is higher in males, in the Sciences and Health Sciences’ students and on displaced students. Students with more than 3 curricular units in delay revealed higher depression and anxiety symptoms. The results also showed that the more positive overall mental health the higher alcohol consumption and the lower depression and anxiety symptoms. The Course and Sex variations significantly influence the overall mental health, the depression and the anxiety. Although the majority of the enquired students did not reveal mental health issues or present risk behaviours, the main conclusions indicate the need to implement health education and mental health literacy programmes in order to enable the institutions to prematurely identify problematic situations and help students to recognize the psychological suffering and the need to seek for professional help.

Predictive factors of post-discharge surgical site infections among patients from a teaching hospital

Introduction Surgical site infections (SSIs) often manifest after patients are discharged and are missed by hospital-based surveillance. Methods We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identified during the hospital stay and after discharge. Results Among 3,427 patients, 222 (6.4%) acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay. Conclusions Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance.