ESALD - Artigos em revistas com arbitragem científica
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- Atitudes/comportamentos dos adolescentes face à sua sexualidadePublication . Antunes, Maria Teresa; Vaz, Ana MariaOver the last years, attitudes and sexual behaviors of teenagers have suffered permanent evolu tion, and have changed into a more permissive sexuality, not always followed by proper information on the most adequate way to deal with their own sexuality, which may lead to several health risks. Statistic analysis of questionnaires from a 521 student sample, from 2 high schools, with ages between 15 and 19 years old, comprising 46,4% boys and 53,6% girls, the age average being 16,37 and standard deviation (SD) 1,07. 196 students already have boyfriend/girlfriend, representing 36,8% of the total boys and 38,4% of the total for girls. 188 students already had sexual intercourse, being 64,9% of these sexual inter courses with boyfriend/girlfriend. After the first sexual intercourse 179 students had at least anoth er sexual intercourse, with the same sexual partner for 116 of these students an with a different sex ual partner for 63 of the subjects. 134 students used a contraceptive method, being the favorite the condom, which was used by 81,2%. About the information on sexuality 457 students (87,7%) con sidered themselves informed, resorting in their vast majority to internet and magazines (42,6%) to obtain information. In order to discuss sexuality most of the students prefer to talk to friends (53,7%). It has been verified that a big percentage of students initiate sexual activity quite early, thoughbeing necessary a greater intervention on school level, investing in sexual education and peer edu cation, as a big percentage of students chooses to discuss their sexuality issues with friends.
- Renal screening sonography. A comparative study in a Portuguese basic emergency servicePublication . Miravent, Sérgio; Jiménez, Carmen; Barbancho, Narciso; Lobo, Manuel; Figueiredo, Teresa; Gomes, Carla; Ratusneac, Ion; Gonçalves, João Mário; Hasnas, Corina; Almeida, Rui Pedro deIntroduction: This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with the imaging findings at the Referral Hospital (RH). Methods: Thirty-one patients suspected of having renal pathology underwent initial renal sonography screening with sonographer reporting at the BES and were subsequently referred to the RH for additional imaging examinations. The results of both examinations were compared to verify whether the findings from the BES were confirmed by the radiologist in the RH and to ensure that the patient referrals from BES to RH were appropriate. Results: In our sample, most patients (80%) exhibited varying degrees of pyelocaliceal distension, with nearly half (48%) presenting obstructions. A strong association between the sonographic findings in the BES and the RH was found in the variables “Dilatation of pyelocaliceal system” (V=0.895; p=0.000), “Simple cystic formation” (V=0.878; p=0.000), respectively. There was a statistically significant correlation between BES and RH findings, indicating a strong association between these two variables respectively (k=0.890; p=0.000) and (k=0.870; p=0.000). In this research, an achieved sensitivity of 96% and a specificity of 85% were demonstrated in the identification of pyelocaliceal dilatation. Conclusion: Renal sonographer reporting screening successfully detected abnormalities in the urinary system of patients suspected of having renal colic. The sonographic data obtained at the BES demonstrated a strong correlation with the additional imaging findings from the RH in Portugal. These results suggest that Radiographers/Sonographers can have an important role in the preliminary assessment of urgent renal pathology in remote areas, contributing to a correct referral and early treatment.
- Effectiveness of ultrasound screening in right upper quadrant pain: A comparative study in a basic emergency servicePublication . Miravent, Sérgio; Figueiredo, Teresa; Jiménez, Carmen; Almeida, Rui Pedro de; Lobo, ManuelBackground and Aims: The use of ultrasound screening is primarily facilitated by point‐of‐care ultrasound (POCUS) and its integration into healthcare systems is a result of the versatility of this imaging technique. This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with that of radiologists at referral hospital (RH) in Portugal. Methods: Twenty patients with right upper quadrant (RUQ) pain and suspected cholecystitis or biliary pathology underwent sonography screening using POCUS in the BES. They were then forwarded to the RH where a radiologist performed a conventional ultrasound exam on the same patients. The results of both exams were compared to determine if the findings obtained in the BES were confirmed by the radiologist in the RH. Results: In our sample, 60% of cases were related to biliary pathology, 20% were liver‐related, 10% had hepatopancreatic biliary etiology, and 10% had unknown etiology. A strong association between the sonographic findings in the BES and the RH was found in the variables “Sonographic Murphy sign” (V = 0.859; p = 0.001), “Cholelithiasis/Gallbladder sludge” (V = 0.840; p = 0.001), and “Intrahepatic biliary tract dilatation” (V = 0.717; p = 0.006). Adequate measures of agreement between the findings of the radiographer and radiologist were obtained for the “Sonographic Murphy sign” (k = 0.664; p = 0.001) and the presence of “Cholelithiasis/Gallbladder sludge” (k = 0.712; p = 0.000). Conclusion: Major biliary abnormalities were detected in patients with RUQ pain in BES using sonography. The correlation between the sonographic findings obtained by the sonographers at BES and those obtained by radiologists at the RH in Portugal was strong, showing that POCUS screening could be extended to other similar settings; however, more studies are needed.
- Discrepancies between screening sonography and ultrasound in emergency department: A case reportPublication . Miravent, Sérgio; Figueiredo, Teresa; Donchenko, Inna; Cruz, Gualter; Almeida, Rui Pedro de; Lobo, ManuelIntroduction: This case report presents a discrepancy in sonographic findings between a screening sonography performed by a Sonographer in the Basic Emergency Service (BES) and a subsequent ultrasound performed by a Radiologist physician in a Referral Hospital (RH). The aim of this report is to discuss the possible reasons for the discrepancy and its implications for patient care. Case Presentation: A patient with a history of epigastric pain and vomiting underwent screening sonography in a BES, which suggested Intrahepatic Biliary Dilatation Duct (IHBD) and main pancreatic duct dilatation. The patient was subsequently referred to the RH for further evaluation. However, the Radiologist in the RH did not confirm any of the initial suspicions from BES through a normal ultrasound procedure. The discrepancy raises questions regarding the quality of the screening ultrasound, misinterpretation of the BES images, or the potential for ambiguity in the point of care ultrasound (POCUS) exam. Conclusion: The differences in sonographic findings between BES and RH, in this case, suggest that the improvement of the patient's clinical condition and therapeutic interventions may have contributed to the discrepancy. Further investigation and standardization of POCUS training and interpretation may improve diagnostic accuracy and patient outcomes.
- Point of care prehospital ultrasound in basic emergency services in PortugalPublication . Miravent, Sérgio; Lobo, Manuel; Almeida, Rui Pedro deBackground and Aims: The Point of Care Ultrasound and Point‐of‐Care Ultrasound in Resource‐Limited Settings are differentiated diagnostic methods using ultrasound, essential in urgent patients screening, allowing better guidance in the diagnostic process and therapeutic approach. This study intends to observe the impact of these techniques in two Basic Emergency Services (SUB) in Portugal. Methods: A longitudinal study was carried out in two remote locations in Portugal (SUB N and SUB S). Data were collected by trained radiographers in each location, and a total of 972 exams were considered. Imaging findings were documented by exam type, the exam normality and the resolution after exam. χ 2 and Cramer's V tests were performed to check significant correlations between the variables. Results: Regarding the type of echographic findings, 289 (29.7%) were considered normal, 628 (64.6%) were classified as abnormal and 55 (5.7%) were considered inconclusive. As for the type of resolution, 58% had local resolution, 24% were referred to a hospital emergency service and 18% referred to ambulatory care. Regarding the Location versus Resolution after exam versus Findings variables, it was verified a stronger statistically significant association for the exams considered “Abnormal” (Cramer´s V = 0.414; p < 0.001). In the variables Location versus Findings versus Resolution after exam, it was verified a stronger statistical significance for “Referral to Ambulatory” (Cramer V = 0.443; p < 0.001) although Referral for Hospital (Cramer V = 0.252; p = 0.003) or Local Resolution (Cramer V = 0.252; p < 0.001) also had a moderate association strength. Conclusion: Ultrasonography is a useful diagnostic tool for patients screening, having an influence on patient management in remote settings. Given the limited literature in Portugal about this matter, further research and literature will be needed to support and complement the results of this study.
- Pre-hospital ultrasonography screening for biliary disease in remote settingsPublication . Miravent, Sérgio; Jimenez, Cármen; Lobo, Manuel; Figueiredo, Teresa; Almeida, Rui Pedro deScreening ultrasound, including Point of Care Ultrasonography (POCUS), is widely utilized for rapid clinical guidance in diverse healthcare settings. In this case report, a 34-year-old male with recurrent biliary colic symptoms underwent a Basic Emergency Service ultrasound, revealing a 13 mm gall bladder calculus and signs of inflammation, and was promptly referred to the hospital for further evaluation and treatment. Medical specialist confirmation at the hospital underscored the significance of early detection through POCUS. Despite inconclusive laboratory results, the detailed ultrasound assessment provided a comprehensive understanding, emphasizing the tool’s value in averting com plications. Thus, screening ultrasound played a pivotal role in justifying the hospital referral, showcasing its vital role in healthcare, especially in resource-limited settings. The judicious use of POCUS can lead to superior outcomes, avoiding unnecessary referrals for non-emergent cases
- Pre-hospital detection of intrahepatic biliary duct dilatation: recognizing the abundance of vessels in the liverPublication . Miravent, Sérgio; Lobo, Manuel; Almeida, Rui Pedro deDiagnosing and confirming intrahepatic biliary duct dilation (IHBDD) involves a coordinated effort across multiple medical specialties, often relying on comprehensive blood analysis. However, the utility of screening ultrasound in detecting intrahepatic biliary dilation becomes particularly valuable in pre-hospital settings like our Basic Emergency Service, especially when access to alternative imaging techniques or detailed blood analyses are unavailable. Detecting the intrahepatic biliary dilation pattern through ultrasound is notably straightforward for a skilled sonographer. The presence of IHBDD can be efficiently identified during a screening ultrasound, allowing identification of imaging findings that help differentiate simple biliary colic from clinical cases that should be prompt referral to the reference hospital and without unnecessary delays or resource expenditure. The etiology of IHBDD is multifactorial1, and while its presentations may vary, the characteristic ultrasound pattern often involves the visualization of “extra vessels within the liver,” related to the distinctive “shotgun” sign2. This sign translates into the observation of dilated bile ducts exhibiting no flow on Doppler imaging3. In cases of extrahepatic obstruction, dilation of the common bile duct (CBD) may be evident. However, with intrahepatic obstruction, a normal CBD caliber can occur. Thus, the sonographer needs to diligently observe the signs outlined and typical sonographic landmarks to identify early indications of bile duct dilation within the innermost or regions of the liver.
- Polimedicação nos idosos admitidos no serviço de urgênciaPublication . Simões, ÂngelaIntrodução: A polimedicação é definida pela OMS como o uso simultâneo de um número excessivo de medicamentos, assumindo-se uma situação de polimedicação major a toma de cinco ou mais princípios activos diferentes por dia. Objectivo: Apresentar os resultados relativos à polimedicação de idosos admitidos em Serviço de Urgência (SU). Metodologia: Apresentamos o resultado de dois estudos observacionais, retrospectivos e descritivos que incidiram sobre a fragilidade e agressividade nos cuidados de fim de vida em idosos admitidos em SU. No primeiro estudo analisamos 8082 episódios de urgência, de pessoas com 65 ou mais anos, em 2019, e no segundo estudo, 2555 episódios de urgência, de idosos residentes em ERPI, em 2019. Foram recolhidos dados de variáveis sociodemográficas e clínicas. Análise estatística com nível de significância de 0,05. Resultados: No primeiro estudo “Fragilidade e cuidados em fim de vida - Prevalência da Fragilidade e Agressividade dos Cuidados em Fim de Vida nos idosos admitidos num SU” cerca de 66% dos idosos que são admitidos no SU apresentam polimedicação major. No segundo estudo “Nursing home residents in the emergency department: Characteristics; Fragility and Aggressiveness in care” cerca de 92% dos idosos residentes em ERPI que recorrem ao SU estão polimedicados, com média de 9 princípios ativos diários, com um máximo de 22 princípios diários. Conclusão: A polimedicação aumenta o risco de interações e reações adversas. Além disso, na pessoa idosa potencia o risco de morbimortalidade, para além de diminuir a adesão ao regime terapêutico. Os resultados destes estudos são muito preocupantes e é por isso fundamental a sensibilização e formação para a desprescrição adequada, redefinindo os objetivos terapêuticos, ajustando a medicação às reais necessidades da pessoa. Além disso, levanta problemas éticas importantes relacionados com a obstinação terapêutica, quando se insiste na prescrição de medicação excessiva e desadequada. Em idosos residentes em ERPI com elevados níveis de fragilidade a situação ganha contornosalarmantes.
- Are the cross-culturally adapted versions of the Tampa Scale for Kinesiophobia 11-item valid, reliable, and responsive? A COSMIN-informed systematic review of measurement propertiesPublication . Alpalhão, Vanessa; Vaz, João R.; Cordeiro, Nuno; Correia, Pedro de PezaratNumerous cultural adaptations of the Tampa Scale of Kinesiophobia 11-item version (TSK-11) scale have emerged since the original version was introduced. We conducted a (COnsensus-based Standards for the selection of health Measurement INstruments) COSMIN-informed systematic review of measurement properties to identify the cross-cultural adaptation of the TSK-11 and report, critically appraise, and systematize its measurement properties. Six databases were searched for studies published since 2005. Studies reporting on the measurement properties of culturally adapted versions of the TSK-11, published in English, Portuguese, and Spanish, were considered for inclusion. The results were synthesized by measurement properties and rated against the COSMIN criteria for good measurement properties. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach and presented in a summary of findings table. Twenty-three studies were included, and cultural adaptations for 15 languages were identified: English, Chinese, Cantonese, Swedish, German, Dutch, Arabic, Turkish, Danish, Spanish, Japanese, Brazilian Portuguese, Marathi, Thai, and Persian. There is “high” certainty in the evidence for “sufficient” criterion validity (TSK-17, r = .84) and “insufficient” measurement error (small detectable change range 5.6–6.16). “Moderate” certainty in the evidence for “sufficient” construct validity (87.8% of hypotheses confirmed), test-retest reliability (intraclass correlation coefficient2,1 = .747–.87), and “low” certainty in evidence for “sufficient” responsiveness. The numerous sources of heterogeneity prevent conclusions from being drawn regarding structural validity. Measurement error, responsiveness, and structural validity of the TSK-11 require further investigation. Clinicians should complement the use of TSK-11 with other instruments. Future studies on the structural validity of the questionnaire should standardize the data analysis methods.
- The Influence of futsal players’ initial physical condition on the occurrence of injuriesPublication . Rebelo, Miguel; Marques, Catarina; Crisóstomo, Rute; Batista, Marco; Paulo, Rui; Rocha, João; Serrano, JoãoAlthough there are some studies that have linked fitness parameters and sports injuries, the literature remains controversial. The aim of the study was to prospectively analyze the influence of initial physical condition parameters on the development of injury in the first three months of the sports season in futsal players. A total of 68 players (24.26±4.63 years old) were assessed before the start of the sports season in relation to certain physical condition parameters, such as body composition (bioimpedance), lower limb power (countermovement jump, CMJ) and muscle strength (isokinetic dynamometer). The injured players showed significantly worse initial performance in the CMJ compared to the uninjured players (p<0.001). There were no significant differences between groups in body composition and muscle strength. Lower power values were associated with a higher risk of injury in the first few months of the sports season (OR=0.92; 95% CI=0.88-0.99). Muscle power was an independent predictor of injury in the first few months of the sports season in futsal players, indicating that improving players' physical condition could help reduce the number of injuries.