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Browsing by Author "Cardoso, J."

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  • Centro de Atendimento a Jovens no Centro de Saúde – Casuística de Nove Anos
    Publication . Cardoso, J.; Dinis, M.J.; Leite, M.J.; Rocha, C.; Pereira, I.; Pinto, M.E.; Santos, H.
    RESUMO Introdução e objectivos: Os Centros de Atendimento a Jovens (CAJ) foram criados com o objectivo de suprir uma lacuna na relação, em termos de saúde, com os jovens portugueses. O objectivo deste estudo foi analisar as características dos utentes do CAJ e o tipo de utilização dos serviços de saúde. Material e métodos: Foi realizado um estudo retrospectivo descritivo dos registos do CAJ num Centro de Saúde do Norte de Portugal nos anos de 2000 a 2008, avaliando variáveis epidemiológicas e de utilização do centro. Resultados: Entre 2000-2008 realizaram-se 2024 primeiras e 10889 segundas consultas; as consultas a jovens do sexo feminino quintuplicaram de 2000 para 2004, tendo-se mantido estáveis para o sexo feminino de 2005 a 2008 e para o sexo masculino de 2000 a 2008. Os principais motivos de recurso ao CAJ foram o início e manutenção da contracepção (47 a 63%), informação geral e sobre sexualidade (19 a 48%). A contracepção de emergência, disponível desde 2002, foi dispensada nesta consulta a 168 utentes até ao ano de 2008. Nos anos analisados, verificou-se que 68% das utentes que recorreram à contracepção de emergência tinham acompanhamento habitual pelo seu médico de família ou no CAJ; a sua necessidade deveu-se, em cerca de 51% dos casos, a relação sexual não protegida e nos restantes 49% a falência do método contraceptivo. Conclusão: A utilização do CAJ tem aumentado ao longo dos anos. A vertente de planeamento familiar foi a mais procurada. O início da vida sexual já tinha ocorrido na maioria dos casos antes do recurso à consulta, e de uma forma desprotegida numa proporção preocupante. O escasso número de rapazes foi sugestivo de uma atitude de desresponsabilização masculina relativamente à contracepção. ABSTRACT Introduction and aim: The youth clinics (YC) were created to promote an age oriented health care services. The objective of this study was to characterize the population attending an YC and the type of utilization of the health care services. Methods: Retrospective descriptive study of a Health Care Center YC in Northern Portugal, between the years 2000 and 2008, with analysis of epidemiologic and utilization characteristics of its population. Results: Between 2000 and 2008 we had 2024 first and 10889 subsequent appointments; consultations for females increased five times between 2000-2004, becoming stable thereafter; the number of consultations for males was similar each year. The main reasons to attend an YC were the start and maintenance of contraception (47-63%) and to get general health and sexuality-related information (19-48%). Emergency contraception, available since 2002, was given to 168 women until 2008; 68% of them had regular medical follow-up at her family doctor or at YC; this method was searched because of previous unprotected sexual intercourse (51%) or failure of the contraceptive method used during the intercourse (49%). Conclusions: YC utilization has been growing up steadily. Contraception search was the main appointment reason. Sex life had already started before the first appointment in most cases, and with no kind of protection in considerable number of users. The small number of males attending YC might be regarded as a non-responsible attitude towards contraception.
    2009-12Journal article Open access Show more
  • Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts
    Publication . Jácome, C.; Pereira, A.; Almeida, R.; Ferreira-Magalhães, Manuel; Couto, M.; Araujo, L.; Pereira, M.; Correia, M.; Loureiro, C.; Catarata, M.; Maia Santos, L.; Pereira, J.; Ramos, B.; Lopes, C.; Mendes, A.; Cidrais Rodrigues, J.; Oliveira, G.; Aguiar, A.; Afonso, I.; Carvalho, J.; Arrobas, A.; Coutinho Costa, J.; Dias, J.; Todo Bom, A.; Azevedo, J.; Ribeiro, C.; Alves, M.; Leiria Pinto, P.; Neuparth, N.; Palhinha, A.; Gaspar Marques, J.; Pinto, N.; Martins, P.; Todo Bom, F.; Alvarenga Santos, M.; Gomes Costa, A.; Silva Neto, A.; Santalha, M.; Lozoya, C.; Santos, N.; Silva, D.; Vasconcelos, M.; Taborda-Barata, L.; Carvalhal, C.; Teixeira, M.; Alves, R.; Moreira, A.; Sofia Pinto, C.; Morais Silva, P.; Alves, C.; Câmara, R.; Coelho, D.; Bordalo, D.; Fernandes, R.; Ferreira, R.; Menezes, F.; Gomes, R.; Calix, M.; Marques, A.; Cardoso, J.; Emiliano, M.; Gerardo, R.; Nunes, C.; Câmara, R.; Ferreira, J.; Carvalho, A.; Freitas, P.; Correia, R.; Fonseca, J.
    Objective: We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. Design: Baseline data from two prospective multicentre observational studies. Setting: 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. Participants: 395 patients (≥13 years old) with persistent asthma. Measures: Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. Results: High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%). Conclusion: Although both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.
    2019-11-07Journal article Open access Show more
  • Tumor carcinóide brônquico: uma imagem que persiste…?
    Publication . Pinho, L.; Oliveira, S.; Cardoso, J.; Santos, L.; Franco, C.; Coelho, E.
    RESUMO Introdução: O tumor carcinóide brônquico é raro, mas constitui a neoplasia maligna pulmonar primária mais frequente na idade pediátrica. Tem como principal forma de apresentação clínica a pneumonia recorrente na mesma localização, sendo diagnosticado mais frequentemente na adolescência tardia. O único tratamento potencialmente curativo é cirúrgico e o prognóstico é muito variável. Caso clínico: Os autores apresentam o caso clínico de um adolescente de 16 anos com história de dois episódios de pneumonia na mesma localização em menos de um ano cuja investigação revelou um tumor carcinóide brônquico. Foi submetido a excisão cirúrgica, com evolução favorável. Conclusão: Na abordagem da pneumonia recorrente na mesma localização os tumores endobrônquicos nomeadamente os carcinóides devem ser equacionados, sendo importante um elevado índice de suspeição para o diagnóstico atempado. ABSTRACT Introduction: Although rare, bronchial carcinoid tumor is the most common malignant pulmonary neoplasm in pediatric patients. Recurrent pneumonia in the same pulmonary segment or lobe is the main form of clinical presentation, typically in late adolescence. Surgery is the mainstay of treatment and prognosis is highly variable. Case report: The authors report the case of a sixteen year old boy with a history of two episodes of pneumonia in the same location within less than one year whose investigation revealed a bronchial carcinoid tumor. He underwent surgical excision, with favorable outcome. Conclusion: Endobronchial tumors including carcinoids should be addressed in the approach of recurrent pneumonia in the same location. A high index of suspicion is important for timely diagnosis.
    2012-12Journal article Open access Show more