Institute Medicina Preventiva

Lisbon, Portugal

Institute Medicina Preventiva

Lisbon, Portugal

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Pinto C.G.,Higher Institute of Management | Paquete A.T.,Research Center on the Portuguese economics | Pissarra I.,Institute Medicina Preventiva
European Journal of Health Economics | Year: 2010

Increasing diagnosis and deaths caused by colorectal cancer (CRC) warrant closer examination of affected patients and focus on management of CRC in Portugal. In order to assess the extent and quality of the information available in Portugal, we first analyse Portuguese cancer registries and then the management of CRC by discussing the diagnostic process and medical care provided, especially pharmaceuticals. Other cancer indications are mentioned in order to illustrate current approaches of cancer in Portugal. Current national data on cancer patients are scarce and there are divergencies in methods of data collection and treatment amongst regional cancer registries. However, the available data is sufficient enough to understand the dimension of CRC, with age-standardised incidence of 37 per 100,000 and mortality of 31 per 100,000 annually. An ongoing project is restructuring health services to improve efficiency and quality, however, some problems exist. The regional inequity of access to health care facilities and long waiting times for diagnostic examinations and surgery are major examples. Despite the non-availability of clinical guidelines, a pilot screening programme started at the beginning of 2009 in the Centre Region of the country. It is hoped that this overview will provide the basis for discussion on improvements in CRC management in Portugal and lead to better outcomes. © 2009 Springer-Verlag.


Cardoso S.,New University of Lisbon | Santos O.,Institute Medicina Preventiva | Nunes C.,New University of Lisbon | Loureiro I.,New University of Lisbon
Revista Portuguesa de Saude Publica | Year: 2015

Introduction There are several factors that can influence food choices. In children and youngsters, parents play an important role in the construction of food preferences. This influence is especially relevant in childhood but it seems to extend throughout adolescence. Objective to characterize the association between the household habits and the food choices of adolescents. Method This is a quantitative and qualitative study. In a first moment, data collection (quantitative) was made by the Eating Habits Scale (EHA). Students from two schools of Coimbra (10th to 12th grade) were asked to complete the EHA. Thus, it was possible to characterize adolescents according to adequacy of eating habits. Then, for the qualitative study, we selected the students according to the best (more appropriate habits) and the worst (bad habits) score EHA obtained. These adolescents were interviewed about their food preferences, including on food choice in different contexts (at home, in school and outside the home), household habits and reasons of the choices. Were also asked about perceptions of risk associated with eating habits, decision before the urge to eat and, finally, about the intentions of changing habits. A content analysis was made, using line-by-line coding method according to Charmaz and axial codification (using MaxQDA software). Results The census of students was invited to participate in the survey, reaching a sample size of 358 students, aged 14 to 18 (mean = 15.78, standard deviation = 1.05; 46.9% boys). The average score on itens of EHA (likert 1-5) was 3,434 (standard deviation 0.346) with mean between 2.15 and 4.3. Among the adolescents, the total score obtained in the EHA ranged between 86 and 172 (possible values between 0 and 200), with an average of 137.4 (standard deviation = 13.85). There were no significant different eating habits according to each age group or socioeconomic stratum, with the girls to take more appropriate food choices (higher scores EHA). The group of adolescents with proper habits (EHA average 3.75-4.3; EHA scores between 150 and 172), includes eleven students. The group of inadequate habits (EHA average 2.65-3.125; EHA scores between 106 and 125), includes 17 students. Adolescents with proper eating habits describe the parenting style as more interventionist than those reported by adolescents with bad habits. This parents' influence is operationalized in several ways: through authoritative style, through behavioral examples (by parents), and/or through negotiation or control of food availability at home. From content analysis we also infer that parents/families of adolescents with low scores in EHA tend to have unhealthy eating habits. Registration of feelings of well -being associated with dietary patterns is common among adolescents with proper habits; among adolescents with inadequate habits, we found conformity, without developing an active remediation attitude as, for example, initiative to change habits, even occasionally. The results point to the need for education interventions among youngsters with particular focus in developing appropriate household eating behaviors, in addition to educational interventions directed only to youngsters. © 2014 Escola Nacional de Saúde Pública.


Rocha T.,Institute Medicina Preventiva | Rocha E.,Institute Medicina Preventiva | Alves A.C.,Grupo de Investigacao Cardiovascular | Medeiros A.M.,Grupo de Investigacao Cardiovascular | And 5 more authors.
Revista Portuguesa de Cardiologia | Year: 2014

Introduction Disease prevention should begin in childhood and lifestyles are important risk determinants of cardiovascular disease. Awareness and monitoring of risk is essential in preventive strategies. Aim To characterize cardiovascular risk and the relationships between certain variables in adolescents. ;copy; 2013 Sociedade Portuguesa de Cardiologia.Methods In a cross-sectional study, 854 adolescent schoolchildren were surveyed, mean age 16.3±0.9 years. Data collection included questionnaires, physical examination, charts for 10-year relative risk of mortality, and biochemical assays. In the statistical analysis continuous variables were studied by the Student's t test and categorical variables by the chi-square test and Fisher's exact test, and each risk factor was entered as a dependent variable in logistic regression analysis.Results Physical activity was insufficient in 81% of students. The daily consumption of soup, salad or vegetables, and fruit was, respectively, 37%, 39% and 21%. A minority (6%) took 3 and 77% took ≥5 meals a day. The prevalence of each risk factor was as follows: overweight 16%; smoking 13%; hypertension 11%; impaired glucose metabolism 9%; hypertriglyceridemia 9%; and hypercholesterolemia 5%. Out-of-school physical activity, hypertension and overweight were more prevalent in males (p0.001). Females had higher levels of cholesterol (p0.005) and triglycerides (p0.001). A quarter of the adolescents had a relative risk score for 10-year cardiovascular mortality of ≥2. Overweight showed a positive association with blood pressure, changes in glucose metabolism and triglycerides, and a negative association with number of daily meals.Conclusions The results demonstrate the need for action in providing and encouraging healthy choices for adolescents, with an emphasis on behavioral and lifestyle changes aimed at individuals, families and communities.


Navarro-Costa P.,Institute Medicina Molecular | Navarro-Costa P.,Institute Histologia e Biologia Do Desenvolvimento | Navarro-Costa P.,Instituto Nacional Of Saude Dr Ricardo Jorge | Nogueira P.,Instituto Nacional Of Saude Dr Ricardo Jorge | And 7 more authors.
Human Reproduction | Year: 2010

BACKGROUND: Successful gametogenesis requires the establishment of an appropriate epigenetic state in developing germ cells. Nevertheless, an association between abnormal spermatogenesis and epigenetic disturbances in germline-specific genes remains to be demonstrated. METHODS: In this study, the DNA methylation pattern of the promoter CpG island (CGI) of two germline regulator genes - DAZL and DAZ, was characterized by bisulphite genomic sequencing in quality-fractioned ejaculated sperm populations from normozoospermic (NZ) and oligoasthenoteratozoospermic (OAT) men. RESULTS: OAT patients display increased methylation defects in the DAZL promoter CGI when compared with NZ controls. Such differences are recorded when analyzing sperm fractions enriched either in normal or defective germ cells (P< 0.001 in both cases). Significant differences in DNA methylation profiles are also observable when comparing the qualitatively distinct germ cell fractions inside the NZ and OAT groups (P= 0.003 and P= 0.007, respectively). Contrastingly, the unmethylation pattern of the DAZ promoter CGI remains correctly established in all experimental groups. CONCLUSIONS: An association between disrupted DNA methylation of a key spermatogenesis gene and abnormal human sperm is described here for the first time. These results suggest that incorrect epigenetic marks in germline genes may be correlated with male gametogenic defects. The Author 2010. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.2010This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2010 The Author. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.


Guerra F.,Institute Medicina Preventiva | Guerra F.,University Hospital Center | Paccaud F.,University Hospital Center | Marques-Vidal P.,University Hospital Center
European Journal of Clinical Nutrition | Year: 2012

Trends in food availability in Switzerland were assessed using the Food and Agricultural Organization food balance sheets for the period 1961-2007. A relatively stable trend in the daily caloric supply was found: 3545 kcal/day in 1961 and 3465 kcal/day in 2007. Calories associated with carbohydrates decreased (slope±s.e.:-1.1±0.2 kcal/day/year), namely regarding cereals (-2.9±0.6 kcal/day/year) and fruit (-1.5±0.1 kcal/day/year), while the availability of sugars increased (1.2±0.5 kcal/day/year). In 1961, protein, fat, carbohydrates and alcohol represented 10.6, 33.5, 50.0 and 5.9% of total caloric supply, respectively; in 2007, the values were 10.8, 40.3, 43.7 and 5.2%. In 1961, palm, groundnut and sunflowerseed oil represented 3.4, 30.7 and 5.3% of total vegetable oils, respectively; in 2007, the values were 10.4, 3.7 and 31.6%. We conclude that between 1961 and 2007 total caloric availability remained relatively stable in Switzerland; the health effects of the increased and differing fat availability should be evaluated. © 2012 Macmillan Publishers Limited. All rights reserved.


Introduction and Objectives: To estimate the cost-effectiveness and cost-utility of dabigatran in the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation in Portugal. Methodology: A Markov model was used to simulate patients' clinical course, estimating the occurrence of ischemic and hemorrhagic stroke, transient ischemic attack, systemic embolism, myocardial infarction, and intra- and extracranial hemorrhage. The clinical parameters are based on the results of the RE-LY trial, which compared dabigatran with warfarin, and on a meta-analysis that estimated the risk of each event in patients treated with aspirin or with no antithrombotic therapy. Results: Dabigatran provides an increase of 0.331 life years and 0.354 quality-adjusted life years for each patient. From a societal perspective, these clinical gains entail an additional expenditure of 2978 euros. Thus, the incremental cost is 9006 euros per life year gained and 8409 euros per quality-adjusted life year. Conclusions: The results show that dabigatran reduces the number of events, especially the most severe such as ischemic and hemorrhagic stroke, as well as their long-term sequelae. The expense of dabigatran is partially offset by lower event-related costs and by the fact that INR monitoring is unnecessary. It can thus be concluded that the use of dabigatran in clinical practice in Portugal is cost-effective. © 2013 Sociedade Portuguesa de Cardiologia. All rights reserved.


Oliveira M.,Centro Hospitalar Lisbon Central | Fernandes M.,Institute Medicina Preventiva | Primo J.,Centro Hospitalar Vila Nova Of Gaia | Reis H.,Centro Hospitalar Do Porto | Nicola P.,Institute Medicina Preventiva
Revista Portuguesa de Cardiologia | Year: 2013

With expanding indications for cardiac implantable electronic devices (CIEDs) capable of treating bradycardias, complex cardiac tachyarrhythmias and heart failure, the number of patients requiring regular long-term specialized care is growing rapidly. Currently, routine face-to-face follow-up consultations for patients with CIEDs are a significant burden on hospital services. Remote telemonitoring appears to offer a safe and effective alternative to conventional follow-up in this area. The Medtronic CareLink Network enables remote monitoring of CIED patients, and thus has the potential to improve the efficiency of medical care in this population. The objective of the PORTLink (PORTuguese Research on Telemonitoring with CareLink) multicenter randomized trial is to assess the safety, efficacy and costs of remote CIED monitoring compared to traditional face-to-face follow-up. It will evaluate aspects such as physicians' and patients' acceptance of and satisfaction with reviewing device data via the website, the complexity for troubleshooting calls to the support center, the use of emergency resources bysymptomatic patients, the incidence of unscheduled consultations after remote interrogations, levels of anxiety, depression and quality of life, and the main resources used by the CareLink sys-tem. Approximately 200 patients will be randomized in up to five centers, with clinical follow-up of 12 months. Enrollment began in 2012 and is expected to be completed in early 2014. © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved.


Peixoto C.,Institute Medicina Preventiva | Carrilho G.,Institute Medicina Preventiva | Alarcao V.,Institute Medicina Preventiva | Guerra F.,Institute Medicina Preventiva | And 7 more authors.
Acta Medica Portuguesa | Year: 2014

Introduction: Blood pressure is significantly improved with weight loss. Behavioral interventions for weight loss seem to be less successful in African immigrants. Our main aims were to assess the effect of a dietary and lifestyle intervention on weight among hypertensive Portuguese natives and immigrants and to identify success factors for weight loss, and also to evaluate changes in knowledge and compliance with food recommendations. Material and Methods: Hypertensive medicated patients followed in primary care setting were randomly enrolled in a two phase study, observational (15-months) and behavioral intervention (six months). Participants were divided in two groups: immigrants from African Countries of Portuguese Official Language and Portuguese natives. Participants were given dietary and life styles recommendations in individual face-to-face and telephone sessions. Results: Of 110 participants with a mean BMI of 31.6 ± 3.7 Kg/m2, 60 were immigrants. The number of dietary recommendations known and followed at the end was significantly greater than at baseline; however natives performed a greater number of recommendations. Weight loss during intervention was in average 1.4 ± 2.7% in natives and 0.8 ± 3.6% in immigrants and was greater than in the observational period. Being male and consuming more than 2 servings of low-fat dairy products/day was associated with higher weight loss, independently of age and ethnicity. Discussion: In general the proposed intervention was efficacious especially in Portuguese natives, confirming other studies. Conclusion: The intervention increased knowledge and adherence to recommendations, highlighting the relevance of nutrition education, culturally adapted in primary care. © Ordem dos Médicos 2014.


PubMed | Institute Medicina Preventiva, Centro Hospitalar Vila Nova Of Gaia, Centro Hospitalar do Porto and Centro Hospitalar Lisbon Central
Type: Comparative Study | Journal: Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology | Year: 2013

With expanding indications for cardiac implantable electronic devices (CIEDs) capable of treating bradycardias, complex cardiac tachyarrhythmias and heart failure, the number of patients requiring regular long-term specialized care is growing rapidly. Currently, routine face-to-face follow-up consultations for patients with CIEDs are a significant burden on hospital services. Remote telemonitoring appears to offer a safe and effective alternative to conventional follow-up in this area. The Medtronic CareLink Network enables remote monitoring of CIED patients, and thus has the potential to improve the efficiency of medical care in this population. The objective of the PORTLink (PORTuguese Research on Telemonitoring with CareLink) multicenter randomized trial is to assess the safety, efficacy and costs of remote CIED monitoring compared to traditional face-to-face follow-up. It will evaluate aspects such as physicians and patients acceptance of and satisfaction with reviewing device data via the website, the complexity for troubleshooting calls to the support center, the use of emergency resources by symptomatic patients, the incidence of unscheduled consultations after remote interrogations, levels of anxiety, depression and quality of life, and the main resources used by the CareLink system. Approximately 200 patients will be randomized in up to five centers, with clinical follow-up of 12 months. Enrollment began in 2012 and is expected to be completed in early 2014.


PubMed | Institute Medicina Preventiva
Type: Journal Article | Journal: European journal of clinical nutrition | Year: 2012

Trends in food availability in Switzerland were assessed using the Food and Agricultural Organization food balance sheets for the period 1961-2007. A relatively stable trend in the daily caloric supply was found: 3545kcal/day in 1961 and 3465kcal/day in 2007. Calories associated with carbohydrates decreased (slopes.e.: -1.10.2kcal/day/year), namely regarding cereals (-2.90.6kcal/day/year) and fruit (-1.50.1kcal/day/year), while the availability of sugars increased (1.20.5kcal/day/year). In 1961, protein, fat, carbohydrates and alcohol represented 10.6, 33.5, 50.0 and 5.9% of total caloric supply, respectively; in 2007, the values were 10.8, 40.3, 43.7 and 5.2%. In 1961, palm, groundnut and sunflowerseed oil represented 3.4, 30.7 and 5.3% of total vegetable oils, respectively; in 2007, the values were 10.4, 3.7 and 31.6%. We conclude that between 1961 and 2007 total caloric availability remained relatively stable in Switzerland; the health effects of the increased and differing fat availability should be evaluated.

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