Strategic Communication for Local Public Health Services in Portugal: A Delphi Study.

INTRODUCTION: Strategic communication plays a decisive role in public health planning and project implementation. However, Portuguese Local Public Health Units, which are responsible for community interventions, still lack guidance models, tools, specialized resources, and training in health communication. The aim of this study was to develop a conceptual model of strategic organizational communication for local public health services, in Portugal. METHODS: This study presents a conceptual model of strategic organizational communication for Local Public Health Units, which was developed through a three-round, modified Delphi online panel. Thirty-seven Portuguese specialists in public health, communication, and community members were invited to analyse a proposed framework, based on an up-to-date literature review. High retention rates were observed in all rounds (first = 22 valid participations; second = 21 valid participations; third = 18 valid participations). RESULTS: Most participants believed that Portuguese Public Health Units were not prepared to communicate effectively and that they would benefit from adequate planning and identification of a communication lead or team. Websites and social media were also identified as essential for effective communication. The validated conceptual model integrated different partners in health and in the community, with emphasis on the relationships with the national network of health authorities, other Public Health Units, primary health care units, municipalities, and schools. The preferred channels identified for communicating with these partners included interpersonal relationships, email, and mobile phone. No consensus was obtained for preferred communication channels between Local Public Health Units and the media. CONCLUSION: Strategic planning based on the proposed conceptual model involving different stakeholders, has potential to improve the effectiveness of internal and external communication and facilitate the implementation of public health programs and projects. The proposed model needs to be validated in Local Public Health Units, considering the potential human, material, and financial constraints.

Salvage cryotherapy for prostate cancer.

BACKGROUND: Most men diagnosed with prostate cancer will be candidates for active treatment and 20 to 50% of patients treated with organ preserving strategies recur within the prostate. Optimal treatment of recurrence is controversial. Prostate cryosurgery has been increasingly used as primary, recurrence and focal treatment for prostate cancer. METHODS: We analysed 55 patients submitted to cryotherapy as salvage treatment after recurrence. RESULTS: Study population presented with a mean age of 70.9 ± 6.2 years, mean initial PSA of 7.6 ng/ml and average prostate volume by ultrasound of 43.2 ± 14.7 grams. Mean follow-up was of 18.0 months. Biochemical free survival at one year of follow-up was of 85%. CONCLUSIONS: Cryotherapy can be an effective and safe treatment for recurrence after primary curative treatment failure.

Predictive factors for successful testicular biopsy.

INTRODUCTION: Infertility, the inability to conceive, constitutes a major problem in modern societies. It affects 10 to 15 percent of couples in the United States. Evaluation of infertile men is usually complex and often demands a testicular biopsy. MATERIALS AND METHODS: We reviewed all azoospermic men submitted to testicular biopsy, in our center, during infertility investigation between January 2015 and December 2021. RESULTS: A total of 117 patients with a mean age of 36.5 was considered. Biopsy was positive, as defined by the presence of viable spermatozoids by microscopy, in 48.7% of patients (n = 57). Patients were divided in two separate groups based on positive (PB) or negative biopsy (NB) and compared. PB-group had normal serum total testosterone levels and higher than NB-group (3.7 ng/mL vs. 2.85 ng/mL, p = 0.021), and normal serum FSH levels and lower than NB-group (6.0 mIU/mL vs. 16.0 mIU/mL, p < 0.001). The groups were similar concerning serum LH levels (3.9 mIU/mL vs. 6.3 mIU/mL, p = 0.343. CONCLUSIONS: Predicting outcomes of testicular biopsy is a difficult task. Our study found that men with normal testicular volume, normal levels of testosterone and FSH and those with type 1 diabetes mellitus had a higher probability of positive testicular biopsy.

Comparison of inertial records during anticipatory postural adjustments obtained with devices of different masses.

Background: Step initiation involves anticipatory postural adjustments (APAs) that can be measured using inertial measurement units (IMUs) such as accelerometers. However, previous research has shown heterogeneity in terms of the population studied, sensors used, and methods employed. Validity against gold standard measurements was only found in some studies, and the weight of the sensors varied from 10 to 110 g. The weight of the device is a crucial factor to consider when assessing APAs, as APAs exhibit significantly lower magnitudes and are characterized by discrete oscillations in acceleration paths. Objective: This study aims to validate the performance of a commercially available ultra-light sensor weighing only 5.6 g compared to a 168-g smartphone for measuring APAs during step initiation, using a video capture kinematics system as the gold standard. The hypothesis is that APA oscillation measurements obtained with the ultra-light sensor will exhibit greater similarity to those acquired using video capture than those obtained using a smartphone. Materials and Methods: Twenty subjects were evaluated using a commercial lightweight MetaMotionC accelerometer, a smartphone and a system of cameras-kinematics with a reflective marker on lumbar vertebrae. The subjects initiated 10 trials of gait after a randomized command from the experimenter and APA variables were extracted: APAonset, APAamp, PEAKtime. A repeated measures ANOVA with post-hoc test analyzed the effect of device on APA measurements. Bland-Altman plots were used to evaluate agreement between MetaMotionC, smartphone, and kinematics measurements. Pearson's correlation coefficients were used to assess device correlation. Percentage error was calculated for each inertial sensor against kinematics. A paired Student's t-test compared th devices percentage error. Results: The study found no significant difference in temporal variables APAonset and PEAKtime between MetaMotionC, smartphone, and kinematic instruments, but a significant difference for variable APAamp, with MetaMotionC yielding smaller measurements. The MetaMotionC had a near-perfect correlation with kinematic data in APAonset and APAamp, while the smartphone had a very large correlation in APAamp and a near-perfect correlation in APAonset and PEAKtime. Bland-Altman plots showed non-significant bias between smartphone and kinematics for all variables, while there was a significant bias between MetaMotionC and kinematics for APAamp. The percentage of relative error was not significantly different between the smartphone and MetaMotionC. Conclusions: The temporal analysis can be assessed using ultralight sensors and smartphones, as MetaMotionC and smartphone-based measurements have been found to be valid compared to kinematics. However, caution should be exercised when using ultralight sensors for amplitude measurements, as additional research is necessary to determine their effectiveness in this regard.

Erectile function in amateur cyclists.

INTRODUCTION: Cycling is a popular means of transport and recreational activity; bicycles are also a source of genitourinary injuries and there is the idea that cycling may have a significant impact on sexual function. The objective of this study was to evaluate the effect of amateur cycling on erectile function. METHODS: We used a questionnaire comparing amateur cyclists (n = 199) and footballers (n = 43), regarding sexual related comorbidities and hours of practice per week. The cyclists were also characterized in terms of road vs cross-country, breaks during cycling, saddle, and shorts. To evaluate erectile function, the International Index of Erectile Function questionnaire was applied. RESULTS: there was no difference in International Index of Erectile Function total score between groups. Age and presence of erectile dysfunction associated comorbidity were negative factors in the International Index of Erectile Function score in cyclists but not in the footballers. CONCLUSIONS: Cycling is usually associated with perineal numbness, but that numbness did not lead to lower International Index of Erectile Function scores. In conclusion amateur cycling has no effect on EF.

Bladder tumour as a first manifestation of metastatic choroid melanoma.

Incidence of melanoma has been increasing, being able to metastasize to any organ with variable clinical presentation and evolution. We present the case of a patient with choroid melanoma metastasis to the bladder, managed by transurethral resection of the bladder with apparent full excision, additional investigation identified probable peritoneal and pulmonary metastases. Further exams revealed a stable pulmonary lesion and no peritoneal disease. Patient was proposed for surveillance. Treatment of metastatic melanoma is variable, some advocate metastasectomy for single metastasis, others systemic therapy or radiotherapy. Regardless of treatment options and new treatments the prognosis of metastatic disease is markedly unfavourable.

Using Digital Technologies in Response to the COVID-19 Pandemic in Portugal.

Digital technologies revolutionized the way we dealt with the COVID-19 pandemic and outstood the obvious societal change in the information age. Currently, data are an essential element of any health institution. Their use has the potential to radically reduce the cost and time needed to strengthen scientific evidence on the effectiveness of interventions. Likewise, information and the potential of these technologies have become a crucial part of the response to the pandemic. Effective implementation of data management strategies has depended on the adoption of digital technologies and their integration with health policies and care systems. In August 2020, Nature Medicine published an article about technological maturity and digital responses in the context of the COVID-19 pandemic. This paper aims to provide a contextualization of the technologies adopted in Portugal in the current crisis while highlighting, when applicable, requirements, potentials, constraints and aspects of possible improvements. The digital maturity of health services is a gradual process that requires preparation, adaptation and response. The future of public health and health care systems will be increasingly digital, and it is necessary to promote a culture of innovation, coordinate and standardize processes and make room for a new paradigm of sustainable digital transformation.

As tecnologias digitais revolucionaram a forma como lidamos com a pandemia da COVID-19, tornando-se evidente a mudança de toda a sociedade na era da informação. Atualmente, os dados são um elemento essencial de qualquer instituição de saúde. O seu uso tem o potencial de reduzir radicalmente o custo e o tempo necessários para fundamentar evidência científica sobre a eficácia das intervenções. Da mesma forma, a informação e potencial tecnológico tornaram-se parte crucial da resposta à pandemia e a implementação eficaz de estratégias de gestão de dados dependeu da adoção de tecnologias digitais e a sua integração com as políticas e cuidados de saúde. Em agosto de 2020, a Nature Medicine publicou um artigo sobre situação de maturidade tecnológica e respostas digitais no contexto da pandemia de COVID-19. Neste sentido, pretendemos contextualizar as tecnologias adoptadas em Portugal na situação de crise atual, realçando, quando aplicável, os requisitos, potenciais, constrangimentos e aspetos de possíveis melhorias. A maturidade digital envolve congruência, preparação, capacidade, infraestrutura e planeamento estratégico com foco nos resultados de saúde. O futuro da saúde pública, e dos sistemas e cuidados de saúde será cada vez mais digital, pelo que, é necessário promover uma cultura de inovação, com processos coordenados e padronizados e criando espaço para um novo paradigma de transformação digital sustentável. © 2022 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health.

Early morning kidney transplantation: Perioperative complications.

INTRODUCTION: To reduce cold ischemia time (CIT), many kidney transplants are performed in the early morning. Conducting complex surgeries in the early morning may influence the surgeon's technical capacity and rate of surgical complications (SC). AIM: Evaluate the influence of surgery start hour (SSH) regarding duration of surgery (DS), immediate diuresis (ID), SC and acute rejection (AR); evaluate the influence of CIT regarding SC, ID, and AR. METHODS: 2855 cadaveric transplants performed between June 1980 and March 2018 were retrospectively evaluated. Regarding SSH, two groups were created: Group M (00: 00h-05.59h, n = 253) and Group D (06: 00h - 23: 59h, n = 2602). Analyzing the impact of SSH on DS, ID, SC and AR. Evaluate the relationship between CIT (< 18h, 18-30h and > 30h) on ID, SC and AR utilizing univariate and multivariate statistical analysis with SPSS. RESULTS AND CONCLUSION: Groups M and D were comparable in all evaluated demographic variables (p > 0.05), except cold ischemia time (Group M with higher CIT, p < 0.001). Regarding univariate analysis, Surgery start hour did not influence DS (p = 0.344), and SC (p = 0.264), but related with higher ID (p = 0.028) and AR (p = 0.018). CIT related with immediate diuresis (p = 0.020) and acute rejection (p < 0.001) but did not relate with complications (p = 0.734). Regarding multivariate analysis, SSH only influenced immediate diuresis (p = 0.026) and did not influenced acute rejection (p = 0.055). CIT influenced immediate diuresis (p = 0.019) and acute rejection (p < 0.001). Surgery start hour influences Immediate diuresis. With this study, we conclude that the priority must be a short cold ischemia time.

Aptamer-based approaches to detect nucleolin in prostate cancer.

We have investigated the expression of nucleolin (NCL) in liquid biopsies of prostate cancer (PCa) patients and healthy controls to determine its correlation with tumor prognosis. To detect NCL we used a modified AS1411 aptamer designated by AS1411-N5. In presence of NCL, AS1411-N5 increases the fluorescence by assuming a G-quadruplex (G4) structure, while in the absence of NCL the fluorescence signal remains quenched. The structural characterization of AS1411-N5 was performed by biophysical studies, which demonstrated the formation of G4 parallel conformation in the presence of 100 mM K+ and the ability to recognize NCL with high affinity (KD = 138.1 ±â€¯5.5 nM). Furthermore, the clinical relevance of NCL in PCa liquid biopsies was assessed by using an NCL-based ELISA assay. The protein was measured in the peripheral blood mononuclear cells (PBMCs) cell lysate of 158 individuals, including PCa patients and healthy individuals. The results depicted a remarkable increase of NCL levels in the PBMC's lysate of PCa patients (mean of 626.1 pg/mL whole blood) when compared to healthy individuals (mean of 198.5 pg/mL whole blood). The ELISA results also provided evidence for the usefulness of determining NCL levels in advanced PCa stages. Furthermore, a microfluidic assay showed the ability of AS1411-N5 in recognizing NCL in spiked human plasma samples.

Giant Penis paraffinoma.

A fifty-year-old healthy, Portuguese male, with prior history of paraffin injections into the penis 30 years ago, was referred for urological consultation because of a large, hardened ulcerated mass on the base of the penis causing deformity and pain. The patient underwent a biopsy that showed a benign granulomatous lesion, and then excision of the mass and penile plasty with a scrotum flap in the same surgical time. Histology confirmed the diagnosis of paraffinoma. Three months after surgery, the patient is satisfied with the functional (urinary function and erectile function) and aesthetic results. Penile paraffinoma is a rare disease (most common in Asia and Eastern Europe) and results from an inflammatory response to the subcutaneous injection of paraffin, Vaseline or other mineral oils. Treatment is usually surgery.

Prognostic value of p16INK4a overexpression in penile cancer.

INTRODUCTION: Penile cancer is rare, accounting for less than 1% of all male cancers in industrialized countries. It is most common in areas of high prevalence of HPV, being a third of cases attributed to the carcinogenic effect of HPV. Tumour cells infected with HPV overexpress p16INK4a, as such p16INK4a has been used as a surrogate of HPV infections. OBJECTIVE: To evaluate the prognostic factor of p16INK4a overexpression in penile cancer. METHODS: Retrospective analysis of patients diagnosed with penile cancer, submitted to surgery in a Portuguese Oncological Institution in the last 20 years (n = 35). Histological review of surgical pieces and immunohistochemical identification of p16INK4a. Relation between p16INK4a and the following factors were studied: age, histological subtype, tumour dimensions, grade, TNM stage, perineural invasion, perivascular invasion, disease free survival (DFS) and cancer specific survival (CSS). RESULTS: p16INK4a was positive in 8 patients (22.9%). Identification of p16INK4a did not correlate with none of the histopathological factors. In this work we identified a better DFS and CSS in patients positive for p16INK4a (DFS at 36 months was 100.0% vs. 66.7%; CSS at 36 months was 100.0% vs. 70.4%), although without statistical significance (p > 0.05). In multivariate analysis of histopathological factors studied, only N staging correlated with DFS and CSS (p = 0.017 and p = 0.014, respectively). DISCUSSION: the percentage of cases positive for p16INK4a is smaller than the one found in literature, which can suggest a less relevant part of HPV infection in the oncogenesis of penile cancer in the studied population. Identification of p16INK4a did not relate with other clinicopathological factors. Tendency for a more favourable prognosis in patients with p16INK4a agrees with results found in literature. The most relevant factor for prognosis is nodal staging. CONCLUSIONS: penile cancer positive for p16INK4a shows a trend for better survival, although the most relevant factor is nodal staging.

Influence of sociodemographic factors on treatment's choice for localized prostate cancer in Portugal.

INTRODUCTION: Patients with localized prostate cancer (PCa) are active participants in the choice of treatment. OBJECTIVES: To access the effects of social and demographic factors in the choice of treatment in cases of localized PCa, in a Portuguese population. METHODS: Identification of all patients with the diagnosis of localized PCa in the last four years in an oncological centre. Evaluation of the effects of sociodemographic factors (age, profession, literacy, marital status, district and number of inhabitants of the place of residence) in the choice of treatment. RESULTS: 300 patients with localized PCa were evaluated: 17.3% (n = 52) opted for radical prostatectomy (RP); 39,3% had (n = 118) external radiotherapy; brachytherapy in 29.3% (n = 88) and other options (active surveillance, cryotherapy and hormonal therapy) in 14.1% (n = 42). In relation to surgical treatment (RP) the following results were obtained: a) > 70 years: 3.9% (n = 5); ≤ 70 years: 27.5% (n = 47), p < 0.001; b) primary sector: 10.3% (n = 3); secondary sector: 16.2% (n = 27); tertiary sector: 24.1% (n = 21); quaternary sector: 8.3% (n = 1), p = 0.296; c) marital status married: 17.9% (n = 47); single: 0% (n = 0); divorced: 25.0% (n = 5); widow: 0% (n = 0), p = 0.734; d) residency in a city: 14.1% (n = 13); city > 4000 habitants: 22.7% (n = 15); city ≤ 4000 habitants: 16.9% (n = 24), p = 0.701. Using multinomial regression with age (p = 0.001), district (p = 0.035), marital status (p = 0.027) and profession (0.179), this model explained 17.2%-28.4% of therapeutic choices (p < 0.001). CONCLUSIONS: The main socioeconomical factor that influence treatment choice was age. Unmarried patients over 70 years choose less radical prostatectomy. Other sociodemographic factors have minor influence in the choice of the treatment.

[Asthma Management and Control in Portuguese Speaking Countries]. / Gestão e Controlo da Asma em Países de Expressão Portuguesa.

INTRODUCTION: Asthma affects more than 339 million people worldwide. In the Community of Portuguese Speaking Countries, in 2016, its prevalence ranged from 9.5% (Portugal) to 3.91% (Brazil). Chronic disease management programs aim to improve the health status of patients with chronic disease and reduce associated costs. The objective of this study is to identify models of asthma asthma 'management and control' that are that are implemented in the Community of Portuguese Speaking Countries (CPLP), and analyse them through the integrated disease management model. MATERIAL AND METHODS: A rapid review of the PubMed indexed scientific literature and grey literature on 'management and control of asthma' in the countries of the Community of Portuguese-Speaking Countries was carried out. RESULTS: Portugal, Brazil and Mozambique presented publications on 'management and control of asthma', at different stages of implementation. Clinical management and organization and service delivery are the dimensions of integrated disease management most addressed in publications. DISCUSSION: The implementation of asthma management and control programs is influenced by health systems, care delivery structures, and the surrounding political and social environment. The dimensions of funding and information systems are the most difficult to implement given the degree of economic, social and technological development of most countries under study. CONCLUSION: Only Portugal, Brazil and Mozambique adopted asthma integrated disease management as the main form of asthma management and control. The programs developed by these countries can constitute a model for asthma integrated disease management in the other countries under study.

Introdução: A asma atinge mais de 339 milhões de pessoas mundialmente. Na Comunidade dos Países de Língua Portuguesa, em 2016, a sua prevalência variou entre 9,15% (Portugal) e 3,91% (Brasil). Os programas de gestão da doença crónica pretendem melhorar o estado de saúde de doentes com doença crónica e reduzir os custos associados. O objetivo deste estudo é identificar modelos de 'gestão e controlo da asma' implementados na Comunidade dos Países de Língua Portuguesa, analisando-os através do modelo de gestão integrada de doença.Material e Métodos: Realizou-se uma revisão rápida da literatura científica indexada na PubMed, e de literatura cinzenta sobre 'gestão e controlo da asma' nos países da Comunidade dos Países de Língua Portuguesa.Resultados: Portugal, Brasil e Moçambique apresentaram publicações sobre 'gestão e controlo da asma', em diferentes fases de implementação dos programas. A gestão clínica e organização e prestação de cuidados são as dimensões mais abordados nas publicações.Discussão: A implementação de programas de gestão e controlo da asma é influenciada pelos sistemas de saúde, estruturas de prestação de cuidados em que se inserem, meio político e social envolventes. As dimensões do financiamento e dos sistemas de informação são as mais difíceis de implementar, dado o desenvolvimento económico, social e tecnológico da maioria dos países em estudo.Conclusão: Apenas Portugal, Brasil e Moçambique adotaram a gestão integrada de doença da asma como principal forma de gestão e controlo da asma. Os programas desenvolvidos por estes países podem servir de modelo nos restantes países em estudo.

Lesion location agreement between prostatic multiparametric magnetic resonance, cognitive fusion biopsy and radical prostatectomy piece.

INTRODUCTION: Prostatic multiparametric magnetic resonance (mpMRI) allows for guided prostate biopsy (PB). OBJECTIVE: To evaluate localization agreement between mpMRI lesions and histology obtained by cognitive PB and radical prostatectomy (RP) surgical specimen (SS). METHODS: Out of 115 consecutive cognitive biopsied patients, 37 with positive PB were studied. Sample was characterized regarding age, prostatic volume, PI-RADS, location of lesion on mpMRI, lesion dimension, total number of fragments obtain by PB, number of fragments directed to the lesion, number of fragments with prostatic adenocarcinoma (PCa) and ISUP classification. The relationship between mpMRI and SS piece was analysed in 15 patients who underwent RP. RESULTS: Regarding agreement between mpMRI and PB, agreement of location was observed in 26 (70.3%); 7 (18.9%) presented PCa positive fragments in the suspected zone plus others in the same lobe; 3 (8.1%) in the suspected zone plus the contralateral lobe and 1 (2.7%) had no PCa in the suspected zone but had bilateral PCa. The total number of fragments with PCa was lower in cases with agreement between mpMRI and PB (p < 0.05). Regarding agreement between mpMRI and SS, 5 cases (33.3%) presented the same location as described by mpMRI, 5 (33.3%) showed ipsilateral lesions in other zones of the prostate; 4 (26.7%) presented extensive bilateral lesions on all prostate zones and 1 (6.7%) showed previously unknown contralateral lesions. None of the factors studied related mpMRI and RP (p > 0.05). CONCLUSIONS: Localization agreement of mpMRI vs PB and mpMRI vs SS was present in 26/37 (70.3%) and 5/15 (33.3%), respectively. That suggests the existence of other lesions (multifocality) not identified on mpMRI.

Intrascrotal lipoblastoma in adulthood.

This case report describes the case of a 37-year-old man that noticed an intrascrotal right mass with 1 month of evolution. During physical exam presented with a large mass at the inferior portion of the right testicle, clearly separated from the testicle, with a tender consistency and mobile. An ultrasound was performed that showed a solid and subcutaneous nodular lesion, extra testicular, heterogeneous, measuring 7.2 cm. Pelvic magnetic resonance imageMRI showed a lesion compatible with a lipoma. The patient was subjected to surgical excision of the lesion by scrotal access, having histology revealed a lipoblastoma (LB) of the scrotum. Histological diagnosis was obtained by microscopic characteristics (well-circumscribed fatty neoplasm) and immunohistochemistry (stains for CD34, S100 protein and PLAG1 were positive; stains for MDM2 and CDK4 were negative). LB is extremely rare after adolescence in any location, being this first described case of intrascrotal LB described in adulthood.

Premature Ejaculation: From Physiology to Treatment.

Objective: To review in literature about the concept of premature ejaculation from physiology to treatment. Materials and methods: A literature search conducted with Pubmed and Cochrane. Results: An accurate clinical history is the best diagnostic method, and in the majority of the cases it is enough to differentiate between primary and acquired premature ejaculation. Nowadays the treatment is not curative but is effective in increasing the Intravaginal Ejaculatory Latency Time, improving the couple's sexual satisfaction. Conclusion: Although PE is the most frequent sexual dysfunction, it is still sub-diagnosed. Combining behavioural techniques with pharmacotherapy is the best way of treatment.