Key Messages for a Frailty Prevention and Management Policy in Europe from the ADVANTAGE JOINT ACTION Consortium.

In the 2015 Ageing Report, the European Commission (EC) and the Economic Policy Committee stated that coping with the challenge posed by an ageing population will require determined policy action in Europe, particularly in reforming pension, health care and long-term care systems. The concern for this situation motivated the EC, the Parliament and many of the Member States (MS) to co-fund, in the 2015 call of the Third European Health Programme of the European Union 2014-2020, the first Joint Action (JA) on the prevention of frailty. ADVANTAGE JA brings together 33 partners from 22 MSs for 3 years. It aims to build a common understanding on frailty to be used in the MSs by policy makers and other stakeholders involved in the management, both at individual and population level, of older people who are frail or at risk for developing frailty throughout the European Union (EU). It is a formidable challenge but also a great opportunity for concerted action resulting in fostering effective and successful policies in frailty prevention and management in the participating MS. The Consortium has 2 years of hard work ahead to contribute to the needed change for frailty related disability free Europe. The first practical step towards this aim was the preparation of a document: the State of the Art on Frailty Report to support an overview of evidence of what works and what does not work on frailty prevention and management. Subsequently, this will be reflected in the advice that the JA will give to policy makers at MS level. Overall, these messages intend to be an instrument of added value to advocate for policy driven decisions on frailty prevention and management in the JA participating MSs and subsequently towards a frailty related disability free older population in Europe. The aim of this paper is to describe ADVANTAGE JA general structure, approach and recommendations towards a European health and social policy which will support frailty prevention in the participating MS.

[Percutaneous closure of patent ductus arteriosus with the Rashkind device]. / Encerramento do canal arterial por via percutânea com o dispositivo de Rashkind.

PURPOSE: To assess the efficacy and safety of the percutaneous closure of the persistent ductus arteriosus with the Rashkind device. DESIGN: Clinical, angiographic and echocardiographic assessment of the patency of the ductus arteriosus at the time of the implantation of the first or second Rashkind device, followed by clinical and echocardiographic control at one, three and six months and yearly thereafter. PATIENTS: Thirty two patients with patent ductus arteriosus. Twenty seven were female and five male. Their ages ranged between 10 months and 33 years (6.8 +/- 7.7 years) and their weights between 7.3 and 52 (20.1 +/- 12.4) kg. Two patients were excluded due to a ductal diameter greater than 8 mm. Thirty patients had successful device implantation. METHODS: Implantation at cardiac catheterization of the Rashkind double umbrella occluder device in the narrowest portion of the patent ductus arteriosus. Twenty one patients had one device implanted and five had the implantation of a second device four to 12 months later, due to persistent patency of the ductus. RESULTS: Total closure was achieved in 26 out of 30 patients. In 21 patients the occlusion was obtained with a single device and in five patients with two devices. Among the remaining four patients, one is awaiting the implantation of a second device and the other three are under follow-up as their first devices were implanted recently. There were no complications. CONCLUSIONS: Percutaneous closure of the ductus arteriosus with the Rashkind device represents an efficient and safe alternative to surgery in most patients.

[Permanent pacing in childhood: a review of 11 years of experience]. / Pacing permanente em idades pediátricas: revisão de uma experiência de 11 anos.

STUDY OBJECTIVE: To review our eleven year experience in the implantation and follow-up of permanent Pacemakers in the paediatric age group. DESIGN: Retrospective study. SETTING: Children submitted to permanent cardiac Pacing implantation and accompanied in the Pacing Center of the Hospital de Santa Maria. PATIENTS: Children from both sexes, aged from neonate to 14 years old, with brady-dysrhythmia and indication for permanent cardiac Pacing implantation. MATERIAL AND METHODS: From November 1980 to September 1991, 16 children had permanent Pacemaker implantation. We describe the clinical and electrocardiographic characteristics of the population, mode of Pacing used, technical data from the implantation and evolution. RESULTS: One children died due to associated cardiac defect not related to the Pacemaker. The other 15 children remain in follow-up with normofunctioning Pacemakers and free of symptoms. We had to perform 11 reinterventions in 8 children due to generator or electrode problems (28,2 months reintervention interval). CONCLUSIONS: Improvements in Pacemaker technology and a careful technique of implantation can significantly reduce the morbidity associated to permanent pacemaker implantation in this age group.

[Lymphangioma of the mediastinum as a cause of chylopericardium]. / Linfangioma mediastínico como causa de quilopericárdio.

Chylopericardium is a rare from of pericardial effusion. A case of a ten-year-old female patient with a chylopericardium incidentally detected during a mild respiratory infection through cardiac enlargement at the chest X ray is reported. The techniques used to achieve this diagnosis are described, a special emphasis being put on the CT-scan and lymphangiography, which have not been used in such cases so far. These techniques provided very useful data which were determinant for the success of the proposed therapy. This and other cases reported in the paper indicate that the most common cause of primary chylopericardium is a mediastinal lymphangioma.

[Aortic valve stenosis without apparent "gradient". Demonstration and treatment in heart catheterization]. / Estenose valvular aórtica sem "gradiente" aparente. Demonstração e tratamento no cateterismo cardíaco.

The case of a six years-old girl with Ductus Arterious, Pulmonary Hypertension, Aortic Stenosis and poor left ventricular function is presented. No aortic valvular gradient could be found on a simple aortic and left ventricular pressure measurement, but it could be recorded when transvalvular aortic flow was increased while the Ductus Arteriosus was occluded with a balloon. This manoeuver forced an increase in pulmonary blood flow by avoiding right-to-left ductal shunting, thus increasing the venous return to the left heart and across the aortic valve. The aortic valve stenosis was subsequently relieved by percutaneous balloon valvuloplasty performed in two separate instances. This was thought to be particularly indicated in this case, considering the high risks of open-heart surgery.

[Atresia of the common pulmonary vein]. / Atrésia da veia pulmonar comum.

A case of common pulmonary vein atresia is presented, in which all pulmonary veins drain into a venous confluence without outlet. The criteria helpful in differentiating this condition from other forms of anomalous pulmonary disease in the neonatal period are discussed.