Suicide time-series structural change analysis in Portugal (1913-2018): Impact of register bias on suicide trends.

BACKGROUND: Suicide is a potentially preventable cause of death. Epidemiology might help to identify death determinants and to monitor prevention strategies. Few studies address secular trends in suicide deaths, and even fewer describe trend-changes in relation to data collection/registration bias. Moreover, suicide is admittedly underreported. It is crucial to validate results in the context of other external causes of death trends, such as unintentional and undetermined intent deaths. We aimed to explore trends in suicide and other external causes of death in Portugal from the inception of registries until 2018, considering breaks in series. METHODS: We collected data from all available official primary sources. We calculated cause-specific age-standardized death rates (SDR) by sex for ages equal or higher than 15 years with reference to the European Standard Population. We considered suicide (S), undetermined intent deaths (UnD), accidents (Accs), and all causes of death (ttMty). A time-series structural analysis was executed. RESULTS: Suicide and other external causes of death rates were consistently higher in males than females. A global decline of deaths by suicide, undetermined intention and unintentional is observable. Breakpoints in years 1930, 1954, 1982, 2000-2001 were associated with major changes in deaths registration procedures or methodology. CONCLUSIONS: The epidemiology of suicide in Portugal has changed over 106 years. However, adjusted data and consideration of bias reduce trends fluctuation. Trend changes are akin to specific changes in methodology of death registry. Suicide surveillance will improve with more reliable and stable procedures.

Higher Autistic Traits Among Criminals, But No Link to Psychopathy: Findings from a High-Security Prison in Portugal.

The relationship between autism, criminality and psychopathy has gained increased attention in recent years, although research has focused on autism spectrum disorders, and not autistic traits. We measured autistic traits (with the Autism Spectrum Quotient) in a sample of 101 inmates from a high-security prison and compared them to a control group, using a logistic regression model that included age, education, psychopathology, psychopathy and attention deficit-hyperactivity disorder as covariates. Prisoners had more autistic traits (OR 1.13, p = 0.002) due to higher scores in the communication (OR 1.23) and imagination (OR 1.30) domains. No correlations were found between autistic and psychopathic traits. Our study points to the presence of autistic traits as being independent risk factors for imprisonment, although not associated with psychopathy.

[Satisfação com o Internato Médico em Portugal]. / Satisfação com o Internato Médico em Portugal.

INTRODUCTION: In the last years, the global context of medical education and Medical Residency programs in Portugal suffered substantial changes. The primary objective of this study was to evaluate and characterize medical residents ́ satisfaction with medical residency programs in Portugal and to identify features that could be improved. MATERIAL AND METHODS: We utilized as model the survey Postgraduate Hospital Educational Environment Measure that has been developed in the United Kingdom and is speci cally targeted to medical residents. The survey was translated and adapted to the Portuguese reality. The survey was available online during April and May of 2016. RESULTS: A total of 3456 responses were obtained, corresponding to a response rate of 35%. Endocrinology/Nutrition, Cardiology, Anesthesiology, Family Physician and Gastroenterology were the specialties in which the degree of satisfaction was higher, while Forensic Medicine, Medical Oncology, Internal Medicine, General Surgery and Pneumology showed the lowest level of satisfaction. DISCUSSION: This study presented a high response rate when compared to previous studies. Portuguese medical residents presented high levels of satisfaction. Depending on year of medical residency, region, type of specialty and type of hospital marked asymmetries were noticed. CONCLUSION: The survey ́s results should constitute in the future a support tool for the implementation of local and national measures relating to the medical residency. It is advisable to regularly conduct satisfaction surveys to medical residents.

Introdução: Nos últimos anos, o contexto global da formação médica, e em particular do Internato Médico em Portugal, sofreu profundas alterações. O presente estudo teve como objetivo avaliar e caracterizar a satisfação dos médicos internos com a realização do Internato Médico em Portugal e identificar aspetos passíveis de melhoria.Material e Métodos: Foi utilizado como modelo de inquérito o questionário Postgraduate Hospital Educational Environment Measuredesenvolvido no Reino Unido e dirigido a médicos internos, o qual foi traduzido e adaptado à realidade portuguesa. O questionário esteve disponível online durante os meses de abril e maio de 2016.Resultados: Foram obtidas 3456 respostas, correspondendo a uma taxa de resposta de 35%. Endocrinologia/Nutrição, Cardiologia, Anestesiologia, Medicina Geral e Familiar e Gastrenterologia foram as especialidades nas quais o grau de satisfação foi mais elevado,enquanto que Medicina Legal, Oncologia Médica, Medicina Interna, Cirurgia Geral e Pneumologia apresentaram o grau de satisfaçãomais baixo.Discussão: O presente estudo apresenta uma elevada taxa de resposta comparativamente com estudos prévios. A nível nacional, no global, os médicos internos apresentaram níveis elevados de satisfação, destacando-se marcadas assimetrias de acordo com o ano de especialidade, região, tipologia de instituição e de especialidade.Conclusão: Os resultados deste inquérito poderão constituir uma ferramenta de apoio à implementação de medidas de âmbito local enacional relacionadas com o Internato Médico, sendo desejável a realização regular de inquéritos de satisfação aos médico internos.

Nitric oxide production and nitric oxide synthase expression in platelets from heroin abusers before and after ultrarapid detoxification.

Prolonged heroin abuse has been associated with neurotoxicity. Thus, the involvement of nitric oxide (NO) in heroin-induced dopaminergic neurotoxicity could be a reasonable explanation for heroin-induced changes in brain. Enzymatically derived NO has been implicated in numerous physiological and pathological processes in the brain. Whereas during development NO participates in growing and maturation processes, excess NO production in the adult in response to inflammation, injury, or trauma, participates in both cell death and repair. The expression and activity of the inducible isoform of NO synthase (iNOS) play a pivotal role in sustained and elevated NO release. Recent evidence suggests that neurons can respond to proinflammatory stimuli and take part in brain inflammation. The effect of heroin abuse on platelet NO production and on expression of iNOS in drug addicts submitted to an ultrarapid detoxification was studied. The NO production was estimated from the nitrite concentration, and nitric oxide synthase was determined by Western blotting analysis. Results showed no difference in nitrite content of resting platelets between heroin abuser and control groups. However, after platelet stimulation, heroin abusers showed significantly lower nitrite values. The Western blotting analysis reinforced these results. After ultrarapid detoxification, platelet nitrite production in heroin abusers showed no differences compared to control subjects. Our results suggest that heroin consumption decreases the iNOS synthase expression and platelet NO production. Detoxification treatment restores these changes.