A narrative exploratory study on the perspectives about physical exercise practise in a sample of Portuguese elderly.

The overall prevalence of inactivity among individuals aged 55 or older in Portugal is the highest in Europe therefore it's important to develop effective strategies to increase adherence to structured exercise programs by older adults (Picorelli et al., 2014a). The purpose of this paper is to characterise different perspectives on barriers and facilitators to the practise of physical exercise in a sample of the Portuguese elderly. Two groups of enrolled and non-enrolled in a community exercise program were recruited. Each group had 6 participants that were included in the study if they were ≥ 60 years of age. Two focus groups were conducted via Zoom and lasted ≤ 60 min. Participants were asked about five domains regarding physical exercise. Data analysis occurred in three phases by 2 trained and experienced examiners. While the enrolled group highlighted benefits (n = 6) and facilitators (n = 6), and shared strategies to overcome some barriers (n = 2) the non-enrolled group focused on the barriers (n = 6) instead and shared more excuses to justify their non-practice of physical exercise (n = 3). To overcome the barriers considered by the participants in the non-enrolled group, some education strategies focused on physical literacy might be crucial. The high number of barriers felt by the less active older people makes it more complicated for them to adopt and maintain an exercise program. Narratives-based methodologies are interesting methodologies to collect patient-centred perspectives about exercise practise and therefore design adequate programs.

Role of the Plastic Surgeon in Tuberculosis Treatment.

Background: Tuberculous empyema is rare. Its treatment requires oral antituberculous drugs, empyema drainage, and in severe cases, decortication and pneumectomy. In the presence of tuberculosis, lung resection has a high risk of postoperative bronchopleural fistula (BPF) and empyema. Treatment includes drainage, fistula occlusion, dead space obliteration, and infection control. Muscle flap transfer allows BPF occlusion and dead space obliteration. Methods: This report presents a case of a 63-year-old man with tuberculosis and postoperative BPF with empyema after pleural decortication and left lower lobe resection. The empyema was drained, and antituberculous drugs were started. The BPF was occluded with a latissimus dorsi and serratus anterior chimeric muscle flap, and the remaining thoracic dead space and chest wall defect were reconstructed with a pedicled pectoralis major myocutaneous flap. Results: Healing occurred uneventfully, and the patient was discharged from the hospital after 2 weeks. Conclusions: This type of thoracic defect is rare nowadays, especially in the setting of tuberculous infections. Although workhorse flaps like latissimus dorsi or pectoralis major flaps have been progressively surpassed by more elegant solutions like fasciocutaneous pedicled flaps and free flaps, they must still be considerations in the decision-making process of a reconstructive surgeon, and flap choice must be made on a case-by-case basis.

Necrotizing Fasciitis Caused by Photobacterium damselae: The First Case in Portugal.

Necrotizing fasciitis is a severe soft tissue infection with a high mortality rate and therefore requires emergent surgical treatment. Several microorganisms can cause this infection, Photobacterium damselae being one of them, with only eight cases previously published in the literature. We report the first ever case of necrotizing fasciitis, caused by this microorganism, in Portugal. In this case report the patient survived after several debridement procedures and reconstruction of the upper limb with acellular dermal matrix and skin graft. A brief review of the Photobacterium damselae soft tissue infection reports as well as the clinical presentation, diagnosis, pathophysiology and treatment of necrotizing fasciitis can also be found in this paper.

Analysis of #PlasticSurgery in Europe: An Opportunity for Education and Leadership.

BACKGROUND: Prior studies demonstrate that social media are used by plastic surgeons to educate and engage. The hashtag #PlasticSurgery has been studied previously and is embraced by American plastic surgeons and journals; however, no studies have examined its use or adoption across Europe. METHODS: A retrospective analysis of 800 tweets containing the words "plastic surgery" or the hashtag #PlasticSurgery in four of the most spoken European languages worldwide excluding English (Spanish, #CirugiaPlastica; French, #ChirurgiePlastique; Portuguese, #CirurgiaPlastica; and German, #PlastischeChirurgie) was performed. The following were assessed: identity of author, subject matter, use of the hashtag #PlasticSurgery in each language, whether posts by surgeons and academic institutions were self-promotional or educational, and whether a link to a journal article or a reference in PubMed was provided. RESULTS: Seventeen percent and 3 percent of analyzed tweets came from plastic surgeons or academic institutions, respectively; only 17.5 percent of them were for educational purpose. None of them had any digital link to a peer-reviewed article or a scientific journal. CONCLUSIONS: This study demonstrates the low participation of plastic surgeons and academic institutions in social media (especially for education) in four of the major world languages. Social media should be considered in Europe as an opportunity to increase leadership, improve education, and spread knowledge of plastic surgery by board-certified plastic surgeons.

Fatores de risco para câncer de mama e colorretal em população assistida por Equipe de Saúde da Família / Risk factors for breast and colorectal cancer in population assisted by Family Health Care

Objetivo: Descrever a frequência e a distribuição de alguns fatores de risco para o câncer colorretal e de mama, dentre adultos e idosos assistidos por uma Equipe de Saúde da Família (ESF). Métodos: Estudo descritivo realizado no município de Barra Funda, RS, com uma amostra não-probabilística de adultos e idosos assistidos pela ESF. A coleta de dados foi feita no período de março a outubro de 2016, através da aplicação de questionário pelas Agentes Comunitárias de Saúde (ACS), sendo analisados por meio de estatística descritiva. Resultados: Foram incluídos 540 participantes sendo os fatores de risco mais frequentes: uso de anticoncepcionais orais, idade, história familiar, obesidade, falta de atividade física, consumo de carnes (vermelha e processada) e de bebida alcoólica. Conclusões: Os resultados estão em conformidade com os altos índices dessas neoplasias no município e no estado, o que demonstra a necessidade da atuação da ESF na prevenção primária voltada, especialmente, aos fatores de risco modificáveis (AU)

Objective: To describe the frequency and distribution of some risk factors for colorectal and breast cancer among adults and the old-aged assisted by a Family Health Care. Methods: A cross-sectional study carried out in the city of Barra Funda, State of Rio Grande do Sul, Brazil, with a non-probabilistic sample of adults and old-aged people assisted by the Family Health Care. Data were collected from March to October 2016, through the application of a questionnaire by the Community Health Agents, and were analyzed by descriptive statistics. Results: 540 participants were included, with the most frequent risk factors being: oral contraceptive use, age, family history, obesity, lack of physical activity, meat consumption (red and processed) and alcoholic beverage. Conclusions: The results are in accordance with the high indexes of these neoplasms in the city and in the state, which demonstrates the need for the Family Health Care to perform primary prevention, especially for modifiable risk factors (AU)

Apoyo al automanejo de condiciones crónicas: un desafío de los sistemas de salud de América Latina / Support to Chronic Conditions Self-management: a Challenge of Health Systems in Latin America

El apoyo al automanejo de la condición crónica representa un pilar esencial en el tratamiento y seguimiento de las enfermedades crónicas no trasmisibles, sin embargo, su implementación efectiva implica varios desafíos. Los desafíos van desde la propia comprensión del término, su diferenciación de otras expresiones, la interiorización y aplicación de los componentes, dimensiones, costo, incentivos, formación, motivación, enfoques educativos, barreras de infraestructuras, etc. Se precisa intercambiar experiencias entre los países de la región, adaptando lo positivo y más apropiado del nivel mundial, al contexto cultural, socioeconómico y político de cada país, de una forma costo-efectiva, que garantice una atención de alta calidad al paciente y su familia. El objetivo del trabajo es exponer algunos de los retos que implica la implementación del apoyo al automanejo sobre todo desde la atención primaria, especialmente en la medicina familiar latinoamericana.

Support for the chronic condition self-management represents an essential basis treating and monitoring non-communicable chronic diseases, its effective implementation implies however, several challenges. The challenges range from the comprehension of the term, its differentiation from other expressions, the internalization and application of the components, dimensions, cost, incentives, training, motivation, educational approaches, infrastructure barriers, etc. It is necessary to exchange experiences among the countries of the region, adapting the positive and most appropriate worldwide, to the cultural, socioeconomic and political context of each country, in a cost-effective way, which guarantees a high-quality patient and family care. The objective of the paper is to present some of the challenges involved in self-management support implementation, especially from primary care, especially in Latin American family medicine.

Reconstruction of late esophagus perforation after anterior cervical spine fusion with an adipofascial anterolateral thigh free flap: A case report.

Reconstruction of late esophageal perforation usually requires flap surgery to achieve wound healing. However, restoring the continuity between the digestive tract and retropharyngeal space to allow for normal swallowing remains a technical challenge. In this report, we describe the use of a thin and pliable free adipofascial anterolateral thigh (ALT) flap in a 47-year-old tetraplegic man with a history of C5-C6 fracture presented with a large posterior esophagus wall perforation allowing an easier flap insetting for a successful wound closure. The postoperative course was uneventful and mucosalization of the flap was confirmed by esophagoscopy 4 weeks postsurgery. The patient tolerated normal diet and maintained normal swallowing during a follow-up of 3 years postoperatively. The adipofascial ALT flap may provide easier insetting due to the thin and pliable layer of adipofascial tissue for reconstructing large defects of the posterior wall of the esophagus by filling the retroesophageal space.