Recurrent Plunging Ranula Due to a Sublingual Ectopic Gland: A Rare Clinical Entity.

Ranula is a benign cystic lesion caused by the escape and collection of salivary mucus. Classically, it is divided into simple ranulas, a cystic mass in the floor of the mouth, and diving/plunging/cervical ranulas, a submandibular mass without apparent intraoral involvement. Although plunging ranula is a well-documented cause of neck swelling, its association with the presence of ectopic sublingual glands is extremely rare, with less than five cases reported. Other cervical cystic lesions may have the same clinical aspect; therefore, advanced diagnostic techniques like a CT scan or MRI play a critical role in early diagnosis. Different approaches have been used to treat ranulas, including non-invasive, minimally invasive, and surgical techniques. The purpose of this paper is to highlight a case report of a giant plunging ranula due to an anatomical aberration of the right sublingual gland, along with a significant literature review.

[Prevalence of Outpatient Use of Medicines by the Elderly Population in Portugal: A Cross-Sectional Study]. / Prevalência da Dispensa de Medicamentos em Ambulatório na População Idosa em Portugal: Um Estudo Transversal.

INTRODUCTION: Like in other countries, the age pyramid in Portugal has been changing considerably, with a substantial increase in the size of the older population and a significant reduction in the number of young people. With aging, co-occurrence of several conditions becomes frequent, often leading to the use of multiple medications (polypharmacy). Polypharmacy in the older population is particularly relevant considering the physiological changes of the ageing process, which increase the risk of drug interactions, poor adherence to treatment, and adverse drug reactions, especially in the oldest-old population (85 years or older). As the size of the older population is likely to increase significantly, it is important to characterize the pattern of medicines' use by the elderly while also identifying cases of polypharmacy in order to obtain evidence that can be used to develop specific measures to tackle the high prevalence of use and its associated risks. To this end, the aim of this study was to characterize medication use by older individuals in Portugal. METHODS: Cross-sectional study with data from the National Health System's Control and Monitoring Center on reimbursed medicines that were prescribed and dispensed to individuals aged 65 years or older in 2019 in all community pharmacies of the Portuguese mainland. We performed a demographic and geographic analysis of the data by international nonproprietary name and therapeutic group. The number of reimbursed packages and the number of reimbursed packages per capita were the metrics used (data from Instituto Nacional de Estatística). RESULTS: A higher consumption of medicines was observed in women, increasing with age, except in the oldest olds, in which the sex difference tended to shrink. Use per capita showed an opposite trend, with the oldest-old men surpassing the oldest-old women (mean reimbursed packages: 55.5 in men versus 55.1 in women). In women, consumption was led by cardiovascular medicines (31%), followed by central nervous system medications (30%) and antidiabetics (13%); in men, 37% of TOP 10 consumption was due to cardiovascular medications, antidiabetics (16%) and drugs for benign prostatic hypertrophy (14%). CONCLUSION: In the elderly, there were sex differences in the pattern of medicines' use, and there were also significant age-related differences in 2019. To the best of our knowledge, our study is the first nationwide analysis of reimbursed medicines' consumption data in the elderly, which is essential to characterize the use of medicines in this age group in Portugal.

Introdução: À semelhança de outros países, a pirâmide etária em Portugal tem sofrido alterações profundas, com um expressivo aumento na dimensão da população idosa. A multimorbilidade que surge com o envelhecimento leva, frequentemente, à utilização concomitante de vários medicamentos. A polimedicação é particularmente importante no idoso devido às alterações fisiológicas associadas ao processo de envelhecimento, que aumentam o risco de interações medicamentosas, de fraca adesão à terapêutica e de reações adversas à medicação, em particular nos indivíduos muito idosos (85 ou mais anos). Dado que a dimensão da população idosa poderá aumentar significativamente, importa caracterizar o padrão de consumo de medicamentos pelos idosos, identificando também os casos de polifarmácia, de forma a gerar-se evidência que permita o desenvolvimento de medidas específicas de combate à elevada prevalência de utilização e riscos associados. Assim, o objetivo desta análise preliminar foi determinar a prevalência e caracterizar do padrão de utilização de medicamentos pelos idosos em Portugal, desagregando por faixa etária, sexo e localização geográfica. Métodos: Estudo transversal com dados relativos aos medicamentos comparticipados e dispensados nas farmácias comunitárias de Portugal Continental em 2019, aos utentes com mais de 65 anos. Efetuou-se análise descritiva demográfica e geográfica, por denominação comum internacional e grupo terapêutico. A utilização foi estudada através do número de embalagens comparticipadas dispensadas e número de embalagens comparticipadas dispensadas per capita (dados do Instituto Nacional de Estatística). Resultados: Observou-se uma dispensa superior nas mulheres, a qual foi aumentando com a idade, à exceção dos idosos 85+, nos quais a diferença tendeu a diminuir. No que diz respeito ao número de embalagens comparticipadas dispensadas per capita, a tendência foi inversa, com os homens muito idosos a ultrapassarem as mulheres 85+ (média de embalagens: 55,5 nos homens versus 55,1 nas mulheres). Nas mulheres, os medicamentos mais consumidos foram os do foro cardiovascular (31%), seguidos dos prescritos para o sistema nervoso central (30%) e antidiabéticos (13%). Nos homens, o ranking foi liderado também pelos medicamentos para o aparelho cardiovascular (37%); contudo, em segundo lugar surgem os antidiabéticos (16%), seguidos dos medicamentos para a hiperplasia benigna da próstata (14%). Conclusão: Existiram diferenças de sexo e idade relevantes no padrão de dispensa de medicamentos comparticipados nos idosos portugueses em 2019. Esta é a primeira análise publicada de âmbito nacional à dispensa de medicamentos em idosos, sendo essencial para caracterizar o perfil de utilização de medicamentos pelos seniores em Portugal.

Hurler Syndrome: Orofacial Clinical Findings.

Hurler syndrome (HS) belongs to the category of mucopolysaccharidosis (MPS), a spectrum of rare genetic disorders of the mucopolysaccharides metabolism. This syndrome is due to a defect in α-iduronidase, an enzyme responsible for the degradation of the glycosaminoglycans (GAGs) heparin and dermatan sulfate. Intra and extracellular accumulation of these non-metabolized substances may lead to multisystemic dysfunction, with severe stomatognathic involvement that may often need treatment. The aim of this article is to present the heterogeneity of orofacial and radiographic findings observed in two patients with HS with long-term follow-up, who were referred to our Stomatology department.

[Validation of the European Portuguese Version of a Pediatric Palliative Needs Assessment Tool: The Pediatric Palliative Screening Scale]. / Validação da Versão Portuguesa de um Instrumento de Avaliação de Necessidades Paliativas Pediátricas: A Pediatric Palliative Screening Scale.

INTRODUCTION: The Pediatric Palliative Screening Scale (PaPaS Scale) was designed to help professionals to identify life-limiting or life-threatening children/young people with complex chronic conditions who would benefit from pediatric palliative care and facilitate their timely and appropriate referral. The aim of this study was to translate, culturally adapt and validate the PaPaS Scale for the Portuguese pediatric population. MATERIAL AND METHODS: A quantitative methodological study involving translation, cultural adaptation and validation of a scale was performed. In the first phase, the translation and cultural adaptation of the original version of the PaPaS Scale from English to European Portuguese was undertaken. The second phase consisted of evaluating the psychometric properties of the Portuguese version of the PaPaS Scale. RESULTS: Fifty-one enquires pertaining to children/young adults with complex chronic conditions were completed and returned, the sum of the responses to the items on the scale revealed that 84.4% of the patients had an indication for referral to pediatric palliative care. The internal consistency analysis obtained a value of Cronbach's alpha above 0.80, so the scale was considered adequate for the analyzed data. In our sample, the item-total correlation values indicated that the 11 variables measured the PaPaS Scale with good reliability and unidimensionally. The confirmatory factor analysis suggested that the items were significant, consistent, and presented convergent validity globally. Only item "2.2. Treatment side effects" obtained a value below the defined threshold. CONCLUSION: The PaPaS Scale was translated and adapted to the European Portuguese version, allowing its immediate use in the Portuguese population. It will be essential to design multicentric studies to expand the knowledge about the psychometric characteristics of this scale.

Introdução: A Pediatric Palliative Screening Scale (PaPaS Scale) foi desenhada para ajudar os profissionais a identificar as crianças/jovens com doença crónica complexa, limitante ou ameaçadora da vida que beneficiariam de cuidados paliativos pediátricos e facilitar referenciação atempada e apropriada. O objetivo deste estudo foi traduzir, adaptar culturalmente e validar a PaPaS Scale para a população pediátrica portuguesa. Material e Métodos: Realizou-se um estudo metodológico quantitativo de tradução, adaptação cultural e validação de uma escala. Numa primeira fase, procedeu-se à tradução e adaptação cultural da versão original da PaPaS Scale de inglês para português europeu. A segunda fase consistiu na avaliação das propriedades psicométricas da versão portuguesa da Escala PaPaS. Resultados: Numa amostra de 51 questionários referentes a crianças/jovens com doença crónica complexa, a soma das respostas aos itens da escala revelou que 84,4% dos doentes tinham indicação para ser referenciados aos cuidados paliativos pediátricos. Na análise de consistência interna obteve-se um valor do alfa de Cronbach superior a 0,80, pelo que se pôde considerar a escala como adequada aos dados analisados. De facto, os valores de correlação item-total indicaram que as 11 variáveis mediram com boa fiabilidade e de forma unidimensional a escala PaPaS. Na análise fatorial confirmatória, os resultados obtidos indicaram que globalmente os itens eram significativos, consistentes e apresentaram validade convergente. Apenas o item "2.2. Efeitos secundários do tratamento" obteve um valor abaixo do limiar definido. Conclusão: A PaPaS Scale foi traduzida e adaptada para a versão em português europeu, o que permite a sua utilização imediata na população portuguesa. Torna-se importante o desenho de estudos, preferencialmente multicêntricos, que aprofundem as características psicométricas desta escala.

Adolescent pregnancy in Sao Tome and Principe: a cross-sectional hospital-based study.

BACKGROUND: Pregnancy starts early in Sao Tome and Principe (STP) and rates of adolescent pregnancy increased 16% in recent years reaching a 27.3% prevalence. This study aimed to understand the pregnant adolescents' characteristics and factors associated to early childbearing in STP. METHODS: A cross-sectional hospital-based study was undertaken in Hospital Dr. Ayres de Menezes between 2016 and 2018 with a randomly selected total sample size of 518 mothers. Mothers' clinical records and interviews were used to collect relevant data. The results among adolescent girls 19 years of age and younger (n=104) were compared to adult mothers (n=414). A subgroup analysis of adolescent pregnant girls was also conducted. Statistically significance was considered at a p-value ≤0.05. Data were analysed using SPSS software. RESULTS: The study revealed that 20.1% were adolescent mothers. Pregnancy at a very early age (≤15) was experienced by 7.7%. The characteristics founded to be positively associated with adolescent pregnancy were: 1) being single (OR 0.39, 95% CI=0.2-0.6, p≤0.001); 2) having a relationship with the baby´s father for a period of less than one year (OR 0.16, 95% CI=0.09-0.3, p≤0.001); 3) lack of the baby´s father support (OR 0.41, 95% CI=0.2-0.7, p=0.002); 4) not using a contraceptive method (OR 0.33, 95% CI=0.2-0.5, p≤0.001), and 5) inappropriate knowledge concerning the identification of the newborn's danger signs (OR 15.7, 95% CI= 9-26, p≤0.001). Comparing pregnancy at very early age (≤15) to late (>18 and ≤19) adolescents, main differences were that previous contraceptives were not used at all in girls ≤15 years compared to 9.8% of late childbearing subgroup. CONCLUSIONS: Unfavourable factors linked to adolescent pregnancies were absence of a contraceptive method, getting pregnant in the early first months of one relationship and to be single. Gap age difference between adolescents' partners, polygamous sexual relationships, previous abortion and having already other living children were also identified. Adolescents also had inappropriate knowledge of the identification of the newborns' danger signs. Before being sexually active, adolescents critically need sexual and reproductive health information provided by a healthy community and through school programmes on sexual education. Schools should promote girl's empowerment and awareness and, at the same time, reinforce boy's role in fatherhood and shared responsibilities. The government should work on the prevention of early sexual initiation, as well as on improving family planning programmes to protect them from pregnancy with special focus for the very early adolescent girls. None of these goals can be achieved if the government doesn't, simultaneously, improve educational and economic opportunities for girls.

The Ethics of Taxing Sugar-Sweetened Beverages to Improve Public Health.

The World Health Organization highlights fiscal policies as priority interventions for the promotion of healthy eating in its Action Plan for the Prevention and Control of Non-communicable Diseases. The taxation of sugar sweetened beverages (SSBs) in particular is noted to be an effective measure, and SSBs taxes have already been implemented in several countries worldwide. However, although the evidence base suggests that this will be effective in helping to combat rising obesity rates, opponents of SSBs taxation argue that it is illiberal and paternalistic, and therefore should be avoided. Bioethical analysis may play an essential role in clarifying whether policymakers should adopt SSBs taxes as part of wider obesity strategy. In this article we argue that no single ethical theory can account for the complexities inherent in obesity prevention strategy, especially the liberal theories relied upon by opponents of SSBs taxation. We contend that a pluralist approach to the ethics of SSBs taxation must be adopted as the only suitable way of accounting for the multiple overlapping, and sometimes, conflicting factors that are relevant to determining the moral acceptability of such an intervention.

Relevancia a corto plazo de la coinfección viral en pacientes menores de 2 años hospitalizados con infecciones de las vías respiratorias inferiores / Short-term relevance of lower respiratory viral coinfection in inpatients under 2 years of age

Introducción: Avances en el diagnóstico molecular han hecho posible la detección de agentes virales desconocidos en infecciones de las vías respiratorias inferiores (IVRI). Sin embargo, sigue habiendo dudas relativamente a su frecuencia y relevancia. Objetivo: Comparar la clínica y la gravedad entre la infección por virus único y la coinfección en niños admitidos por IVRI. Métodos: Se realizó un estudio durante 3 años consecutivos (2012-2015) que incluyó a niños menores de 2 años ingresados por IVRI. La identificación viral se realizó mediante la técnica de PCR para 16 virus. Los datos clínicos y el uso de los recursos hospitalarios se recogieron de forma estándar durante la estancia hospitalaria y se compararon la infección única con coinfecciones virales. Resultados: Fueron analizadas 524 muestras (451 pacientes); 448 (85,5%) tuvieron al menos un virus identificado. Coinfecciones virales se encontraron en 159 (35,5%). RSV y HRV fueron los virus más frecuentes; bronquiolitis y neumonía, los diagnósticos principales. Los pacientes con coinfecciones virales eran mayores, iban a la guardería, tenían sibilancias recurrentes con más frecuencia y eran más sintomáticos al ingreso. No fueron sometidos a más exámenes, pero les fueron prescritos medicamentos con más frecuencia. El grupo de la coinfección viral no mostró una mayor duración de la estancia hospitalaria, de la necesidad de oxígeno, de UCI o soporte ventilatorio. Discusión: Nuestro estudio mostró una proporción significativa de coinfecciones virales en los niños pequeños ingresados con IVRI y confirma dados previos que muestran que la prescripción es más frecuente en las coinfecciones virales, sin asociación con peor resultado clínico (AU)

Introduction: Advances in molecular diagnosis have made it possible to detect previously unknown viral agents as causative agents of lower respiratory tract infections (LRTI). The frequency and relevance of viral coinfections is still debatable. Objective: compare clinical presentation and severity between single virus infection and viral coinfection in children admitted for LRTI. Methods: A 3-year period observational study (2012-2015) included children younger than two years admitted for LRTI. Viral identification was performed using PCR technique for 16 viruses. Clinical data and use of health resources was gathered during hospital stay using a standard collection form and we compared single virus infection and viral coinfections. Results: The study included 524 samples (451 patients); 448 (85,5%) had at least one virus identified. Viral coinfections were found in 159 (35,5%). RSV and HRV were the most commonly identified virus; bronchiolitis and pneumonia the most frequent diagnosis. Patients with viral coinfections were older, attended day-care centers, had previous recurrent wheezing more frequently and were more symptomatic at admission. These patients did not have more complementary exams performed but were prescribed medications more often. Viral coinfection group did not show longer length of hospital stay and oxygen need, more need for ICU nor ventilatory support. Discussion: Our study showed a significant proportion of viral coinfections in young infants admitted with LRTI and confirmed previous data showing that prescription was more frequent in inpatients with viral coinfections, without an association with worst clinical outcome (AU)

[Short-term relevance of lower respiratory viral coinfection in inpatients under 2 years of age]. / Relevancia a corto plazo de la coinfección viral en pacientes menores de 2 años hospitalizados con infecciones de las vías respiratorias inferiores.

INTRODUCTION: Advances in molecular diagnosis have made it possible to detect previously unknown viral agents as causative agents of lower respiratory tract infections (LRTI). The frequency and relevance of viral coinfections is still debatable. OBJECTIVE: compare clinical presentation and severity between single virus infection and viral coinfection in children admitted for LRTI. METHODS: A 3-year period observational study (2012-2015) included children younger than two years admitted for LRTI. Viral identification was performed using PCR technique for 16 viruses. Clinical data and use of health resources was gathered during hospital stay using a standard collection form and we compared single virus infection and viral coinfections. RESULTS: The study included 524 samples (451 patients); 448 (85,5%) had at least one virus identified. Viral coinfections were found in 159 (35,5%). RSV and HRV were the most commonly identified virus; bronchiolitis and pneumonia the most frequent diagnosis. Patients with viral coinfections were older, attended day-care centers, had previous recurrent wheezing more frequently and were more symptomatic at admission. These patients did not have more complementary exams performed but were prescribed medications more often. Viral coinfection group did not show longer length of hospital stay and oxygen need, more need for ICU nor ventilatory support. DISCUSSION: Our study showed a significant proportion of viral coinfections in young infants admitted with LRTI and confirmed previous data showing that prescription was more frequent in inpatients with viral coinfections, without an association with worst clinical outcome.

Psychosocial Profile in Portuguese Adolescents with Chronic Disease Attending an Outpatient Department in a Hospital Setting.

Living with a chronic disease (CD) in adolescence involves new multifaceted challenges. This study aims to conduct a psychosocial characterization of a group of adolescents with chronic diseases in a hospital setting and to compare such dimensions for the total group and for different diseases. A cross-sectional study included 135 adolescents with chronic diseases (51.9% boys; 48.1% girls), having an average age of 14±1.5 years (SD=1.5) and attending a paediatric outpatient department in a hospital setting. Statistically significant differences were found among the different chronic diseases for the variables self-regulation (adolescents with diabetes had significantly higher competencies) and multiple psychosomatic symptoms (adolescents with neurologic diseases reported significantly more complaints). Boys presented both better health-related quality of life and psychosomatic health when compared to girls. No statistically significant differences were observed for health-related quality of life, psychosomatic health, resilience, and social support. These findings bring important suggestions especially while planning interventions, which must take into account the promotion of a healthy psychosocial development, through an inclusive perspective (covering different chronic diseases), that take into consideration specific and gendered approaches. Such suggestions might help healthcare professionals to better plan interventions in order to increase their effectiveness.

Short-term relevance of lower respiratory viral coinfection in inpatients under 2 years of age.

INTRODUCTION: Advances in molecular diagnosis have made it possible to detect previously unknown viral agents as causative agents of lower respiratory tract infections (LRTI). The frequency and relevance of viral coinfections is still debatable. OBJECTIVE: Compare clinical presentation and severity between single virus infection and viral coinfection in children admitted for LRTI. METHODS: A 3-year period observational study (2012-2015) included children younger than two years admitted for LRTI. Viral identification was performed using PCR technique for 16 viruses. Clinical data and use of health resources was gathered during hospital stay using a standard collection form and we compared single virus infection and viral coinfections. RESULTS: The study included 524 samples (451 patients); 448 (85.5%) had at least one virus identified. Viral coinfections were found in 159 (35.5%). RSV and HRV were the most commonly identified virus; bronchiolitis and pneumonia the most frequent diagnosis. Patients with viral coinfections were older, attended day-care centers, had previous recurrent wheezing more frequently and were more symptomatic at admission. These patients did not have more complementary exams performed but were prescribed medications more often. Viral coinfection group did not show longer length of hospital stay and oxygen need, more need for ICU nor ventilatory support. DISCUSSION: Our study showed a significant proportion of viral coinfections in young infants admitted with LRTI and confirmed previous data showing that prescription was more frequent in inpatients with viral coinfections, without an association with worst clinical outcome.

INTRODUCCIÓN: Avances en el diagnóstico molecular han hecho posible la detección de agentes virales desconocidos en infecciones de las vías respiratorias inferiores (IVRI). Sin embargo, sigue habiendo dudas relativamente a su frecuencia y relevancia. OBJETIVO: Comparar la clínica y la gravedad entre la infección por virus único y la coinfección en niños admitidos por IVRI. MÉTODOS: Se realizó un estudio durante 3 años consecutivos (2012-2015) que incluyó a niños menores de 2 años ingresados por IVRI. La identificación viral se realizó mediante la técnica de PCR para 16 virus. Los datos clínicos y el uso de los recursos hospitalarios se recogieron de forma estándar durante la estancia hospitalaria y se compararon la infección única con coinfecciones virales. RESULTADOS: Fueron analizadas 524 muestras (451 pacientes); 448 (85,5%) tuvieron al menos un virus identificado. Coinfecciones virales se encontraron en 159 (35,5%). RSV y HRV fueron los virus más frecuentes; bronquiolitis y neumonía, los diagnósticos principales. Los pacientes con coinfecciones virales eran mayores, iban a la guardería, tenían sibilancias recurrentes con más frecuencia y eran más sintomáticos al ingreso. No fueron sometidos a más exámenes, pero les fueron prescritos medicamentos con más frecuencia. El grupo de la coinfección viral no mostró una mayor duración de la estancia hospitalaria, de la necesidad de oxígeno, de UCI o soporte ventilatorio. DISCUSIÓN: Nuestro estudio mostró una proporción significativa de coinfecciones virales en los niños pequeños ingresados con IVRI y confirma dados previos que muestran que la prescripción es más frecuente en las coinfecciones virales, sin asociación con peor resultado clínico.

Effect of Motivational Interviewing on depression scale scores of adolescents with obesity and overweight.

The aim of this study was to compare the effect of motivational interview (MI) with conventional care on the depression scale scores of adolescents with obesity/overweight. It was a controlled cluster randomized trial with parallel design, including two groups: intervention group [Motivational Interview Group (MIG)], control group [Conventional Intervention Group (CIG)]. INTERVENTION: three face-to-face 30min' interviews three months apart (only MIG interviews were based on MI principles). OUTCOMES: change in Children Depression Inventory (CDI) scores. We used a mixed repeated-measures ANOVAs analysis to assess the group vs time interaction. Effect size was calculated for ANOVA with difference of means of the total score (DOMTS). CDI scores were compared by a paired t-test. Eighty-three (84%) adolescents finished the intervention. There was a significant time vs group interaction both groups. While in the CIG scores significantly increased, in the MIG the scores significantly decreased. The DOMTS was significantly different between the two groups. We concluded that MI showed a positive effect on depression scale scores over time relatively to conventional intervention.

Cross-sectional study showed psychosocial variables, gender and family involvement played an important role in an adolescent weight management programme.

AIM: This study aimed to investigate the psychosocial gains perceived by overweight adolescents attending a 12-week weight management programme and to analyse gender-specific differences. METHODS: A quantitative cross-sectional study was conducted with a sample of 70 overweight adolescents aged between 12 and 18 (52.9% girls), evaluated at baseline and at week 12 using anthropometric measurements and self-reported questionnaires. We analysed gender-specific differences related to body self-esteem, social life, relationships with their family, physical comfort, health responsibility, perceived benefits of the intervention, self-efficacy and adherence. We further investigated whether the variables at week 12 would predict changes in their body mass index. RESULTS: While weight had a greater impact on the body self-esteem of girls, both at baseline and week 12, boys reported higher self-efficacy and adherence as well as a greater perception of the benefits of the intervention at week 12. The body mass index change was positively associated with body self-esteem, relationships within the family and self-efficacy and adherence. CONCLUSION: Gender specifics and the role of psychosocial variables must be taken into account during weight management programmes for adolescents, and it is important to include the family throughout the entire process.

Adolescent's subjective perceptions of chronic disease and related psychosocial factors: highlights from an outpatient context study.

BACKGROUND: Adolescents with chronic disease (CD) can be more vulnerable to adverse psychosocial outcomes. This study aims: 1) to identify differences in psychosocial variables (health-related quality of life, psychosomatic complaints, resilience, self-regulation and social support) among adolescents who feel that CD affects or does not affect school/peers connectedness (measured by self-reported participation in school and social activities); and 2) to assess the extent to which psychosocial variables are associated with connectedness in school and peer domains. METHODS: A cross-sectional study was conducted in 135 adolescents with CD (51.9% boys), average age of 14 ± 1.5 years old (SD = 1.5). Socio-demographic, clinical, and psychosocial variables were assessed, using a self-reported questionnaire, which included the Chronic Conditions Short Questionnaire, KIDSCREEN-10 Index, Symptoms Check-List, Healthy Kids Resilience Assessment Module Scale, Adolescent Self-Regulatory Inventory, and Satisfaction with Social Support Scale. Descriptive statistics, GLM-Univariate ANCOVA and Logistic Regression were performed using the IBM Statistical Package for Social Sciences (SPSS), version 22.0. The significance level was set at p < 0.05. RESULTS: Thirteen to eighteen percent of the adolescents felt that CD affected participation at school (PSCH) and participation in leisure time with friends (PLTF). These adolescents presented lower results for all psychosocial study variables, when compared with adolescents who did not feel affected in both areas of participation. From the studied psychosocial variables, the most important ones associated with PSCH (after controlling for age, gender, diagnosis, and education level of father/mother) were self-regulation and psychosomatic health. Concerning the PLTF, social support was the sole variable explaining such association. CONCLUSIONS: The present study pointed out the association between psychosocial variables; and living with a CD and school/peers connectedness. The need to focus on the assessment of the effects of a CD on adolescents' lives and contexts is suggested, as well as on the identification of vulnerable adolescents. Such identification could help to facilitate the maximization of social participation of adolescents with CD, and to plan interventions centered on providing support and opportunities for a healthy youth development. For that purpose, a complex and multifactorial approach that includes clinicians, schools, family, and peers may be proposed.

Effectiveness analysis of an internet-based intervention for overweight adolescents: next steps for researchers and clinicians.

BACKGROUNDS: The development of effective strategies for the management of overweight in adolescence is a well recognized need. The current study investigates the effectiveness of an e-therapeutic platform (Next.Step) which aims to promote weight management skills and the adoption of health-promoting behaviours among overweight adolescents. METHODS: We conducted a randomized clinical trial with a sample of 80 adolescents. The control group followed the standard intervention. The experimental group was invited to access the platform during 12 weeks in addition to the standard intervention. RESULTS: Although there was no change in the primary outcomes (body mass index and percentage of fat mass), the results suggest that the program is associated with an improvement in the 'positive perspective of life' and 'benefits perceived from the intervention', which have been identified as relevant factors for an effective weight management. CONCLUSIONS: Our findings provide little support for the effectiveness of internet-based weight management programs as an add-on to the standard intervention. TRIAL REGISTRATION: NCT01904474.

Contextual factors related to chronic condition in portuguese adolescents: highlights from the HBSC/WHO study

Abstract Adolescence's changes may become more pronounced when living with a chronic condition (CC). This study aims to examined the differences in satisfaction with family life, perception of school competence and "pressure with homework" of Portuguese adolescents' 1) living with CC; 2) how living with CC affects school participation; taking into account age, gender and family socioeconomic status (SES). Five thousand fifty Portuguese adolescents (mean age 14 ± 1.85) of the Health Behaviour in School-aged Children (HBSC/WHO) were included. Results showed increased vulnerability in adolescents living with CC, presenting a lower satisfaction with family life and poor school outcomes. Younger boys, having a higher SES and not having CC are significantly associated with satisfaction with family life. Older girls, having a lower SES and living with CC were associated with more stress related to school work. Future interventions should include these featurescombined with 'listening' to adolescents and their needs, allowing their participation in the promotion of personal health. (AU)

[Birth rate and fertility: knowledge and expectations analysis of 3585 university students]. / Natalidade e Fertilidade: Análise dos Conhecimentos e Expectativas de 3585 Estudantes Universitários Portugueses.

INTRODUCTION: Nowadays, Portuguese birth rate is insufficient to ensure renewal of generations. Women high education levels and labor market integration and increased economic difficulties are some of multiple factors leading to a delay in average parenting age and an increase of infertility; also subject to others such as obesity, smoking and alcohol consumption. MATERIAL AND METHODS: Transversal epidemiological study, analytical, uncontrolled, from self-filled online questionnaires, promoted by students' university unions. A sample of 3585 university students was considered and a global and by gender statistic analysis was done through SPSS, Excel was used to build graphics and tables and ArcMap to represent maps. RESULTS: Mainly students from the Health Sciences (40.6%), Universidade de Lisboa (59.4%), female (76.9%), median age of 22; intention to marry/ union 71.0%, parenthood 85.7%. A total of 18.4% smoke, 22.3% consume alcohol and obesity 15.4%; employment (47.4%) and the partner's will (39.9%) were important determinants for parenthood decision as well as having financial stability to provide a good education (33.6%) and healthcare (38.6%); A total of 53.6% have considered the hypothesis of infertility and highlight above 35 year old maternal age (18.7%), obesity (18%) and female smoking (19.0) as factors. Higher and more significant values for smoking (p = 0.001) and alcohol consumption (p = 0.000) in males were found. DISCUSSION: The sample seems representative, well distributed among different areas of study, with more female respondents than the university portuguese ratio. There are more students with parenting projects than marriage/cohabitation, in accordance with Portuguese data. Nevertheless, the same students identify the family as a priority in comparison with employment and career. Parenting decisions are tied by social-economic situation but an important factor is the low fertility due to the maternal age delay of the first pregnancy. CONCLUSION: University student unions are an excellent instrument to access them; a high number of respondents consider having children but delay the decision; there is a lack of information about the consequences of delaying parenting age and about infertility factors. The negative trend of fertility must be seen as a necessity to develop specific policies.

Introdução: Em Portugal, a taxa de natalidade não é suficiente para assegurar a renovação de gerações. A licenciatura e participação no mercado de trabalho das mulheres e a actual instabilidade económica são alguns determinantes e têm como consequência, o adiamento da parentalidade e infertilidade condicionada ainda pela obesidade, tabagismo e álcool.Material e Métodos: Estudo epidemiológico transversal, analítico, através de questionários auto-preenchidos, online, divulgados pelas Associações de estudantes das Universidades Portuguesas. A análise estatística da amostra de 3585 estudantes foi desenvolvida em SPSS, Excel nas representações gráficas e ArcMap, para os mapas.Resultados: Predomínio de estudantes de Ciências de Saúde (40,6%), da Universidade de Lisboa (59,4%) e sexo feminino (76,9%), mediana de idades de 22 anos; tabagismo 18,4%, consumo de álcool 22,3% e excesso de peso e obesidade 15,4%; intenção de casamento/união de facto 71,0%, projecto de parentalidade 85,7%; o emprego (47,4%) e a vontade do parceiro (39,9%) foram considerados determinantes na probabilidade de ter filhos assim como a segurança financeira para boa educação (33,6%) e cuidados de saúde (38,6%); 53,6% consideram a hipótese de infertilidade. Encontrámos valores mais elevados e significativos para o tabagismo (p = 0,001) e consumo de álcool (p = 0,000) no sexo masculino.Discussão: Consideramos a amostra representativa, bem distribuída pelas áreas de estudo, a maioria jovem, predomínio feminino superior aos rácios das faculdades. Há mais estudantes com projectos de parentalidade do que de casamento/união de facto, o que está de acordo com a evolução em Portugal. No entanto, os mesmos estudantes identificam a família como prioritária relativamente ao emprego e carreira. A decisão da parentalidade é condicionada pelas condições socioeconómicas mas um factor importante a considerar é uma baixa fertilidade biológica devida ao adiamento da idade da primeira gestação.Conclusão: As associações de estudantes universitários são um excelente instrumento de acesso; um número muito significativopensa ter filhos mas adia essa decisão; há falta de informação relativamente às consequências de adiar a idade do primeiro filho e aos factores de infertilidade. A tendência negativa da fecundidade deve ser encarada como necessidade de desenvolver políticas específicas.

[Hospital protocol for snakebite victims management]. / Protocolo de actuação hospitalar na abordagem de mordedura de ofídio.

Venomous snakebites are relatively rare in Portugal. Pediatric victims present with greater severity and are at risk of fatal complications. Clinical management protocols are the gold standard of care worldwide. We report two cases of venomous adder bites in pediatric patients. Based on a literature review we also discuss the clinical management and present a treatment protocol that ensures multidisciplinary and updated practice by medical teams.

A mordedura de ofídio venenoso é uma situação rara em Portugal. Quando ocorre em idade pediátrica apresenta maior gravidade e risco de complicações fatais. A actuação protocolada constitui o gold standard of care nos centros internacionais. Neste artigo apresentamos dois casos clínicos de mordedura de ofídio venenoso em idade pediátrica. Baseados na literatura actual, discutimos a actuação clínica tomada e expomos uma proposta de protocolo de actuação hospitalar que visa uma intervenção multidisciplinar e actualizada das equipas médicas envolvidas.

Staphylococcus aureus reservoirs and transmission routes in a Portuguese Neonatal Intensive Care Unit: a 30-month surveillance study.

Although Staphylococcus aureus is a major cause of outbreaks in neonatal intensive care units (NICUs), there are no studies on the epidemiology of S. aureus isolates responsible for infection in Portuguese NICUs. Between July 2005 and December 2007, a total of 54 methicillin susceptible S. aureus (MSSA) isolates were recovered from 16 infected infants, parents, health care workers (HCWs), and the environment in a level III NICU. Isolates were characterized by pulsed-field gel electrophoresis (PFGE), spa typing, and multilocus sequence typing. Virulence determinants were detected by multiplex polymerase chain reaction. Three major MSSA clones were endemic in the NICU, representing 70% (n=38) of the isolates: PFGE type A-ST5 (n=17); type B-ST30 (n=12); and type C-ST1 (n=9). Leukotoxins and hemolysins were present in all isolates, although none of them carried PVL. HCWs, plastic folders protecting clinical files, and mothers' nipples were identified as potential reservoirs and/or vehicles of dissemination of S. aureus. Consequently, additional infection control measures were implemented in this NICU.