Evolution of Primary Health Care appointments in mainland Portugal in 2020

Background

The COVID-19 pandemic has had an impact on the Portuguese Health Care System. During the first months of the pandemic, there was a great reduction in the number of health rendering services. (1) The aim of this study is to analyse the evolution of Primary Health Care appointments in mainland Portugal, during the whole year of 2020 and to compare it to the period of 2015-2019. The type of appointment and the number of users will also be characterized.

Methods

An observational, descriptive-retrospective, longitudinal, quantitative study was performed. ‘Portal da Transparência' was used as the source of free access data about the Portuguese National Health Service.

Results

The results which are here presented are comparing the year 2020 to the average of 2015-2019. In mainland Portugal, in 2020, there were 7% more Primary Health Care appointments (PHCA). Although there were less PHCA during the first five months of 2020, there was a rise in the number of PHCA since June 2020. In 2020, 59% were distance PHCA, a rise of 113% compared to the average of 2015-2019. There was a fall of 38% on presential PHCA in 2020. The number of presential PHCA was inferior in each month of 2020, in comparison to the homologous month of the average of 2015-2019. The month with less presential PHCA was April 2020 (less 72% than the average of 2015-2019). Regarding domiciliary PHCA, there was a 36% reduction.In mainland Portugal, the number of Primary Health Care users with, at least, one face-to-face or distance PHCA, in 2020 was 6,661,927, 3% less than the average of 2015-2019.

Conclusions

The transition from presential PHCA to distance PHCA that occurred in 2020 due to the COVID-19 pandemic allowed the follow-up of most of the patients. However, there is a need to assess if distance PHCA are as effective as presential PHCA and which are its effects in communities' health.

(1) Vieira A et al. Excesso de mortalidade, mortalidade colateral e resposta dos serviços de saúde em Portugal em tempos de COVID-19

Key messages

In 2020, in mainland Portugal, there was an increase on distance Primary Health Care appointments and a decrease on presential ones.

Its impact on population’s health should be assessed.

Tuberculosis’ surveillance in a group of primary healthcare centres of Lisbon district

Background

Tuberculosis (TB), a communicable disease, is the leading cause of death from a single infectious agent and one of the top 10 causes of death worldwide. Its burden varies among different countries. In the 31 European Economic Area member states, in 2017, the TB notification rate was 10.7/100,000 population; in Portugal, this rate was 17.5/100,000 population and the majority of the notified cases occurred in two districts: Lisbon and Oporto. The aim of this study is to analyse TB's notifications in a group of primary healthcare centres of Loures-Odivelas (ACES LO), between 2015 and 2019.

Methods

An observational, descriptive, retrospective, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included were: age, sex, TB's presentation, antimicrobial susceptibility testing, HIV testing. Descriptive analysis was performed for all variables.

Results

In ACES LO, notified cases of TB dropped 18.0% between 2015 and 2017, having since increased by 54.8% (n = 113), a notification rate of 32.3/100,000 population in 2019. The male to female ratio was 1.7 and the most affected age group was the 30-40 year old group (n = 25). Notified cases in children <10 years old have increased from 0 in 2016 to 7 in 2019. Pulmonary TB was reported in 73.5% (n = 83) of the notified cases; in 56.6% (n = 64), antimicrobial susceptibility testing revealed that first-line treatment would be effective; HIV testing was positive in 10.6% (n = 12).

Conclusions

Surveillance is the first step towards taking action to control and eliminate TB. ACES LO has a high notification rate of TB, therefore effort should be made in order to reduce TB's incidence. More investigation should be performed in order to evaluate the possibility of reintroduction of Bacille Calmette-Guérin (BCG) vaccine to the general population, instead of only risk groups, as it happens in ACES LO since 2016.

Key messages

Surveillance is one of the ten essential Public Health operations, allowing us to measure and analyse health problems in a certain population. Tuberculosis’ incidence is still high in some populations; it is a critical issue to raise awareness about.

Do long-term care services meet the minimal requirements for the elderly?

Background

As the percentage of elderly people (aged over 65) is expected to rise, from 16.0% of the population in 2010 to 29.3% in 2060 in Europe, a quality long-term care system is of increasing priority for governments. The aim of this study is to analyse long-term care services (LTCS) in the geographical area of the group of primary healthcare centres of Loures-Odivelas.

Methods

A retrospective, observational, descriptive study comprising data from public health inspections to LTCS between 2015 and 2019. Variables included were the number of residents, nurses, orderly, cooks, kitchen helpers and medical doctors; licensing status, public health inspection results and the presence of air conditioning. Descriptive analysis was performed for all variables.

Results

Between 2015 and 2019, a total of 200 public health inspections were carried out in 106 LTCS. Only 41 (38.7%) LTCS were licensed. The total number of residents was 2,803, 168 (6.0%) of which were bedridden. Concerning the staff ratio, 79 (74.5%) LTCS fulfilled the ratio of nurse to resident of 1:40 and 67 (63.2%) the ratio of orderly to resident of 1:8. On the first inspection, 11 LTCS (10.4%) complied with the minimal requirements for health care, hygiene, food preparation and facilities conditions. After the implementation of corrective measures proposed by the Public Health Unit, the number of LTCS which had complied for the same criteria was 64 (60.4%).

Conclusions

Society needs to adapt to a growing ageing population. LCTS, while part of the solution, still have deficiencies. In this sample, the majority were illegal and lacked the appropriate conditions. Public Health interventions can contribute to improving these services.

Key messages

In an ageing society, long-term care services are essential but the majority lack the appropriate conditions. Public Health intervention is crucial in implementing corrective measures that will result in better conditions for the elderly.

Carrageenan hydrogel as a scaffold for skin-derived multipotent stromal cells delivery

Carrageenan is a thermoreversible polymer of natural origin widely used in food and pharmaceutical industry that presents a glycosaminoglycan-like structure. Herein, we show that kappa-type carrageenan extracted by a semi-refined process from the red seaweed Kappaphycus alvarezii displayed both chemical and structural properties similar to a commercial carrageenan. Moreover, both extracted carrageenan hydrogel and commercial carrageenan hydrogel can serve as a scaffold for in vitro culture of human skin-derived multipotent stromal cells, demonstrating considerable potential as cell-carrier materials for cell delivery in tissue engineering. Skin-derived multipotent stromal cells cultured inside the carrageenan hydrogels showed a round shape morphology and maintained their growth and viability for at least one week in culture. Next, the effect of the extracted carrageenan hydrogel loaded with human skin-derived multipotent stromal cells was evaluated in a mouse model of full-thickness skin wound. Macroscopic and histological analyses revealed some pointed ameliorated features, such as reduced inflammatory process, faster initial recovery of wounded area, and improved extracellular matrix deposition. These results indicate that extracted carrageenan hydrogel can serve as a scaffold for in vitro growth and maintenance of human SD-MSCs, being also able to act as a delivery system of cells to wounded skin. Thus, evaluation of the properties discussed in this study contribute to a further understanding and specificities of the potential use of carrageenan hydrogel as a delivery system for several applications, further to skin wound healing.

The skin regeneration potential of a pro-angiogenic secretome from human skin-derived multipotent stromal cells

Multipotent stromal cells stimulate skin regeneration after acute or chronic injuries. However, many stem cell therapy protocols are limited by the elevated number of cells required and poor cell survival after transplantation. Considering that the beneficial effects of multipotent stromal cells on wound healing are typically mediated by paracrine mechanisms, we examined whether the conditioned medium from skin-derived multipotent stromal cells would be beneficial for restoring the skin structure of mice after wounding. A proteomic characterization of skin-derived multipotent stromal cell-conditioned medium was performed, and the angiogenic function of this secretome was investigated in vitro using an endothelial cell tube formation assay. We then applied the skin-derived multipotent stromal cell-conditioned medium directly to full-thickness excisional wounds or embedded it into carrageenan or poly(vinyl alcohol) hydrogels to monitor tissue regeneration in mice. Biological processes related to wound healing and angiogenesis were highlighted by the analysis of the skin-derived multipotent stromal cell secretome, and a pro-angiogenic capacity for promoting tubule-like structures was first confirmed in vitro. Skin wounds treated with skin-derived multipotent stromal cell-conditioned medium also displayed increased angiogenesis, independently of the association of the conditioned medium with hydrogels. However, improvements in wound closure and epidermis or decreased inflammatory cell presence were not observed. Hence, the use of the secretome obtained from human skin-derived multipotent stromal cells may be a potential strategy to aid the natural skin repair of full-thickness lesions mainly based on its pro-angiogenic properties.

Glucose Homeostasis Is Not Affected in a Murine Model of Parkinson's Disease Induced by 6-OHDA

There is a mutual relationship between metabolic and neurodegenerative diseases. However, the causal relationship in this crosstalk is unclear and whether Parkinson’s disease (PD) causes a posterior impact on metabolism remains unknown. Considering that, this study aimed to evaluate the appearance of possible changes in metabolic homeostasis due to 6-hydroxydopamine (6-OHDA) administration, a neurotoxin that damage dopaminergic neurons leading to motor impairments that resemble the ones observed in PD. For this, male Wistar rats received bilateral 6-OHDA administration in the dorsolateral striatum, and the motor and metabolic outcomes were assessed at 7, 21, or 35 days post-surgical procedure. Dexamethasone, a diabetogenic glucocorticoid (GC), was intraperitoneally administered in the last 6 days to challenge the metabolism and reveal possible metabolic vulnerabilities caused by 6-OHDA. Controls received only vehicles. The 6-OHDA-treated rats displayed a significant decrease in locomotor activity, exploratory behavior, and motor coordination 7 and 35 days after neurotoxin administration. These motor impairments paralleled with no significant alteration in body mass, food intake, glucose tolerance, insulin sensitivity, and biochemical parameters (plasma insulin, triacylglycerol, and total cholesterol levels) until the end of the experimental protocol on days 35–38 post-6-OHDA administration. Moreover, hepatic glycogen and fat content, as well as the endocrine pancreas mass, were not altered in rats treated with 6-OHDA at the day of euthanasia (38th day after neurotoxin administration). None of the diabetogenic effects caused by dexamethasone were exacerbated in rats previously treated with 6-OHDA. Thus, we conclude that bilateral 6-OHDA administration in the striatum causes motor deficits in rats with no impact on glucose and lipid homeostasis and does not exacerbate the adverse effects caused by excess GC. These observations indicate that neurodegeneration of dopaminergic circuits in the 6-OHDA rats does not affect the metabolic outcomes.

Análise do Processo de Degradação do Material Obturador Através da Diminuição da Concentração de Zinco

Este estudo in vivo teve como objetivo analisar a degradação do material obturador de acordo com a idade de tratamento através do decréscimo da concentração de zinco presente no material obturador. Foram removidos materiais obturadores do interior de canais radiculares que apresentavam indicações de retratamento. O material obturador foi colhido do interior dos canais radiculares com auxílio de limas Hedströem, sem uso de solventes ou brocas. As informações a respeito do tempo de tratamento foram obtidas diretamente com os pacientes. Foram utilizadas 30 amostras com tempos de tratamentos entre 2 e 30 anos. Espectrometria de absorção atômica, EDX e difração de raios-X foram os métodos empregados para identificar e quantificar os elementos químicos e os compostos de zinco. Todas as análises foram executadas em triplicata. Todos os resultados obtidos foram comparados com os dados provenientes de cones novos, e então submetidos à análise estatística, utilizando-se o teste ANOVA (SPSS 12.0). Todas as amostras, para os diferentes períodos de tempo apresentaram decréscimo na concentração de zinco. Após 15 anos de tratamento, os resultados mostraram-se com diferenças estatisticamente significantes de concentração de zinco (p 0,0103). O método utilizado foi apropriado para quantificar a concentração do zinco nas amostras analisadas.Palavras-chave: Canal Radicular. Obturação. Zinco.

Birth-cohort and dual diagnosis effects on age-at-onset in Brazilian patients with bipolar I disorder

OBJECTIVE

Substance use disorders and birth-cohort have been associated with an earlier onset in bipolar disorder (BD). This study aimed at evaluating the inter-relations of these factors in age-at-onset in bipolar illness.

METHOD

Two-hundred and thirty patients with bipolar I disorder were cross-sectionally evaluated. Patients were categorized into four age groups for analysis. Lifetime comorbidity and age-at-onset were derived from the Structured Clinical Interview for DSM-IV.

RESULTS

There was a strong linear association between age group and age-at-onset. Lifetime alcohol and drug use disorders were also associated with age-at-onset. Illicit drug and alcohol use disorders and age group remained significant in the multivariate model. No interactions appeared.

CONCLUSION

Both age group and dual diagnoses had strong and independent impacts on age-at-onset in out-patients with BD. Substance abuse may be partly accountable for earlier symptom onset, but other features of BD in younger generations are still in need to be accounted for.

Vaginal colonization by Candida in asymptomatic women with and without a history of recurrent vulvovaginal candidiasis

OBJECTIVE

The asymptomatic carriage of Candida in the vagina of women with a history of recurrent vulvovaginal candidiasis was compared with that of women with no such history.

METHODS

Vaginal swabs from 50 women with a history of recurrent vulvovaginal candidiasis and 45 women with one or fewer episodes of candidal vaginitis within the past 12 months were evaluated for Candida by wet mount/Gram stain, culture, and polymerase chain reaction (PCR). All women were asymptomatic for at least 30 days.

RESULTS

Candida was identified in 28 women by PCR, in 14 women by culture, and in 13 women by wet mount/Gram stain. Candida was identified by PCR in a similar proportion of patients with previous recurrent vulvovaginal candidiasis (30%) and in controls (28.8%). However, Candida was identified by culture in more women with previous recurrent vulvovaginal candidiasis (22%) than in controls (6.6%, P = .04); it also was identified by wet mount/Gram stain in more women with recurrent vulvovaginal candidiasis (22%) than in controls (4.4%, P = .01). For the recurrent vulvovaginal candidiasis patients, culture and wet mount/Gram stain had a sensitivity of 66.6% compared with PCR. For the controls, the sensitivity of the two former assays relative to PCR was only 15.3%.

CONCLUSION

Women with a history of recurrent vulvovaginal candidiasis have more easily detectable Candida in their vagina, even when asymptomatic, than do other women. A relative inefficiency in regulating the proliferation of Candida in the vagina may increase susceptibility to periodic symptomatic recurrences.

[Hearts with double inlet ventricle. Morphological aspects in 20 cases]

PURPOSE

The authors intended to verify the most common anatomical presentations of hearts with double inlet ventricle (DIV) and the associated lesions, in order to provide information regarding surgical palliation/correction.

MATERIAL AND METHODS

Twenty hearts presenting DIV, from pathological collections. The sequential segmental analysis was applied.

RESULTS

Fourteen cases showed usual atrial arrangement, and six isomeric atria (4 with right isomerism and 2 with left isomerism). "Situs solitus" showed two atrioventricular (AV) valves, and the others a single valve. The main ventricle was morphologically left in 13 cases, right in one and of indeterminate morphology in six. The ventriculoarterial connexion was discordant in 10 cases, concordant in two, of double outlet type in eight (6 from an indeterminate ventricle, one from the main chamber and one from the rudimentary ventricle). Pulmonary obstructive lesions were common in the group with atrial isomerism (67%). AV valve stenosis was present in 4 cases, two of the left valve and two of the right one. Straddling of one AV valve was observed in 5 cases and aortic coarctation in three. The ventricular septal defect was restrictive in two cases, both with double inlet to a dominant left ventricle and a concordant AV connexion (Holmes'heart).

CONCLUSION

In those with atrial isomerism, the obstructive pulmonary lesions are the dominant feature and require early attention. For the other group, the atriopulmonary anastomosis procedures should take into account peculiarities such as AV valve dysfunctions and aortic coarctation.

[Anatomic study of the coronary arteries in transposition of great vessels]

The authors studied 64 hearts presenting transposition of the great arteries, in order to evaluate the pattern of distribution and origin of the main coronary arteries. Regarding the origin in each sinus of Valsalva, there was no significant difference with the data from the literature. It was also evaluated the precise site of origin inside the sinuses, which were divided in three thirds: the medial and those adjacent to the valvar commissures. We observed that, although the coronary ostia took origin from the medial third in more than half of the cases, there was some variation when considering the different patterns of distribution. This observations is relevant, since, when Jatene's procedure is considered, the surgical disinsertion of a coronary artery may put at risk the valvar leaflet, when the ostium is near the commissure.