Escola Nacional Saúde Pública

Most approaches to learn classifiers for structured objects (e.g., images) use generative models in a classical Bayesian framework. However, state-of-the-art classifiers for vectorial data (e.g., support vector machines) are learned discriminatively. A generative embedding is a mapping from the object space into a fixed dimensional score space, induced by a generative model, usually learned from data. The fixed dimensionality of these generative score spaces makes them adequate for discriminative learning of classifiers, thus bringing together the best of the discriminative and generative paradigms. In particular, it was recently shown that this hybrid approach outperforms a classifier obtained directly for the generative model upon which the score space was built.

Aims Uncertainty persists regarding the impact of the off-pump technique on coronary bypass graft patency. The primary objective of this study was to assess coronary artery bypass graft patency in patients randomized to off-pump and onpump multivessel coronary artery bypass grafting (CABG). Secondary objectives were clinical outcomes and neuropsychological functioning. Methods and results One hundred and fifty patients were randomized to off-pump (n ¼ 75) or on-pump CABG (n ¼ 75). Graft patency was assessed by multidetector computed tomography 5 weeks after surgery. The two groups were similar regarding patients' characteristics and logistic Euroscore (3.6 vs. 3.7%). Mean number of grafts performed was 3.5 + 0.6 and 3.5 + 0.6 in off-pump and on-pump, respectively (P ¼ 0.7). Raw graft patency rate was 89.9% in off-pump and 95.0% in on-pump (OR 2.2, 95% CI 1.07-4.44; P ¼ 0.03). Nineteen (27%) off-pump and 9 (13%) on-pump patients had at least one occluded graft (P ¼ 0.04) and the proportion of patent grafts per patient was 0.91 + 0.2 in off-pump vs. 0.96 + 0.1 in on-pump (P ¼ 0.06). However, after adjusting by heparin dose, graft patency was not statistically different between groups (OR 0.87, 95% CI 0.25-2.98, P ¼ 0.83). At 30 days, there was no statistically significant difference in major adverse events and neuropsychological functioning between off-pump and on-pump groups. One-year follow-up showed similar functional class and positive treadmill exercise tests. Conclusions Under the conditions this trial was conducted, CABG performed off-pump had lower overall graft patency rate than on-pump, which was not statistically different after controlling for total heparin dose. Thirty-day complications, neuropsychological functioning, and one-year clinical and functional outcomes were not statistically different between the two techniques.

Aims: To identify prognostic factors to outpatient alcohol treatment on admission as well as during the treatment period. Methods: A cohort study of n = 209 alcoholic patients (DSM-IV) during 6 months of outpatient treatment. Eight medical doctors from two hospitals were involved. Co-responsible participation in treatment was a necessary condition. At admission, we documented socio demographic factors, use of other drugs and severity of alcohol consumption. During the 6 months, we observed medication for prevention of alcohol relapse [disulfiram (DIS), acamprosate], number of sessions with the doctor, number of phases of the consultation and medication for depression. Primary outcome variables were time to first heavy relapse and abstinence of heavy alcohol consumption. These were measured with Timeline Followback. Five or more alcohol units of 10 g in one relapse day were considered heavy relapse. Results: The patients were 84% males, with 41 years median age; the median alcohol consumption was 192 g per day with a median duration of 13 years of heavy consumption. The median education was 6 years with 61% of the patients from lower socioeconomic levels. The Kaplan-Meier heavy relapse rate at 6 months was 23%. On admission to treatment, female gender, lower socioeconomic levels, cocaine use, >20 years of consumption, gamma glutamyl transferase values above normal and five or more alcohol-related problems on the Alcohol-Related Problem Questionnaire predicted worse outcomes. Having a full-time job and shorter abstinence time before treatment (until 7 days) predicted better outcomes. During the 6 months, we found that DIS for <120 days was a prognostic factor of worse outcomes. DIS for at least 120 days, >50% of adherence to consultations and more than two phases on each consultation predicted better outcomes. The combined sensitivity and specificity for DIS for at least 120 days, >50% of adherence to consultations and more than two phases on consultation regarding abstinence from heavy relapse were respectively 100 and 71%. Conclusions: During 6 months of outpatient treatment, longer adherence to DIS and consultations as well as more phases in a consultation involving necessarily a co-responsible predict a good outcome independently of the patient features at admission.

RESUMO - A recente evolução do registo informático dos atos de prescrição e levantamento de medicação disponibiliza um conjunto de dados que possibilita a mensuração dos comportamentos de adesão terapêutica, por recurso a Fontes administrativas de dados. Pretendeu-se caracterizar o comportamento de adesão terapêutica, no subgrupo fármaco-terapêutico dos antagonistas dos recetores da angiotensina, dos doentes hipertensos residentes na região de saúde do Alentejo nos anos de 2010-2011. Constatou-se que a adesão terapêutica primária foi de 61,2% e que a adesão terapêutica total se situou entre 55,7-69,5%, com elevada variabilidade nos padrões comportamentais por idade, sexo e área geográfica.ABSTRACT - The recent development in electronic pharmacy records made possible the measure of patients’ adherence behavior using administrative data sources. The overall objective of the study was to characterize the adherence behavior to Angiotensin Receptor Blockers of hypertensive patients livin...

A recente evolução do registo informático dos atos de prescrição e levantamento de medicação disponibiliza um conjunto de dados que possibilita a mensuração dos comportamentos de adesão terapêutica, por recurso a Fontes administrativas de dados. Pretendeu-se caracterizar o comportamento de adesão terapêutica, no subgrupo fármaco-terapêutico dos antagonistas dos recetores da angiotensina, dos doentes hipertensos residentes na região de saúde do Alentejo nos anos de 2010-2011. Constatou-se que a adesão terapêutica primária foi de 61,2% e que a adesão terapêutica total se situou entre 55,7-69,5%, com elevada variabilidade nos padrões comportamentais por idade, sexo e área geográfica.

3):217-223 ▪ http://dx.doi.org/10.20344/amp.6712 RESUMO O sistema de saúde português tem sido caraterizado pela existência de uma permanente relação entre o setor público e o setor privado tanto na prestação como no financiamento dos cuidados de saúde. Nas últimas décadas, ao nível da prestação de cuidados o setor privado aumentou significativamente a sua capacidade de resposta ampliando o seu nível de envolvimento na relação com o setor público. Esta relação decorre do enquadramento jurídico definido na Lei de Bases da Saúde desenvolvendo-se sob a forma de acordos, convenções e contratos bem como, mais recentemente, através do modelo de parcerias-público privadas. No que se refere ao caso específico da rede hospitalar esta nova dinâmica de relação contribuiu, nas últimas duas décadas, para acentuar a natureza mista do sistema através de um evidente reforço da componente privada na rede hospitalar particularmente através do investimento em unidades de âmbito generalista.

DOI: 10.15448/1980-6108.2017.1.24919Aims: The excess demand for pediatric emergency services has caused much concern among health professionals and hospital administrators. The aim of this study was to assess the utilization of a pediatric emergency department and to determine whether its use was injudicious. Methods: Retrospective cross-sectional analysis of all emergency cases treated throughout 2012 in a general hospital located in the metropolitan area of Lisbon, Portugal. The data were obtained from the hospital’s computer information system. Each patient was submitted at admission to the Manchester triage system adapted for Portugal, and the episodes were categorized into immediate, very urgent, urgent, standard, non-urgent, and not classified. All those episodes classified as standard and non-urgent were denoted as unjustified urgent episodes. The data were collected anonymously and analyzed by the IBM SPSS Statistics software using the chi-square test and one-way ANOVA at a ...

Portugal has faced an economic and financial crisis that began circa FY2009 and whose effects are still ongoing. In FY2011, the Portuguese state and the European triumvirate – composed of the European Commission, the International Monetary Fund, and the European Central Bank – signed the Memoranda of Understanding. This troika agreement aimed to improve the operational efficiency of public services. This crisis had a considerable impact on the Portuguese citizens’ life and productivity, as well as on the public health care system. Cuts over public expenditures have been made to reduce the risk of noncompliance with budgetary targets, despite their potential impact on quality and access to health care services. We analyzed the main policies and measures undertaken by the Portuguese Ministry of Health with respect to the bailout program associated with the troika agreement. Then, we focused on the budgetary cuts–related risks over the social performance of the care system. Evidence su...

Double Blind Review pelo SEER/OJS Revisão: Gramatical, normativa e de formatação AUSTERIDADE CONDUZ ACESSIBILIDADE À ASSISTÊNCIA MÉDICA? Em presença da crise económica pode ter ocorrido uma adaptação dos sistemas de saúde com impacto na acessibilidade. Com o objetivo de avaliar esta hipótese foram recolhidos dados anuais para oito países europeus -Alemanha, Reino Unido, Espanha, França, Itália, Irlanda, Grécia e Portugalentre 2005 e 2011. Os países foram agrupados em três grupos, de acordo com a tipologia de intervenção externa. Foi considerado um período anterior e outro posterior à crise, e avaliada a diferença nas médias, através do teste t de Student, para as variáveis relacionadas com a percentagem de doentes que manifestou necessidades médicas não satisfeitas devido ao custo excessivo dos cuidados de saúde, da distância, ou das listas de espera. Depois procedeu-se a uma análise de correlação recorrendo ao cálculo do coeficiente de Spearman, entre as variáveis associadas à acessibilidade e a taxa de desemprego. Foi observado um aumento de doentes com necessidades médicas não satisfeitas por custo excessivo, durante a austeridade, exceto para a Alemanha e Reino Unido. Os valores identificados foram mais elevados para os segmentos de rendimentos mais baixos, e de níveis de instrução elementares. Foi observado que para a França, Itália e Espanha a acessibilidade aumenta com o desemprego; contudo não foi encontrada associação para a Grécia, Irlanda e Portugal.