Browsing by Author "Martins, H"
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- Bullying nas escolas de Guimarães: tipologias de bullying e diferenças entre génerosPublication . Sousa-Ferreira, T; Ferreira, S; Martins, HIntrodução: O bullying escolar é o tipo mais comum de violência nas escolas e parece estar a aumentar nos últimos anos. Os vários tipos de agressão e vitimização por bullying apre- sentam-se com diferentes frequências conforme o género dos alunos. Objetivos: Avaliar a frequência das diferentes tipologias de vitimização e de agressão por bullying nos alunos participantes das escolas públicas de Guimarães. Comparar as frequên- cias de vitimização e de agressão por bullying entre alunos de sexo feminino e masculino. Desenho do estudo: Estudo observacional e transversal. Métodos: Foi selecionado um igual número de turmas do 6º e do 8º ano das escolas públicas do concelho de Guimarães, em Portugal. Os alunos preencheram autonomamente um questionário com informação demográfica e o Multidimensional Peer Victimization Scale adaptado para Portugal. Técnicas de estatística descritiva e analítica foram utilizadas na análise dos dados. Considerou-se Bullying, na relação com os cole- gas, 2 ou mais episódios de maus-tratos no mês anterior. Resultados: Avaliaram-se 660 alunos, de 11 a 16 anos de idade, 48.8% do 6º ano, 48.8% do sexo feminino, de dez escolas das catorze do concelho. Declararam-se envolvidos diretamente em comportamentos de bullying, como autores ou alvo de maus tratos, 71.2% dos alunos (78.1% dos rapazes e 64.0% das raparigas). As prevalências, por tipologia, foram de 61.2% no verbal, 36.8% no social, 24.8% no físico e 22.9% de envolvidos no bullying relativo à propriedade. As tipologias mais frequentemente reportadas pelas vítimas, em ambos os géneros, masculino e feminino, foram a verbal (54.0% e 41.3%, respetivamente) e a social (26.7% e 30.1%, respetivamente). No total dos alunos as tipologias de vitimização mais frequentes foram a vitimização verbal com 48.4% e a vitimização social com 28.8%. Nos agressores, a verbal e a física nos rapazes (respetivamente 44.5% e 25.5%) e a verbal e a social nas raparigas (28.3% e 9.3%) foram as mais frequentes. No total dos alunos as tipologias de agressão mais frequentes foram a agressão verbal com 36.6% e a agressão física com 15.3%. Os alunos do sexo masculino estiveram mais frequentemente envolvidos diretamente em comportamentos de bullying. Nos rapazes encontraram-se proporções de vítimas de todas as tipologias exceto a social, e de agressores verbais e físicos, significativamente superiores. Encontraram-se diferenças significativas nas proporções de vítimas e agressores entre escolas, grupos etários e anos de escolaridade. Conclusão: Os alunos que negaram envolvimento direto no bullying foram apenas 28.8%. Encontraram-se vários comportamentos de bullying significativamente diferentes entre géneros, mas não em todas as escolas, grupos etários e ano de escolaridade. Estes dados indicam que os fatores genéticos podem não ser importantes, devendo a atuação centrar-se noutros aspetos. O estudo dos fatores que condicionam as diferenças dos comportamentos e tipologias de bullying poderá facilitar a identificação de situações de violência de forma a evitá-las.
- Cystatin C as a marker of acute kidney injury in the emergency departmentPublication . Soto, K; Coelho, S; Rodrigues, B; Martins, H; Frade, F; Lopes, S; Cunha, L; Papoila, A; Devarajan, PBACKGROUND AND OBJECTIVES: The diagnosis of acute kidney injury (AKI) is usually based on changes in serum creatinine, which is a poor marker of early renal dysfunction. The discriminative and predictive abilities of serum and urinary cystatin C were examined for the prediction of AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this prospective cohort study, serum and urinary cystatin C were serially measured in a heterogeneous group of patients (n = 616) presenting to a tertiary care emergency department. The primary outcome was AKI, classified according to RIFLE and AKIN criteria. The secondary outcome was an adjudication based on clinical criteria to AKI, prerenal azotemia, chronic kidney disease (CKD), and normal kidney function. RESULTS: Patients were adjudicated to have AKI in 21.1%, prerenal azotemia in 25.8%, CKD in 2.4%, and normal kidney function in 50.7%. For the diagnosis of AKI, the discriminatory ability of urinary creatinine and cystatin C was marginal. Both serum cystatin C and serum creatinine (at presentation and 6 hours later) showed high discriminatory ability for the diagnosis of AKI. However, only serum cystatin C attained a significant early predictive power (Hosmer-Lemeshow P value > 0.05). Serum cystatin C could differentiate between AKI and prerenal azotemia, but not between AKI and CKD. CONCLUSIONS: Serum cystatin C is an early, predictive biomarker of AKI, which outperforms serum creatinine in the heterogeneous emergency department setting. However, neither biomarker discriminated between AKI and CKD. Additional biomarkers continue to be needed for improved specificity in the diagnosis of community-acquired AKI.
- Destructive sinusopathy and middle ear involvement in Behçet's syndrome. A case report.Publication . Martins, H; Santos, S; Lourenco, J; Araújo, J
- Imunoglobulina endovenosa no Serviço de Medicina I do Hospital Prof. Dr. Fernando Fonseca EPEPublication . Neves, M; Martins, H; Elias, J; Araújo, JM
- Imunoglobulina intravenosa e Síndrome de SjögrenPublication . Neves, M; Martins, H; Lourenço, JF; Araújo, JMA síndrome de Sjögren (SS) é uma patologia auto-imune com incidência e prevalência importantes, manifestações clínicas variadas e critérios diagnósticos bem definidos. Áreas como os seus mecanismos fisiopatológicos e novas estratégias terapêuticas têm merecido atenção crescente. A imunoglobulina intravenosa (IgIV) está indicada para o tratamento de várias entidades nosológicas, sendo crescente a investigação acerca dos seus mecanismos de acção, nomeadamente sobre a actividade imunitária. O seu espectro de indicações terapêuticas continua altamente controverso mas tem vindo a expandir-se, sobretudo no âmbito da auto-imunidade. Existem apenas alguns casos descritos de utilização da IgIV no tratamento da SS, principalmente quando se apresenta com manifestações neurológicas. Apresentamos uma revisão da indicação do uso da IgIV na SS, fazendo uma análise dos resultados de relatos de casos da sua utilização, entretanto publicados. A IgIV parece ser uma opção terapêutica a ter em conta na SS. Segundo o que se sabe, à data, será uma opção terapêutica, de segunda linha, para os casos com manifestações extraglandulares graves refractários à terapêutica convencional.
- Is Manchester (MTS) more than a triage system? A study of its association with mortality and admission to a large Portuguese hospital.Publication . Martins, H; Cunha, L; Freitas, PTBACKGROUND: The Manchester Triage System (MTS) is a 5-point triage scale used to triage patients presenting to the emergency department. It was introduced in the UK in 1996 and is now widespread, especially in Europe, and has been in use in our hospital since 2000 via a computerised protocol. A study was undertaken to determine whether the subgroups created by the application of MTS have different propensities for indirect triage outcomes such as death in the A&E department or being admitted to hospital. METHODS: A database of 321 539 patients triaged during a 30-month period (from January 2005 to June 2007) was used. MTS codes, death outcomes, admission and admission route were used to estimate the proportions and association between MTS codes and the remaining variables by chi(2) univariate analysis. RESULTS: There was a clear association between the priority group and short-term mortality as well as with the proportion of patients admitted to hospital. CONCLUSIONS: The MTS provides information that extends beyond its immediate usefulness as a prioritisation mechanism. It is a powerful tool for distinguishing between patients with high and low unadjusted risk of short-term death as well as those who will stay in hospital for at least 24 h and those who will return home. Its discriminatory power is not equal for medical and surgical specialities, which may be linked to the nature of its inbuilt discriminators.
- Manchester triage system version II and resource utilisation in emergency departmentPublication . Santos, A; Freitas, PT; Martins, HEmergency department (ED) triage systems aim to direct the best clinical assistance to those who are in the greatest urgency and guarantee that resources are efficiently applied.The study's purpose was to determine whether the Manchester Triage System (MTS) second version is a useful instrument for determining the risk of hospital admission, intrahospital death and resource utilisation in ED and to compare it with the MTS first version.This was a prospective study of patients that attended the ED at a large hospital. It comprised a total of 25 218 cases that were triaged between 11 July and 13 October 2011. The MTS codes were grouped into two clusters: red and orange into a 'high acuity/priority' (HP) cluster, and yellow, green and blue into a 'low acuity/priority' cluster.The risk of hospital admission in the HP cluster was 4.86 times that of the LP cluster for both admission route and ages. The percentage of patient hospital admission between medical and surgical specialties, in high and low priority clusters, was similar. We found the risk of death in the HP cluster to be 5.58 times that of the risk of the low acuity/priority cluster. The MTS had an inconsistent association relative to the utilisation of x-ray, while it seemed to portray a consistent association between ECG and laboratory utilisation and MTS cluster.There were no differences between medical and surgical specialities risk of admission. This suggests that improvements were made in the second version of MTS, particularly in the discriminators of patients triaged to surgical specialties, because this was not true for the first version of MTS.
- Mobile health platform for pressure ulcer monitoring with electronic health record integration.Publication . Rodrigues, J; Pedro, L; Vardasca, T; Torre-Diez, I; Martins, HPressure ulcers frequently occur in patients with limited mobility, for example, people with advanced age and patients wearing casts or prostheses. Mobile information communication technologies can help implement ulcer care protocols and the monitoring of patients with high risk, thus preventing or improving these conditions. This article presents a mobile pressure ulcer monitoring platform (mULCER), which helps control a patient's ulcer status during all stages of treatment. Beside its stand-alone version, it can be integrated with electronic health record systems as mULCER synchronizes ulcer data with any electronic health record system using HL7 standards. It serves as a tool to integrate nursing care among hospital departments and institutions. mULCER was experimented with in different mobile devices such as LG Optimus One P500, Samsung Galaxy Tab, HTC Magic, Samsung Galaxy S, and Samsung Galaxy i5700, taking into account the user's experience of different screen sizes and processing characteristics
- Plataforma de dados de saúdePublication . Martins, HA Plataforma de Dados de Saúde é um sistema de partilha de dados de saúde. A PDSpermite que a mesma informação seja fragmentada e enviada aos diferentes agentes da prestação de cuidados (utentes, profissionais do SNS e de fora do SNS). Os dados são acedidos através de PORTAISespecíficos, seguros e contextualizados, a partir das instituições locais onde permanecem guardados. É assim criado um repositório de informação clínica anonimizada, no âmbito da Direção-Geral da Saúde, para os fins de saúde pública consignados na missão desta autoridade.
- Staphylococcus aureus nasal carriage among homeless population in Lisbon, PortugalPublication . Conceição, T; Martins, H; Rodrigues, S; Lencastre, H; Aires-de-Sousa, MMethicillin-resistant Staphylococcus aureus (MRSA) nasal carriage is a major risk factor for infection, namely among populations in the community with inherent prompting factors, such as the homeless. In Portugal, there are no data on S. aureus/MRSA nasal carriage among the homeless community. A total of 84 homeless individuals living in Lisbon (34 with no permanent address and 50 living in shelter) were nasally screened for S. aureus/ MRSA. All isolates were characterized to determine antimicrobial susceptibility and clonal type. A total of 43 (51.2%) S. aureus carriers were identified, including a single individual colonized with MRSA (1.2%). S. aureus carriage rate was higher among individuals with no permanent address (58.8% versus 46%), younger (45.7 ± 12.7 versus 52.5 ± 10.8 years), and with diagnosis of asthma (9% versus 0%). The single MRSA belonged to the EMRSA-15 clone (PFGE D, ST15-SCCmec IVh, and spa type t790). Almost half of the methicillin-susceptible S. aureus (MSSA) isolates (41.9%, n = 18) belonged to two major clones, ST398-t1451 (n = 13) and ST30-t399/t11980/t12808 associated with PFGE I (n = 5). A high proportion of isolates showed non-susceptibility to mupirocin (64%), erythromycin (45%), and fusidic acid (20%) and induced resistance to clindamycin (39%). None of the isolates harboured PVL. Our results suggest that the homeless population of Lisbon does not constitute a reservoir of MRSA in the community, but harbour the highly transmissible ST398-t1451 MSSA lineage.