bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge Regarding Blood Pressure Measurement among First and Second Year Undergraduate Medical Students: A Descriptive Cross-sectional Study
Authors: Rana Shavana Rajya Laxmi , Thapa Bikalp , Budhathoki Lee , Rajaure Yesha Shree , Shrestha Bipin Kumar , Mahat Barun , Dhungel Sunil , Amatya Tara Man
Published: March 2022

Introduction: Blood pressure measurement has a great implication in medicine. Every medical personnel should have a sound knowledge regarding blood pressure measurement. This study was conducted with the aim of determining the knowledge regarding blood pressure measurement among first and second year medical students of a medical college.
Methods: A descriptive cross-sectional study was conducted by Department of Physiology of Nepalese Army Institute of Health Sciences from June to December 2021 after receiving the ethical approval from Institutional Review Committee with registration number 394. One hundred ninety-seven students from first and second year were included in the study using whole sampling technique. Data was entered and analysed using Microsoft Excel 2019 and Statistical Package for Social sciences version 16.0. Descriptive statistics like frequency, percentage for binary data and mean, standard deviation for continuous data were calculated.
Results: Among 197 students from first and second year, 175 (88.83%) had satisfactory knowledge regarding blood pressure measurement with score≥8 in Objective Structured Practical Examination. Eighty five (85.86%) students from first year and 90 (91.84%) students from second year had scores ≥8, hence had satisfactory knowledge on blood pressure measurement. A total of 18 (18.18%) first year students achieved a score of 10, while 24 (24.49%) students of the second year scored 12, which were the modal score.
Conclusions: The proportion of first and second year students having satisfactory knowledge regarding blood pressure measurement is higher in our study.
Metadata of Linguistic Resources: History and Current State
Authors: Antopolskii Alexander
Published: March 2022

The main metadata projects for linguistic (language) resources developed over the past 20 years are described. These include the IMDI initiative, the OLAC metadata system. the META-SHARE meta-model, the International Standard Number of Language resources, the evaluation map of language resources, and the CLARIN component metadata model. The content of the ISO metadata standard is described. Projects for creating dictionaries, ontologies, and lexical databases for metadata of language resources are described.
Dissemination Strategy, July 1995–January 1998
Authors:   Population Council
Published: March 2022

During the first phase of the ANE OR/TA project (1990–95), 55 studies and 23 workshops were conducted in 9 countries. In support of this effort, a dissemination strategy was produced that guided the communications activities of the first phase. Regional communications officers were hired in New Delhi and Cairo, and the project began to systematically address its objectives of communicating the findings of all studies to a diverse array of audiences within each country, subregion, and internationally. Several activities were undertaken to create a coherent and unified framework for disseminating the results of studies and informing audiences of recent project developments. As detailed in this dissemination strategy report, the ANE OR/TA project evaluation recommended exploring the development of additional dimensions during the next phase, such as an audience needs assessment, developing local capacities for dissemination, conducting more follow-up efforts to enhance utilization of OR results, and disseminating results from clusters of projects that synthesize the OR experience regionally.
Waste Legislation and the Circular Economy
Authors: Salca Rotaru Cristina Mihaela
Published: March 2022

The circular economy transforms the traditional economic model by introducing those models of production and consumption that ensure the reuse and recycling of materials and products. The life cycle of the products is thus much extended. However, any product will at some point become waste. This article sets out how waste legislation supports or even imposes the circular economy by (i) regulating the notion of by-product (ii) introducing mandatory recycling targets and (iii) specific criteria for recycling certain categories of waste.
The Urgent Need for the Adoption of an European Convention on the Profession of Lawyer
Authors: Savu Elena Cristina
Published: March 2022

Lawyers play an essential role amongst professions as primary actors in the system of justice and so by their contribution to protecting the Rule of Law, ensuring access to justice for citizens and protecting fundamental rights and freedoms. In this respect, the profession of lawyer can come under considerable pressure from the executive and legislative powers, as well as from the judiciary or non-state actors. The continuing attacks on the role of lawyers since the Recommendation No. R(2000)21 of the Committee of Ministers to Member States on the freedom of exercise of the profession of lawyer was adopted, that have accelerated lately, emphasize that The European Convention on the Profession of Lawyer is urgently needed.
Non-Pecuniary Compensatory Damages. Comparative Law Aspects – Specific References to France and Italy
Authors: Tudurut Laura
Published: March 2022

The article briefly outlines the evolution of the non material damage concept in Romanian civil law as well as the conversion hereof in other states’ legislation especially of France and Italy. This legislation adjunction is not at all random considering the fact that these are EU member states and share a common juridical patrimony inherited from Roman law. The article also presents the analyses of the European Guidelines drafted by the European Group on Tort Law, principles aiming for the harmonisation of European legislation in matters relating to tort. The article concludes with an assessment of national current regulation on compensation of non material damage.
Present Issues regarding Liability for Prejudice caused in the Exercise of Profession by the Medical Staff
Authors: Barsan Maria Magdalena
Published: March 2022

Doctrine and judicial practice point out situations in which liability for prejudice caused during the performance of the medical profession by the medical staff is removed, considering the fact that not always the behaviour of medical staff is culpable. Also, the article aims to point out those situations in which guilt is retained in accordance with the laws in force. The present endeavour also aims to emphasize and explain a current issue, considering the evolution of the Romanian health system and the discrepancy between the private health system and the public health system in which the doctor-patient relationship is in a permanent transformation with many valences.
Civil Servant – Active Subject of Service Offenses
Authors: Ghigheci Costel Cristinel
Published: March 2022

The distinct regulation in the Criminal Code of service offenses raised the issue of defining the notion of civil servant in this branch of law. It is unanimously accepted in doctrine and jurisprudence that the notion of civil servant in criminal law is different from that in administrative law, having an autonomous meaning. This is the reason why the legislator defined in art. 175 of the Criminal Code the notion of civil servant used in criminal law, but referring to two categories: that of “proper” civil servants and that of “assimilated” civil servants. In the case of service offenses, only the first category of civil servants, defined in art. 175 paragraph (1) of the Criminal Code, is of interest.
Specific Issues facing the European Union. Fight against Serious and Organized Crime
Authors: Tolbaru Carmina
Published: March 2022

In the pandemic context generated by the epidemiological situation we face, crime has increased worldwide, criminals adapting to the environmental changes in which they operate. Thus, online criminal activities have become more widespread, especially in the area of fraud, and concrete and structured action is needed at EU level to combat all forms of organized crime. Modern technology is an essential tool in terms of serious and organized crime, facilitating systematic cooperation between criminals, in achieving the common goal, respectively the achievement of profit. Thus, it becomes much easier to access illegal tools and goods, the economic crisis generated by the pandemic giving a safe lever in this regard. The European Union is working to establish the tools and measures to be developed in the period 2020-2025, to ensure security in the physical and digital environment.
Building an enhanced sentiment classification framework based on natural language processing
Authors: Tran Thien Khai , Dinh Hoa Minh , Phan Tuoi Thi
Published: March 2022

Sentiment classification is one of the major tasks of natural language processing (NLP) and has gained much attention by researchers and businesses in recent years. However, the semantics of the social networking language is becoming increasingly complex and unpredictable, affecting the accuracy of the associated NLP systems. In this paper, we propose a hybrid sentiment analysis (SA) framework that classifies the opinions of Vietnamese reviews into one of two types: positive or negative. The special feature of the proposed framework is that it is built on a combination of three different text representation models that focus on analyzing social media network language characteristics. Our system achieved an accuracy score of 81.54% on the test set, which is better than other strategies. Based on the experimental results, this work proves that the choice of text representation model determines the performance of the system.
Robotic exploration algorithms in simulated environments with Python
Authors: Mysore Aniruddha , TSB Sudarshan
Published: March 2022

Swarm Robotics is inspired by the biological swarms of social insects such as ants and bees, where individuals performing basic tasks give rise to complex behavior. It utilizes a team of cooperating robots to perform tasks more efficiently than possible by isolated robots. In this research, we study the exploration of unknown indoor areas using robots that coordinate with each other. In particular, we implement the Reverse Nearest Neighbor coordination algorithm with certain modifications to account for real-world constraints. The library developed as part of this work provides scripts to help with robotic tasks for exploration and robotic arm control that can be used to set up simulation tools like VREP, without much prior experience thereby lowering the barrier for entry and making the robotics projects more accessible.
Disturbance observer supported fuzzy model based controller with application to bilateral teleoperation systems
Authors: Asad Muhammad Usman , Gu Jason , Farooq Umar , Balas Marius , Chen Zheng , Qureshi Khurram Karim , Abbas Ghulam , Chang Chunqi
Published: March 2022

This paper proposes a disturbance observer supported Takagi-Sugeno (TS) fuzzy model-based control scheme for uncertain systems. The baseline controller is a guaranteed performance fuzzy model based parallel distributed controller (PDC) which is constructed using the nominal system’s parameters. The model approximation error and parametric uncertainties are treated as a lumped disturbance and a nonlinear disturbance observer (NDOB) is introduced to counter the lumped disturbance. The applicability of the proposed scheme is demonstrated on the bilateral control of nonlinear teleoperation system in MATLAB/Simulink/QUARC environment through simulations as well as semi-real time experiments.
Classification of imbalanced medical data: An empirical study of machine learning approaches
Authors: Mundra Shikha , Vijay Shounak , Mundra Ankit , Gupta Punit , Goyal Mayank Kumar , Kaur Mandeep , Khaitan Supriya , Rajpoot Abha Kiran
Published: March 2022

Thousands of patients around the world affecting their health with various factor as age, body mass index, cholesterol levels, albumin levels and several other factor. Prediction of health outcome due to these factors at a proper time can be served as an early warning. Recent growth in machine learning algorithm inspired us to build a predictive model for better healthcare facilities. In our work we have focused on problem of noisy and imbalanced dataset in which majority class is favored over minority one that leads to false prediction. We have experimented with two publicly available medical imbalanced dataset which varies in its size as MIT’s GOSSIS death and PIMA Indians Diabetes Dataset based on binary class. In this model we have investigated 3 oversampling techniques (Synthetic Minority Oversampler, Random Oversampler and Adaptive Synthetic Sampler) along with two undersampling techniques (Random Undersampler and Near Miss) which were paired with 3 data reduction and cleaning methods namely Tomek Links, One Sided Selection and Edited Nearest Neighbors. At last, we found that combination of Adaptive Synthetic Sampler along with One Sided Selection perform better in case of large size dataset while combination of random oversampler along with Tomek Link showed better performance in case of low size data dataset. We have also analyzed that oversampling technique gives quite promising results in comparison to undersampling methods specifically when applied with machine learning classifiers as these classifiers are data hungry algorithms.
An evaluation of smart learning approach using bloom taxonomy based neuro-fuzzy system
Authors: Soomro Saima Siraj , Jalbani Akhtar Hussain , Channa Muhammad Ibrahim , Lakho Shamshad , Memon Imran Ali
Published: March 2022

The World Health Organization has stated Covid-19 as a pandemic that has posture a current hazard to humanity. Covid-19 pandemic has magnificently forced global shutdown of several events, including educational activities. This has caused in tremendous crisis-response immigration of educational institutes with online smart learning helping as the educational platform. Smart learning targets at providing universal learning to students consuming modern technology to completely prepare them for a fast-changing world everywhere. In this research paper an evaluation system has been developed that is based on bloom taxonomy. A Neuro-fuzzy system for the training and testing of the data for smart and traditional learning outcomes has been applied on collected data. For this research work, we have selected students of the computing discipline and focus on core-computing subjects. The findings of this research work shows the importance of smart learning and its positive impact on student learning outcomes. The evaluation criteria are based on revised bloom taxonomy levels, such that all six levels have been covered. The students’ performance are very much encouraging when compared with ground truth values and reported 91.2% overall accuracy of proposed model on collected samples.
Deep transferable learning on heartbeat classification for imbalance dataset
Authors: Sabir Imran , Baber Junaid , Ahmed Atiq , Sheikh Naveed , Bakhtyar Maheen , Khan Azam , Devi Varsha
Published: March 2022

Electrocardiogram (ECG) data recorded by medical devices are hard to analyze manually. Therefore, it is important to analyze and categorize each heartbeat using machine learning. Recently, advancements in machine learning have made classification of complex data easy and fast. However, these machine learning algorithms require sufficient amount of training data and have limited performance in case the data is imbalance. In case of MIT-BIH arrhythmia dataset, the distribution of training instances are quite imbalance. Many machine learning, particularly deep learning, algorithms give high accuracy on these datasets but still the minority classes have zero accuracy. In this paper, we improve the accuracy of minority classes without hurting the overall accuracy of other classes using transfer learning. The accuracy of existing deep learning model is increased from 90.67% to 98.47%, respectively.
Simulation, analysis, fabrication and characterization of tunable AAO membrane for microfluidic filtration
Authors: Manzoor Saher , Tayyaba Shahzadi , Ashraf Muhammad Waseem
Published: March 2022

Microfluidic filtration is an essential process in many biomedical applications. Micro or nanoporous membranes are used for colloidal retention. During the membrane filtration process visualization of various phenomena is challenging. Theoretical models have been proposed to visualize the transport mechanism. In this work, ANSYS Fluent is used for 3D designing of the microfluidic system and Fuzzy simulations are used to study flow rate and velocity, to get the maximum benefit from Anodized Aluminium oxide membrane in practical applications. The proposed method exploits relations between driving force, membrane area, and fluid flow. After optimization of parameters for the filtration, the AAO membrane with desired pore diameter was fabricated using the two-step anodization method. Scanning electron microscope is used for characterization of fabricated AAO membrane. The simulated and theoretical results using computer-based programs are then compared for manipulation of flow rate during the filtration process. Along with the manipulation of flow rate from nanoporous membrane other challenges faced during the filtration process are also highlighted with possible solutions.
ECONOMIC AND INSTITUTIONAL ASPECTS OF DEVELOPER PORTFOLIO FORMATION: PARADIGM SHIFT AND INNOVATIVE MANAGEMENT SOLUTIONS
Authors: Prykhodko Dmytro , Dykyi Oleksandr , Malykhina Oksana , Valinkevych Nataliia , Ishchenko Tetyana , Savchuk Tetyana
Published: March 2022

The article formulates the basic provisions and builds a conceptual model of the processes of formation, selection, implementation of competitive strategy of the enterprise, which provides for the relationship of the following subprocesses: clarification of general strategic goals; diagnosing the external environment; diagnosing the internal environment; setting the goals of the competitive strategy; determining the criteria for selecting the best option for a competitive strategy; determination of restrictions on the choice of competitive strategy; development of options of competitive strategy and definition of possible results of their realization; selection of the optimal variant of competitive strategy according to certain criteria; detailing the content and configuration of the selected competitive strategy; coordination of functional strategies with competitive; preparation for the implementation of the selected competitive strategy; its implementation; evaluation of the results of the implementation of the competitive strategy of the enterprise. methodological basis of the study provides a scientifically sound solution to the leading methodological problem in the administration of the developer in construction - to productively reconcile the priorities of strategic value and image growth of the developer with the requirements of project administration in autonomous economic, budgetary and administrative logistics . Based on the methodology, as introduced in accordance with the new ideas about the essence of the strategy of the developer in construction, developed and substantiated - a new scientific and applied tools for the administration of operational activities of developers in construction and its transformations. It must be adapted to the content of the investment cycle of construction projects. Such a system is implemented thanks to the proposed economic and mathematical model "Bud-alternative" and software modules for its implementation.
SCIENTIFIC BASIS OF CONVERGENT PROJECT MANAGEMENT OF ECO-LOGISTICS SYSTEMS
Authors: Kovtun Tetiana
Published: March 2022

Sustainable development today is one of the most important, urgent and comprehensive issues on which the future of humanity and life on the planet as a whole depends. The high growth rates of material production and population, which have been determining factors in the development of civilization in recent years, have led to a sharp increase in anthropogenic pressure on the environment. To reduce it requires a change in the technogenic type of civilization development to another paradigm. The problem of the mankind future in general has come to the forefront of scientific research and public consciousness. One of the ways to implement the principles of the sustainable development concept is convergent management, in which there is a convergence of scientific and methodological foundations of different fields of knowledge to achieve the goals. The purpose of the article is to substantiate the scientific basis of convergent project management of eco-logistics systems. To achieve this goal, the following tasks were set: to determine the role of values convergence in achieving the goals of sustainable development; substantiate the application of logistics, environmental and project management methodologies convergence in projects of eco-logistics systems; substantiate the application of scientific approaches convergence in project management of eco-logistics systems. The convergence of economic and environmental values is due to changes in the worldview of mankind from consumer attitudes to nature to environmentally-oriented development, which meets the goals of the sustainable development concept. Systems convergence is the creation of environmentally-oriented economic systems, which include eco-logistics systems. Management of eco-logistics systems is based on the convergence of  project, logistics and environmental management methodologies, as well as the convergence of general management approaches (system, process, scenario) and scientific-natural  (biological, environmental, physical) ones.
REVEALING SIGNIFICANT CHEMICAL COMPOSITION EFFECTS ON THE SUPER ALLOYS PERFORMANCE BY DATA MINING TECHNIQUES APPLICATION
Authors: Nengjun Ben , Tkachenko Igor , Miroshnichenko Victoria
Published: March 2022

Based on the early developed integrated investigation approach combining mutually consistent computer aided: statistical exploratory techniques, multiple regression models development, Monte-Carlo simulations and multipurpose manufacturing technology parameters optimization, computer statistical investigations of chemical composition effects on some basic performance characteristics of modern industrial superalloys (SAs) were conducted. According to the developed approach, the Data Mining-based C&RT statistical technology was used in the current work as the first stage of the further analysis. An important feature of the developed approach to the “passive experimentation” in general and the applied technique in particular was emphasized as both providing minimal investigation expanses, as compared to the “active”  one and so having no alternative in free market economic conditions. As the stage primary results, the dendrograms were constructed providing the following statistically grounded visual information for each SAs controlled performance index: – a full list of statistically significant chemical elements;  allowable variants of the elements combinations; limits of the chemical element concentration intervals spillover of which provides changes in the chemical elements combinations; variation tendencies for the control indexes within the revealed concentration intervals. Interactions of the most of the chemical elements comprised by SAs in their effects on the investigated performance indexes were shown. High effectiveness of the obtained dendrograms application to reveal individual and mutual chemical element effects on the multi element alloys performance together with uniqueness of such an information for industrial alloys were emphasized. Some prospect possibilities were noted for the obtained dendrograms application: - as a first stage of a multi-parameter process analysis in industrial conditions, – a ground stage of  the multiple regression models further development and final multipurpose technological processes optimization conducting.
FEATURES OF SPORTS PROJECTS AND SPECIFICS OF MANAGING THEM
Authors: Savina Oksana , Kozlenko Andriy
Published: March 2022

Problems in the field of physical culture and sports lead to serious consequences: a significant part of the population of Ukraine leads an unhealthy and passive lifestyle, almost the entire sports infrastructure is inaccessible to persons with disabilities; Ukraine occupies one of the highest places in the world for doping, which negatively affects the country's image in the international sports environment; the mechanisms of sports self-development do not function properly; the sphere of physical culture and sports does not provide significant economic and social and humanitarian preferences to territorial communities and the state. This, accordingly, causes an increase in the need to increase the efficiency and cost-effectiveness of the use of sports projects, an increase in the advantages and elimination of disadvantages from their use, as well as justification of the costs of physical culture and sports. In the context of reforming the field of physical culture and sports, the management faces the task of identifying, evaluating, researching and implementing effective tools, methods, techniques, means and methods of implementing the strategy for the development of physical culture and sports. To meet this need, regular use in the management system of physical culture and sports projects is becoming increasingly important. The analysis of the works of domestic and foreign scientists and researchers in the field of management in the branch of physical culture and sports, as well as the management of sports projects is carried out. The existing models, methods and mechanisms of sports project management are analyzed, the main problems and factors influencing their composition, driving forces, as well as the preconditions for making changes are identified. The features of sports projects are revealed. The main types of sports projects are identified. The classification of sports projects is carried out and its specifics is considered. The peculiarities of sports project management are highlighted and main problems of such management are identified. The main groups of external and internal risks of sports projects have been identified. Using the Ishikawa causal diagram method, a preliminary qualitative analysis of the risk factors that lead to ineffective management of sports projects (an increase in the cost and execution time and a deterioration in the quality of such projects) was carried out. The high dependence of the efficiency of sports project management at all stages of the life cycle on the stakeholders of such projects has been determined.
USING MOBILE CROWD SENSING FOR SOCIAL DISTANCING REAL-TIME NAVIGATION
Authors: Pasichnyk Volodymyr , Kunanets Nataliia , Artemenko Olga , Fedorka Pavlo , Nebesnyi Ruslan
Published: March 2022

The study focuses on current trends in the use of smartphones and other smart devices to provide information support to users in a COVID pandemic. The perspective adaptations of mobile crowd sensing (MCS) information technologies to ensure the social distance of pedestrians while walking through the city are described. Specifics of navigation and data collection from users' smartphone’s sensors in the case of open space and in large buildings (stations, hospitals, government agencies and other social infrastructure) navigation are considered. A project approach to the creation of a mobile recommender application for a safe walking route in real time with the support of social distancing based on hybrid tourist recommender systems, mobile crowd sensing and big data analysis is proposed. The main problems and challenges presented with the implementation of such a project are outlined. Safe navigation of users in large rooms is also an increase in the urgent task. After all, even the best strict guarantees of the ban do not make it possible to determine the assessment of health care facilities, construction of social, educational, trade, transport infrastructure, etc.  The main problems and stages of data extraction from the user 's device are considered, as well as the approaches to the organization of user navigation within the city are analyzed: both indoors and outdoors. The algorithm was proposed for building a safe route recommendation with mobile crowd sensing application with multi-criteria context evaluation for social distancing real-time navigation.
BIM TECHNOLOGIES AS A TOOL FOR CREATION INFORMATION MODEL OF THE LIFE CYCLE OF THE CONSTRUCTION OBJECT
Authors: Honcharenko Tetyana
Published: March 2022

The problem of expediency of application of information modeling technology for creation of information models of construction objects at different stages of a life cycle is considered. A review of models of different levels: two-dimensional flat drawings – 2D, three-dimensional 3D models – 3D, models that include time indicators – 4D, models supplemented by financial indicators – 5D, models that contain information about a wide range of resources and others indicators – ND. The need to use the BIM platform to create a digital duplicate of the construction site based on the information model was noted. Today, BIM-technologies are most often used at the design stage and partly at the construction stage. However, the greatest efficiency from the digital duplicate of the construction site can be obtained during the operation phase. The transition to BIM-models is effective only if you work with them at all stages of the life cycle of the construction site. In this regard, it is proposed to introduce the concept of "information model of the life cycle of the construction object." The analysis of the reasons which cause problems of mass introduction of such approach in construction practice is carried out. Contradictory interests of the participants in the construction process, the lack of common goals do not allow to form and use a single information model. To overcome this contradiction, a generalized comprehensive information model of the living environment is proposed, which can be presented as an element of a higher level system. It can be considered as a tool for urban planning and zoning for regional and sectoral development schemes.
A importância da decisão partilhada em consulta: um relato de caso
Authors:   USF Conde de Oeiras, Esteves Ana Catarina , Carteiro Jorge Ramalho ,   Médico de Família
Published: March 2022

Introdução: O rastreio do cancro da mama tem, como propósito, não só o diagnóstico mais precoce como também a possibilidade de uma intervenção menos agressiva e com melhores resultados em saúde. Contudo, apesar de estar preconizada esta recomendação em mulheres a partir dos 50 anos, o mesmo não acontece naquelas com idades inferiores, em que a importância da discussão risco-benefício e a decisão partilhada apresentam ainda maior relevância. Este caso clínico pretende realçar a importância das decisões esclarecidas e partilhadas com o utente sobre saúde. Descrição do caso: Mulher de 48 anos, profissional de saúde, sem antecedentes familiares ou pessoais relevantes. Aos 40 anos, numa consulta particular de ginecologia, foi prescrita mamografia, sem esclarecimentos adicionais, cujo resultado foi BI-RADS 4, motivando a sua referenciação a uma consulta hospitalar. Realizou punção-biópsia aspirativa, que não revelou células malignas. Manteve vigilância no médico de família e aos 47 anos obteve novo resultado BI-RADS 4 em mamografia e voltou à consulta hospitalar, onde optou pela excisão cirúrgica da lesão, devido ao impacto psicológico negativo causado pela expectativa e incerteza do resultado. Comentário: Neste caso em particular, considerando a ausência de fatores de risco major para cancro da mama e a idade da utente, há que ponderar o risco de sobrediagnóstico e sobretratamento quando se inicia o rastreio do cancro da mama. É, por isso, essencial que a transmissão de informação seja feita de forma clara e que a tomada de decisão final seja partilhada e reflita a vontade da utente.
CADASIL: a propósito de um caso clínico
Authors:   USF Joane, ACES Ave - Famalicão, Real Ana Luísa Corte , Zeferino Sara ,   USF Joane, ACES Ave - Famalicão
Published: March 2022

Introdução: A arteriopatia cerebral autossómica dominante com enfartes subcorticais e leucoencefalopatia (CADASIL) é a doença de pequenos vasos cerebrais hereditária mais comum, causada por mutações no gene NOTCH3. As suas manifestações clínicas iniciam-se tipicamente em adultos jovens e incluem enxaqueca com aura, acidentes isquémicos transitórios (AIT) e acidentes vasculares cerebrais recorrentes, perturbações psiquiátricas e demência. O diagnóstico é estabelecido através de teste genético. Este relato de caso tem como objetivo alertar para esta entidade clínica, destacando a sintomatologia, diagnóstico, orientação e prognóstico. Descrição do caso: Mulher de 51 anos, avaliada em 2011 na sua unidade de saúde familiar por hipoestesia da hemiface e membro superior direitos. Ao exame neurológico apresentava diminuição da sensibilidade tátil do hemicorpo direito. Encaminhada para o serviço de urgência efetuou tomografia computorizada crânio-encefálica, que evidenciou leucoencefalopatia isquémica microangiopática, tendo tido alta, após reversão dos défices, com diagnóstico de AIT e medicada com ácido acetilsalicílico. Acompanhada em consulta de neurologia realizou ressonância magnética (RMN) cerebral que revelou leucoencefalopatia isquémica, tendo sido medicada com estatina. Apresentou mais três AIT até 2018, quando efetuou RMN cerebral que evidenciou lesões sugestivas de CADASIL. O estudo genético foi positivo. Atualmente com 60 anos, após múltiplos eventos isquémicos, a doente refere esquecimentos cada vez mais frequentes, dificuldades na nomeação e na fluência verbal, sendo evidente o declínio progressivo da sua cognição e a sua subsequente limitação funcional. Comentário: Não existe tratamento eficaz para a CADASIL. A sua abordagem consiste em aconselhamento genético, controlo de fatores de risco vascular e de sintomas. Representando um desafio diagnóstico, o médico de família poderá assumir um papel importante na sua suspeição, considerando o conhecimento privilegiado do indivíduo e sua família. Por último, o médico de família acompanhará o doente em todas as fases da evolução da doença, fornecendo-lhe o suporte necessário a ele e à sua família.
COVID-19: adaptação de uma unidade de saúde familiar a novos desafios de acessibilidade aos cuidados de saúde
Authors:   USF Terras de Cira, Costa Luís Paulo , Lira Luís Terroso ,   USF Terras de Cira, Magalhães Alice ,   USF Terras de Cira, Garuta Ina ,   USF Terras de Cira, Esperanço Nuno ,   USF Terras de Cira, Real Valeriya ,   USF Terras de Cira, Silva Hugo ,   USF Terras de Cira, Cardoso Sérgio Barros ,   USF Terras de Cira, Vicente Ana ,   USF Terras de Cira
Published: March 2022

A pandemia COVID-19 obrigou a uma rápida adaptação dos serviços de saúde para que se pudesse manter a resposta e qualidade dos cuidados. De forma a garantir a acessibilidade dos utentes aos cuidados de saúde primários e minimizar as consequências do distanciamento social, oferecendo alternativas à consulta presencial, a nossa Unidade de Saúde Familiar (USF) criou a linha de apoio ao utente. Os profissionais da USF adquiriram de forma autónoma seis telemóveis e criaram seis linhas diferentes: duas linhas para apoio médico geral, duas linhas para assuntos relacionados com a COVID-19, uma linha de apoio de enfermagem e uma linha de apoio do secretariado clínico. Foi criada uma base de dados para registo de contactos médicos e de enfermagem. Esta base de dados permitiu ainda a referenciação direta a apoio de psicologia. Avaliou-se um período de seis meses (entre 16 de março e 16 de setembro de 2020). Foram registadas 7.535 chamadas: 5.281 nas linhas de apoio médico geral e 230 nas linhas médicas relacionadas com a COVID-19. Foram feitas 51 referenciações para apoio psicológico. As restrições que obrigaram a medidas extraordinárias serão levantadas e esta experiência pode fornecer bases para o futuro, nomeadamente como diversificar a acessibilidade de uma unidade de saúde familiar, salientando a necessidade de investimento nessa área. No contexto atual, a telemedicina tem-se revelado uma alternativa adequada para o atendimento e orientação dos utentes.
Papel de uma intervenção estruturada na prescrição racional e desprescrição de benzodiazepinas na população geriátrica em cuidados primários
Authors:   USF Condeixa, Cardoso Carlos Seiça , Rebelo-Marques Alexandre ,   Faculty of Medicine, Universit of Coimbra, Oliveira Pedro ,   Faculty of Medicine, Universit of Coimbra, Loureiro Mariana ,   USF Fernando Namora, Oliveiros Bárbara ,   Laboratory of Biostatistics and Medical Informatics, Ribeiro Carlos Fontes ,   Faculty of Medicine, Universit of Coimbra
Published: March 2022

Introdução: As benzodiazepinas (BDZ) são amplamente utilizadas para controlar os sintomas na insónia e nas perturbações de ansiedade. Na população geriátrica, as preocupações relacionadas com estes tratamentos são maiores, sendo que, além da possibilidade de causarem sonolência diurna, existe ainda evidência de associação com o aumento do risco de quedas, declínio cognitivo e delirium. Neste contexto surge a necessidade de estudar e avaliar estratégias para prescrição racional e desprescrição de BDZ, evitando utilização prolongada/crónica sempre que clinicamente desnecessária, bem como desenvolvimento de guidelines para apoiar estas intervenções terapêuticas. Este estudo teve como objetivo primário avaliar a eficácia de uma intervenção composta na prescrição racional/desprescrição de BDZ na população geriátrica acompanhada em cuidados de saúde primários. Métodos: Ensaio clínico aleatorizado envolvendo duas Unidades de Saúde Familiar (USF) do mesmo centro de saúde, com vista a testar a eficácia de uma intervenção composta na melhoria do perfil de prescrição de BDZ em indivíduos com mais de 65 anos. Conclusão: Após nove meses a probabilidade de não existir prescrição de BDZ é, em média, 1.004 vezes maior (cerca de 0,4%) na USF onde existiu intervenção do que na USF controlo e, portanto, demostrando que a intervenção pode ser benéfica. Acredita-se que outros estudos, metodologicamente otimizados, poderão ser um contributo importante para ajudar a resolver este problema.
Inércia terapêutica na diabetes mellitus tipo 2: perceção dos médicos de família e clínica geral do ACeS Almada-Seixal
Authors:   Médica Interna de Medicina Geral e Familiar, Rosa Sara , Reis Joana ,   Médica Interna de Medicina Geral e Familiar, Ferreira Sara ,   Médica Interna de Medicina Geral e Familiar, Alves Ricardo ,   Médica Interna de Medicina Geral e Familiar, Silva Ricardo ,   Médico Interno de Medicina Geral e Familiar, Leite Pedro ,   Médico Interno de Medicina Geral e Familiar, Faria Mariana ,   Médica Interna de Medicina Geral e Familiar, Ribeiro Anabela ,   Médica Interna de Medicina Geral e Familiar
Published: March 2022

Introdução: O objetivo deste estudo foi identificar barreiras ao início de insulina e fatores sociodemográficos e laborais associados. Material e Métodos: Estudo transversal desenvolvido a partir de um questionário aplicado a 146 médicos do ACeS Almada-Seixal, entre outubro e dezembro de 2019, avaliando a concordância com 30 barreiras, utilizando uma escala de Likert de 5 pontos. Utilizou-se uma regressão logística para medir a associação entre a concordância com cada item e os fatores associados ao médico. Resultados: A taxa de resposta foi de 74%. Numa amostra de 146 médicos, a idade média foi de 44 anos, 75% eram mulheres e 64% trabalhavam numa USF modelo B. As barreiras que geraram maior concordância estão relacionadas com características dos utentes e o impacto positivo da insulina no prognóstico da diabetes. As de maior discordância foram a possibilidade de prejudicar a relação médico-doente, dúvidas sobre a quem compete e quando deve ser iniciada a insulina. Os médicos mais velhos discordam com barreiras relacionadas com características dos utentes e com a falta de formação. Com o aumento da categoria profissional tendem a discordar com fatores relacionados com a falta de formação, experiência e relação médico-doente. Os médicos das UCSP concordam que não têm uma equipa multidisciplinar adequada ao acompanhamento de diabéticos. Discussão: Identificaram-se barreiras já descritas na literatura, sobretudo para médicos mais novos, em formação e das UCSP. Conclusão: Os resultados podem ser usados localmente, melhorando a formação de médicos mais novos e incentivando a criação de equipas multidisciplinares dedicadas à diabetes nas UCSP.
Intervenções educacionais baseadas na família para a autogestão da diabetes em adultos: revisão baseada na evidência
Authors:   USF Balsa, ACeS Algarve III - Sotavento, Joaquim Natércia , Nunes Tiago ,   USF Mirante, ACeS Algarve I, Miranda Rui ,   USF Balsa, ACeS Algarve III
Published: March 2022

Objetivo: Nos últimos anos assistiu-se à mudança da abordagem da diabetes para uma estratégia que coloca o paciente e a sua família no centro da gestão dos cuidados. As intervenções educacionais são fundamentais para capacitar o diabético para o autocuidado adequado. Apesar de diversos estudos terem demonstrado impacto positivo da inclusão da família na gestão das doenças crónicas, pouca relevância tem sido dada às intervenções educacionais baseadas na família. Assim, o objetivo deste trabalho é fazer uma atualização da evidência sobre intervenções educacionais baseadas na família na autogestão da diabetes em adultos. Métodos: Efetuou-se uma pesquisa de artigos publicados entre janeiro de 2010 e dezembro de 2019 em língua inglesa, portuguesa ou espanhola, utilizando os termos Diabetes, Family-based Intervention e Self-care ou Self-management nas bases de dados de medicina baseada na evidência. Foram selecionados e analisados os artigos que avaliavam a efetividade de intervenções educacionais baseadas na família na autogestão da diabetes em populações adultas. A Strength Of Recommendation Taxonomy (SORT) foi utilizada para classificar a qualidade dos estudos e atribuir a força de recomendação. Resultados: Selecionaram-se três revisões sistemáticas, uma meta-análise e quatro ensaios clínicos aleatorizados, cujos resultados apontam para o facto de que, de modo geral, as intervenções baseadas na família apresentam benefícios em outcomes biológicos/clínicos, comportamentais e psicossociais. No entanto, estes estudos incluem uma grande diversidade de níveis de envolvimento da família, do modelo das intervenções educacionais e dos resultados avaliados. Conclusões: Apesar da evidência disponível ser ainda limitada, os estudos incluídos nesta revisão demonstraram benefícios das intervenções educacionais baseadas na família em outcomes de saúde. Assim, recomenda-se (SORT B) a participação dos doentes com as suas famílias em programas educacionais para a promoção da autogestão da diabetes.
Migração de dispositivo intrauterino: relato de caso
Authors:   Médica Especialista de Medicina Geral e Familiar, Correia Maria José , Lopes Ana Magro ,   Médica Especialista de Medicina Geral e Familiar
Published: March 2022

Introdução: Os dispositivos intrauterinos (DIU) são um método contracetivo de longa duração, amplamente colocados por médicos de família e ginecologistas. Apesar de serem seguros e fiáveis existem possíveis complicações, como perfurações e abcessos associados à sua colocação. Na literatura estão descritos mais de mil casos de migração de DIU desde o útero até outras localizações, como o cólon sigmoide ou a cavidade peritoneal. Descrição do caso: Descreve-se o caso de uma mulher de 54 anos, natural da Guiné-Bissau, com dor pélvica e dispareunia recorrente desde há dez anos, tendo sido seguida em consulta hospitalar de ginecologia durante quatro anos. Nos últimos anos apresentava queixas irritativas urinárias, como disúria, polaquiúria e urgência miccional, com presença de hematúria, piúria e uroculturas positivas. Apesar do tratamento antibiótico dirigido, com vários ciclos de antibióticos, constatava-se recorrência das queixas, pelo que realizou ecografia ginecológica e vesical, onde se detetou uma formação hiperecogénica linear na bexiga, compatível com DIU. A utente foi encaminhada para o serviço de urgência de urologia, onde foi confirmado o diagnóstico e se procedeu à remoção. Comentário: Na literatura, praticamente todos os casos de DIU extrauterinos são descritos como consequência da migração dos mesmos. As utentes utilizadoras de DIU devem efetuar um controlo clínico regular e, ante a suspeita de DIU “desaparecido” numa mulher com dor pélvica, disúria ou infeções urinárias recorrentes, deve proceder-se sempre à realização de exames complementares de diagnóstico para descartar a hipótese rara, mas possível, da sua migração.
Fatores que influenciam a escolha do contracetivo na mulher
Authors:   Centro Hospitalar Universitário de Coimbra, Cunha Rebeca de Sousa e , Ferreira António Cruz ,   USF Mealhada, Santiago Luiz Miguel ,   USF Topázio
Published: March 2022

Introdução: A escolha do método contracetivo da mulher em idade fértil é determinada por um conjunto de receios e condicionalismos. Objetivos: Identificar fatores que condicionam a escolha do método contracetivo num grupo de mulheres em idade fértil e discutir possíveis estratégias a utilizar pelo médico de família, promovendo uma escolha esclarecida. Métodos: Inicialmente realizou-se uma revisão da literatura, através de pesquisa na PubMed, circunscrita ao período entre 2010 e 2019, utilizando a equação: contraception OR family planning AND selection criteria. Posteriormente realizou-se um estudo observacional, descritivo, em setembro de 2019, em três USF da região centro de Portugal. As mulheres em idade fértil, com consulta programada de planeamento familiar, foram a população alvo. A amostra foi selecionada aleatoriamente (n=127). Responderam a um questionário que permitiu recolher dados pessoais, como idade, estado civil e número de partos e gravidezes, e a sua avaliação quantitativa relativamente a uma lista de fatores que poderiam influenciar a decisão sobre a escolha do método contracetivo. Resultados: O contracetivo hormonal oral foi o método mais utilizado pelas participantes (57,5%), enquanto a segurança (78,7%) e a eficácia do método (78%) foram os fatores considerados mais importantes. Com menor destaque, as mulheres referiram: facilidade no uso/aplicação (59,8%), evitar perdas sanguíneas irregulares (55,9%), proteger contra doenças sexualmente transmissíveis (54,3%), acessibilidade (53,5%) e evitar efeitos colaterais (53,5%). Quanto à opinião de terceiros, apenas a opinião do médico foi considerada muito importante para 59,1% delas. Conclusão: Este estudo permitiu identificar os fatores considerados relevantes para as mulheres em idade fértil no momento da escolha do seu contracetivo. Estes resultados poderão auxiliar os médicos de família a direcionar a sua abordagem, dando resposta às suas dúvidas e inquietações para que, posteriormente, estas possam decidir sobre o método a utilizar.
Rastreio da infeção por Chlamydia trachomatis: sim ou não?
Authors:   ACeS Madeira - Centro de Saúde do Bom Jesus, Silva Daniela Sofia Abreu , Macedo Francisco ,   ACeS Madeira - Centro de Saúde do Bom Jesus, Quintal Dolores ,   ACeS Madeira - Centro de Saúde do Bom Jesus
Published: March 2022

A infeção por Chlamydia trachomatis é a infeção sexualmente transmissível bacteriana mais comum no mundo. Habitualmente é assintomática, mas pode conduzir a graves consequências, em especial no sexo feminino, como doença inflamatória pélvica, infertilidade, gravidez ectópica e dor pélvica crónica. A prevalência global é de 3,8% nas mulheres, sendo a maioria dos casos entre os 15-24 anos. O diagnóstico é feito com testes de amplificação de ácidos nucleicos. Diversos países já dispõem de programas de rastreio desta infeção, com benefício comprovado na redução da prevalência e das complicações reprodutivas. Em Portugal é uma doença de notificação obrigatória, mas não existem recomendações formais que orientem o seu diagnóstico e tratamento. O médico de família tem um papel determinante na prevenção e atuação nas infeções sexualmente transmissíveis. Este trabalho pretende rever as recomendações internacionais e sublinhar os benefícios do rastreio da infeção por Chlamydia trachomatis.