Portuguese National Research Articles

Representations of Catherine of Braganza in Portuguese National Collections: A Continuous Visual Construction?

Some of the National Museums of Portugal keep in their collections representations of Catherine of Braganza (1638–1705), which are under the supervision of the Directorate General of Cultural Heritage (DGPC). By analysing the different types of support used, ranging from canvas to ceramics, paper and metal, we can outline the way in which the image of the queen of England was constructed from her early days to her maturity. In this article the aim is not only to trace the evolution of her iconography, but also to present the most recent developments in relation to the portrait of Catherine of Braganza on the basis of comparative analysis and original evidence from archival research.

Quality decreases from introducing patient choice in a National Health Service

A view often expressed about patient choice of health care providers is that it will increase competition between providers, which benefits the efficiency of the health system. We address here a patient choice initiative, regarding selection of hospital for specialty consultations, in the Portuguese National Health Service (NHS) that has two specific features. The first feature involves shared decision making between patients and GPs, in the choice of hospital for referral, which should be based on publicly available information on “quality”. The second specific feature is that the patient choice initiative did not involve payment changes to NHS hospitals associated with patients’ movements. We show that explaining initial asymmetries in qualities (waiting times) with systematic differences in hospital characteristics (cost advantages and managerial talent) leads to potential asymmetric responses to the introduction of patient choice in the NHS. This implies that the empirical analysis has to accommodate such asymmetries. Explicitly allowing for asymmetries in responses to the policy measure reveals that reactions were indeed different, with top-performance hospitals reducing their qualities (increasing waiting times) after the patient choice initiative was introduced.

EPI-ASTHMA study protocol: a population-based multicentre stepwise study on the prevalence and characterisation of patients with asthma according to disease severity in Portugal

IntroductionIn Portugal as in other countries, data on the epidemiology of asthma are mainly grounded in questionnaire studies. Additionally, the detailed characterisation of asthma in terms of disease severity, control...

The bidirectional interplay between self-regulation and expressive vocabulary during toddlerhood.

The interplay between self-regulation related skills and language is well recognized in dynamic theories, but few empirical studies have tested it, especially in toddlers. The current study examines the bidirectional links between self-regulation related skills and expressive vocabulary in a longitudinal study during toddlerhood. Participants were 268 toddlers (Mage = 29.6 months, SD = 4.2; 52% boys), mostly of Portuguese nationality, with medium to high sociocultural and economic status, attending private for-profit and nonprofit facilities in Portugal. Self-regulation (executive function and effortful control) and expressive vocabulary were assessed across three assessment waves. Results from cross-lagged panel models suggested bidirectional links between self-regulation and expressive vocabulary across the three assessment waves. These findings add to previous research by taking a first step into establishing the early onset of the intertwined development of these two foundational skills. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

O3-2 Evaluation of implementation and impact of a national mass media campaign to promote active lifestyles in Portugal: ‘Follow the Whistle: Physical Activity is Calling You'

Abstract Background Portugal has one of the highest rates of physical inactivity in Europe. To raise the profile of physical activity (PA) among adults, the Portuguese National Physical Activity Promotion Program of the Directorate-General of Health developed and implemented a national mass media campaign in 2019 named ?Follow the Whistle?. The campaign was based on social marketing principles and behavior change theory, namely the COM-B model, and was developed through formative research. We aim to describe the implementation process and short-term impact evaluation data. Methods ‘Follow the Whistle' was launched in June 2019 and continued for 4 weeks (TV, Radio, Online and Cinema, newspapers, outdoors). Pre (n = 878, 57%women) and post (n = 1319, 58%women) independent adult population samples were used to assess campaign impact. Participants were recruited through the mailing list of a Portuguese mutual insurance company, a network from across Portugal. The online questionnaire comprised socio-demographic factors, campaign awareness and recall, and psychosocial and behavioral measures linked to the four targets of the COM-B model, including items to assess perceived capability for physical activity(C), perceived opportunity for practice/ ease of integration of PA in daily living(O), motivation for PA practice(M) and behavior(B) assessed with IPAQ and the Activity Choice Index. Results Pre-and post-campaign samples were broadly demographically similar. Campaign recall increased significantly from 1% to 24% in prompted tagline recall (1/3 at post-campaign correctly recalled specific campaign images). All the targeted COM-B indicators changed in the expected direction, suggesting increases in perceived capability to engage in PA, perceived daily opportunities for being physically active, and in motivation (considering PA as fun, important, and compatible with other important things in life) (all p > 0.05). Results from PA behavior measures revealed increases only for vigorous activities (p > 0.001). Conclusions The GAPPA recommends the creation of active societies starting with best-practice community-wide communications campaigns. Although one focus of the ?Follow-the whistle? (i.e. promotion of active transport and incidental everyday forms of physical activity) was not entirely achieved (i.e. changes only in vigorous activities), the initial campaign objectives of increases in awareness, and influencing intermediate outcomes were achieved. Further campaign waves are planned for future years.

Burnout among Physicians Working in Palliative Care During the COVID-19 Pandemic in Portugal: A Cross-Sectional Study.

Physicians working in palliative care have a greater risk of burnout. Burnout has three dimensions: emotional exhaustion, depersonalization and reduction of personal accomplishments. Burnout is associated with different consequences for the professionals like less professional satisfaction and increase of overall levels of exhaustion. Burnout in healthcare professionals has an impact in the patients with increased probability of clinical erros. In order to monitor the quality of the care it is mandatory to assess overall levels of burnout. This study aimed to determine burnout levels and associated variables of physicians working in the Portuguese national network of palliative care. A cross-sectional, exploratory and quantitative design was employed and participants were sampled using convenience and snowball technique. The Copenhagen Burnout Inventory was used to determine burnout levels of physicians working in the Portuguese National Network of Palliative Care. The contributions of personal, work and COVID-19 variables were evaluated in three subclasses: work, personal and patient-related burnout. The results obtained enabled the identification of healthcare professionals at risk, comparison with previous results published and to assess the impact of COVID-19 in their non COVID-19 activity. Seventy-five physicians participated. Socio-demographic characterization was conducted and the levels of burnout and determinants were explored. High levels of personal, work and patient-related burnout were present in 32 (43%), 39 (52%) and 16 (21%) physicians, respectively. The majority agreed that COVID-19 had an impact on their activities. Exclusive dedication to palliative care and type of palliative care unit were associated with lower levels of patient and work-related burnout. Weekly physical activity was associated with lower levels of work and personal burnout. Self-perceived health status was associated with lower levels of burnout for all subclasses. There was a high level of burnout among physicians working in the Portuguese National Network of Palliative Care. Measures to identify and prevent burnout are necessary in order to protect these professionals.

Predictors of physical activity promotion in clinical practice: a cross-sectional study among medical doctors

BackgroundPhysical activity is a major determinant of physical and mental health. International recommendations identify health professionals as pivotal agents to tackle physical inactivity. This study sought to characterize medical doctors’ clinical practices concerning the promotion of patients’ physical activity, while also exploring potential predictors of the frequency and content of these practices, including doctors’ physical activity level and sedentary behaviours.MethodsA cross-sectional study assessed physical activity promotion in clinical practice with a self-report questionnaire delivered through the national medical prescription software (naturalistic survey). Physical activity and sedentary behaviours were estimated using the International Physical Activity Questionnaire (short form). Indicators of medical doctors’ attitudes, knowledge, confidence, barriers, and previous training concerning physical activity promotion targeting their patients were also assessed. Multiple regression analysis was performed to identify predictors of physical activity promotion frequency by medical doctors, including sociodemographic, attitudes and knowledge-related variables, and physical activity behaviours as independent variables.ResultsA total of 961 medical doctors working in the Portuguese National Health System participated (59% women, mean age 44 ± 13 years) in the study. The majority of the participants (84.6%) reported to frequently promote patients’ physical activity. Five predictors of physical activity promotion frequency emerged from the multiple regression analysis, explaining 17.4% of the dependent variable (p < 0.001): working in primary healthcare settings (p = 0.037), having a medical specialty (p = 0.030), attributing a high degree of relevance to patients’ physical activity promotion in healthcare settings (p < 0.001), being approached by patients to address physical activity (p < 0.001), and having higher levels of physical activity (p = 0.001).ConclusionsThe sample of medical doctors approached reported a high level of engagement with physical activity promotion. Physical activity promotion frequency seems to be influenced by the clinical practice setting, medical career position and specialty, attitudes towards physical activity, and perception of patients´ interest on the topic, as well as medical doctors’ own physical activity levels.

Treatment-resistant depression and major depression with suicide risk-The cost of illness and burden of disease.

IntroductionTreatment-Resistant Depression (TRD) and Major Depression with Suicide Risk (MDSR) are types of depression with relevant effects on the health of the population and a potentially significant economic impact. This study estimates the burden of disease and the costs of illness attributed to Treatment-Resistant Depression and Major Depression with Suicide Risk in Portugal.MethodsThe disease burden for adults was quantified in 2017 using the Disability-Adjusted Life Years (DALYs) lost. Direct costs related to the health care system and indirect costs were estimated for 2017, with indirect costs resulting from the reduction in productivity. Estimates were based on multiple sources of information, including the National Epidemiological Study on Mental Health, the Hospital Morbidity Database, data from the Portuguese National Statistics Institute on population and causes of death, official data on wages, statistics on the pharmaceutical market, and qualified opinions of experts.ResultsThe estimated prevalence of TRD, MDSR, and both types of depression combined was 79.4 thousand, 52.5 thousand, and 11.3 thousand patients, respectively. The disease burden (DALY) due to the disability generated by TRD alone, MDSR alone, and the joint prevalence was 25.2 thousand, 21 thousand, and 4.5 thousand, respectively, totaling 50.7 thousand DALYs. The disease burden due to premature death by suicide was 15.6 thousand DALYs. The estimated total disease burden was 66.3 thousand DALYs. In 2017, the annual direct costs with TRD and MDSR were estimated at € 30.8 million, with the most important components being medical appointments and medication. The estimated indirect costs were much higher than the direct costs. Adding work productivity losses due to reduced employment, absenteeism, presenteeism, and premature death, a total cost of € 1.1 billion was obtained.ConclusionsAlthough TRD and MDSR represent relatively small direct costs for the health system, they have a relevant disease burden and extremely substantial productivity costs for the Portuguese economy and society, making TRD and MDSR priority areas for achieving health gains.

The unintended consequences of hospital strikes on patient outcomes evidence from multiple strikes in the Portuguese National Health Service.

Hospital strikes in the Portuguese National Health Service (NHS) are becoming increasingly frequent. This paper analyses the effect of different health professionals' strikes (physicians, nurses, and diagnostic and therapeutic technicians (DTT) - DTT) on patient outcomes and hospital activity. Patient-level data, comprising all NHS hospital admissions in mainland Portugal from 2012 to 2018, is used together with a comprehensive strike dataset with almost 130 protests. Data suggests that hospital operations are partially disrupted during strikes, with sharp reductions in surgical admissions (up to 54%) and a decline on both inpatient and outpatient care admissions. The model controls for hospital characteristics, time and regional fixed effects, and case-mix changes. Results suggest a modest increase in hospital mortality limited for patients admitted during physicians' strikes, and a slight reduction in mortality for patients already at the hospital when a strike takes place. Increases in readmission rates and length of stay are also found. Results suggest that hospitals and legal minimum staffing levels defined during strikes are not flexible enough to accommodate sudden disruptions in staffing, regardless of hospital quality in periods without strikes.

Impact of pharmacological treatment of gestational diabetes on the mode of delivery and birth weight: a nationwide population-based study on a subset of singleton pregnant Portuguese women.

To access the impact of increasing use of metformin on cesarean section and large for gestational age rates, when compared to insulin. A retrospective observational study was developed using data from the Portuguese National Registry, between 2011 and 2019, of 5038 Portuguese women with single pregnancies and gestational diabetes treated with metformin and/or insulin. Three groups were defined according to the therapeutic regimen adopted: g1-insulin in monotherapy (n = 3027[60.1%]); g2-metformin in monotherapy (n = 1366[27.1%]); g3-metformin and insulin (n = 645[12.8%]). Multivariate analysis was adjusted for statistically significant covariates. The cesarean section rate in g1 was similar to g2 (g1:36.9% vs. g2:37%, p = 0.982), although g3 was associated with cesarean delivery (g3:43.6% vs. g1:36.9%, p = 0.005; g3:43.6% vs. g1:37.0%, p = 0.002), with no differences reported in the multivariate analysis adjusted for year of delivery and pregestational body mass index. A delivery of a large for gestational age newborn was less frequently observed in g2 than in g1 (g2:4.1% vs. g1:5.4%, p = 0.044) and in g3 (g2:4.1% vs. g3:9.1%, p < 0.001), and in g1, when compared to g3 (g1:5.4% vs. g3:9.1%, p < 0.001). In the multivariate analysis, g2 showed lower odds of delivering a large for gestational age newborn, compared to g1 (β = -0.511, OR = 0.596, CI95% = 0.428-0.832, p < 0.001). The use of metformin was not associated with higher cesarean section rates, compared to insulin. Instead, it was suggested a protective role of metformin on large gestational age rates. The concomitant use of dual therapy suggests more complex pregnancies, requiring closer surveillance that mitigate serious perinatal and obstetrical outcomes.

Cutaneous Lesions From Monkeypox Infection.

A 33-year-old man presented to a sexually transmitted disease clinic in Lisbon with a 1-week history of facial and gluteal skin lesions. He had a mild fever and malaise during the first 3 days. He was otherwise healthy, reported sexual intercourse exclusively with men, and had no previous illnesses of sexual transmission. Physical examination disclosed multiple papules with a central dark crust distributed in the inner aspect of the buttocks, as well as an erosion on the posterior portion of the right thigh (Fig. 1). Two similar papules were found on the perioral region and a painful anterior cervical lymphadenopathy was palpable.Figure 1: Multiple papules with a dark crust in the center. Note the erosion on the right posterior thigh, compatible with a more advanced lesion. Figure 1 can be viewed online in color at www.stdjournal.com.A swab performed at the base of the lesions was sent to the Portuguese National Health Institute, which revealed the presence of monkeypox virus, via real-time polymerase chain reaction (PCR) technique. Serologies were negative for HIV, hepatitis C and syphilis. The PCR tests were positive for Chlamydia trachomatis in the urine, and Neisseria gonorrhoeae was positive in anal and oral samples. The PCR for herpes simplex virus 1 and 2 was not detected in the lesions. Antibiotic treatment for concomitant sexually transmitted diseases was prescribed. Regarding monkeypox infection, a symptomatic treatment was given, and contact isolation was advised. The patient made a full recovery in 1 week. Monkeypox is a rare zoonosis that is causing a worldwide outbreak.1 Cutaneous lesions frequently evolve the anogenital area and are variable during time, evolving from whitish papules, which become umbilicated with central crust and detach spontaneously in 1 to 2 weeks.2 When all the crusts fall off, the patient is no longer considered contagious. With this case, we intend to disclose a clinical picture, from this outbreak, and alert our colleagues worldwide for the different appearance of monkeypox lesions over time.

Delivery Mode and Neurological Complications in Very Low Birth Weight Infants.

The risk of intraventricular hemorrhage (IVH) and periventricular leukomalacia is associated with low birth weight and gestational age. Caesarean section (CS) may reduce the risk of IVH, although it has been a matter of debate. The aim of this study was to evaluate the influence of the mode of delivery (MOD) on the development of IVH and cystic periventricular leukomalacia (cPVL). We analyzed an initial cohort of 11,023 very low birth weight (VLBW) infants born between January 2010 and December 2019. Infants with major malformations and gestational age <23 weeks and ≥32 weeks were excluded. A final cohort of 8,251 newborns was analyzed. Data was collected from Portuguese National very low birth weight registry. Cases were classified as vaginal delivery (VD) or CS. Outcome was assessed in univariate and logistic regression analyses. The median gestational age was 29 weeks (IQR 3.3) and the median weight was 1,100 g (IQR 555). The prevalence of IVH was significantly higher in the VD group versus the CS group, across all grading levels:1,144 newborns had grade I IVH (16% VD vs. 14% CS, p <0.01), 706 had grade II IVH (12% VD vs. 7.6% CS, p <0.01), and 777 had grade III IVH (14% VD vs. 7.9% CS, p <0.01). Post-hemorrhagic ventricular dilatation occurred in 457 newborns (8.3% VD vs. 4.6% CS, p <0.01) and 456 newborns had periventricular hemorrhagic infarction (8.4% VD vs. 4.5% CS, p <0.01). There was no association between MOD and cPVL. After applying a logistic regression analysis, including known risk factors for IVH and cPVL, VD was independently associated with an increased risk of IVH (odds ratio [OR] 1.600[1.423-1.799], p <0.001) and its complications (OR 1.440[1.195-1.735], p <0.001). MOD was not associated with an increased risk of cPVL. Our study suggests that CS is associated with a reduced risk of IVH and its complications in preterm VLBW infants < 32 weeks of gestational age. A CS should be considered in this group of infants to prevent the development of IVH and its complications. · IVH and cPVL are risk factors for neurological disabilities.. · CS may decrease the risk of IVH in preterms <32 weeks GA.. · There is no association between the MOD and cPVL..

PERMA Model of Well-Being Applied to Portuguese Senior Tourists: A Confirmatory Factor Analysis

Tourism has been affirmed as an activity that promotes health and well-being. The present study aims to present a confirmatory analysis of the PERMA model in a sample of Portuguese senior tourists who visited the island of São Miguel (Azores). After approval of the study by the ethics committee (reference 6/2022), a Sociodemographic Questionnaire, PERMA Profiler, and Life Satisfaction Scale—SWLS were applied to 1083 senior tourists (≥55 years) of various nationalities. To evaluate the PERMA model for senior tourism in Portugal, a total of 434 senior tourists of Portuguese nationality were extracted from the sample. The results revealed that most of the participants attributed scores above the midpoint in the five dimensions of PERMA (positive emotions, engagement, relationships, meaning, accomplishment) and in the satisfaction with life scale. Using scale reliability analyses, we found that some of the dimensions in the PERMA model showed relatively low values both for Cronbach alpha and composite reliability. Several confirmatory structural equation models (single factorial, second order, and five factors) were calculated, as well as the usual adjustment measures, with the five-factor PERMA model presenting the best structure, although with a relatively low fit. The modification of the model by the weight of regressions between some of the items with larger covariances allowed a better adjustment: χ2(73) = 264.960, p &lt; 0.001, χ2/df = 3.63, CFI = 0.94, TLI = 0.91, IFI = 0.94; GFI = 0.92, RMSEA = 0.078, p &lt; 0.001. Although the results revealed that the experiences of senior tourists when visiting the island of São Miguel contributed significantly to their well-being and the modified model presented superior adjustment quality, future studies are suggested to evaluate the quality of the PERMA model applied to tourism.

Ecological factors associated with areas of high tuberculosis diagnosis delay

ObjectiveWe aimed to identify areas of high tuberculosis (TB) diagnosis delay in mainland Portugal in 2017 and ecological factors associated with these areas. Study designThis was an ecological study. MethodsWe considered all notified pulmonary TB cases from the Portuguese National Tuberculosis Surveillance System in mainland Portugal. Diagnostic delays were calculated at the municipality level. Demographic variables, proxies for TB awareness, health services capacity indicators, and socio-economic variables were included and extracted from official databases, such as Statistics Portugal, Ministeries, Foreigners and Border Services. We used spatial analysis to identify areas of high delay in 2017 and logistic generalised additive models to identify ecological factors associated with the identified cluster. ResultsWe identified an area of high delay in 2017 in the South region of the country. Overall, municipalities with a smaller population density, smaller proportion of unemployed, fewer health centres and higher old-age dependency ratio, proportion of men, TB incidence, proportion of immigrants and high school dropout had a higher probability of belonging in a high delay area. ConclusionThe role of primary health care in TB diagnosis should be further explored. Interventions should address factors interplaying at the local and individual levels. Policies influencing social and health conditions, leading to changes in individual behaviour, can lead to sustained improvements over time.

Teleconsultation in the Portuguese National Health Service During the COVID-19 Pandemic: A Survey of Physicians' Views and Future Implications

The COVID-19 pandemic led to the reorganization of healthcare services and teleconsultation emerged as a solution to facilitate patient appointments. The aim of this study was to characterize, from a physician perspective, the teleconsultations carried out in the Portuguese National Health Service (SNS) during the first phase of the pandemic and to identify factors that influence the experience of the teleconsultation. A cross-sectional analytical study was conducted based on an online survey, between July-September 2020, aimed at SNS doctors. Data on demographics, practice, attitudes and perceptions associated with the teleconsultation was collected. The adjusted prevalence ratio (aPR) was calculated to identify demographic factors and determinants of teleconsultation associated with satisfaction, use of video calls and greater motivation to carry out teleconsultations in the future. 2225 valid responses were obtained. Teleconsultation was carried out by 93.8% of participants in this period, 99.0% used the telephone as a form of communication and only 8.0% used a video call. A high degree of satisfaction with the teleconsultation was significantly associated with perceiving the teleconsultation as providing care with equivalent quality to a face-to-face consultation (aPR = 1.472) and being motivated to do teleconsultation after the pandemic (aPR = 4.081). Reporting clinical (aPR = 0.763) or technical difficulties (aPR = 0.666) was negatively associated with satisfaction). 70.4% of doctors would like to continue doing follow-up teleconsultations and 53.3% consider that video call technologies should always or often be used during teleconsultations. Teleconsultation seems to have potential to to become a common practice in the future. However, it is important to address clinical, technical, organizational, and legal questions and, above all, to ensure that it is a safe and valuable practice for patients.

Spatial and Temporal Analysis of COVID-19 in the Elderly Living in Residential Care Homes in Portugal.

Background: The goal of this study is to identify geographic areas for priority actions in order to control COVID-19 among the elderly living in Residential Care Homes (RCH). We also describe the evolution of COVID-19 in RHC throughout the 278 municipalities of continental Portugal between March and December 2020. Methods: A spatial population analysis of positive COVID-19 cases reported by the Portuguese National Health Service (NHS) among the elderly living in RCH. The data are for COVID-19 testing, symptomatic status, comorbidities, and income level by municipalities. COVID-19 measures at the municipality level are the proportion of positive cases of elderly living in RCH, positive cases per elderly living in RCH, symptomatic to asymptomatic ratio, and the share of comorbidities cases. Spatial analysis used the Kernel density estimation (KDE), space-time statistic Scan, and geographic weighted regression (GWR) to detect and analyze clusters of infected elderly. Results: Between 3 March and 31 December 2020, the high-risk primary cluster was located in the regions of Braganca, Guarda, Vila Real, and Viseu, in the Northwest of Portugal (relative risk = 3.67), between 30 September and 13 December 2020. The priority geographic areas for attention and intervention for elderly living in care homes are the regions in the Northeast of Portugal, and around the large cities, Lisbon and Porto, which had high risk clusters. The relative risk of infection was spatially not stationary and generally positively affected by both comorbidities and low-income. Conclusion: The regions with a population with high comorbidities and low income are a priority for action in order to control COVID-19 in the elderly living in RCH. The results suggest improving both income and health levels in the southwest of Portugal, in the environs of large cities, such as Lisbon and Porto, and in the northwest of Portugal to mitigate the spread of COVID-19.

Investigating unrecognized needs and structural barriers to treatment of depressive symptoms: A nationwide cross-sectional study in Portugal

This study assesses factors associated with perception of need and affordability concerns regarding mental health services (MHS), among 978 persons with meaningful depressive symptoms (Patient Health Questionnaire≥10). We used data from the 6th Portuguese National Health Interview Survey and used logistic regressions with gender, age, severity of symptoms, education, and income as explanatory variables. Health insurance was added as mediation variable. Unrecognized need (59.3% of the sample) was more likely amongst men, those over 65, high-educated, and those with moderate symptoms, compared to women, aged 18–34, low-educated, and those with severe symptoms. Among those reporting they needed MHS, 44.6% were not able to pay for them. Affordability concerns were more likely amongst men, those under 50, severely depressed, high-educated, and less likely amongst those within the highest income quintile. Adjusting for health insurance did not change the results in a meaningful way. Unrecognized need and affordability concerns are common among depressed persons in Portugal but seem unevenly distributed across social groups. Investing in the capacity of primary healthcare services to treat depression may be crucial to promote perception of need and reduce structural barriers.

The impact of outpatient emergency medical system in STEMI patients undergoing primary angioplasty: a single-centre experience

Abstract Funding Acknowledgements Type of funding sources: None. Background In ST-segment elevation myocardial infarction (STEMI), emergency medical system delays importantly affect outcomes. The place of first medical contact may affect the time to reperfusion and consequently affect outcomes, as the most direct transfer to the catheterization laboratory is warranted. Purpose The authors aimed to retrospectively describe the association between place of first medical contact and STEMI patient’s care standards and outcomes. Methods Characteristics and outcomes of 1205 consecutive STEMI patients treated in a PCI-centre were collected. Outpatient emergency medical system (EMS) was provided by different vehicles of the Portuguese National Institute of Medical Emergency. Other patients were first observed in primary care centres or in hospitals (PCC/H). Time delays, in-hospital and one-year all-cause mortality were assessed. Results A total of 281 patients (23%) were first observed by the EMS and 924 patients (77%) were first observed in PCC/H. Of those first observed in PCC/H, 258 patients (28%) were admitted in the PCI reference centre. Baseline characteristics were well-balanced between groups, including the percentage of patients that presented in cardiogenic shock (EMS: 6% vs PCC/H: 5%; p=0.43). Median total ischaemic time was significantly lower in patients first observed by EMS when compared to patients admitted in PCC/H (182 min vs. 246 min, respectively. p &amp;lt;0.01). Median emergency system dependent time to reperfusion (i.e. first-medical contact to reperfusion) was significantly lower after first contact with EMS instead of direct PCC/H contact (105 min vs. 130 min, respectively. p&amp;lt;0.01). In patients admitted directly in the PCI-centre, median time from first-medical contact to reperfusion was significantly lower than in those first contacted by the EMS (76 min vs. 105 min; respectively. p&amp;lt;0.01). However, the total ischaemic time did not differ between the two groups (EMS 182 min vs. PCC/H: 195 min ; p=0.64). First medical contact in a hospital without catheterization laboratory was a strong predictor of time of first-medical contact to artery opening of &amp;gt;120 min (odds ratio 6.09 CI95% [4.74-7.82]; p&amp;lt;0.001). The authors observed no association between place of first medical contact and in-hospital mortality (EMS: 5% vs. PCC/H 5%, p = 0.94) or 1-year mortality (EMS: 9% vs. PCC/H 10%, p=0.50). Nonetheless, the observed time intervals for nonsurvivors were significantly longer than in survivors (table 1) and time of first-medical contact to artery opening of &amp;gt;120 min was a strong predictor of in-hospital (odds ratio 2.51 CI95%[1.42-4.46]; p &amp;lt; 0.01) and 1 year mortality (odds ratio 2.31 CI95%[1.55-3.44]; p &amp;lt; 0.01). Conclusion In a contemporary well-organized emergency network, STEMI patients should be first observed by the EMS as it leads to shorter delays treatment. However, less than one-third of the patients with STEMI is first contacted by the EMS.

240P COVID-19 pandemic impact on diagnosis and management of breast cancer in Northern Portugal

COVID-19 pandemic brought pressure to Portuguese National Health Service (NHS). We aim to assess pandemic impact on diagnosis and management of breast cancer (BC) in a high-volume Portuguese comprehensive cancer centre, which was classified as a COVID-free institution by public health authorities.

Clinical Trial Classification of SNS24 Calls with Neural Networks

SNS24, the Portuguese National Health Contact Center, is a telephone and digital public service that provides clinical services. SNS24 plays an important role in the identification of users’ clinical situations according to their symptoms. Currently, there are a number of possible clinical algorithms defined, and selecting the appropriate clinical algorithm is very important in each telephone triage episode. Decreasing the duration of the phone calls and allowing a faster interaction between citizens and SNS24 service can further improve the performance of the telephone triage service. In this paper, we present a study using deep learning approaches to build classification models, aiming to support the nurses with the clinical algorithm’s choice. Three different deep learning architectures, namely convolutional neural network (CNN), recurrent neural network (RNN), and transformers-based approaches are applied across a total number of 269,654 call records belonging to 51 classes. The CNN, RNN, and transformers-based model each achieve an accuracy of 76.56%, 75.88%, and 78.15% over the test set in the preliminary experiments. Models using the transformers-based architecture are further fine-tuned, achieving an accuracy of 79.67% with Adam and 79.72% with SGD after learning rate fine-tuning; an accuracy of 79.96% with Adam and 79.76% with SGD after epochs fine-tuning; an accuracy of 80.57% with Adam after the batch size fine-tuning. Analysis of similar clinical symptoms is carried out using the fine-tuned neural network model. Comparisons are done over the labels predicted by the neural network model, the support vector machines model, and the original labels from SNS24. These results suggest that using deep learning is an effective and promising approach to aid the clinical triage of the SNS24 phone call services.