ABSTRACT
The pandemic originated a set of impacts of different magnitudes in the territory. This article presents an exploratory approach to understand how the existence of certain vulnerabilities in the pre-crisis moment led to different impacts on territories in Portugal. Starting from the municipal scale, the analysis defines a typology of vulnerable territories according to the degrees of exposure and susceptibility they present, and compares the different groups of municipalities in this typology with territorial impacts of the pandemic crisis in terms of unemployment dynamics. The results attest to the existence of increased vulnerabilities in territories highly dependent on tourism and those that are part of metropolitan areas, whose socioeconomic structures resulted in situations of higher un-employment growth in 2020. The article has implications for reflection on territorial vulnerability, resilience and policies to transform the Portuguese economy in the post-pandemic period. © 2023,Revista Portuguesa de Estudos Regionais. All Rights Reserved.
ABSTRACT
The SARS-CoV-2 pandemic has largely exposed pre-existing inequalities, deepening prevalent vulnerabilities and resulting in large and insidious impact on people's lives. Gender-based and domestic violence was configured within perverse and serious circumstances, as victims and aggressors were forced to remain in the same spaces, because of the confinements and mobility restriction, demanded by Governments worldwide to protect Global Public Health. In Portugal the situation was no different. A qualitative study was addressed to assess narratives and perspectives of key stakeholders and workers in the field. In-depth semistructured interviews were applied to six professionals with crucial roles both in terms of representation of the State and local structures, intervention, and response in the processes of domestic violence, as well as acting directly with victims. The results show important gaps in addressing domestic violence during the confinements. Nevertheless, our participants unanimously stated that social isolation associated to economic crisis intensified the occurrence of domestic violence and hinder victims' access to adequate care services. Additionally, the shortage of human resources in this area, and lack of adequate investment and financial resources contributed to impoverishment of health, protection, and guarantee of dignity and human rights for victims of gender-based and domestic violence. © Copyright 2023, Mary Ann Liebert, Inc., publishers 2023.
ABSTRACT
Objective: To assess the efficacy and safety of CBCT-guided percutaneous cryoablation of bone metastases due to endocrine tumors. Outcomes included reduction of skeletal-related events and pain control. Method(s): This is a prospective, single arm, tertiary single-center study. Inclusion criteria included age >18 years;ECOG 0-3;mean life expectancy >one month;biopsy-proven bone metastases <7.0 cm in diameter from thyroid, adrenal and neuroendocrine tumors, with pain, hypercalcemia or at risk to develop fracture or spinal cord compression. Prior to ablation, all patients were evaluated by a pain specialist and a brief pain inventory (BPI) was obtained. Follow-up was carried out weekly for the first 8 weeks and then at 3, 6, 12 and 24 months when a BPI was obtained and observation of skeletal-related events. Result(s): This is an interim analysis of 17 patients,12 women and 5 men, mean age of 64.2+/- 12.3 years. Ten patients had papillary thyroid cancer (58.8%), 5 medullary thyroid cancer (29.4%) and 2 with adrenocortical cancer. A total of 24 lesions were treated (21 sessions);current mean follow-up time: 11.1+/- 7.3 months.Cementoplasty was carried out in three lesions;mean size lesions were 3.3 +/- 1.3 cm. Only one mild adverse event was observed (transient sciatic neuropraxia). From the group of patients included with bone pain (N= 14), a mean pre-procedural BPI was 8.3 +/- 2.1 (10 being highest score). After procedure, all patients had reduction of the pain score;complete pain relief was observed in 6 (31.6%) patients within 1-week and the other patients reported a significant reduction of BPI score: mean 2.8+/- 3.3 (1-week);0.9 +/- 1.8 (6-months). Eleven (64.7%) patients achieved complete ablation;radiation therapy was required in 2 patients and no patients required additional surgery. Pathologic fracture was observed in 2 treated lesionswhich recovered spontaneously within 1month. Six non-procedure related deaths were reported during follow-up (oncologic disease progression n = 5;Covid-19 infection n = 1);Discussion/Conclusion: Cryoablation proved to be safe and effective to treat bone metastases due to endocrine tumors, providing a rapid and durable pain palliation, local disease control, and should be considered an option to improve patient care in selected cases.
ABSTRACT
Background and aims: COVID-19 is a respiratory disease caused by SARS-CoV-2. Nevertheless, neurological complications have been described. Delirium, seems frequent, prolonged, and difficult to control. Methods: To evaluate the prevalence and characteristics of delirium in a cohort of critically ill patients with COVID- 19, compared to a historical cohort of critically ill patients with other respiratory infections. Retrospective comparative analysis of demographic, clinical and laboratory data from two cohorts: patients admitted to an Infectious Diseases Intensive Care Unit (IDICU) with COVID-19 and for other respiratory infections in 2018-2019. Olanzapine equivalent dosages of antipsychotics necessary to control delirium was used as a severity marker. Results: We included 114 patients (74 COVID-19 and 40 non-COVID-19). The COVID-19 cohort presented with a statistically significant higher median age of 67 years old and a slight male predominance (56.8%). Previous neurological disease was present in 12.2%. Delirium developed in 45.9% of which, lasted a median of four days and needed a median of 10mg/day of olanzapine equivalents to control. Samples were matched to sex, previous neurological disease and use of benzodiazepines/ antipsychotics. There was no difference in prevalence of delirium or its duration between cohorts (p>0.05). In patients with delirium the univariate analysis demonstrated a difference in the severity of delirium (p=0.045). In a model of multiple logistic regression, COVID-19 was associated with increased severity of delirium (p≤0.001) adjusted for confounding factors. Conclusion: COVID-19 is not associated with higher prevalence or duration of delirium. However, it seems to be associated with severe forms with increasing doses of antipsychotics needed its control.
ABSTRACT
Objective: We aimed to describe the characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) admitted to an intensive care unit (ICU) in Portugal. Design: This is an observational retrospective study. Demographic and clinical data were col-lected. Respiratory failure treated with invasive mechanical ventilation (IMV) and death during ICU stay were the main outcomes evaluated. Setting: This study was conducted in the Infectious Diseases ICU of Centro Hospitalar e Uni-versitário de São João, in Porto, Portugal, be-tween March 11 and August 17, 2020. Patients and participants: All consecutive patients with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infec-tion, admitted to the ICU during the study peri-od were enrolled, and 62 patients were included. Measurements and results: The median age was 71 years (IQR, 54-78) and 39 (62.9%) were male. Thirty-four (54.8%) patients received. IMV in contrast to 28 (45.2%) who were not intubated and the median lowest PaO2/FiO2 was 86 (IQR, 70-113) in IMV and 150 (94-257) in non-IMV patients. Several patients with severe hypoxemic COVID-19 were treated without IMV, especially with high flow nasal cannu-la (HFNC). Overall mortality was 21.8% and older age, male sex, active cancer, lower lym-phocyte count, higher aspartate aminotransfer-ase (AST) level, and higher creatinine level at admission, hematologic dysfunction, and renal dysfunction during ICU stay were all associated with fatal outcome. Mortality was lower than observed in other series of critically ill patients, although comparisons are limited by different ICU admission criteria, management practices, and duration of follow-up. Conclusions: This study provides data regard-ing the characteristics and outcomes of COVID-19 critically ill patients that can be used to op-timize ICU preparedness in the future. © 2021, The Indonesian Foundation of Critical Care Medicine. All rights reserved.