[Lead Exposure as Cause of a Clinical Scenario of Cardiac Arrhythmias]. / A Exposição ao Chumbo na Base de um Quadro de Arritmias Cardíacas.

The recycling of used batteries has raised public health concerns as this activity is associated with occupational and environmental exposure to lead. We describe the case of a 26-year-old woman who experienced palpitations associated with headaches, fatigue and insomnia. Blood tests showed anemia (Hb 11.9 g/dL) and a lead concentration of 59 µg/dL. This was reported about four months after starting work in a battery recycling company. She left the company and, reported a gradual decrease in symptoms about one month later. The analytical study revealed a normalization of hemoglobin levels (12.2 g/dL) and a decrease in blood lead levels to 23.4 µg/dL. The health effects of lead exposure are nonspecific, and its diagnosis requires a high degree of suspicion. In this context, the collaboration between the Attending Physician and the Health and Safety Departments of companies is important.

A reciclagem de baterias usadas tem suscitado preocupações de saúde pública uma vez que esta atividade está associada à exposição ocupacional e ambiental ao chumbo. Descreve-se o caso de uma mulher de 26 anos que iniciou quadro de palpitações associado a cefaleias, fadiga e insónias, cerca de quatro meses após iniciar funções numa empresa de reciclagem de baterias. Analiticamente, observou-se anemia (Hb 11,9 g/dL) e plumbémia de 59 µg/dL. Cessou funções na empresa e, após um mês, referiu uma diminuição progressiva da sintomatologia. O estudo analítico revelou uma normalização dos valores da hemoglobina (12,2 g/dL) e uma diminuição do valor de chumbo no sangue para 23,4 µg/dL. Os efeitos na saúde da exposição ao chumbo são inespecíficos e o seu diagnóstico requer um alto grau de suspeição. Neste âmbito revela-se importante a articulação entre o médico assistente e os serviços de Saúde, Higiene e Segurança no Trabalho das empresas.

Does the white coat influence satisfaction, trust and empathy in the doctor-patient relationship in the General and Family Medicine consultation? Interventional study.

OBJECTIVES: To understand the influence of the white coat on patient satisfaction, opinions about medical clothing, perception about confidence, empathy and medical knowledge and the satisfaction and comfort level of physicians in consultation. SETTING: An interventional study was conducted with a representative sample of the population attending primary care in central Portugal. PARTICIPANTS: The sample was composed by 286 patients divided into two groups exposed or not to a doctor wearing a white coat. The first and last patients in consultation every day for 10 consecutive days were included. INTERVENTIONS: Every other day the volunteer physicians consulted with or without the use of a white coat. At the end of the consultation, a questionnaire was distributed to the patient with simple questions with a Likert scale response, the Portuguese version of the 'Trust in physician' scale and the Jefferson Scale of Patient Perceptions of Physician Empathy - Portuguese Version (JSPPPE-VP scale). A questionnaire was also distributed to the physician. OUTCOMES: Planned and measured primary outcomes were patient satisfaction, trust and perception about empathy and secondary outcomes were opinion about medical clothing, satisfaction and comfort level of physicians in consultation. RESULTS: The sample was homogeneous in terms of sociodemographic variables. There were no statistically significant differences between the groups in terms of satisfaction, trust, empathy and knowledge perceived by the patients. There were differences in the opinion of the patients about the white coat, and when the physician was wearing the white coat this group of patients tended to think that this was the only acceptable attire for the physician (p<0.001). But when the family physician was in consultation without the white coat, this group of patients tended to agree that communication was easier (p=0.001). CONCLUSIONS: There was no significant impact of the white coat in patient satisfaction, empathy and confidence in the family physician. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID number: NCT03965416.