Ongoing outbreak of hepatitis A associated with sexual transmission among men who have sex with men, Portugal, October 2023 to April 2024.

An outbreak of hepatitis A is ongoing in Portugal, with 71 confirmed cases from 7 October 2023 to 24 April 2024. Most cases are male, aged 18-44 years, with many identifying as men who have sex with men (MSM) and reported as suspected sexual transmission. Phylogenetic analysis identified the subgenotype IA, VRD 521-2016 strain, last observed in an MSM-associated multi-country outbreak in 2016 to 2018. We wish to alert colleagues in other countries to investigate potential similar spread.

Salmonella Saintpaul outbreak associated with cantaloupe consumption, the United Kingdom and Portugal, September to November 2023.

In September 2023, the UK Health Security Agency identified cases of Salmonella Saintpaul distributed across England, Scotland, and Wales, all with very low genetic diversity. Additional cases were identified in Portugal following an alert raised by the United Kingdom. Ninety-eight cases with a similar genetic sequence were identified, 93 in the United Kingdom and 5 in Portugal, of which 46% were aged under 10 years. Cases formed a phylogenetic cluster with a maximum distance of six single nucleotide polymorphisms (SNPs) and average of less than one SNP between isolates. An outbreak investigation was undertaken, including a case-control study. Among the 25 UK cases included in this study, 13 reported blood in stool and 5 were hospitalized. One hundred controls were recruited via a market research panel using frequency matching for age. Multivariable logistic regression analysis of food exposures in cases and controls identified a strong association with cantaloupe consumption (adjusted odds ratio: 14.22; 95% confidence interval: 2.83-71.43; p-value: 0.001). This outbreak, together with other recent national and international incidents, points to an increase in identifications of large outbreaks of Salmonella linked to melon consumption. We recommend detailed questioning and triangulation of information sources to delineate consumption of specific fruit varieties during Salmonella outbreaks.

Contact tracing management of a measles case in a paediatric hospital: experience of the local public health unit, Portugal, January 2024.

In January 2024, a child was diagnosed with measles in a paediatric hospital in Lisbon. Of 123 contacts, 39 (32%) were not fully immunised, presenting a risk for a potential outbreak. The public health unit initiated control measures and identified challenges during the response, such as the lack of interoperability between information systems and accessing vaccination records. The lessons learned prompted changes to national contact tracing procedures for measles, further strengthening Portugal's preparedness.

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal.

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.

Task Force for a rapid response to an outbreak of severe acute hepatitis of unknown aetiology in children in Portugal in 2022.

On 5 April 2022, the United Kingdom reported an increase of cases of severe acute hepatitis of unknown aetiology in children, several needing hospitalisation and some required liver transplant or died. Thereafter, 35 countries reported probable cases, almost half of them in Europe. Facing the alert, on 28 April, Portugal created a multidisciplinary Task Force (TF) for rapid detection of probable cases and response. The experts of the TF came from various disciplines: clinicians, laboratory experts, epidemiologists, public health experts and national and international communication. Moreover, Portugal adopted the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) case definition and recommendations. By 31 December 2022, 28 probable cases of severe acute hepatitis of unknown aetiology were reported: 16 male and 17 aged under 2 years. Of these cases, 23 were hospitalised but none required liver transplant or died. Adenovirus was detected from nine of 26 tested cases. No association was observed between adenovirus infection and hospital admission after adjusting for age, sex and region in a binomial regression model. The TF in Portugal may have contributed to increase awareness among clinicians, enabling early detection and prompt management of the outbreak.

Complex life cycles drive community assembly through immigration and adaptive diversification.

Most animals undergo ontogenetic niche shifts during their life. Yet, standard ecological theory builds on models that ignore this complexity. Here, we study how complex life cycles, where juvenile and adult individuals each feed on different sets of resources, affect community richness. Two different modes of community assembly are considered: gradual adaptive evolution and immigration of new species with randomly selected phenotypes. We find that under gradual evolution complex life cycles can lead to both higher and lower species richness when compared to a model of species with simple life cycles that lack an ontogenetic niche shift. Thus, complex life cycles do not per se increase the scope for gradual adaptive diversification. However, complex life cycles can lead to significantly higher species richness when communities are assembled trough immigration, as immigrants can occupy isolated peaks of the dynamic fitness landscape that are not accessible via gradual evolution.

Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022.

Up to 27 May 2022, Portugal has detected 96 confirmed cases of monkeypox. We describe 27 confirmed cases (median age: 33 years (range: 22-51); all males), with an earliest symptom onset date of 29 April. Almost all cases (n = 25) live in the Lisbon and Tagus Valley health region. Most cases were neither part of identified transmission chains, nor linked to travel or had contact with symptomatic persons or with animals, suggesting the possible previously undetected spread of monkeypox.

Femoral fractures in the elderly in Brasil - incidence, lethality, and costs (2008-2018).

OBJECTIVES: To describe the incidence by gender and region, lethality, and costs associated with the treatment of femoral fractures in the elderly (≥ 60 years) hospitalized in the Unified Health System (SUS) of Brasil between 2008 and 2018. METHODS: This is a cross-sectional, descriptive, retrospective study of hospitalizations of elderly people due to femoral fractures by analyzing secondary data obtained from the SUS Hospital Information System (SIH/SUS) between 2008 and 2018; for calculation of epidemiological coefficients, we used information from demographic censuses (2000 and 2010) of the Brazilian Geography and Statistics Institute (IBGE). RESULTS: A total of 478,274 hospitalizations were recorded in the period; the incidence was 1.7 times higher in females (overall average of 274.91/100,000 for women and 161/100,000 for men). The Southeast region had the highest absolute number of hospitalizations and the South region presented the highest annual overall average incidence (224.02/100,000). The average annual cost for SUS for the treatment of femoral fractures in the elderly was R$ 99,718,574.30. CONCLUSIONS: In the evaluated period (2008-2018), femoral fractures in the elderly had a high incidence (478,274 hospitalizations; 224.02 cases/100,000 elderly), a predominance of females (1.7F/1.0M), a higher absolute number of hospitalizations in the Southeast region and a higher incidence in the South region; the lethality was high (an increase of 17.46%; overall mean coefficient of 4.99%/year); and the costs for the SUS were huge (an increase of 126.24%; average annual expenditure of R$ 99,718,574.30).

Femoral fractures in the elderly in Brasil - incidence, lethality, and costs (2008-2018)

SUMMARY OBJECTIVES: To describe the incidence by gender and region, lethality, and costs associated with the treatment of femoral fractures in the elderly (≥ 60 years) hospitalized in the Unified Health System (SUS) of Brasil between 2008 and 2018. METHODS: This is a cross-sectional, descriptive, retrospective study of hospitalizations of elderly people due to femoral fractures by analyzing secondary data obtained from the SUS Hospital Information System (SIH/SUS) between 2008 and 2018; for calculation of epidemiological coefficients, we used information from demographic censuses (2000 and 2010) of the Brazilian Geography and Statistics Institute (IBGE). RESULTS: A total of 478,274 hospitalizations were recorded in the period; the incidence was 1.7 times higher in females (overall average of 274.91/100,000 for women and 161/100,000 for men). The Southeast region had the highest absolute number of hospitalizations and the South region presented the highest annual overall average incidence (224.02/100,000). The average annual cost for SUS for the treatment of femoral fractures in the elderly was R$ 99,718,574.30. CONCLUSIONS: In the evaluated period (2008-2018), femoral fractures in the elderly had a high incidence (478,274 hospitalizations; 224.02 cases/100,000 elderly), a predominance of females (1.7F/1.0M), a higher absolute number of hospitalizations in the Southeast region and a higher incidence in the South region; the lethality was high (an increase of 17.46%; overall mean coefficient of 4.99%/year); and the costs for the SUS were huge (an increase of 126.24%; average annual expenditure of R$ 99,718,574.30).

RESUMO OBJETIVOS: Descrever a incidência por gênero e região, a letalidade e os custos associados ao tratamento de fraturas do fêmur em idosos (≥ 60 anos) internados no Sistema Único de Saúde (SUS) do Brasil entre 2008 e 2018. MÉTODOS: Estudo transversal, descritivo e retrospectivo das internações de idosos por fraturas do fêmur mediante análise dos dados secundários obtidos do Sistema de Informações Hospitalares do SUS (SIH/SUS) entre 2008 e 2018; para cálculo dos coeficientes epidemiológicos, utilizamos informações dos censos demográficos (2000 e 2010) do Instituto Brasileiro de Geografia e Estatística (IBGE). RESULTADOS: Foram registradas 478.274 mil internações no período. A incidência foi 1,7 vezes maior no gênero feminino (média geral de 274,91/100.000 para mulheres e 161/100.000 para homens). A região sudeste obteve maior número absoluto de internações e na região sul apresentou a maior incidência média geral anual (224,02/100.000). O custo médio anual do SUS para o tratamento das fraturas de fêmur em idosos foi de R$ 99.718.574,30. CONCLUSÕES: No período avaliado (2008-2018), as fraturas do fêmur em idosos apresentaram alta incidência (478.274 mil internações; 224,02 casos/100.000 idosos), predomínio do gênero feminino (1,7F/1,0M), maior número absoluto de internações na região sudeste e maior incidência na região sul; a letalidade foi elevada (aumento de 17,46%; média geral do coeficiente de 4,99%/ano); e, os custos para o SUS foram vultuosos (aumento de 126,24%, média anual de gastos de R$ 99.718.574,30).

How Does Joint Evolution of Consumer Traits Affect Resource Specialization?

Consumers regularly experience trade-offs in their ability to find, handle, and digest different resources. Evolutionary ecologists recognized the significance of this observation for the evolution and maintenance of biological diversity long ago and continue to elaborate on the conditions under which to expect one or several specialists, generalists, or combinations thereof. Existing theory based on a single evolving trait predicts that specialization requires strong trade-offs such that generalists perform relatively poorly, while weak trade-offs favor a single generalist. Here, we show that this simple dichotomy does not hold true under joint evolution of two or more foraging traits. In this case, the boundary between trade-offs resulting in resource specialists and resource generalists is shifted toward weaker trade-off curvatures. In particular, weak trade-offs can result in evolutionary branching, leading to the evolution of two coexisting resource specialists, while the evolution of a single resource generalist requires particularly weak trade-offs. These findings are explained by performance benefits due to epistatic trait interactions enjoyed by phenotypes that are specialized in more than one trait for the same resource.

Failure to complete treatment for latent tuberculosis infection in Portugal, 2013-2017: geographic-, sociodemographic-, and medical-associated factors.

There is conflicting evidence about factors associated with failure to complete treatment (FCT) for latent tuberculosis infection (LTBI). We aim to identify the geographic, sociodemographic, and medical factors associated with FCT in Portugal, highlighting the two main metropolitan areas of Porto and Lisbon. We performed a retrospective cohort study including LTBI patients that started treatment in Portugal between 2013 and 2017. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using multivariable logistic regression to identify geographic, sociodemographic, and medical factors associated with FCT. Data on completion of treatment were available for 15,478 of 17,144 patients (90.3%). Of those, 2132 (13.8%) failed to complete treatment. Factors associated with FCT were being older than 15 years (aOR, 1.65 (95% CI = 1.34-2.05) for those aged 16 to 29), being born abroad (aOR, 2.04 (95% CI = 1.19-3.50) for Asia; aOR, 1.57 (95% CI = 1.24-1.98) for Africa), having a chronic disease (aOR, 1.29 (95% CI = 1.04-1.60)), alcohol abuse (aOR, 2.24 (95% CI = 1.73-2.90)), and being intravenous drug user (aOR, 1.68 (95% CI = 1.05-2.68)). Three-month course treatment with isoniazid plus rifampicin was associated with decreased FCT when compared with 6- or 9-month courses of isoniazid-only (aOR, 0.59 (95% CI = 0.45-0.77)). In Lisbon metropolitan area, being born in Africa, and in Porto metropolitan area, alcohol abusing and being intravenous drug user were distinctive factors associated with FCT. Sociodemographic and medical factors associated with FCT may vary by geographical area and should be taken into account when planning interventions to improve LTBI treatment outcomes. This study reinforces that shorter course treatment for LTBI might reduce FCT.

Validade e Confiabilidade do Maastricht Clinical Teaching Questionnaire para Língua Portuguesa / Validity and Reliability of the Portuguese-Language Version of the Maastricht Clinical Teaching Questionnaire

RESUMO Introdução Num cenário de aprendizagem clínica, preceptores devem se comportar como mediadores entre os saberes que o estudante já tem e os que necessita adquirir, integrando a teoria e a prática no contexto da assistência ao paciente. Para isso, é necessário capacitar preceptores e desenvolver instrumentos capazes de aferir o desempenho de tais docentes. Em 2008, foi desenvolvido na Holanda o Maastricht Clinical Teaching Questionnaire (MCTQ), destinado à avaliação de preceptores pelos estudantes com o objetivo de proporcionar feedback a esses sobre suas habilidades de ensino em relação à supervisão realizada durante o estágio. A validação de um instrumento para outro idioma é de grande valia, uma vez que permite avaliar e investigar determinado fenômeno em diferentes países. Objetivo Realizar a validação do MCTQ para a língua portuguesa. Metodologia Trata-se de um estudo de validação de instrumento de pesquisa realizado em quatro hospitais do Nordeste brasileiro com a aplicação da versão adaptada para a língua portuguesa do MCTQ em uma amostra não probabilística composta por 246 estudantes de Medicina do quinto e sexto anos de quatro diferentes instituições de ensino do Estado de Pernambuco. Para avaliar a validade do construto, foi utilizado o índice Kappa. A confiabilidade foi medida por meio do Coeficiente Alfa de Cronbach padronizado. O nível de reprodutibilidade do MCTQ foi calculado pelo teste t de Student para medidas repetidas, comparando valores do teste e do reteste. A pesquisa foi aprovada no Comitê de Ética e Pesquisa da Faculdade Pernambucana de Saúde. Resultados O índice Kappa variou entre 0,527 e 0,710, e o Coeficiente Alfa de Cronbach de 0,77 a 0,954, comprovando bom grau de concordância e de consistência interna do instrumento, respectivamente. Em relação à reprodutibilidade, todos os valores de coeficiente de correlação encontrados foram significativos e de boa magnitude (≥ 0,72). Conclusão A versão em português do MCTQ mostrou-se confiável e válida para uso na língua portuguesa e pode ser útil como instrumento a promover melhorias pedagógicas nos cursos de graduação e pós-graduação, especialmente aqueles relacionados às ciências da saúde.

ABSTRACT Introduction In clinical learning scenarios, preceptors should mediate between the knowledge students already possess and the knowledge they need to acquire, integrating theory and practice into the patient care context. In order to make this possible, we must train preceptors and develop instruments for evaluating their performance as educators. In 2008, the Maastricht Clinical Teaching Questionnaire (MCTQ) was developed in the Netherlands with the purpose of enabling students to evaluate their preceptors, in order to provide preceptors with feedback regarding their teaching skills and the supervision provided by them during the internship period. Validating an instrument that has been translated is important and valuable, because it enables certain phenomena to be evaluated and investigated in different countries. Objective To validate the Portuguese-language version of the MCTQ. Methodology This is an instrument validation study, with research carried out in four different hospitals in the Northeast Region of Brazil. It applied the Portuguese-language version of the MCTQ to a non-probability sample composed of 246 fifth- and sixth-year students of Medicine from four different institutions in the state of Pernambuco. Kappa values were used to evaluate the validity of the construct, and reliability was measured using standardized Cronbach's alpha coefficient. The reproducibility level of the MCTQ was calculated using the Student's t-test for repeated measures, comparing test and re-test values. This study was approved by the Human Research Ethics Committee of the Faculdade Pernambucana de Saúde. Results The kappa index was between 0.527 and 0.71, and Cronbach's alpha coefficient was between 0.77 and 0.954, demonstrating that the instrument has good levels of agreement and internal consistency, respectively. With respect to reproducibility, all coefficient correlation values found were significant and showed good magnitude (≥0.72). Conclusion The Portuguese-language version of the MCTQ proved to be reliable and valid for use in Portuguese-language settings, and can be useful as an instrument for promoting pedagogical improvements in undergraduate and graduate courses, especially in health sciences.

Original Research: ACE2 activator associated with physical exercise potentiates the reduction of pulmonary fibrosis.

The interstitial lung diseases are poorly understood and there are currently no studies evaluating the association of physical exercise with an ACE2 activator (DIZE) as a possible treatment for this group of diseases. We evaluate the effects of pharmacological treatment with an angiotensin-converting enzyme 2 activator drug, associated with exercise, on the pulmonary lesions induced by bleomycin. From the 96 male Balb/c mice used in the experiment, only 49 received 8 U/kg of bleomycin (BLM, intratracheally). The mice were divided into control (C) and bleomycin (BLM) groups, sedentary and trained (C-SED, C-EXE, BLM-SED, BLM-EXE), control and bleomycin and also sedentary and trained treated with diminazene (C-SED/E, C-EXE/E, BLM-SED/E, BLM-EXE/E). The animals were trained five days/week, 1 h/day with 60% of the maximum load obtained in a functional capacity test, for four weeks. Diminazene groups were treated (1 mg/kg, by gavage) daily until the end of the experiment. The lungs were collected 48 h after the training program, set in buffered formalin and investigated by Gomori's trichrome, immunohistochemistry of collagen type I, TGF-ß1, beta-prolyl-4-hydroxylase, MMP-1 and -2. The BLM-EXE/E group obtained a significant increase in functional capacity, reduced amount of fibrosis and type I collagen, decreased expression of TGF-ß1 and beta-prolyl-4-hydroxylase and an increase of metalloproteinase -1, -2 when compared with the other groups. The present research shows, for the first time, that exercise training associated with the activation of ACE2 potentially reduces pulmonary fibrosis.

Ebola impact on African health systems entails a quest for more international and local resilience: the case of African Portuguese speaking countries.

INTRODUCTION: Ebola epidemics have shown to have significant impacts on many aspects of healthcare systems. African countries have been facing many difficulties while addressing Ebola epidemics, moreover due to both lack of resources and fragmented involvement of national and international entities. The participation of multiple organizations has created serious problems of coordination of aid and the operation of that aid on the ground. This paper aims at addressing the impact of Ebola epidemics on African health systems, with a special focus on the definition of impact mitigation guidelines and the role of resilience. The example of Portuguese speaking countries is presented. METHODS: A combination of literature review and case study methods are used. A literature review on Ebola outbreak impact on health systems will provide information to define a set of guidelines for healthcare services response to Ebola. The role of cooperation in providing additional resilience is described. Finally a case study focusing on the Portuguese collaboration and intervention in African Portuguese Speaking Countries (PALOP) is presented, as an example how the international community can provide additional resilience. RESULTS: The existing knowledge is very helpful to guide both the preparation and the coordination of Ebola preparedness interventions. Additional resilience can be provided by international cooperation. CONCLUSION: In addition to international concrete support in times of crisis, to have a regional strategy of creating (multi-national) teams to rapidly implement an intervention while establishing better regional capacity to have sufficient resources to support the "resilience" required of the health system.

Experiência multiprofissional na investigação de infecção por Toxocara spp em crianças atendidas pelo Sistema Único de Saúde / Experiência multiprofissional na investigação de infecção por Toxocara spp em crianças atendidas pelo Sistema Único de Saúde

A toxocaríase é uma doença causada geralmente pela ingestão acidental de ovos larvados de Toxocara canis e/ou Toxocara cati, acometendo principalmente crianças. Esses ovos larvados permanecem viáveis por longos períodos no ambiente. Objetivou-se detectar focos de Toxocara spp a partir da análise do local habitado por crianças diagnosticadas com a doença em 2012 e 2013 em Belo Horizonte, Minas Gerais. Os responsáveis pelos pacientes foram entrevistados e foram coletadas amostras de solo dos domicílios para pesquisa de ovos de Toxocara spp. pelo método de Faust. Também foi realizada entrevista com as pediatras responsáveispela notificação e tratamento na suspeição do diagnóstico de Larva Migrans Visceral (LMV). As famílias tinham características socioeconômicas semelhantes, viviam em lotes multifamiliares e em 100% dos casos havia contato com cães filhotes e adultos. Verificou-se presença de fezes caninas expostas em locais de risco, sem recolhimento diário, e as crianças diagnosticadas tinham contato diário com essas áreas, não eram orientadas quanto à higiene das mãos e alimentos crus eram lavados apenas com água. Havia ovos infectantes viáveis de Toxocara spp. em 100% das amostras coletadas. Mesmo sob tratamento, no período do estudo, não houve mudança nos fatores de risco ambientais, nem desverminação de algum cão após o diagnóstico nas crianças. Foram propostas atividades de educação em saúde sobre este tema, sob forma de cartilhas direcionadas para a população e para os profissionais de saúde. Este trabalho proporcionou aos participantes do PET-Saúde ampla visão sobre os desafios do trabalho multiprofissional no SUS na intervenção de uma importante zoonose.

Toxocariasis is a disease that mainly affects children and is generally caused by the accidental ingestion of Toxocara canis and/or Toxocara cati embryonated eggs. These embryonated eggs remain viable for long periods in the environment. This study aimed at detecting outbreaks of Toxocara spp by analyzing places inhabited by children who had been diagnosedwith the disease in 2012 and 2013, in Belo Horizonte, Minas Gerais. The patients? guardians were interviewed, and soil samples were collected from their households to survey the presence of Toxocara spp. eggs through the method of Faust. The patients? pediatricians, who notified and treated the suspected cases with a diagnosis of (LMV), were also interviewed. All interviewed families had similar socio-economic characteristics, lived in multi-family lots, and had contact with puppies and adult dogs. The presence of exposed canine feces, which were not collected daily, was observed in places of risk; the diagnosed children had daily contact with these areas and were not oriented with regard to hand hygiene; in addition, raw food was washed with water only. Infective viable eggs of Toxocara spp. were detected in 100% of collected samples.Changes in environmental risk factors or dog deworming were not executed even after the diagnosed children were placed under treatment, during the study period. Health education activities on this topic were proposed with the use of booklets directed to the population and health professionals. This study provided ample insight to PET-Health participants into the challenges of multi-professional work in the SUS about intervention on an important zoonosis.

Right subclavian vein catheterism complication due to a 'foreign body': a case report.

INTRODUCTION: Central venous access devices are widely used in hospital practice. Complications associated with their use are well described and reviewed. In this paper, we report a former complication that in turn created a new complication during a standardized procedure. CASE PRESENTATION: We report the case of an 81-year-old Caucasian woman requiring total parenteral nutrition due to a high-debt enterocutaneous fistula. In a previous right subclavian catheterization a fragmentation of the tip of the catheter, probably not recognized at the time, provoked an extrinsic compression of the vessel. CONCLUSION: Fragmentation of a central venous catheter is a possible complication of catheterization and can be missed. Control of a catheter is imperative after its removal, even if not always practiced.

Plano de intervenção para aumentar a adesão dos idosos ao tratamento de hipertensão arterial no PSF Baguari - município de Governador Valadares/MG

O município de Governador Valadares conta com 41 equipes da Estratégia Saúde da Família (ESF), entre elas Baguari, zona rural, que possui 250 indivíduos hipertensos, que necessitam de acompanhamento contínuo e programado. O trabalho realizado teve como objetivo elaborar uma proposta de intervenção para o enfrentamento do problema de baixa adesão dos usuários inscritos no Sistema de Cadastramento e Acompanhamento de Hipertensos e Diabéticos (HIPERDIA) ao tratamento farmacológico instituído, na área de abrangência da Equipe Baguari do município de Governador Valadares. Para a elaboração da proposta de intervenção que permitirá a melhoria da adesão dos usuários da área de abrangência da equipe Baguari, serão instituídas três etapas: diagnóstico situacional, revisão bibliográfica e elaboração do plano de ação, utilizando como base o Planejamento Estratégico Situacional Simplificado. Espera-se com este trabalho um acompanhamento mais efetivo dos portadores de hipertensão arterial sistêmica na área de abrangência de atendimento desta equipe.