Post-Surgical Quality of Life, Psychological State and what Patients Think about the Effectiveness of Heller Myotomy in the Treatment of Achalasia.

INTRODUCTION: The disruption of esophageal motility that characterizes achalasia typically provokes dysphagia, pain, loss of weight and malnutrition. Therefore, patients frequently report a reduction in quality of life and negative emotional states. Laparoscopic Heller myotomy proved to be an effective therapy, enabling the resumption of good quality of life. MATERIAL AND METHODS: The authors studied 45 patients previously submitted to laparoscopic Heller myotomy. Postoperative evaluation was performed using a customized version of the achalasia disease-specific quality of life questionnaire. Quality of life and the presence of depressive and anxiety symptoms were assessed using the Portuguese versions of the Medical Outcomes Study SF-36 and the Hospital Anxiety and Depression Scale. RESULTS: Thirty-one patients responded to the survey. Dysphagia was the main clinical symptom before surgery. A clear improvement in dysphagia, regurgitation, pain and weight loss was found after surgery (p < 0.001). The Mental Health domain of SF-36 presented a Pearson correlation coefficient of -0.689 with HADS-D and of -0.557 with HADS-A (p < 0.001 and p = 0.002, respectively). CONCLUSION: This study demonstrates that the Heller myotomy is associated with a good quality of life in patients with achalasia and strengthens the evidence that this is a safe and reliable procedure.

Introdução: A interrupção da motilidade esofágica que caracteriza a acalásia provoca disfagia, dor, perda de peso e desnutrição. Portanto, estes doentes referem uma redução na qualidade de vida e apresentam estados emocionais negativos. Procedimentos cirúrgicos, como a miotomia de Heller, têm-se revelado eficazes, permitindo retornar a uma qualidade de vida melhor. Material e Métodos: Foram incluídos no presente estudo 45 pacientes submetidos a miotomia de Heller. A avaliação pós-operatória foi realizada usando uma versão modificada do questionário de Qualidade de Vida Específico para a Acalasia. A qualidade de vida e a presença de sintomas psicológicos foram avaliados utilizando a versão portuguesa do Medical Outcomes Study SF-36 e a Escala de Ansiedade e Depressão Hospitalar. Resultados: Um total de 31 doentes (69%) foi avaliado, média de idades de 53 anos (18). A disfagia foi o principal sintoma clínico. Uma clara melhoria da disfagia, regurgitação, dor e perda de peso foi evidenciada após a cirurgia (p < 0,001). O domínio da saúde mental do SF-36 apresentou um coeficiente de correlação de Pearson de -0,689 com HADS -D e de -0,557 com HADS-A (p < 0,001 e p = 0,002, respetivamente). Conclusão: Este estudo demonstra que a miotomia de Heller se associa a uma boa qualidade de vida nos doentes com acalásia e reforça a ideia de que este é um procedimento seguro e eficaz.

An ecological study on the geographic patterns of ischaemic heart disease in Portugal and its association with demography, economic factors and health resources distribution.

OBJECTIVES: Being one of the main causes of morbidity and mortality in developed countries, ischaemic heart disease's (IHD) incidence and mortality present clear differences between and within countries. Several authors already proposed possible explanations based on the demography, environmental factors, diet and level of urbanisation. This study reflects the Portuguese reality concerning IHD, by analysing the geographical distribution of hospital admissions and mortality due to this condition, in Portugal, and its association with demography, economical factors and the distribution of healthcare resources at the regional level. DESIGN: Ecological study. SETTING: Data from all Portuguese Public Hospitals were obtained using the National Registry of Hospital Admissions, between 2000 and 2007, and data on demography, economical factors and health resources distribution were obtained from the National Institute of Statistics. PARTICIPANTS: Aggregated statistics on hospital admissions and mortality were computed for 278 counties based on almost 200 000 admissions. PRIMARY AND SECONDARY OUTCOME MEASURES: Mortality rate; hospital admissions rate. RESULTS: The geographical distribution of non-adjusted mortality and hospital admission showed an inner/coastal pattern but no North/South gradient was clear. Counties with higher economical development had significantly higher mortality and admission rates. However, healthcare resources distribution was not significantly associated with IHD hospital admission and mortality. When adjusted for age, gender, economic development and health resources distribution, there was still unexplained geographical variation both in hospital admissions and mortality rates. CONCLUSION: A pattern in the geographic distribution of incidence and mortality of IHD was clear even after the adjustment for age and gender. Economical variables were the ones presenting the strongest association. These types of analysis may be very helpful for the definition of health policies, in particular to identify priority regions for disease prevention and guidelines for healthcare resources distribution.