A.M. Nogueira

Impact of a women ' s counselling programme on combined hormonal contraception in Portugal - The IMAGINE Study

ABSTRACT Background The aim of this health education project was to measure the impact of counselling about combined hormonal contraceptive (CHC) methods on the subsequent choice of method by Portuguese women. Method This was a multi-centre study with a representative population, at the national and regional levels, of 2951 Portuguese women ≥ 16 years of age visiting the gynaecologist. Counselling on available CHC methods was provided using a single leaflet, and their CHC choice was assessed before and after counselling. Results A combined oral contraceptive (COC) was the method preferred by the majority of the women prior to counselling. After counselling, 35% of women who initially had chosen the pill, switched to either the vaginal ring or the transdermal patch, and the difference was statistically significant. Ease of use was the major reason for choosing the COC, while a lower probability of omission was the reason for choosing the vaginal ring and the patch. Conclusions The implementation of a counselling programme significantly affected contraceptive choices leading in a number of cases to the selection of alternatives better suited to womens lifestyle. Age and educational level are socio-demographic factors which play an important role.

Knowledge-attitude-practice survey among Portuguese gynaecologists regarding combined hormonal contraceptives methods

ABSTRACT Objectives To evaluate knowledge, attitude and practices of Portuguese gynaecologists regarding combined hormonal contraceptives. Methods A cross-sectional survey was conducted among 303 gynaecologists. Results Ninety percent of the gynaecologists considered that deciding on contraceptive methods is a process wherein the woman has her say. Efficacy, safety and the womans preference were the major factors influencing gynaecologists, while efficacy, tolerability and ease of use were the major factors perceived by the specialists to influence the womens choice. Gynaecologists believed that only 2% of women taking the pill were 100% compliant compared to 48% of those using the patch and 75% of those using the ring. The lower risk of omission was the strong point for the latter methods. Side effects were the main reason to change to another method. Vaginal manipulation was the most difficult topic to discuss. Conclusions Most gynaecologists decided with the woman on the contraceptive method. The main reasons for the gynaecologists recommendation of a given contraceptive method and the womens choice were different. Counselling implies an open discussion and topics related to sexuality were considered difficult to discuss. Improving communication skills and understanding womens requirements are critical for contraceptive counselling.

The cost of managing severe hypoglycemic episodes in Type 2 diabetic patients

Introduction: Hypoglycemia is an acute complication of diabetes that increases morbidity, mortality and disease costs. We aim to estimate healthcare resource consumption and costs associated with severe hypoglycemia using the societal perspective. Methods: A cross-sectional, observational, nationwide, multicenter, hospital-based study was conducted in seven centers of Portuguese mainland with a 1-year enrolment period. Unit costs were extracted from official/public data sources. Patient-level data were used to quantify healthcare resource use related to emergency transportation, emergency-department care and hospitalization. Productivity loss was calculated based on the Human Capital Approach. Results: The study enrolled 238 Type-2 diabetic patients and the proportion of hypoglycemic episodes among all emergency events during the study period was 0.075% (95% CI: 0.067–0.083%). Mean patient age was 76 years and 57.6% were female. At time of the emergency department admission, 55% of patients were using insulin, 31.5% were being treated with secretagogues, 6.7% were on a combination of both, and 6.7% were on other oral antihyperglycemic agents. Estimated mean costs in the emergency department were: emergency transportation €33, medication €4, laboratory workup €56, other exams €72, physician and nurse time €30 and €13, respectively. Mean hospitalization cost was €1271. Indirect cost averaged €15. Overall cost per hypoglycemic episode averaged €1493 (standard deviation: €2962; range: €34–26,818). Patients treated with secretagogues had the highest rates of hospitalizations and mean costs. Conclusion: We conclude that severe hypoglycemic events represent a substantial cost for society and in particular for the hospitals of the National Health Service.

Severe hypoglycaemia among patients with type 2 diabetes requiring emergency hospital admission: The Hypoglycaemia In Portugal Observational Study–Emergency Room (HIPOS–ER)

To analyse the prevalence of severe hypoglycaemia in patients with type 2 diabetes (T2DM) treated with antihyperglycaemic agents (AHA) and requiring emergency room (ER) assistance, and to analyse the prevalence according to type of AHA therapy.

X-linked adrenoleukodystrophy and haemophilia A in the same kindred

Adrenoleukodystrophy (ALD; McKusick 300100) is a severe X-linked neurodegenerative disorder affecting young males. It is characterized by progressive demyelination, adrenocortical insufficiency and accumulation in tissues and body fluids of saturated very long-chain fatty acids (VLCFA) (Moser et al 1991). Interestingly, ALD kindreds also include males with infrequent dementia with a variety of neurological complications including spasticity and gait disturbance. These later-presenting males are said to have adrenomyeloneuropathy (AMN) and have similarly elevated VLCFA levels