Haemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory syndrome caused by deficient down-regulation of the immune response. Presence of central nervous system (CNS) involvement at diagnosis is a poor prognostic sign, and should be carefully investigated. Herein, we describe the neuroradiological findings, clinical data, and treatment outcome in 12 patients with genetic HLH and CNS complications. Neuroimaging was important in identifying CNS involvement, monitoring treatment responses, and detecting treatment complications.

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European Journal of Breast Health (Eur J Breast Health) is an international, scientific, open access periodical published by independent, unbiased, and double-blinded peer-review principles. It is the official publication of the Turkish Federation of Breast Diseases Societies, and Senologic International Society is the official supporter of the journal.

Background: The increased focus on quality indicators (QIs) and the use of clinical registries in real-world cancer studies have increased compliance with therapeutic standards and patient survival. The European Society of Breast Cancer Specialists (EUSOMA) established QIs to assess compliance with current standards in breast cancer care. Methods: This retrospective study is part of H360 Health Analysis and aims to describe compliance with EUSOMA QIs in breast cancer management in different hospital settings (public vs. private; general hospitals vs. oncology centers). A set of key performance indicators (KPIs) was selected based on EUSOMA and previously identified QIs. Secondary data were retrieved from patients’ clinical records. Compliance with target KPIs in different disease stages was compared with minimum and target EUSOMA standards. Results: A total of 259 patient records were assessed. In stages I, II, and III, 18 KPIs met target EUSOMA standards, 5 met minimum standards, and 8 failed to meet minimum standards. Compliance with KPIs varied according to the type of hospital (particularly regarding diagnosis) and disease stage. Although small differences were found in KPI compliance among institutions, several statistical differences were found among treatment KPIs according to disease stage, particularly in stage III. Conclusions: This study represents the first assessment of the quality of breast cancer care in different hospital settings in Portugal and shows that, although most QIs meet EUSOMA standards, there is room for improvement. Differences have been found across institutions, particularly between oncology centers and general hospitals, in diagnosis and compliance with KPIs among disease stages. Stage III showed the greatest variability in compliance with treatment KPIs, probably related to the lower specificity of the guidelines in this disease stage.

RESUMOIntrodução: Na Europa, a evidência sobre o impacto da crise económica nos médicos ainda é escassa. Este estudo explora perceções, opiniões e estratégias de adaptação à crise económica por parte de médicos do setor público na área da Grande Lisboa em Portugal. Material e Métodos:Um inquérito foi aplicado a 484 médicos, selecionados aleatoriamente, no Hospital de São José de Lisboa (n = 302) e nos agrupamentos de centros de saúde primários de Cascais (n = 96) e Amadora (n = 86). Este trabalho baseia-se na análise estatística descritiva das respostas dadas pelos médicos inquiridos sobre as suas perceções do impacto da crise económica no mercado de serviços médicos (n = 484), das mudanças introduzidas no seu trabalho nos setores público (n = 346) e privado (n = 187), e nas suas intenções de migrar (n = 482). Resultados: Os médicos inquiridos percepcionaram um aumento da procura dos serviços, mas também uma redução de serviços oferecidos no público, relacionando estas situações com a crise e com um aumento da oferta no setor privado. Os médicos reportaram uma diminuição de salário no setor público (-30,5%), e um ligeiro aumento no número de horas de trabalho semanal neste setor (+ 2 horas). As respostas indicaram que a mediana das horas de trabalho e rendimentos no privado mantiveram-se constantes entre 2010 e 2015 (16 horas e €2000 mensais). O ajustamento no estilo de vida foi reportado como a principal consequência da crise. O gosto pela profissão médica, a independência e a flexibilidade do trabalho foram os fatores de alívio mais mencionados. Uma percentagem de 15% dos médicos inquiridos declarou considerar a emigração como uma opção para o futuro. Discussão: Segundo os médicos inquiridos, a crise trouxe mudanças importantes nas suas condições de trabalho e no mercado dos serviços médicos. Conclusão: À redução salarial e às piores condições de trabalho, correspondeu uma resposta baseada na motivação intrínseca da profissão. Palavras-chave: Médicos; Política de Saúde; Portugal; Recessão Económica; Saúde Pública ABSTRACT Introduction: In Europe, scant scientific evidence exists on the impact of economic crisis on physicians. This study aims at understanding the adjustments made by public sector physicians to the changing conditions, and their perceptions on the market for medical services in the Lisbon metropolitan area. Material and Methods: A random sample of 484 physicians from São José Hospital and health center groups in Cascais and Amadora, to explore their perceptions of the economic crisis, and the changes brought to their workload. This paper provides a descriptive statistical analysis of physicians' responses. Results: In connection to the crisis, our surveyed physicians perceived an increase in demand but a decrease of supply of public health services, as well as an increase in the supply of health services by the private sector. Damaging government policies for the public sector, and the rise of private services and insurance providers were identified as game changers for the sector. Physicians re...

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