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- Ensino de Medicina Geral e Familiar no Mestrado Integrado de Medicina da Universidade da Beira InteriorPublication . Simões, José Augusto Rodrigues; Prazeres, José Filipe Chaves Pereira; Santiago, Luiz Miguel de Mendonça Soares; Castelo-Branco, MiguelA educação médica é um processo organizado que leva à aquisição de co-nhecimentos, atitudes e aptidões para atingir a proficiência. É um processo contínuo e dinâmico em que o atingir de cada objetivo abre a perspetiva de novos objetivos, permitindo estruturar estratégias mais eficientes para a execução de tarefas. No ensino médico, este processo estrutura-se através de um ciclo pré-clínico de estudos em ciências básicas, seguido de um ciclo clínico de formação médica. No fim, o processo de graduação é concluído e a Universidade reconhece a competência para a prática da medicina.
- Pharmacist intervention program to enhance hypertension control: a randomised controlled trialPublication . Morgado, Manuel; Rolo, Sandra; Castelo-Branco, MiguelObjective Studies have demonstrated that hypertension remains inadequately managed throughout the world, with lack of adherence to BP-lowering medication being a major factor. The aim of the present study was to evaluate if a pharmaceutical care program could improve antihypertensive medication adherence and blood pressure control. Setting This study was conducted in a secondary care hypertension/dyslipidemia outpatient clinic in the university teaching hospital of Cova da Beira Hospital Centre, Covilha˜, located in the Eastern Central Region of Portugal. Method This report evaluates the pharmacist’s interventions during a prospective randomised controlled trial, from July 2009 to June 2010. Patients with diagnosis of essential hypertension attending the clinic for routine follow-up were randomly allocated either to a control group (no pharmaceutical care) or to an intervention group (quarterly follow-up by a hospital pharmacist during a 9- month period). The pharmacist interventions, aimed to increase medication adherence and blood pressure control, involved educational interventions and counselling tips directed to the patient. Main outcome measure Systolic blood pressure, diastolic blood pressure and blood pressure control (according to JNC 7 guidelines) assessed at the baseline visit and at the end of pharmaceutical care were the main outcome measures. Blood pressure measurements were performed by blinded nurses. Medication adherence was also evaluated, using a validated questionnaire at baseline and at the end of investigation. Results A total of 197 hypertensive patients were randomly assigned to the study (99 in the control group and 98 in the intervention group). Although there were no significant differences (P[0.05) in both groups concerning mean age, gender, body mass index, and antihypertensive pharmacotherapy, blood pressure control was higher in the intervention group (P = 0.005) at the end of the study. Significant lower systolic blood pressure (-6.8 mmHg, P = 0.006) and diastolic blood pressure (-2.9 mmHg, P = 0.020) levels were observed in the intervention group. Medication adherence was also significantly higher in the intervention group at the end of the study (74.5% vs. 57.6%, P = 0.012).Conclusion Pharmacist intervention can significantly improve medication adherence and blood pressure control in patients treated with antihypertensive agents.
- Predictors of uncontrolled hypertension and antihypertensive medication nonadherencePublication . Morgado, Manuel; Rolo, Sandra; Macedo, Ana Filipa; Pereira, Luísa; Castelo-Branco, MiguelBackground: Although hypertension is, in most cases, a controllable major risk factor in the development of cardiovascular disease, studies have demonstrated that hypertension remains poorly controlled in Portugal. Our aim was to evaluate the covariates associated with poor blood pressure (BP) control in a Portuguese hypertensive population. Patients and Results: We conducted a cross-sectional survey in a hospital hypertension outpatient clinic, located in the Eastern Central Region of Portugal. Patients attending the clinic from July to September 2009 were asked to participate in a structured interview including medication adherence and knowledge about hypertension. Eligible participants were all adults aged 18 or over with an established diagnosis of arterial hypertension and had been on antihypertensive drug treatment for at least 6 months. Exclusion criteria were dementia, pregnancy, and breastfeeding. Detailed clinical information was prospectively obtained from medical records. A total of 197 patients meeting the inclusion criteria and consenting to participate completed the interview. Of these, only 33.0% had their BP controlled according to the JNC 7 guidelines. Logistic regression analysis revealed three independent predictors of poor BP control: living alone (OR = 5.3, P = 0.004), medication nonadherence (OR = 4.8, P < 0.001), and diabetes (OR = 4.4, P = 0.011). Predictors of medication nonadherence were: unawareness of target BP values (OR = 3.7, P < 0.001), a report of drug side effects (OR = 3.7, P = 0.002), lack of BP monitoring (OR = 2.5, P = 0.015) and unawareness of medication indications (OR = 2.4, P = 0.021), and of hypertension risks (OR = 2.1, P = 0.026). Conclusions: Poor medication adherence, lack of information about hypertension, and side effects should be considered as possible underlying causes of uncontrolled BP and must be addressed in any intervention aimed to improve BP control.
- Association of statin therapy with blood pressure control in hypertensive hypercholesterolemic outpatients in clinical practicePublication . Morgado, Manuel; Rolo, Sandra; Macedo, Ana Filipa; Castelo-Branco, MiguelBackground: Some clinical evidence revealed that statins, apart from lowering cholesterol levels, also have an antihypertensive effect. Our aim was to evaluate the existence of a possible association of statin therapy with blood pressure (BP) control in clinical practice. Materials and Methods: Patients attending a hypertension/ dyslipidemia clinic were prospectively evaluated. Those patients with a diagnosis of stage 1 hypertension and hypercholesterolemia who consented to participate were included in the study, either in the statin group (when taking a statin) or in the control group (when not taking a statin). Exclusion criteria included dementia, pregnancy, or breastfeeding, and history or evidence of stage 2 hypertension. Detailed clinical information was prospectively obtained from medical records. A total of 110 hypertensive patients were assigned to the study (82 in the statin group and 28 in the control group). Results: Although there were no signifcant differences (P > 0.05) in both groups concerning gender, body mass index, antihypertensive pharmacotherapy, and serum levels of high-density lipoprotein cholesterol and triglycerides, a higher BP control was observed in the statin group (P = 0.002). Signifcantly lower systolic BP (−6.7 mmHg, P = 0.020) and diastolic BP (−6.4 mmHg, P = 0.002) levels were reported in the statin group. Serum levels of low-density lipoprotein were also signifcantly lower in the statin group (P < 0.001). Conclusions: This observational study detected an association of statin therapy with BP control in hypertensive hypercholesterolemic patients in clinical practice. These fndings raise the possibility that statin therapy may be useful for BP control in the studied population.
- What’s the importance of portable tele-monitoring devices in patient therapeutic adherence?Publication . Rodrigues, Orlando; Costa, Tiago; Castelo-Branco, Miguel; Gaspar, Pedro DinisIn the UK it is estimated the NHS spends almost £100 million every year in unused drugs. In addition, hospital admission costs attributed to patients not taking their prescribed medicine properly was estimated to be between £36m and £197m per year. In the U.S., medication non-adherence is estimated to lead to between $100 and $300 billion of avoidable healthcare costs annually, representing 3–10% of total U.S. healthcare costs. Studies show that improving medication adherence may have a greater influence on the health of the population than the discovery of any new therapy. Effective medicines are available for many conditions and yet patients are non-adherent 50% of the time. This can be critical point in certain disease states, such as asymptomatic conditions like hypertension, where the incidence may approach 80% non-compliance. It is proposed to create a therapeutic adherence monitoring device within a smart blister pack that is coupled to a device with the capacity to collect and send data to a common server. This would allow a clinician to know, with high certainty, if the patient is taking their medication as prescribed and on schedule. This paper gathers information to identify current technology to support integrated monitoring and control of therapeutic adherence.
- Telemonitoring Devices and Systems: Current Status and Future TrendsPublication . Machadeiro, Liliana Tavares; Gaspar, Pedro Dinis; Castelo-Branco, MiguelIn the future, the number of elderly and chronically ill will be quite large. Additionally, pathologies will in many cases be in comorbidity. Along with this reality, the health care resources will be insufficient for the population, thus the current research for technological solutions needs to be implemented in the future. There are available several telemonitoring devices and systems for chronic diseases. Massive use of these devices will be essential to address the current and future lack of health system resources. Research on telemonitoring devices and systems for chronic diseases was conducted in academic and scientific databases. The technical specifications were collected from the manufacturers’ web page. The collected data was analysed and compared in order to propose scenarios for the future trend of technical specifications required in telemonitoring devices/system. Telemonitoring for chronic diseases can bring great benefits to patient and health systems. Widening this practice will be a reality in the near future. This procedure will be fostered by the promotion and regulation of interoperability between devices/systems, as well as of front-end programs providing the link between health support systems. Interoperability issues are the main flaws of telemonitoring devices/systems on the market today.
- Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: Review and meta-analysisPublication . Morgado, Manuel; Morgado, Sandra; Mendes, Liliana; Pereira, L.; Castelo-Branco, MiguelPurpose. Pharmacist interventions to enhance blood pressure (BP) control and adherence to antihypertensive therapy in adults with essential hypertension were reviewed. Methods. A literature search was conducted to identify relevant articles describing pharmacist interventions intended to improve adherence to antihypertensive medications. Studies were included if they described a pharmacist intervention to improve medication adherence and analyzed adherence to therapy and BP control as outcomes. A fixed-effects model was used to combine data from randomized controlled trials. Results. A total of 15 studies were identified, testing 16 different interventions and containing data on 3280 enrolled patients. Although 87.5% of the interventions resulted in significant improvements in treatment outcomes, only 43.8% of the interventions were associated with significant increases in medication adherence. All interventions that increased antihypertensive medication adherence also significantly reduced BP. Almost all the interventions that were effective in increasing adherence to medication were complex, including combinations of different strategies. Meta-analysis of 2619 patients in 8 studies found that pharmacist interventions significantly reduced systolic blood pressure (SBP) (p < 0.001) and diastolic blood pressure (DBP) (p = 0.002) and that the meta-analytic differences in SBP and DBP changes from baseline to endpoint in intervention and control groups were –4.9 ± 0.9 mm Hg (p < 0.001) and –2.6 ± 0.9 mm Hg (p < 0.001), respectively. Conclusion. A literature review and meta-analysis showed that pharmacist interventions can significantly improve medication adherence, SBP, DBP, and BP control in patients with essential hypertension. Interventions were complex and multifaceted and included medication management in all analyzed studies.
- Enzymatic time-temperature integrator device for chromatic quality check of Cova da Beira’s cherry (Portugal)Publication . Quelhas, Adriana Sebastião; Gaspar, Pedro Dinis; Castelo-Branco, MiguelCherry is a fruit widely appreciated by consumers in general. In Portugal, within the Beira Interior region, and particularly, Cova da Beira, is the most representative area with a production of more than 50% of the national production. The peculiar characteristics of cherries, such as color, firmness, palate, among others, increase the demand for this fruit, which can only be commercialized during a short period. Its high perishability interferes with the shelf life and consequently generates undesirable changes in the cherry flow chain. In order to ensure food quality and safety and prevent food waste, a time-temperature integrator (TTI) device to monitor the quality of the cherry in real time is proposed. This device suffers a chromatic change with the temperature variation over time. For the specific case of the cherry, the kinetic parameters for thermal inactivation are determined which leads to the proposal of an enzymatic-type TTI, where the degradation of the phenolic compounds occurs, which are substrates of the polyphenol oxidase enzyme, whose hydroxylation reaction of a monophenol in o-diphenol leads to the oxidation in o-Quinone. This device aims to help retailers to decide when and where to sell the food items taking into account the remaining shelf life, as well as support the decision of purchase by the consumer predicting through a chromatic and expedite stamp the food quality and safety
- Telemonitoring Devices and Systems: Current Status and Future TrendsPublication . Machadeiro, Liliana Tavares; Gaspar, Pedro Dinis; Castelo-Branco, MiguelIn the future, the number of elderly and chronically ill will be quite large. Additionally, pathologies will in many cases be in comorbidity. Alongside this reality, the health care resources will be insufficient for the population, thus the current research for solutions that can be fully implemented in the future. There are available several telemonitoring devices and systems for chronic diseases. Massive use of these devices will be essential to address the current and future lack of health system resources. Research on telemonitoring devices and systems for chronic diseases was con-ducted in academic and scientific databases. The technical specifications were collected in the manufacturers’ web page. The gathered data was analysed and compared in order to propose scenarios for the future trend of technical specifi-cations required in telemonitoring devices/system is performed. Telemonitoring for chronic diseases can bring great benefits to patient and health systems. Widening this practice will be a reality in the near future. This procedure will be fostered by the promotion and regulation of interoperability between de-vices/systems, as well as of front-end programs providing the link between health support systems. Interoperability issues are the main flaw of tedevicesring devices/systems on the market today.
- Reaching 100 in the Countryside: Health Profile and Living Circumstances of Portuguese Centenarians from the Beira Interior RegionPublication . Afonso, Rosa Marina; Ribeiro, Oscar; Patto, Maria Da Assunção Vaz; Loureiro, Marli; Loureiro, Manuel; Castelo-Branco, Miguel; Patricio, Susana; Alvarinhas, Sara; Tomaz, Tatiana; Rocha, Clara; Jerónimo, Ana Margarida; Gouveia, Fatima; Amaral, Ana PaulaThe interest in studying a specific population of centenarians who lives in the country’s interior region (PT100-BI) emerged during the first Portuguese systematic study about centenarians (PT100 Oporto Centenarian Study). This region of Portugal is predominantly rural and is one of the regions with the largest number of aged people. The aim of this study is to provide information on the centenarians who live in the Beira Interior region, specifically in terms of their health status and the health services they use. A total of 101 centenarians (mean age: 101.1 years; SD = 1.5 years), 14 males and 87 females, were considered. Most centenarians lived in the community, and 47.6% lived in nursing homes. Nearly half (47.5%) presented cognitive functioning without deficits. A noteworthy percentage presented conditioned mobility and sensory problems. The most common self-reported diseases include urinary incontinence (31.7%), high blood pressure (23.8%), and heart conditions (19.8%). Despite these health and functional characteristics, formal support services and technical assistance were found to be scarcely used. Further research is needed to understand how the role of contextual variables and the countryside environment contribute to the centenarians’ adaptation to advanced longevity.