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- Central Portuguese Doctors’ agreement with the “Ten Commandments for patient-centred treatment”Publication . Santiago, Luiz Miguel de Mendonça Soares; Marques, Pedro Paulo; Simões, José Augusto RodriguesBackground. The “Ten Commandments for patent-centred treatment” suggest a different approach to therapy. Objectves. To ascertain the level of agreement with the “Ten Commandments for patent-centred treatment” by physicians in Central Portugal, exploring differences by age group, sex and medical speciality. Material and methods. An online questonnaire in September of 2016, sent to doctors registered in the Central Regional Secton of the Portuguese Medical Associaton, with weekly reminders to non-respondents. The English wording was translated to Portuguese, a questonnaire with a four-grade answer was created and its reliability determined. Variables such as sex, age group and medical specialty were considered. Descriptve and inferental statstcs were performed. Results. A representatve yet convenient sample of 811 doctors partcipated. Their descripton is as follows: ≤ 35 years n = 203, ≥ 36 and ≤ 55 years n = 217 and ≥ 56 years n = 373, women n = 391 (49.2%), General Practce/Family Medicine (GP/FM) n = 301, medical specialty n = 303 and medico-surgical specialty n = 173. By medical specialty, for commandment 1, there is higher prevalence of “Disagree/Completely Disagree” in the GP/FM specialty (p < 0.001). By gender, for commandment 1, women vs men doctors “Disagree/Completely Disagree” proporton of 11.7% vs 6,4% (p = 0.003). For the younger age groups, there is a greater proporton of “Disagree/Completely Disagree” for Commandment 1 (p = 0.016), for Commandment 4 (p = 0.007), for Commandment 6 (p = 0.001), for Commandment 7 (p = 0.001) and for Commandment 8 (p = 0.020). Conclusions. There is vast agreement with the “Ten Commandments for patent-centred treatment” in central Portugal. For Commandments 1, 3 and 6, the proporton of “Disagree/Completely Disagree” is higher than for the remaining. There is a need for future investgatons to explain the present results.
- Prevalence of chronic obstructive pulmonary disease in general practice patients in the Central Region of PortugalPublication . Ricardo, Jéssica; Simões, José Augusto Rodrigues; Santiago, Luiz Miguel de Mendonça SoaresIntroduction COPD is a common worldwide condition associated with morbidity and mortality. Its symptoms can be easily overlooked, accounting for an elevated level of under-recognition and under-diagnosis. Knowledge of the prevalence of COPD and the significance of its associated factors in the population enables better management of medical resources. To establish the prevalence of COPD in General Practice patients in the Central Region of Portugal and analyze the correlation with associated factors. Material and methods Cross-sectional study of patients’ data with COPD (R95, International Classification for Primary Care 2), anonymously gathered from the official database of the Central Health Administration of Portugal. Results Out of 937,817 individuals, 24,148 patients were identified with COPD, a prevalence of 2.57/100,000. 73.7% were above 65 years of age, and 60.2% were males. BMI was recorded in 60.2% patients, FEV1(%) in 8.0%, and smoking pack-years in 37.1%. Age and BMI were significantly negatively correlated (ρ = -0.032, p < 0.001), with the same occurring between age and FEV1(%) (ρ = -0.073, p < 0.05). A strong association of COPD with male gender and older age groups was found. Conclusions The prevalence of COPD was significantly higher in males, and age was identified as a risk factor for this condition. Higher age was non-significantly associated with lower FEV1(%) and significantly associated with BMI. The lack of e-records calls for an improvement.
- Defining Multimorbidity: From English to Portuguese Using a Delphi TechniquePublication . Prazeres, Filipe; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesObjective. To translate the EuropeanGeneral Practice ResearchNetworkmultimorbidity definition according to Portuguese cultural and linguistic features. Methods. Similar to the process completed in several other European countries, a forward and backward translation of the English multimorbidity definition using the Delphi technique was performed in Portugal. Results. Twenty-three general practitioners (GPs)—14 males and 9 females—agreed to form the Portuguese expert panel for the Delphi process (59% acceptance rate).The Portuguese definition of multimorbidity was achieved after two Delphi rounds with a mean (SD) consensus score for final round of 8.43/9 (0.73). Conclusion. With this paper the definition of multimorbidity is now available in a new language—Portuguese. Its availability in the local language will raise Portuguese GPs’ awareness about multimorbidity and allow future national and international research. The operationalization of the definition will allow an easier identification of patients with multimorbidity.
- Pessoas que sofrem de hipertensão arterial: implicações na atividade médica das diferenças entre os controlados e os não controladosPublication . Martins, Ricardo; Santiago, Luiz Miguel de Mendonça Soares; Reis, Maria Teresa; Roque, Ana Carolina; Pinto, Mariana; Simões, José Augusto Rodrigues; Rosendo, InêsObjetivos: Comparar características clínicas, de atividade médica e de caracterização familiar e social entre populações sofrendo de hipertensão arterial segundo estejam ou não controladas. Metodologia Estudo observacional em amostra aleatória por ordem alfabética e representativa com reposição em população de cuidados de saúde primários de 25 médicos especialistas em medicina geral e familiar de três unidades de cuidados de saúde primários no centro de Portugal, em 2018, pela análise dos registos clínicos informáticos das pessoas com a classificação ICPC‐2 de hipertensão arterial. Estudaram‐se variáveis epidemiológicas, clínicas, familiares, sociais e de atividade médica terapêutica. Realizou‐se estatística descritiva e inferencial. Resultados Num universo de 8750 pessoas com a classificação hipertensão arterial estudou‐se uma amostra de n = 387 (tamanho calculado para IC 95% e margem de erro de 5% em n = 369). Hipertensão arterial não controlada em 56,1% da amostra, significativamente mais frequente em quem vive só (p = 0,024), vive em família nuclear (p = 0,011), em situação de mais baixa classificação social (p = 0,018), com prescrição concomitante de AINE (p = 0,018). O risco cardiovascular calculado é não significativamente mais elevado no não controlo (p = 0,116). A inércia terapêutica não se verifica em número de associações e em número médio de medicamentos (p = 0,274) não se verificando igualmente diferença para as restantes variáveis estudadas. Viver só, pertencer a famílias com mais baixa classificação social e viver em família nuclear representam 9,6% da responsabilidade de não haver controlo. Conclusões A atividade médica no ambiente de medicina geral e familiar, e não só, deve assim aliar as competências terapêuticas com as habilidades de estudo individual e social para a melhoria do controlo da HTA em Portugal.
- 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.
- Promoting players’ safety and welfare through the sharing of scientific knowledge with sports agents: the new reality of Portuguese rugby sevensPublication . Ferreira, António Miguel da Cruz; Ferreira, Eduardo Cruz; Barata, Luis Taborda; Santiago, Luiz Miguel de Mendonça SoaresAs the authors of the recently published article “Epidemiology of injuries in senior male rugby union sevens: a systematic review”, we would like to share with you its impact on the Portuguese rugby community and our achievements since then. [...]
- Prevalence Of Potentially Inappropriate Medication In The Older Adult Population Within Primary Care In Portugal: A Nationwide Cross-Sectional StudyPublication . Simões, Pedro Augusto Gomes Rodrigues Marques; Santiago, Luiz Miguel de Mendonça Soares; Maurício, Katia; Simões, José Augusto RodriguesBackground: In potentially inappropriate medications harm potentially outweighs benefits. Even appropriately prescribed medications may become inappropriate. They can lead to a high risk of adverse drug reactions, morbidity and mortality. The aim of this study was to determine the prevalence of potentially inappropriate medication in the older adult population attending primary care in Portugal and to identify associated sociodemographic and clinical factors. Methods: We conducted a cross-sectional, analytical study in primary care centres from the five Portuguese healthcare administrative regions and the two autonomous regions. We used a random sample of 757 older patients provided by the information department of the ministry of health (SPMS) and family doctors from the autonomous regions. Data collection occurred March 2018 and we studied sociodemographic characteristics, clinical profile and medication. We used 2015 Beers Criteria to assess potentially inappropriate medications. Logistic regression analyses were performed to determine associations between potentially inappropriate medications’ prescriptions and other variables. Results: Potentially inappropriate medication was present in 68.6% and 46.1% of the sample had two or more. The likelihood of having potentially inappropriate medication increased significantly with being female (OR=1.56 [1.05 to 2.31]), number of chronic health problems (OR=1.06 [1.01 to 1.13]), number of pharmacological subclasses (OR=1.40 [1.30 to 1.51]) and number of prescribers (OR=1.34 [1.09 to 1.65]). Proton-pump inhibitors, nonsteroidal anti-inflammatory drugs and benzodiazepines were the most commonly found ones. Conclusion: Potentially inappropriate medication in older adults was found to be a common occurrence in Portugal. It is important that doctors are aware of this problem, namely in the primary care setting due to the longitudinal care.
- Epidemiology of Time-Loss Injuries in Senior and Under-18 Portuguese Male Rugby PlayersPublication . Ferreira, António Miguel da Cruz; Ferreira, Eduardo Cruz; Ribeiro, Pedro Barbosa; Santiago, Luiz Miguel de Mendonça Soares; Barata, Luis TabordaRugby union has one of the highest injury incidence rates in team sports, however, most of the available data focus on the epidemiology of injuries in countries where rugby is popular. We aimed to report the incidence rate and relevant epidemiological aspects of injuries occurred in a group of Portuguese male rugby players. A prospective cohort study was conducted with a group of 45 senior and 32 under-18 male players (total of 77 players). Outcome measures included injury incidence, position, type, location and severity of injuries. The match injury incidence for all players was 55.84 per 1000 player match-hours (66.66 for seniors, 42.85 for under-18), while mean time-loss for injury was 20.79 days. No statistical differences were found between groups. Lower limb injuries accounted for 60.5% of all injuries, while joint/ligament injuries were the most prevalent type. Contact events were responsible for 65.1% of injuries. Despite the limitations, the obtained data are consistent with the literature. Time-loss injuries seem highly prevalent in rugby union and the incidence rates found in this Portuguese-based study were lower than the reported for international and senior men's professional rugby union, but higher than those occurring in community rugby in tier-1 countries. The authors believe these data reinforce the need to develop and implement effective injury surveillance and prevention programs.
- Multimorbidity daily life activities and socio-economic classification in the Central Portugal primary health care setting: an observational studyPublication . Santiago, Luiz Miguel de Mendonça Soares; Prazeres, José Filipe Chaves Pereira; Boto, Tânia; Mauricio, Katia; Rosendo, Inês; Simões, José Augusto RodriguesBackground. Multimorbidity (MM) is associated with decreased quality of life, mainly due to decreased functional capacity and increased use of health care. Objectives. Evaluate the prevalence of MM in older people of Central Portugal and understand the impact of MM on daily life activities (DLA) and how socioeconomic level influenced prevalence of MM. Material and methods. Observational study of data on age, sex, number of ICPC2 codes and Barthel (Bt) and Graffar (Gr) Indexes in clinical records of all aged between 65 to 99 years enrolled in the Health Centers of the Central Region of Portugal. The Bt was used to assess the dependence on DLA and the Gr the socioeconomic level. Results. Population of 190025, mean age of 80.16± 8.03 years. MM prevalence of 80% out of which, 52.9% were female and the majority was aged between 76-85 years (39.1%). Average number of health problems of 8.7 problems for males and 9.5 for females. The Bt and Gr Indexes filling for the studied sample were of, Barthel 7.4% and Graffar 4,9%. Older people without MM have higher dependency rates than those with MM (total dependence 7.4% vs 6.2% and severe dependence 20.1% vs 9.6%). MM in older people are mainly in the middle (55.3% vs 27.5%) and low (31.8% vs 19.6%) Graffar class, while the older people without MM are mainly at middle to upper (35.3%) and upper (17.6%) Graffar classes. Conclusions. Multimorbidity is mainly associated with lower social classes. Dependence for DLA appears unrelated to MM. Multimorbidity persons need special attention, based on socio-economic contexts.
- Cross-cultural adaptation and validation of the PRISMA-7 scale for European PortuguesePublication . Santiago, Luiz Miguel de Mendonça Soares; Silva, Raquel; Velho, Denise Alexandra Cunha; Rosendo, Inês; Simões, José Augusto RodriguesBackground. Frailty is an age-associated biological syndrome and a predictor of multimorbidity outcomes, whose early recognition allows for the identification of those older patients at risk. The PRISMA-7 scale allows for the identification of frail older people. Objectives. To make a cross-cultural adaptation and validation of the PRISMA-7 to the European spoken Portuguese language. Material and methods. Cross-cultural adaptation by translation of the PRISMA-7 scale into European Portuguese, debriefing and back-translation to English. Application for intra-observer reliability assessment and validation by simultaneous and concurrent application of the Katz scale. Results. Cronbach’s alpha coefficient was of 0.420 and 0.409 after a re-test. Spearman’s Rank Order Correlation of 0.969 in the re-test operation in a sample of 64 older people (35 female). More than 3 affirmative answers were found for older people (p < 0.001), for a higher number of self-reported drugs taken, (p = 0.001), self-reported years of education (p = 0.001), higher values for those with less years of studies were found in the validation of the translated PRISMA-7 scale, in a purposive sample of 127 older people, 72 (56.7%) female. No differences were found between gender (p = 0.414) and for number of self-reported diseases (p = 0.258). A Spearman correlation of ρ = 0.477 (p < 0.001) between the total of the two scales was found. Discussion. This comprehensive tool enables health care providers to discuss and architect more effective and efficient measures for these patients’ care, regardless of gender, socio-demographic factors, number of self-reported drugs taken and diseases. Conclusions. The PRISMA-7 scale is now recommended to identify frail older people in the Portuguese community.