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- The Elderly’s Thoughts and Attitudes about Polypharmacy and Deprescribing: A Qualitative Pilot Study in PortugalPublication . Simões, Pedro Augusto Gomes Rodrigues Marques; Foreman, Nicole; Xavier, Beatriz de Oliveira; Prazeres, Filipe; Maricoto, Tiago; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesThe high prevalence of polypharmacy and potentially inappropriate medications in the elderly makes them a vulnerable group to adverse drug events. Deprescribing is the medication review plus cessation of potentially inappropriate medications with a health professional’s help. Several barriers and enablers influence it, and its knowledge can help health professionals. The objective of the study is to understand the Portuguese elderly’s attitudes and ideas about polypharmacy and deprescription. We made a qualitative approach through a focus group with elderly patients from an adult daycare center with transcription and codification into themes and subthemes based on previous frameworks. Eleven elderly patients participated in the focus group. The identified elderly’s ideas and attitudes could be clustered into five main barriers: appropriateness, process, influences, fear, and habit, and five main enablers: appropriateness, process, influences, dislike, and cost. Although the elderly’s strong beliefs regarding medication benefits and necessity prevail, contrary opinions regarding lack of benefit/necessity, drug interaction/side effects, and medication complexity/number may influence their willingness to deprescribe positively. The health professional’s influence and the patient’s trust in their doctors were perceived essential for decision-making as either a barrier or an enabler. The medication benefit was a big barrier, and side effects/drug interaction experiences are an important enabler.
- Physician empathy and patient enablement: survey in the Portuguese primary health carePublication . Simões, José Augusto Rodrigues; Prazeres, José Filipe Chaves Pereira; Maricoto, Tiago; Simões, Pedro Augusto Gomes Rodrigues Marques; Lourenço, Joana; Romano, João Pedro; Santiago, Luiz Miguel de Mendonça SoaresBackground: Empathy is the capacity to understand and resonate with the experiences of other people. Patient enablement is the degree to which a patient feels strengthened in terms of being able to deal with, understand and manage their disease. Methods: Secondary cross-sectional analysis of existing data from 2 independent datasets (456 primary health care patients), with the application of two validated questionnaires, Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and Patient Enablement Instrument (PEI). Objective: Evaluate medical empathy and patients’ enablement after consultation with their family doctors and to verify if there was an association between these two concepts. Results: The median value of JSPPPE-VP score was 6.60 (interquartile range 1.00) and of PEI/ICC score was of 1.83 (interquartile range 0.67). Regarding empathy (JSPPPE-VP), patients taking chronic medication had a slight but significantly higher median score than patients not taking them (6.70 versus 6.60, P = 0.049), although regression modelling did not confirm any relevant predictor of JSPPPE-VP score. Regarding enablement (PEI/ICC), we found significantly higher scores on younger patients, as well as, on more educated and professionally active ones (P < 0.001). Multivariable linear regression and Poisson regression modelling confirmed such variables as statistically significant potential predictors. Conclusions: A significant positive association was found between empathy score (JSPPPE-VP) and enablement score (PEI/ICC), when adjusted to sociodemographic cofactors. On this linear regression model, age category and educational level were also significantly associated with empathy score, with the same pattern found on bivariate analysis.
- Determining factors associated with inhaled therapy adherence on asthma and COPD: A systematic review and meta-analysis of the global literaturePublication . Monteiro, Constança Lourenço Pelicho; Maricoto, Tiago; Prazeres, José Filipe Chaves Pereira; Simões, Pedro Augusto Gomes Rodrigues Marques; Simões, José Augusto RodriguesBackground Adherence to therapy has been reported worldwide as a major problem, and that is particularly relevant on inhaled therapy for Asthma and Chronic Obstructive Pulmonary Disease (COPD), considering its barriers and features. We reviewed the global literature reporting the main determinants for adherence on these patients. Methods Searches were made using the Cochrane Library, MEDLINE, EMBASE and ISI Web of Science databases. Analytical, observational and epidemiological studies (cohort, case-control and cross-sectional studies) were included, reporting association between any type of determinant and the adherence for inhaler therapy on Asthma or COPD. Random-effects meta-analysis were used to summarise the numerical effect estimates. Results 47 studies were included, including a total of 54.765 participants. In meta-analyses, the significant determinants of adherence to inhaled therapy were: older age [RR = 1.07 (1.03–1.10); I2 = 94; p < 0.0001] good disease knowledge/literacy [RR = 1.37 (1.28–1.47); I2 = 14; p = 0.33]; obesity [RR = 1.30 (1.12–1.50); I2 = 0; p = 0.37]; good cognitive performance [RR = 1.28 (1.17–1.40); I2 = 0; p = 0.62]; higher income [RR = 1.63 (1.05–2.56); I2 = 0; p = 0.52]; being employed [RR = 0.87 (0.83–0.90); I2 = 0; p = 0.76] and using multiple drugs/inhalers [RR = 0.81 (0.79–0.84); I2 = 0; p = 0.80]. Overall, the strength of the underlying evidence was only low to moderate. Conclusions Many determinants may be associated to patient's adherence, and personalised interventions should be taken in clinical practice to address it by gaining an understanding of their individual features.
- The link between happiness and health: a review of concepts, pathways and strategies for enhancing well-beingPublication . Mendes, Mafalda Pereira; Simões, Pedro Augusto Gomes Rodrigues Marques; Simões, José Augusto Rodrigues; Santiago, Luiz Miguel de Mendonça Soares; Prazeres, José Filipe Chaves Pereira; Maricoto, TiagoBackground. Recent years have seen a signifcant body of research independently associatng the presence of happiness and well-being with a lower risk of mortality and with an improved physical and mental health status, which presents a relevant impact on public health. Nonetheless, there are stll gaps in literature, and the underlying mechanisms are stll unclear. Objectves. this paper reviews literature regarding the main concepts and measurements associated with well-being, discussing pathways that link happiness to health and compiling strategies to improve it. Material and methods. A narratve literature review was performed gathering the most relevant artcles concerning concepts, defnitons and measurements associated with well-being, as well as regarding pathways and mechanisms that link happiness to health. The concepts and defnitons associated with happiness and well-being are discussed, and common constructs related to the later are then considered. Additonally, the available methods to measure happiness and well-being, and their limitatons, are analysed. Results. The main pathways that link mental to physical well-being include: 1) neurobiological processes, 2) the indirect impact on health behaviours, 3) the promoton of protectve psychosocial resources and 4) stress buffering effects. Conclusions. Happiness and well-being play a major role on human’s health, and many features and dimensions may be involved in this relatonship. Public health measures should focus on upstream determinants of health and well-being, but more research is needed in order to fll in some gaps, such as the variety of available instruments to address, evaluate and promote efcient interventon.
- COVID-19 or threat of a nuclear war in Europe? A cross-sectional study of anxiety levels in adults living in PortugalPublication . Prazeres, José Filipe Chaves Pereira; Maricoto, Tiago; Lima, Inês Sampaio; Simões, Pedro Augusto Gomes Rodrigues Marques; Simões, José Augusto RodriguesBackground: Since 2019, Europe has experienced ongoing stressors with the emergence of the COVID-19 pandemic and the Russian–Ukrainian War, which have had social, financial, physical, and psychological impacts. Studies suggest that anxiety, fear, post-traumatic stress disorder, depression, and other psychological disorders are common in such situations, and there is a need for more research on the impact of the war on mental health in Portugal. The main goal of the present study was to assess the impact of the fear of COVID-19 and anxiety related to nuclear war on the general anxiety levels of adult individuals living in Portugal. Methods: A cross-sectional study was conducted from May to July 2022 using an online questionnaire built on the Google Forms platform. Portuguese-speaking male and female individuals aged 18 years or older, who provided informed consent and agreed to participate, were included. The outcome variable was defined using the Portuguese version of the GAD-7 scale, while the main predictors were the FCV-19S and the NWA Scale in Portuguese. Linear and logistic regression models were used to test associations between predictors and outcome variable. Results: The study included 1,182 participants, with a mean age of 46.5 (±11.7) years, mostly women (80.6%). The global mean GAD-7 score was 5.8 (±4.5) points, and 17.9% of the participants scored above the 10-point cutoff. Higher scores were found in both the FCV-19S and the NWA scale among participants with anxiety, as measured by both a 10-point cutoff (p < 0.001), and GAD-7 scale mean scores (p < 0.001). The study showed that fear of COVID-19 [OR of 1.133 (95%CI: 1.097–1.170)] and, at a lesser extent, nuclear war anxiety [OR of 1.020 (95%CI, 1.009–1.031)] contribute to anxiety in the general population. This is also true for those with a personal history of anxiety, revealed by multiple regression. Discussion: This study contributes to the research on COVID-19’s impact on anxiety and provides the first comprehensive assessment of nuclear war anxiety in Portugal. Results highlight the need for long-term care for anxiety, as prevalence is expected to increase due to the pandemic and war, even in non-conflict areas like Portugal.
- Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or Chronic Obstructive Pulmonary Disease: A Meta-AnalysisPublication . Maricoto, Tiago; Monteiro, Luís; Gama, Jorge; Sousa, Jaime Correia de; Barata, Luis TabordaOBJECTIVES: To evaluate the effect of inhaler education programs on clinical outcomes and exacerbation rates in older adults with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Older adults with asthma or COPD, either in primary or secondary health care and pharmacy setting. MEASUREMENTS: We searched the Medline, Embase, and Central databases according to the main eligibility criteria for inclusion: systematic reviews, meta-analysis, clinical trials and quasi-experimental studies; participants aged 65 and older; education on inhaler technique and reporting of disease control and exacerbation rates. We used the Grading of Recommendations, Assessment, Development and Evaluations scale for quality assessment and used a random-effect model with Mantel–Haenszel adjustment to perform a meta-analysis. RESULTS: We included 8 studies (4 randomized, 4 quasiexperimental) with a total of 1,812 participants. The most frequent type of intervention was physical demonstration of inhaler technique, training with placebo devices. Five studies showed significant reduction in exacerbation rates (pooled risk ratio=0.71, 95% confidence interval=0.59–0.86; p < .001), although effect on disease control and quality of life showed high discrepancy in the reported results, and all randomized studies revealed uncertainty in their risk of bias assessment. CONCLUSION: All interventions seemed to improve inhaler performance and clinically relevant outcomes, but a placebo device could be the most effective. There is evidence that interventions reduce exacerbation risk in older adults, although to an overall moderate degree.
- Inhaler technique performance in elderly patients with asthma and COPDPublication . Maricoto, Tiago João Pais; Barata, Luís Manuel Taborda; Sousa, Jaime Correia deChronic Obstructive Pulmonary Disease (COPD) and Asthma affect up to 400 million people worldwide, and almost half of these patients have poor disease control. The elderly are more vulnerable to exacerbations, and that is due to the presence of comorbidities and frequent inhaler misuse. Educational programmes may reduce exacerbation risk, but its real impact on clinical outcomes is still unknown, as well as the main factors associated with individual risk. This thesis aims to evaluate the impact of inhaler technique performance on major outcomes in elderly patients and to identify their principal potential predictors. Several methods were performed: A systematic review with meta-analysis focusing on interventional studies with inhaler education and clinical outcomes was carried out; through its results, a cost-effectiveness analysis was performed, estimating potential cost-savings and available budget for educational interventions; In addition, a cross-sectional study was performed, aiming to identify major predictors of inhaler performance and clinical risk. Several variables were collected as predictors, as well as the main clinical outcomes; finally, we designed a protocol for a randomised, single-blinded clinical trial, aiming to test the impact of a teach-to-goal placebo device education programme on clinical outcomes, in a one-year follow-up, versus "usual care". The systematic review with meta-analysis collected data from eight interventional studies and a significant reduction in exacerbation risk of 29% (95% CI=14-41) was observed in the clinical trials. From the cost-effectiveness perspective, the affordable budget for educational interventions was estimated to be up to 1800 euros per patient per year, and the estimated average savings is 311.88 euros per patient per year, which may represent up to 131 million euros for the whole National Health Service. The cross-sectional study was performed with 130 elderly patients, with a mean age of 74.4 (± 6.4) years. The prevalence of errors in the inhaler technique was 71.6% (95% CI: 64-78.5) and that of critical errors was 31.1% (95% CI: 24-38.8). Major predictors of inhaler performance were: cognitive performance, adherence index, male gender, having previous education with placebo device performed by a physician, the existence of allergies or comorbidities with respiratory impact, active smoking and depression. The main predictors of symptoms control were: having previous teaching of inhaler technique delivered by a physician, smoking load, anti-influenza vaccination, depression, respiratory comorbidities, and educational level. Lung function was associated with smoking load, as well as presence of errors in drug activation and absence of end pause. Our results suggest that interventions with inhaler technique education can significantly reduce the risk of exacerbations in elderly patients with Asthma or COPD, and are cost-effective. Moreover, it is possible to identify patients who are at greater risk of misusing their devices, and also have an increased risk of poor outcomes. However, causal studies with longitudinal designs and well-designed clinical trials should be carried out to clarify the major predictors for individual risk, as well as the real impact of inhaler performance education programmes.