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- 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.
- 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.
- Patients’ and tutors’ evaluations of medicine students’ consultations in general practice/family medicine in CoimbraPublication . Santiago, Luiz Miguel de Mendonça Soares; Caetano, Inês; Simões, José Augusto RodriguesBackground Undergraduate teaching of General Practice/Family Medicine (GP/FM) must ensure students acquire the necessary competencies and skills to perform an adequate GP/FM consultation with adequate annotations (the SOAP model) and classifications. So aimed to study and to correlate students’ evaluation by tutors and patients in specific consultations in the formal practical evaluation of GP/FM Curricular Unit of the Integrated Masters on Medicine at the Faculty of Medicine of the University of Coimbra (IMM-FMUC) in the academic years of 2017–2018 and 2018–2019. Methods Observational study of the 2017–2018 and 2018–2019 academic years of the assessment grids for tutor’s evaluation of SOAP performance and fluency in consultation and for patient’s evaluation of the student ‘performance, in the convenience sample of those who chose to be so evaluated. Results We studied a population of 435 (67,7%) out of a universe of 646 students, 125 (28,7%) males, ns by sex and academic year who performed this evaluation. In a mark up to 20 from tutors, difference was found for Plan (P) mark, higher in 2018–2019 (18,38 ± 2,18vs18,54 ± 2,11, p = 0,005) of the SOAP methodology evaluation. Patients’ evaluation was not different 19,34 ± 1,70vs19,35 ± 1,40, p = 0,091. A positive significant correlation was found between tutors and patients marks (ρ = 0,278; p < 0,001), as well as between tutor mark and final mark (ρ = 0,958; p < 0,001) and patient and final marks (ρ = 0,465; p < 0,001). Final marks were not different in both years, 18,61 ± 1,38vs18,78 ± 1,15, p = 0,158. Conclusions This innovative model of evaluation of student’s performance in medical appointment, showed a significant positive moderate correlation between patients’ and tutors’ marks in the setting of GP/FM at the IMM-FMUC, and was not different between years. Yearly evaluation must be continued.
- Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self‐report and physician assessmentPublication . Cachim, Afonso; Pereira, Ana Margarida; Almeida, Rute; Amaral, Rita; Correia, Magna Alves; Marques, Pedro Vieira; Loureiro, Cláudia Chaves; Ribeiro, Carmelita; Cardia, Francisca; Gomes, Joana; Vidal, Carmen; Silva, Eurico; Rocha, Sara; Rocha, Diana; Marques, Maria Luís; Páscoa, Rosália; Morais, Daniela; Cruz, Ana Margarida; Santalha, Marta; Simões, José Augusto Rodrigues; Silva, Sofia da; Silva, Diana; Gerardo, Rita; Bom, Filipa Todo; Morete, Ana; Vieira, Inês; Vieira, Pedro; Monteiro, Rosário; Raimundo, Rosário; Monteiro, Luís; Neves, Ângela; Santos, Carlos; Penas, Ana Margarida; Regadas, Rita; Marques, José Varanda; Rosendo, Inês; Aguiar, Margarida Abreu; Fernandes, Sara; Cardoso, Carlos Seiça; Pimenta, F.; Meireles, Patrícia; Gonçalves, Mariana; Fonseca, Joao A; Jácome, CristinaBackground Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. Methods This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0–100). Results A total of 193 patients (72% female; median [P25–P75] age 28 [19–41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0–71]%; 1 month: 18 [0–48]%) than patient self-report (80 [60–95]) and physician assessment (82 [51–94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118–0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). Conclusions Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.
- Study of dyslipidemia in patients with Obstructive Sleep Apnea Syndrome in primary health carePublication . Junqueira, José Luís Ferraro; Rosendo, Inês; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesBackground. Obstructve Sleep Apnea Syndrome (OSAS) is associated with several morbidites. The most important ones are obesity, hypertension and diabetes mellitus. A clear relatonship of OSAS and dyslipidemia is yet to be demonstrated. Objectves. To evaluate the prevalence of dyslipidemia as a morbidity associated with OSAS and to understand its relatonship with the severity of OSAS. Material and methods. We randomly selected 92 patents diagnosed untl the end of May 2016 with OSAS from two primary health care units and 184 patents as controls (no OSAS diagnosed) from random lists of patents matched in age and gender with patents with OSAS. We calculated the prevalence of the classifed comorbidites (overweight, hypertension, type 2 diabetes mellitus and dyslipidemia) in both groups. We used logistc regression to check the associaton between them. We evaluated the relatonship between dyslipidemia and OSAS severity by using the Apnea/Hypopnea Index (AHI). Results. The prevalence of dyslipidemia was 80% in patents with OSAS. Patents with OSAS were diagnosed as overweight (97%), had arterial hypertension (89%) and type 2 diabetes mellitus (43%). OSAS was not independently related to type 2 diabetes mellitus (p = 0.101) and to dyslipidemia (p = 0.389). However, overweight and arterial hypertension were related independently to OSAS (p < 0.001) with a risk for OSAS. The prevalence of dyslipidemia in patents with mild, moderate and severe OSAS was 22%, 13% and 25%, respectvely. Conclusions. Patents with OSAS have a high prevalence of dyslipidemia despite not being independently related. There were no statstcal differences between patents with mild, moderate and severe OSAS.
- Auto Perceção do Desempenho da Medicina Centrada na Pessoa em Medicina Geral e Familiar: Criação de Um Instrumento de MediçãoPublication . Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto Rodrigues; Vale, Martinha; Faria, Elleni de; Ferreira, Pedro Lopes; Rosendo, InêsIntrodução: A Medicina Centrada na Pessoa é um método e modelo de prática permitindo ganhos para o médico e o paciente, devendo a sua prática ser avaliada para fns de desenvolvimento profssional contínuo e educação médica continuada. O objectivo deste estudo foi construir, determinar a fabilidade e a validade de um instrumento capaz de aferir a auto perceção genérica da prática médica segundo a medicina centrada na pessoa no ambiente de medicina geral e familiar. Material e Métodos: Uma primeira versão de um questionário segundo as quatro dimensões do método clínico centrado na pessoa foi revista por um grupo focal garantindo a validade de conteúdo. O questionário fnal engloba 22 itens, utilizando para resposta uma escala de Likert com quatro opções. A análise fatorial permitiu confrmar as dimensões defnidas por Moira Stewart, tendo também sido determinada a consistência interna, a reprodutibilidade por teste-reteste e a correlação item-total. A aplicação online a uma amostra de 905 médicos de medicina geral e familiar permitiu testar as validades de constructo e de critério. Resultados: O instrumento de medição inclui quatro dimensões: (i) explorar a saúde, a doença e a experiência de doença, (ii) investir na relação médico-doente; (iii) procurar entendimento; e (iv) compreender a pessoa como um todo. A consistência interna foi demonstrada com um alfa de Cronbach global de 0,892, variando entre 0,783 a 0,844 para todas as dimensões. A reprodutibilidade teste-reteste obteve um valor de correlação intraclasse entre 0,678 e 1,000. As correlações item-total variaram entre 0,457 e 0,870. As mulheres médicas estão mais sensibilizadas do que os seus colegas no que respeita à procura de entendimento com o doente e os médicos mais novos são os mais sensíveis à abordagem da doença através da anamnese e à procura de entendimento com o doente. Os especialistas demonstraram ter mais cuidado com a anamnese e com o facto de encarar o doente como um todo, e os profssionais que trabalham numa unidade de Saúde Familiar são os que procuram um melhor entendimento com a pessoa. Por fm, a formação específca sobre medicina centrada na pessoa e sobre consulta em medicina centrada na pessoa demonstraram ter um impacto positivo em todas as dimensões da medicina centrada na pessoa e isso é reconhecido pelos próprios profssionais. Discussão: A avaliação da auto perceção de desempenhar medicina centrada na pessoa é agora possível. Conclusão: O presente questionário apresenta boa fabilidade e validade permitindo ao médico verifcar quais as principais insufciências bem como desenvolver formação específca.
- Compassion and extracurricular activities of Portuguese Health Sciences students in PortugalPublication . Santiago, Luiz Miguel de Mendonça Soares; Rosendo, Inês; Valente, Catarina; Ferreira, António Miguel da Cruz; Simões, José Augusto RodriguesBackground Compassion, one of the items of empathy, is crucial in health care professions. So, the evaluation of the levels of compassion of Medicine, Dentistry and Pharmaceutical Sciences Master Degrees’ (M.D.) students of the public Colleges in Portugal according to the type of Master Degree and the participation in extracurricular activities (E.A.) was a task to be performed. Methods Cross-sectional study in 2020, applying an on-line questionnaire including the “Compassion” items of the Jefferson Medical Empathy Scale – Students’ version and questions about the participation in E.A. Results A sample of 901 students was studied. Its distribution by participation in E.A. did not differ significantly between M.D. (p = 0,854), most of the students participating in E.A. Using quartile distribution of compassion, the distribution of compassion levels was different among the three I.M. (p < 0.001), between Colleges (p < 0.001), and between curricular years (p < 0.001), with not different between genders (p = 0.036). For 56.4%, 74,6% and 69,5% of the respondents there was “medium-low” and “low” compassion for I.M. in Medicine, Pharmaceutical Sciences and Dentistry. These levels were also more prevalent among students in the 1st and 5th years. Levels of compassion were not different with the participation (p = 0,865), type (p = 0,177) and frequency of E.A. (p = 0,109). Conclusions For their importance in future health care professionals, compassion and their differences found among the M.Ds. of this area deserve future studies. Levels of compassion showed differences between the M.D. studied and academic years of frequency. There was no relationship between the participation, type, and frequency of E.A. and the students’ levels of compassion. The distribution of the level of compassion did not vary significantly with participation in E.A. (p = 0.865), with the type of E.A. (p = 0.177), with the frequency of E.A. (p = 0.109) or with the answer to the question “The practice of E.A. can make a person more compassionate?” (p = 0.503).
- Health literacy and cardiovascular complications in people with type 2 DiabetesPublication . Vieira, Maria; Rosendo, Inês; Gomes, Pedro; Santiago, Luiz Miguel de Mendonça Soares; Domingues, Ana Catarina; Simões, José Augusto RodriguesBackground Cardiovascular complications are the main causes of death for type 2 diabetes. Their relationship to socioeconomic factors, such as health literacy, is not well known. Objectives To study the relationship between health literacy and cardiovascular complications (acute myocardial infarction, cerebrovascular accident, transient ischemic attack and ischemic heart disease) in type 2 diabetes patients and to understand the relationship of type 2 diabetes mellitus associated cardiovascular disease with empowerment and therapy adherence. Material and methods A cross-sectional study with a convenience sample of people with type 2 diabetes in central Portugal. Socio--demographic and clinical characteristics (blood pressure, LDL cholesterol, hemoglobin A1c and history of cardiovascular diseases) were collected, and validated scales were applied to assess health literacy, adherence to therapy, empowerment and quality of life. Bivariate inferential analysis between literacy, other variables and cardiovascular diseases, with subsequent Logistic Regression, was performed. Results A sample of n = 202, mean age 68.11 ± 10.19 years, n = 116 (57.4%) males was studied. Higher health literacy was significantly associated with a lower prevalence of cardiovascular diseases (p = 0.015). This relationship was independent of the remaining variables (OR = 0.947; 95% CI: 0.913–0.982; p = 0.003). Significant relationships were demonstrated between cardiovascular disease and quality of life (p = 0.001), adherence to total therapy (p = 0.045), general diet (p = 0.002), physical activity (p = 0.027), age (p = 0.004) and LDL cholesterol (p = 0.036). Conclusions The independent relationship between health literacy and cardiovascular disease in people with type 2 diabetes, when confirmed, will indicate that health literacy promotion acts as an important health policy measure to be adopted.
- Breastfeeding and childhood obesity in the AzoresPublication . Ferreira, Ana Vaz; Rosendo, Inês; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesBackground. The hypothesis that breasteeding has a protectve effect in childhood obesity is not new; however, controversial results have been published. Since the Azores reported the lowest rate of breasteeding in Portugal and a high prevalence of childhood obesity, it becomes important to understand whether these facts are related or not. Objectves. To investgate the relatonship between breasteeding and childhood obesity in a populaton of Azorean children. Material and methods. A cross-sectonal study was carried out on 183 Azorean children between 5–10 years of age between September and December 2016. The weight and height of the children were measured at the consultaton and other variables were investgated through a questonnaire. The associaton between breasteeding and childhood obesity was tested using logistc regression models. Results. 18.6% of the children were obese and 74.3% were breasted. The exclusive breasteeding rate at 6 months was 3.3%. Complementary breasteeding was present in 39.3% at 6 months and 7.1% at 2 years. Obese children were breasted less tme than non-obesechildren, suggestng a dose-effect relatonship (p = 0.025). We found a signifcant and independent relatonship between infant obesity and total tme of breasteeding (RR = 0.906; 95% CI [0.842, 0.974]; p = 0.008), physical actvity (RR = 0.883; 95% CI [0.801, 0.972]; p = 0.012) and maternal nutritonal status (RR = 3.452; 95% CI [1.361, 8.755]; p = 0.009). Conclusions. Breasteeding and physical actvity behaved as protectve factors for childhood obesity, while the nutritonal status of the mother acted as a risk factor. Childhood obesity is a current problem in the Azores, and breasteeding can be an effectve, simple and affordable tool to reduce this.