Determinantes sociais da depressão : diferenças entre idade, sexo e modelo de cuidados de saúde primários

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017Objectivo: Este estudo analisa a prevalência, durante um mês, da depressão e sintomas depressivos e a sua associação com fatores de risco sociodemográficos, nos utentes dos cuidados de saúde primários do concelho de Almada. Métodos: Usou-se dados dos utentes dos cuidados de saúde primários de Almada recolhidos da base de dados do ACES Almada Seixal. O instrumento de diagnóstico utilizado neste estudo para a identificação de casos foi o International Classification of Primary Care, Second edition (ICPC-2), especificamente os códigos "P76: Perturbação Depressiva" e "P03: Sensação de depressão". Resultados: A probabilidade de ser afetado por depressão ou sintomas depressivos é aproximadamente 3,21 vezes superior nas mulheres do que nos homens. No que diz respeito à idade, as taxas de prevalência mais baixas e mais elevadas de depressão são observadas entre as pessoas com 0-17 anos de idade e 40-64 anos, respectivamente. Os utentes entre os 40 e 64 anos têm uma probabilidade cerca de 2,21 vezes superior de ter depressão ou sintomas depressivos, em relação às restantes faixas etárias. Não se identificou uma associação estatisticamente relevante entre o tipo de unidade de cuidados de saúde primários (USF ou UCSP) e a prevalência de depressão ou sintomas depressivos. A probabilidade de ter depressão ou sintomas depressivos no grupo dos utentes com médico de família atribuído é cerca de 2,24 vezes superior à dos utentes sem médico de família atribuído. Conclusão: Em relação à distribuição por grupo etário e sexo, os padrões descobertos neste conjunto de dados são consistentes com as taxas de prevalência relatadas anteriormente noutros países ocidentais. No que diz respeito à relação entre a prevalência de depressão e sintomas depressivos e a atribuição de médico de família aos utentes, esta demonstrou ser altamente significativa.Objective: This study reports the one-month prevalence of depressive disorder and depressive symptoms and its association with sociodemographic risk factors, in Almada’s primary health care population. Method: Almada’s primary care users' data were collected from the ACES Almada Seixal database. The diagnostic tool used in this study for the identification of cases was the International Classification of Primary Care, Second Edition (ICPC-2), specifically the codes "P76: Depressive Disorder" and "P03: Feeling Depressed". Results: The odds ratio of depression and depressive symptoms for women compared with men is about 3.21. Concerning age, the lowest and highest rates of depression are seen among people with 0-17 years old, and 40-64 years old, respectively. The odds ratio of depression and depressive symptoms for people with 40—64 years, compared with other age groups, is 2.21. There was no relationship between the prevalence of depressive disorder and depressive symptoms and whether the patient was followed in a USF or in a UCSP. The odds ratio of depression and depressive symptoms for people with a fixed primary health care physician, compared with users without a fixed primary health care physician is 2.24. Conclusion: Concerning the distribution by age group and gender, the patterns uncovered in this dataset are consistent with previously reported prevalence rates for other Western countries. The relationship between the prevalence of depression and depressive symptoms and the attribution of family doctor to the users is highly significant

Portugal as a Case Study

Introduction: The International Health Regulations (IHR) were developed to prepare countries to deal with public health emergencies. The spread of SARS-CoV-2 underlined the need for international coordination, although few attempts were made to evaluate the integrated implementation of the IHR's core capacities in response to the COVID-19 pandemic. The aim of this study was to evaluate whether IHR shortcomings stem from non-compliance or regulatory issues, using Portugal as a European case study due to its size, organization, and previous discrepancies between self-reporting and peer assessment of the IHR's core capacities. Methods: Fifteen public health medical residents involved in contact tracing in mainland Portugal interpreted the effectiveness of the IHR's core capabilities by reviewing the publicly available evidence and reflecting on their own field experience, then grading each core capability according to the IHR Monitoring Framework. The assessment of IHR enforcement considered efforts made before and after the onset of the pandemic, covering the period up to July 2021. Results: Four out of nine core IHR capacities (surveillance; response; risk communication; and human resource capacity) were classified as level 1, the lowest. Only two were graded level 3 (preparedness; and laboratory), the highest. The remaining three) (national legislation, policy & financing; coordination and national focal point communication; and points of entry) were classified as level 2. Conclusion: Portugal exemplifies the extent to which implementation of the IHR was not fully achieved, which has resulted in the underperformance of several core capacities. There is a need to improve preparedness and international cooperation in order to harmonize and strengthen the global response to public health emergencies, with better political, institutional, and financial support.publishersversionpublishersversionpublishe

A saúde digital em Portugal

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