First contact with the health system: a survey study in northern Portugal

Objective The objective of this study is to characterise the self-reported first contact with the health system and the reasons stated for each choice, testing associations with population characteristics. Design Cross-sectional survey. Setting Primary care department of a local health unit in northern Portugal. Participants Random sample of 4286 persons, retrieved from all registered adults. Outcomes Participants who stated they usually see the same doctor when a health problem arises were considered to adopt first-contact care and were asked to identify their regular doctor. Participants were asked why they adopt first-contact care or why they choose to do otherwise. Associations between personal characteristics and the adoption of first-contact care were tested using logistic regression. Results There were 808 valid questionnaires received (19% response rate). The mean age of respondents was 53 years, 58% were women and 60% had a high school or higher degree. Most (71%) stated always seeing the same doctor when facing a health problem. This was a general practitioner (GP) in 84%. The main reasons were previous knowledge and trust in the doctor. When this doctor was not a GP, the main reason was the need to obtain an appointment quickly. Participants who chose first-contact care were less likely to have university degrees than those who did not (OR 0.31; 95% CI 0.13 to 0.76). Being registered with the same GP for over 1 year increased the odds of adopting first-contact care: twice as likely for those registered for 1-4 years with the same GP (2.07; 95% CI 1.04 to 4.11), and three times more likely for those registered for over 10 years (3.21; 95% CI 1.70 to 6.08). Conclusions The high adoption of first-contact care and the reasons given for this suggest a strong belief in primary care in this population. The longer patients experience continuity, the more they adopt first-contact care. The preferences of higher-educated patients regarding first-contact care deserve reflection. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Funding text 1: Funding Instituto de Saúde Pública, Universidade do Porto, covered the costs of printing the paper questionnaires. Matosinhos Local Health Unit (National Health Service, Portugal) supported this study by covering the costs of stamped institutional envelopes for sending and returning the questionnaire. This work is financed by national funds through the FCT- Foundation for Science and Technology, I.P., within the scope of projects UIDB/04750/2020 and LA/P/0064/2020

Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors

BackgroundThe Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners' (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal.MethodsAll GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the chi 2 statistic and the Student t-test was used to compare means of continuous variables.ResultsA total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0-56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients.ConclusionsMost GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs' preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery

Índices de qualidade de serviço em sistemas de drenagem e tratamento de águas residuais

O abastecimento de água, o saneamento de águas residuais urbanas e a gestão integrada de resíduos sólidos urbanos constituem serviços públicos de carácter estrutural, essenciais ao bem-estar geral, à saúde pública e à segurança colectiva das populações, às actividades económicas e à protecção do ambiente. A Entidade Reguladora dos Serviços de Águas e Resíduos (ERSAR) implementou um sistema de avaliação de desempenho das entidades gestoras (EG) baseado em indicadores de desempenho (ID). Estes indicadores incidem sobre aspectos parcelares do desempenho duma dada EG, tendo por objectivo o aumento dos padrões de eficiência e de eficácia dos serviços prestados. Este trabalho tem como principal objectivo contribuir para a melhoria do modelo de avaliação de desempenho existente, através da definição e cálculo de índices (sectoriais e global) de qualidade de serviço em sistemas de drenagem e tratamento de águas residuais, com base numa metodologia de análise multicritério. O seu valor resulta duma criteriosa combinação das pontuações normalizadas de cada ID. Além de facilitarem a aplicação de estratégias de benchmarking, a integração destes índices em sistemas de suporte à decisão, associados à gestão patrimonial de infra-estruturas de saneamento básico poderá ser um instrumento muito útil para as EG na definição das suas prioridades de investimento e de planos operacionais de reabilitação

Morphodynamics of the Cávado estuary inlet (NW Portugal)

The Cávado estuary inlet is situated in the coastal zone of Esposende (NW Portugal) where sandy beaches have migrated inland and thinned, and cliffs have retreated rapidly over the last years. The coastal zone of Esposende extends over 15 km from the Neiva River until Apúlia. The coastal segment of Esposende can be considered of mixed energy and wave-dominated type, according to DAVIS and HAYES (1984). The local tide is mesotidal and semidiurnal, with a maximum equinoctial spring tide high-water level of 3.9 m, a minimum low-water level of 0.2 m, and a mean spring tide of 3.49m (data from Instituto Hidrográfico da Marinha). The inlet is a natural feature of the Cávado estuary, subject to silting up, and enclosed between a breakwater on the northern side and the end of a migrant sandy spit on the southern side. Recently, it was suggested that the best option for decreasing silting-up and increasing navigability, would be to build two breakwaters and artificially manage the inlet. This proposal was not accepted by all concerned and is presently frozen. Behind the spit lies the town of Esposende, and so it is crucial as its natural defence against sea incursions. Several times the sea overwashed the spit, and broke through twice during the last twenty years. The present study concerns the period between 1991 and 2003. Using the hydrographical maps of 1991, 1992 and 2001, and topo-hydrographic surveys of 2002 and 2003, the sedimentary budget of the inlet, and the morphological changes of the flood and ebb tidal deltas were calculated. Moreover, two hydrodynamic mathematical models and a sediment transport mathematical model were implemented, in order to assess the bottom morphodynamic behaviour at the inlet. The first one is a two-dimensional hydrodynamic (2DH) model that was created using the RMA2 software (WES-HL, 1996). The river stretch considered in this finite elements model begins downstream of the Angelino weir and ends in the Atlantic Ocean

Abrupt field-induced transition triggered by magnetocaloric effect in phase-separated manganites

The occurrence at low temperatures of an ultrasharp field-induced transition in phase separated manganites is analyzed. Experimental results show that magnetization and specific heat step-like transitions below 5 K are correlated with an abrupt change of the sample temperature, which happens at a certain critical field. This temperature rise, a magnetocaloric effect, is interpreted as produced by the released energy at the transition point, and is the key to understand the existence of the abrupt field-induced transition. A qualitative analysis of the results suggests the existence of a critical growing rate of the ferromagnetic phase, beyond which an avalanche effect is triggered.Comment: 6 pages, 4 figures included. Acepted for publication in Phys. Rev.

Morphodynamic modelling of a gravel beach at the NW Portuguese coast

Besides exhibiting an erosion trend for decades, the NW coastal zone of Portugal, since the end of 20th century, was the stage of a new phenomenon. Between Lima and Cávado rivers, previously dissipative, sandy beaches transformed in mixed sand-gravel beaches with gravelly beach cusps (by the end of 80?s) and progressively convert in entire reflective gravel beaches (since 2000), though maintaining the inherited dune systems on their backshore. This beach is being monitored since 2013 using DGPS, aerophotogrametic surveys and expedite gravel size characterization. Based on these monitoring results a modeling work was carried out to simulate the beach morphodynamics, applying XBeach-G software. The model was able to simulate the beach morphodynamics

Effects of Fe doping in La1/2Ca1/2MnO3

The effect of Fe doping in the Mn site on the magnetic, transport and structural properties of polycrystalline La1/2Ca1/2MnO3 was studied. Doping with low Fe concentration (< 10%) strongly affects electrical transport and magnetization. Long range charge order is disrupted even for the lowest doping level studied (~2%). For Fe concentration up to 5% a ferromagnetic state develops at low temperature with metallic like conduction and thermal hysteresis. In this range, the Curie temperature decreases monotonously as a function of Fe doping. Insulating behavior and a sudden depression of the ferromagnetic state is observed by further Fe doping.Comment: 2 pages, presented at ICM2000, to appear in JMM