MM-PT study: Multimorbidity in primary care

Chronic diseases are undeniably important as a cause of morbidity and mortality. Most of the patients with numerous chronic diseases (or chronic health problems) – multimorbidity - receive treatment in primary health care. The negative impact of multimorbidity is felt at several levels: patient (and their caregivers), general practitioner (GP), and the health system. Multimorbidity entails increasing complexity in health care (e.g. accessibility and organization of the consultation). International literature shows that it is common for people with multimorbidity to have poor health outcomes, lower quality of life, psychological distress, greater use of health services, greater complications of medical treatments, and greater health expenditure. This thesis aimed to study multimorbidity in the primary health care context in Portugal, from various perspectives (epidemiologic, patient’s and GP’s views), and explore its relevance. To achieve this general objective, the research project was divided into three Phases, specific objectives were defined (PAPER I) and it resulted in four manuscripts published in international scientific journals: 1. Determine the prevalence of multimorbidity in the adult population attending primary care in Portugal, to identify associated sociodemographic factors, and to reveal combinations of chronic health problems (PAPER II). 2. Analyse the relationship between multimorbidity, health-related quality of life, perceived family support and unmet health needs in adult patients attending primary care (PAPER III). 3. Translate the European General Practice Research Network (EGPRN) definition of multimorbidity, according to Portuguese cultural and linguistic features (PAPER IV). 4. Access GPs’ knowledge, awareness, and practices regarding multimorbidity and its management. Evaluate the clarity and usefulness of the EGPRN definition of multimorbidity. Study if providing informational material depicting results of our previous studies on multimorbidity, would change current GPs’ views on the subject (PAPER V). The first study of this thesis (PAPER II), cross-sectional and analytical, conducted from October 2013 to December 2014, across the five mainland Portugal Healthcare Administrative Regions, included 1993 individuals aged 18 and older (1279 women e 714 men), approached by their GPs (98.3% acceptance rate). Through the patient’s self-report (in-person interview), the medical records, and the GP’s knowledge of the patient’s history, information regarding clinical data and sociodemographic characteristics was collected. In the absence of a consensual definition of multimorbidity, two definitions were used: presence of two or more chronic health problems in the same individual, as well as, three or more chronic problems (from a list of 147 possible chronic health problems). In this sample of primary health care users, with a mean age of 56.3 years, 69.5% were married/cohabiting, 41.5% were pensioners/retirees, 48.7% had a low educational level and 54.4% reported a sufficient monthly income. Multimorbidity was present in 72.7% (≥2 chronic problems) and 57.2% (≥3 chronic problems) of the sample. Multimorbidity increased significantly with age. Pensioners/retirees and individuals with low levels of education were more likely to suffer from multimorbidity. Cardiometabolic and mental disorders were the most common chronic health problems. Six combinations of chronic problems were identified. The second study of this thesis (PAPER III), also cross-sectional, conducted from January 2014 to January 2015, in the Centre region of Portugal, included 521 primary health care patients aged 18 and older (334 women e 187 men) with multimorbidity (≥2 chronic health problems, of which at least one was required to be hypertension, diabetes, asthma or osteoarthritis). Through a face-to-face interview, was collected information regarding sociodemographic characteristics, clinical data, health-related quality of life (Portuguese Short Form-12 Health Status Questionnaire), family support (Portuguese Family APGAR), and unmet health needs (medical, surgical and dental care; prescription medications; mental healthcare or counselling; and eyeglasses or other technical aid). In this sample of patients, with a mean age of 58.2 years, 70.2% were married/cohabiting, 43.0% were pensioners/retirees, 57.2% had a low educational level and 46.3% reported a sufficient monthly income. Two to three chronic problems were found in 42.2%, four to five in 27.6% and six or more chronic problems in 30.1% of the patients (mean chronic health problems 4.5). Increased multimorbidity levels were linked to worse health-related quality of life, particularly the physical health. Male patients with high monthly incomes and highly functional families had better physical and mental health. High levels of education and the presence of asthma were also associated with better physical health. Contrariwise, elderly patients with high levels of multimorbidity and with osteoarthritis had lower physical health. The majority of the patients lived in highly functional families and did not have unmet health needs. When health needs were stated they were mostly for generalist medical care, dental care, and eyeglasses/other technical aid. Financial insufficiency was the primary reason for not fulfilling their health needs. In the third study of the thesis (PAPER IV), a panel of experts was assembled, consisting of 23 Portuguese GPs, who using the Delphi technique translated into Portuguese, after two rounds, the EGPRN definition of multimorbidity, with a consensus score of 8.43 out of 9: “A multimorbilidade é definida como qualquer combinação de uma doença crónica com pelo menos uma outra doença (aguda ou crónica), ou com um fator biopsicossocial (associado ou não), ou com um fator de risco somático. Qualquer fator biopsicossocial, qualquer fator de risco somático, a rede social, a carga das doenças, o consumo de cuidados de saúde e as estratégias de adaptação do doente podem funcionar como modificadores (dos efeitos da multimorbilidade). A multimorbilidade pode modificar os resultados em saúde e levar a um aumento da incapacidade, à diminuição da qualidade de vida ou à fragilidade.” The fourth and final study of this thesis (PAPER V), a web-based qualitative descriptive study, carried out in the first trimester of 2016, included 74 GPs from the districts of Coimbra and Aveiro. The sample was highly aware of multimorbidity and pointed out several difficulties and challenges in its management. Extrinsic factors were associated with the healthcare system logistics’ management (consultation time, organization of care teams, clinical information) and society (media pressure, social/family support). Intrinsic factors related to the GP, patient, and physician-patient relationship were also stated. The fundamental characteristics of family medicine were pointed out as the tools to deal with the difficulties. Also, the complex care required by multimorbid patients needs an adequate consultation time, multidisciplinary teamwork, and more education/training. The clarity and usefulness of the EGPRN definition of multimorbidity was evident, as well as the added value of disclosing to the GPs the data of the first Phases of this thesis. In conclusion, multimorbidity is a common and complex problem in primary health care in Portugal. The knowledge of its determinants and consequences, as described in this research project, may have an important role in improving the management of patients with multimorbidity. The studies of multimorbidity frequently deal with the diagnosis of medical conditions, but one should never forget that GPs also deal with the burden of a person’s suffering. Thus, one must dare to design future guidelines not just for the patient with multimorbidity, but mostly for the person with multimorbidity.As doenças crónicas assumem inegável importância como causa de morbilidade e mortalidade. Aos Cuidados de Saúde Primários é comum recorrerem doentes que apresentam múltiplas doenças crónicas (ou problemas crónicos) – multimorbilidade. O impacto negativo da multimorbilidade é sentido a nível do doente (e dos seus cuidadores), do médico e do sistema de saúde. A multimorbilidade acarreta crescente complexidade aos cuidados de saúde (p. ex. acessibilidade e organização da consulta). A literatura internacional demonstra que é comum a pessoa com multimorbilidade apresentar fracos resultados em saúde, diminuição da qualidade de vida, sofrimento psicológico, maior utilização dos serviços de saúde, maior número de complicações dos tratamentos médicos e maior despesa em saúde. Esta tese teve como objetivo o estudo da multimorbilidade no contexto dos Cuidados de Saúde Primários em Portugal, a partir de várias perspetivas (epidemiológica global, do doente e do médico de família) e a exploração da sua relevância. Para alcançar este objetivo geral, a investigação foi dividida em três Fases, foram definidos objetivos mais específicos (PAPER I) e resultou em quatro manuscritos publicados em revistas científicas internacionais: 1. Estimar a prevalência da multimorbilidade na população adulta observada nos Cuidados de Saúde Primários em Portugal, identificar os fatores sociodemográficos associados, e caracterizar as combinações de problemas crónicos de saúde (PAPER II). 2. Analisar a relação entre a multimorbilidade, a qualidade de vida relacionada com a saúde, o apoio familiar percecionado, e as necessidades não satisfeitas em saúde, em doentes adultos observados nos Cuidados de Saúde Primários (PAPER III). 3. Traduzir a definição de multimorbilidade da European General Practice Research Network (EGPRN), de acordo com as características culturais e linguísticas portuguesas (PAPER IV). 4. Avaliar o conhecimento, a compreensão e as práticas percecionadas pelos médicos de família em relação à multimorbilidade e ao seu controlo. Avaliar a clareza e a utilidade da definição de multimorbilidade da EGPRN traduzida para português. Analisar se ao ser fornecido material informativo descrevendo os resultados dos estudos anteriores sobre multimorbilidade, este mudaria as opiniões dos médicos de família sobre o assunto (PAPER V). O primeiro estudo da tese (PAPER II), transversal e analítico, realizado no período compreendido entre outubro de 2013 e dezembro de 2014, nas cinco Administrações Regionais de Saúde de Portugal Continental, englobou 1993 indivíduos com 18 anos ou mais (1279 mulheres e 714 homens), convidados a participar pelos seus médicos de família (taxa de participação de 98.3%). Através de uma entrevista presencial aos utentes, da consulta dos seus processos clínicos e do conhecimento que cada médico de família tem da história clínica dos utentes, foram recolhidas informações sobre a história individual de doença e as características sociodemográficas. Na ausência de uma definição consensual de multimorbilidade, foram utilizadas duas definições: presença de dois ou mais problemas crónicos de saúde no mesmo indivíduo e também de três ou mais problemas crónicos (de uma lista de 147 problemas crónicos de saúde possíveis). Nesta amostra de utentes dos Cuidados de Saúde Primários, com uma média etária de 56.3 anos, 69.5% eram casados/coabitantes, 41.5% eram pensionistas/reformados, 48.7% tinham escolaridade baixa e 54.4% tinham rendimentos médios. A multimorbilidade estava presente em 72.7% (≥2 problemas crónicos) e 57.2% (≥3 problemas crónicos) dos indivíduos. A multimorbilidade aumentou significativamente com a idade. Os pensionistas/reformados e os indivíduos com escolaridade baixa apresentaram maior probabilidade de sofrer de multimorbilidade. As patologias cardiometabólica e mental foram as mais comuns. Foram identificadas seis combinações de problemas crónicos de saúde. O segundo estudo da tese (PAPER III), também transversal, realizado no período compreendido entre janeiro de 2014 e janeiro de 2015, na Região Centro de Portugal, englobou 521 doentes (334 mulheres e 187 homens) dos Cuidados de Saúde Primários com 18 anos ou mais e com multimorbilidade (≥2 problemas crónicos de saúde e em que pelo menos um teria de ser hipertensão, diabetes, asma ou osteoartrose). Através de uma entrevista presencial aos doentes, foram recolhidas informações sobre as características sociodemográficas, a história individual de doença, a qualidade de vida relacionada com a saúde (questionário de estado de saúde SF-12), o apoio familiar (questionário APGAR familiar), e as necessidades não satisfeitas em saúde (cuidados médicos generalistas, cirúrgicos e dentários; receitas/renovação de receituário; psiquiatra/aconselhamento em saúde mental; óculos ou outras ajudas técnicas). Nesta amostra de doentes, com uma média etária de 58.2 anos, 70.2% eram casados/coabitantes, 43.0% eram pensionistas/reformados, 57.2% tinham escolaridade baixa e 46.3% tinham rendimentos médios. Dois a três problemas crónicos foram encontrados em 42.2%, quatro a cinco em 27.6% e seis ou mais problemas crónicos em 30.1% dos doentes (média de problemas crónicos de saúde 4.5). Com o aumento dos níveis de multimorbilidade verificou-se um agravamento na qualidade de vida relacionada com a saúde, particularmente a saúde física. Doentes do sexo masculino com rendimentos elevados e famílias altamente funcionais apresentaram melhor saúde física e mental. Um nível de escolaridade mais elevado e a presença de asma também estiveram associados a melhor saúde física. Pelo contrário, idosos com elevada multimorbilidade e com osteoartrose obtiveram pior saúde física. A maioria dos doentes vivia em famílias altamente funcionais e não referiu necessidades em saúde não satisfeitas. Os restantes declararam necessidades de cuidados médicos, dentários, e óculos/outras ajudas técnicas. A incapacidade financeira foi a principal razão para não satisfazerem as suas necessidades em saúde. No terceiro estudo da tese (PAPER IV), foi formado um painel de peritos constituído por 23 médicos de família portugueses, que através da técnica Delphi traduziu para a língua portuguesa, em duas etapas, a definição de multimorbilidade da EGPRN com uma concordância de 8.43 em 9: “A multimorbilidade é definida como qualquer combinação de uma doença crónica com pelo menos uma outra doença (aguda ou crónica), ou com um fator biopsicossocial (associado ou não), ou com um fator de risco somático. Qualquer fator biopsicossocial, qualquer fator de risco somático, a rede social, a carga das doenças, o consumo de cuidados de saúde e as estratégias de adaptação do doente podem funcionar como modificadores (dos efeitos da multimorbilidade). A multimorbilidade pode modificar os resultados em saúde e levar a um aumento da incapacidade, à diminuição da qualidade de vida ou à fragilidade.” O quarto e último estudo da tese (PAPER V), descritivo e qualitativo, baseado num questionário online, realizado no primeiro trimestre de 2016, englobou 74 médicos de família dos distritos de Coimbra e Aveiro. A amostra apresentou elevada consciência sobre a multimorbilidade e assinalou várias dificuldades e desafios na sua gestão. Fatores extrínsecos foram associados à gestão e logística do sistema de saúde (tempo de consulta, organização das equipas de saúde, informação clínica) e à sociedade (pressão dos média, apoio social/familiar). Fatores intrínsecos relacionados com o médico de família, o doente e a relação médico-doente também foram enumerados. As características fundamentais da medicina geral e familiar foram apontadas como as ferramentas para lidar com as dificuldades. Além disso, para gerir a complexidade do doente com multimorbilidade é necessário um tempo de consulta adequado, trabalho em equipa multidisciplinar e mais educação/treino. A clareza e a utilidade da definição de multimorbilidade da EGPRN ficou patente, assim como, a mais-valia da divulgação aos médicos de família dos dados das primeiras Fases desta tese. Em conclusão, a multimorbilidade é um problema comum e complexo nos Cuidados de Saúde Primários em Portugal. O conhecimento dos seus determinantes e suas consequências, tal como são descritos neste projeto de investigação, pode ter um importante lugar na melhoria da gestão do doente com multimorbilidade. Os estudos de multimorbilidade lidam frequentemente com o diagnóstico dos problemas de saúde, mas nunca se deve esquecer que os médicos de família também lidam com o peso do sofrimento da pessoa. Assim, no futuro deve-se ousar desenhar guidelines não apenas para o doente com multimorbilidade, mas principalmente para a pessoa com multimorbilidade

Key Factors to Consider in Team Meetings when Dealing with Multimorbidity in Primary Care: Results from a Delphi Panel

Background: Multimorbidity brings several difficulties and challenges to the daily work of primary care teams. Team meetings are opportunities to discuss approaches and solutions on how to best manage multimorbid patients. Objective: This qualitative study aimed to collect a consensus, from general practitioners that deal with multimorbid patients, about their perspectives regarding multimorbidity team meetings in primary care. Methods: The study followed a modified Delphi method with 15 Portuguese general practitioners. After every round of responses, results were analyzed, and justifications for non-consensual items were aggregated by the investigators, and then a new Delphi round with the revised questionnaire was again initiated. This process was repeated until consensus has been reached. Results: Overall, a list of 10 key themes associated with the ideal meeting was agreed: (a) definition; (b) setting; (c) duration; (d) frequency; (e) number of participants; (f) attendance; (g) requirement of patient’s presence; (h) number of patients/clinical cases; (i) structure of the meeting; and (j) sharing meeting results. The consensus was achieved after two Delphi rounds with a mean score between 7.9 and 8.7 (maximum score of 9.0 per key theme). Conclusion: The complexity of multimorbidity affects meetings’ periodicity, duration, and participants. Ideally, it should be an interprofessional primary care team meeting. Further research exploring meeting outcomes (organizational effectiveness and healthcare quality) of the proposed factors is needed before they can be recommended for general use.info:eu-repo/semantics/publishedVersio

Psicologia positiva do “desenrascanço” na multimorbilidade: a perspetiva dos médicos de família

The untranslatable word desenrascanço, a Portuguese construct related to people’s ability to skilfully negotiate complex issues and to solve them with originality and creativity, was studied using a common medical complex scenario – multimorbidity. An online qualitative survey was carried out in the last trimester of 2018. A total of 117 general practitioners (GPs) completed the full survey. Ninety-one (77.8%) were familiar with the concept of desenrascanço. Responses were coded using thematic analysis. Desenrascanço is commonly used by GPs; 77 out of 91 GPs use desenrascanço in at least half of the appointments with multimorbid patients. Three components of desenrascanço were identified: adaptive response; creativity and art; and positivity. It could conceivably be hypothesised that the positive drive of desenrascanço (e.g. creativity) are used by GPs collectively to adapt to multimorbidity – a medical complex situation. Nonetheless, one should not forget that it may not be the ideal solution, as stated by participant GPs. Keywords: multimorbidity, primary care, desenrascanço, untranslatable word.A palavra desenrascanço, sem tradução para inglês, construto português relacionado com a habilidade das pessoas em negociar, com habilidade, questões complexas, e de resolvê-las com originalidade e criatividade, foi estudado usando um cenário médico complexo e frequente: a multimorbilidade. Uma investigação qualitativa, online, foi realizada no último trimestre de 2018. Um total de 117 médicos de família (MF) completaram a pesquisa. Noventa e um (77,8%) estavam familiarizados com o conceito de desenrascanço. As respostas foram codificadas por meio de análise temática. Desenrascanço é comummente usado por MF; 77 de 91 participantes usam desenrascanço em pelo menos metade das consultas com pacientes com multimorbilidade. Foram identificados três componentes do desenrascanço: resposta adaptativa; criatividade e arte; e positividade. Pode-se supor que o impulso positivo do desenrascanço (por exemplo, a criatividade) é usado pelos MF coletivamente para se adaptarem à multimorbilidade – uma situação médica complexa. No entanto, não se deve esquecer que esta pode não ser a solução ideal, conforme afirmado pelos MF participantes.info:eu-repo/semantics/publishedVersio

The impact on health-related quality of life of mixed mental and physical multimorbidity in adults aged 60 years and older: secondary analysis of primary care data

Introduction Given the number of patients with mental conditions who receive treatment within the primary care (PC) context, and the high prevalence of multimorbidity (especially in older people), there is a need to study mental-physical multimorbidity (MPM) in this population and context. This study sought to identify the impact on health-related quality of life (QoL) of MPM in adults aged 60 years and older. Material and methods Secondary analysis of data derived from 251 primary health individuals. Data were collected via a sociodemographic and clinical questionnaire. Health-related QoL was assessed using the SF-12 instrument. Multiple linear regressions were performed for physical and mental health in MPM patients and in patients with physical-only multimorbidity. Results Mean age of participants was 70.6 years; 57.8% were female. Quali¬ty of life was lower in MPM patients than in those with physical-only multimorbidity. Regarding MPM patients, female sex, 75 years and over, and low income were associated with worse physical health. Female sex was also associated with worse mental health. Conclusions This study contributes to the global knowledge of MPM in older people, illuminates health-related QoL differences among MPM and physical- only multimorbidity patients, and highlights the importance of non-modi-fiable characteristics associated with deterioration of health-related QoL. Team collaboration between primary care physicians, psychiatrists (and other mental health providers), and social workers may be necessary to assess psychiatric and physical symptoms and provide for the care needs of older people with MPM.info:eu-repo/semantics/acceptedVersio

The Choice of Medical Specialty: Can University Professors Influence The Decision?

A carreira profssional médica inicia-se com a importante decisão pela especialidade a ser seguida. Usualmente a escolha dos futuros especialistas é influenciada por factores pessoais (personalidade, estilo de vida, valores e interesses), pelas características da própria especialidade, além de experiências prévias. O contacto com a especialidade durante a formação pré-graduada pode ainda ser considerado um fator influenciador na escolha, visto que a sensibilização para a Medicina Geral e Familiar (MGF) teve alguma relevância para 23,4% dos médicos, num estudo anterior.info:eu-repo/semantics/publishedVersio

COVID-19 or threat of a nuclear war in Europe? A cross-sectional study of anxiety levels in adults living in Portugal

Background: 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.info:eu-repo/semantics/publishedVersio

Determining factors associated with inhaled therapy adherence on asthma and COPD: A systematic review and meta-analysis of the global literature

Background 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.info:eu-repo/semantics/publishedVersio

COVID-19-Related Fear and Anxiety: Spiritual-Religious Coping in Healthcare Workers in Portugal

The COVID-19 pandemic has negatively affected the mental health of the general population, and for healthcare workers (HCWs) it has been no different. Religiosity and spirituality are known coping strategies for mental illnesses, especially in stressful times. This study aimed to describe the role of spiritual-religious coping regarding fear and anxiety in relation to COVID-19 in HCWs in Portugal. A cross-sectional quantitative online survey was performed. Socio-demographic and health data were collected as well as the Duke University Religion Index, Spirituality Scale, Fear of COVID-19 Scale, and Coronavirus Anxiety Scale. Two hundred and twenty-two HCWs participated in the study, 74.3% were female and 81.1% were physicians. The median age was 37 years (Q1, Q3: 31, 51.3). Religiosity was neither a significant factor for coronavirus-related anxiety nor it was for fear of COVID-19. Participants with higher levels in the hope/optimism dimension of the Spirituality Scale showed less coronavirus-related anxiety. Female HCWs, non-physicians, and the ones with a previous history of anxiety presented higher levels of fear and/or anxiety related to COVID-19. HCWs’ levels of distress should be identified and reduced, so their work is not impaired.info:eu-repo/semantics/publishedVersio

Multimorbidity daily life activities and socio-economic classification in the Central Portugal primary health care setting: an observational study

Background. 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.info:eu-repo/semantics/publishedVersio

The link between happiness and health: a review of concepts, pathways and strategies for enhancing well-being

Background. 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.info:eu-repo/semantics/publishedVersio