Implementing screening and brief Interventions for excessive alcohol consumption in primary health care

O consumo de bebidas alcoólicas é um dos principais fatores de risco da morbilidade e mortalidade prematura a nível mundial. As pessoas que consomem este género de bebidas têm um risco aumentado de vir a desenvolver mais de 200 problemas de saúde diferentes. A maioria do impacto do consumo de álcool na saúde humana é determinado por duas dimensões: o volume total de álcool consumido e o padrão de consumo. Existem várias medidas com comprovada eficácia que podem ser empregues para reduzir o risco associado ao consumo de álcool, entre as quais se encontra a deteção precoce e intervenção breve ao nível dos Cuidados de Saúde Primários. A maioria dos profissionais de saúde neste nível de cuidados considera o consumo de álcool como um importante problema de saúde e manifesta o seu apoio a medidas que visem reduzir o seu impacto. No entanto, poucos são os profissionais dos Cuidados de Saúde Primários que de forma sistemática identificam e aconselham os seus doentes relativamente aos seus hábitos etílicos. Como tal, o objetivo geral desta tese foi investigar como implementar a deteção precoce e intervenção breve no consumo excessivo de álcool nos Cuidados de Saúde Primários. Foi realizada uma revisão sistemática das barreiras e facilitadores à implementação da deteção precoce e intervenção breve no consumo excessivo de álcool nos Cuidados de Saúde Primários. As barreiras e facilitadores identificados nesta revisão foram analisados à luz da teoria de modificação comportamental para compreender a ligação destes fatores aos determinantes da mudança de comportamento, e para identificar as estratégias conceptualmente mais eficazes para abordar as barreiras e facilitadores à mudança de comportamento dos profissionais dos Cuidados de Saúde Primários no sentido de aumentar as taxas de deteção precoce e intervenção breve no consumo excessivo de álcool. Esta metodologia foi utilizada para desenhar um programa de implementação com base em pressupostos teóricos que foi testado num estudo experimental randomizado e controlado em clusters. Esta tese identificou diversas barreiras à implementação, ligadas a todos os domínios teóricos da mudança comportamental. As barreiras mais frequentemente mencionadas pelos profissionais foram: preocupação sobre as suas competências e eficácia para realizar a deteção precoce e intervenção breve; falta de conhecimento específico sobre o consumo de álcool; falta de tempo; falta de materiais; falta de apoio; e atitudes para com o doente com consumos excessivos de álcool. Esta tese mostrou também a existência de dois grupos distintos de médicos de família com base nas suas atitudes para com estes doentes, um com atitudes mais positivas, o outro com atitudes mais negativas. Esta tese mostrou ainda que um programa de implementação da deteção precoce e intervenção breve, desenhado com base em pressupostos teóricos de modificação comportamental, adaptado às barreiras e facilitadores da implementação, aumenta de forma significativa as taxas de identificação precoce dos consumos de álcool. Esta tese contribui para aumentar o conhecimento atual no sentido em que põe à disposição dos investigadores evidência prática sobre como abordar os fatores com influência na implementação da identificação precoce e intervenção breve para o consumo de álcool ao nível dos Cuidados de Saúde Primários. Esta tese contribui também para um melhor entendimento dos mecanismos subjacentes à resistência e à mudança de comportamento dos profissionais dos Cuidados de Saúde Primários no que respeita à implementação da deteção precoce e intervenção breve do consumo de álcool. Os resultados desta tese poderão ser usados por investigadores e decisores políticos para desenhar novos programas de implementação tendo como objetivo modificar esta prática clínica ao nível dos Cuidados de Saúde Primários.Alcohol use is among the leading risk factors for the global burden of disease and premature death. People who drink alcoholic beverages are at risk of developing more than 200 diseases and injury conditions. Most of the impact of alcohol consumption on human health and well-being is determined by two dimensions of drinking: the total volume of alcohol consumed and the pattern of drinking. Several effective strategies exist to reduce the harmful use of alcohol, which includes screening and brief interventions for excessive alcohol use in primary health care. The majority of primary health care providers agree that the excessive consumption of alcohol is an important health issue and express their support to policies for reducing the impact of alcohol on the health of their patients. Notwithstanding, implementation of screening and brief interventions is low at the primary health care level. Therefore, the overall aim of this thesis is to investigate how to implement screening and brief interventions for excessive alcohol consumption in primary health care. This thesis reviewed the barriers of, and facilitators for, the implementation of alcohol screening and brief interventions in primary health care. Behaviour change theory was used to understand how these factors linked to the determinants of behaviour change and how they could be addressed in order to change primary health care providers’ behaviour, i.e. to increase the delivery of alcohol screening and brief interventions. A comprehensive theory-based implementation programme was designed and tested in a cluster randomized controlled trial. This thesis identified several barriers to implementation which were mapped to all the theoretical domains of behaviour change. Primary health care providers concerns about their ability to deliver alcohol screening and brief interventions and to help patients to cut down, lack of alcohol-related knowledge, lack of time, lack of materials and support, and providers’ attitudes towards at-risk drinkers were among the most commonly cited barriers. This thesis found evidence that the attitudes of family physicians could be used to divide practitioners into two distinct groups, one with more positive and the other with more negative attitudes towards at-risk drinkers. This thesis also found that a behaviour change theory-based programme, tailored to the barriers for, and facilitators of, the implementation of screening and brief intervention in primary health care is effective in increasing alcohol screening rates. This thesis contributed to the evidence base by providing researchers with practical evidence on how to address the factors influencing the implementation of screening and brief interventions in primary health care. This thesis also provides researchers with insight into the behavioural mechanisms mediating primary health care providers’ decision to deliver alcohol screening and brief interventions. The results of this thesis could be used by researchers and policymakers to inform the design of novel theory-oriented interventions to support the implementation of alcohol screening and brief interventions in primary health care

O Dinheiro Vivo e a cobertura online das manifestações de 15 de setembro , 13 de outubro e 14 de novembro de 2012

Relatório de Estágio apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Ciências da ComunicaçãoEste trabalho analisa a cobertura que o Dinheiro Vivo realizou das manifestações de 15 de setembro, 13 de outubro e 14 de novembro de 2012 em Portugal, em comparação com aquela que os seus concorrentes no mercado do jornalismo económico português, o Jornal de Negócios e o Diário Económico, realizaram nos seus respetivos sítios online. O objetivo é saber se a natureza do Dinheiro Vivo como jornal online, que o distingue dos seus concorrentes, terá, ou não, influenciado a qualidade da sua cobertura. Para encontrar uma resposta, procede-se a uma análise de conteúdo dos artigos sobre as manifestações realizados pelos três jornais. Os resultados dessa análise mostram que o Jornal de Negócios apostou numa maior variedade de géneros jornalísticos, essencialmente devido à articulação entre o seu sítio online e a edição em papel. As conclusões apontam para uma influência negativa da natureza online do Dinheiro Vivo sobre a qualidade da sua cobertura, com a velocidade de produção de artigos a ser privilegiada em detrimento de um trabalho jornalístico mais aprofundado

Fatores Condicionantes da Implementação da Deteção Precoce e Intervenções Breves no Consumo Excessivo de Álcool nos Cuidados de Saúde Primários: Protocolo de Revisão Sistemática da Literatura

Introduction: Alcohol is a leading risk factor contributing to the global burden of disease. National and international agencies recommend evidence-based screening and brief interventions in primary care settings in order to reduce alcohol consumption. However, the majority of primary care professionals do not routinely deliver such interventions.  Objective: To identify factors influencing general practitioners/family physicians' and primary care nurses' routine delivery of alcohol screening and brief intervention in adults.  Material and Methods: A systematic literature search will be carried out in the following electronic databases: Medline, CINAHL, CENTRAL, and PsycINFO. Two authors will independently abstract data and assess study quality using the NIH National Heart, Lung, and Blood Institute quality assessment tools for quantitative studies, and the CASP checklist for qualitative studies. A narrative synthesis of the findings will be provided, structured around the barriers and facilitators identified. Identified barriers and facilitators will be further analysed using the Behavioural Change Wheel/Theoretical Domains Framework.  Discussion: This review will describe the barriers to, and facilitators for, the implementation of alcohol screening and brief interventions by general practitioners/family physicians and nurses at primary care practices. By mapping the barriers and facilitators to the domains of the Behavioural Change Wheel/Theoretical Domains Framework, this review will also provide implementation researchers with a useful tool for selecting promising practitioner-oriented behavioural interventions for improving alcohol screening and brief intervention delivery in primary care.  Conclusion: This review will provide important information for implementing alcohol screening and brief intervention in primary health care.  Systematic Review Registration: PROSPERO CRD4201605268

Identification of a novel AluSx-mediated deletion of exon 3 in the SBDS gene in a patient with Shwachman-Diamond syndrome

Shwachman–Diamond syndrome (SDS) is caused by mutations in the SBDS gene, most of which are the result of gene conversion events involving its highly homologous pseudogene SBDSP. Here we describe the molecular characterization of the first documented gross deletion in the SBDS gene, in a 4-year-old Portuguese girl with SDS. The clinical diagnosis was based on the presence of hematological symptoms (severe anemia and cyclic neutropenia), pancreatic exocrine insufficiency and skeletal abnormalities. Routine molecular screening revealed heterozygosity for the common splicing mutation c.258+2T>C, and a further step-wise approach led to the detection of a large deletion encompassing exon 3, the endpoints of which were subsequently delineated at the gDNA level. This novel mutation (c.258+374_459+250del), predictably giving rise to an internally deleted polypeptide (p.Ile87_Gln153del), appears to have arisen from an excision event mediated by AluSx elements which are present in introns 2 and 3. Our case illustrates the importance of including gross deletion screening in the SDS diagnostic setting, especially in cases where only one deleterious mutation is detected by routine screening methods. In particular, deletional rearrangements involving exon 3 should be considered, since Alu sequences are known to be an important cause of recurrent mutations

Bronsted Acid Mediated Facile Greener Multicomponent Synthesis of 2,4-Diaryl-quinoline Derivatives in Water

Quinolines are an important class of natural and synthetic products, with several biological activity and applications in medicine and electronics. In this work we present a greener method of synthesis of 2,4-diaryl-quinoline derivatives by an easy one-pot multicomponent reaction between aniline derivatives, aldehyde derivatives and phenylacetylene in water, with hydrochloric acid as promoter. With this method we could synthesize several compounds with good yield and reaction time, including new alkylamino-containing 2,4-diaryl-quinoline derivatives that could not be synthesized with niobium pentachloride catalyst in similar conditions. DOI: http://dx.doi.org/10.17807/orbital.v14i1.168

Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework

Background Alcohol is a leading risk factor contributing to the global burden of disease. Several national and international agencies recommend that screening and brief interventions (SBI) should be routinely delivered in primary care settings to reducing patients’ alcohol consumption. However, evidence shows that such activities are seldom implemented in practice. A review of the barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking. This study aimed to conduct a theory-informed review of the factors influencing general practitioners’ and primary care nurses’ routine delivery of alcohol SBI in adults. Methods A systematic literature search was carried out in four electronic databases (Medline, CINAHL, CENTRAL, PsycINFO) using comprehensive search strategies. Both qualitative and quantitative studies were included. Two authors independently abstracted and thematically grouped the data extracted. The barriers and facilitators identified were mapped to the domains of the Capability-Opportunity-Motivation-Behaviour system/Theoretical Domains Framework (TDF). Results Eighty-four out of the 258 studies identified met the selection criteria. The majority of the studies reported data on the views of general practitioners (n = 60) and used a quantitative design (n = 49). A total of 660 data items pertaining to barriers and 253 data items pertaining to facilitators were extracted and thematically grouped into 46 themes. The themes mapped to at least one of the 14 domains of the TDF. The three TDF domains with the highest number of data units coded were ‘Environmental Context and Resources’ (n = 158, e.g. lack of time), ‘Beliefs about Capabilities’ (n = 134, e.g. beliefs about the ability to deliver screening and brief advice and in helping patients to cut down) and ‘Skills’ (n = 99, e.g. lack of training). Conclusions This study identified a range of potential barriers and facilitators to the implementation of alcohol SBI delivery in primary care and adds to the scarce body of literature that identifies the barriers and facilitators from a theoretical perspective. Given that alcohol SBI is seldom implemented, this review provides researchers with a tool for designing novel theory-oriented interventions to support the implementation of such activity

Versões validadas em Português do Alcohol Use Disorders Identification Test: protocolo de revisão sistemática da literatura

Introduction. Alcohol consumption ranks in the top ten risk factors contributing to the global disease burden. Several international organizations recommend the use of the Alcohol Use Disorders Identification Test to screen for at-risk drinkers. However, a fully validated Portuguese version of this test is lacking. Objectives. To systematically review validated versions of the Alcohol Use Disorders Identification Test in the Portuguese language, the documented problems and solutions in its application and proposed cut-offs to identify at-risk drinkers. Material and Methods. A systematic search will be performed in Ovid MEDLINE, CINAHL, PsycINFO, ÍndexRMP, LILACS, African Journals Online and Scielo databases, together with grey literature searches to identify validation studies of the AUDIT in Portuguese. Two authors will independently extract data and assess the studies’ methodological quality using QUADAS-2 and CASP Checklists. Discussion. This review will compare different validation studies of the Alcohol Use Disorders Identification Test in Portuguese-speaking countries, reporting, where possible, the psychometric properties, performance characteristics, suggested cut-offs and any documented limitations and suggestions. The results of this review could be used to propose an update of the alcohol screening and brief intervention guidelines in Portugal. The results could also prove useful to support the implementation of alcohol screening delivery by healthcare providers in Portugal and other official Portuguese-speaking countries. Conclusion. This review will provide important information on the validity of the Alcohol Use Disorders Identification Test as a screening tool for at-risk drinking in Portugal and other official Portuguese speaking countries. Introdução. O consumo de álcool é um importante fator de risco modificável. Várias organizações internacionais recomendam a utilização do Alcohol Use Disorders Identification Test para identificar consumidores excessivos de álcool. No entanto, não parece haver uma versão totalmente validada deste questionário em português. Objetivo. Identificar versões validadas do Alcohol Use Disorders Identification Test em português, problemas e soluções na sua aplicação, e pontos de corte para identificar consumidores excessivos. Material e Métodos. Será realizada uma revisão sistemática da literatura nas bases Ovid MEDLINE, CINAHL, PsycINFO, ÍndexRMP, LILACS, African Journals Online e Scielo, bem como na literatura cinzenta, por estudos de validação do AUDIT em português. Dois autores extrairão informação, e avaliarão a qualidade dos estudos selecionados, de forma independente, utilizando as grelhas QUADAS-2 e CASP. Discussão. Esta revisão irá comparar estudos de validação do Alcohol Use Disorders Identification Test em português e reportar, se descrito, propriedades psicométricas, características de desempenho, pontos de corte sugeridos, limitações e sugestões documentadas. Os resultados poderão ser importantes para propor uma revisão da guideline portuguesa sobre o rastreio e intervenções breves nos consumidores de álcool. Por outro lado, os resultados poderão ser utilizados para apoiar a implementação do rastreio do consumo de álcool na prática clínica em Portugal e noutros países de língua oficial portuguesa. Conclusão. Esta revisão irá fornecer informação relevante sobre a validade do Alcohol Use Disorders Identification Test como método de rastreio do consumo excessivo de álcool em Portugal e noutros países de língua oficial portuguesa

Portuguese validated versions of the Alcohol Use Disorders Identification Test: a systematic review protocol

Introduction. Alcohol consumption ranks in the top ten risk factors contributing to the global disease burden. Several international organizations recommend the use of the Alcohol Use Disorders Identification Test to screen for at-risk drinkers. However, a fully validated Portuguese version of this test is lacking. Objectives. To systematically review validated versions of the Alcohol Use Disorders Identification Test in the Portuguese language, the documented problems and solutions in its application and proposed cut-offs to identify at-risk drinkers. Material and Methods. A systematic search will be performed in Ovid MEDLINE, CINAHL, PsycINFO, ÍndexRMP, LILACS, African Journals Online and Scielo databases, together with grey literature searches to identify validation studies of the AUDIT in Portuguese. Two authors will independently extract data and assess the studies’ methodological quality using QUADAS-2 and CASP Checklists. Discussion. This review will compare different validation studies of the Alcohol Use Disorders Identification Test in Portuguese-speaking countries, reporting, where possible, the psychometric properties, performance characteristics, suggested cut-offs and any documented limitations and suggestions. The results of this review could be used to propose an update of the alcohol screening and brief intervention guidelines in Portugal. The results could also prove useful to support the implementation of alcohol screening delivery by healthcare providers in Portugal and other official Portuguese-speaking countries. Conclusion. This review will provide important information on the validity of the Alcohol Use Disorders Identification Test as a screening tool for at-risk drinking in Portugal and other official Portuguese speaking countries. Introdução. O consumo de álcool é um importante fator de risco modificável. Várias organizações internacionais recomendam a utilização do Alcohol Use Disorders Identification Test para identificar consumidores excessivos de álcool. No entanto, não parece haver uma versão totalmente validada deste questionário em português. Objetivo. Identificar versões validadas do Alcohol Use Disorders Identification Test em português, problemas e soluções na sua aplicação, e pontos de corte para identificar consumidores excessivos. Material e Métodos. Será realizada uma revisão sistemática da literatura nas bases Ovid MEDLINE, CINAHL, PsycINFO, ÍndexRMP, LILACS, African Journals Online e Scielo, bem como na literatura cinzenta, por estudos de validação do AUDIT em português. Dois autores extrairão informação, e avaliarão a qualidade dos estudos selecionados, de forma independente, utilizando as grelhas QUADAS-2 e CASP. Discussão. Esta revisão irá comparar estudos de validação do Alcohol Use Disorders Identification Test em português e reportar, se descrito, propriedades psicométricas, características de desempenho, pontos de corte sugeridos, limitações e sugestões documentadas. Os resultados poderão ser importantes para propor uma revisão da guideline portuguesa sobre o rastreio e intervenções breves nos consumidores de álcool. Por outro lado, os resultados poderão ser utilizados para apoiar a implementação do rastreio do consumo de álcool na prática clínica em Portugal e noutros países de língua oficial portuguesa. Conclusão. Esta revisão irá fornecer informação relevante sobre a validade do Alcohol Use Disorders Identification Test como método de rastreio do consumo excessivo de álcool em Portugal e noutros países de língua oficial portuguesa

Lipidomics reveals similar changes in serum phospholipid signatures of overweight and obese pediatric subjects

Obesity is a public health problem and a risk factor for pathologies such type 2 diabetes mellitus, cardiovascular diseases, and nonalcoholic fatty liver disease. Given these clinical implications, there is a growing interest to understand the pathophysiological mechanism of obesity. Changes in lipid metabolism have been associated with obesity and obesity-related complications. However, changes in the lipid profile of obese children have been overlooked. In the present work, we analyzed the serum phospholipidome of overweight and obese children by HILIC-MS/MS and GC-MS. Using this approach, we have identified 165 lipid species belonging to the classes PC, PE, PS, PG, PI, LPC, and SM. The phospholipidome of overweight (OW) and obese (OB) children was significantly different from normal-weight children (control). Main differences were observed in the PI class that was less abundant in OW and OB children and some PS, PE, SM, and PC lipid species are upregulated in obese and overweight children. Although further studies are needed to clarify some association between phospholipid alterations and metabolic changes, our results highlight the alteration that occurs in the serum phospholipid profile in obesity in children.publishe

Bronsted Acid Mediated Facile Greener Multicomponent Synthesis of 2,4-Diaryl-quinoline Derivatives in Water

Quinolines are an important class of natural and synthetic products, with several biological activity and applications in medicine and electronics. In this work we present a greener method of synthesis of 2,4-diaryl-quinoline derivatives by an easy one-pot multicomponent reaction between aniline derivatives, aldehyde derivatives and phenylacetylene in water, with hydrochloric acid as promoter. With this method we could synthesize several compounds with good yield and reaction time, including new alkylamino-containing 2,4-diaryl-quinoline derivatives that could not be synthesized with niobium pentachloride catalyst in similar conditions. DOI: http://dx.doi.org/10.17807/orbital.v14i1.168