Prevalence of chronic obstructive pulmonary disease in general practice patients in the Central Region of Portugal

Introduction COPD is a common worldwide condition associated with morbidity and mortality. Its symptoms can be easily overlooked, accounting for an elevated level of under-recognition and under-diagnosis. Knowledge of the prevalence of COPD and the significance of its associated factors in the population enables better management of medical resources. To establish the prevalence of COPD in General Practice patients in the Central Region of Portugal and analyze the correlation with associated factors. Material and methods Cross-sectional study of patients’ data with COPD (R95, International Classification for Primary Care 2), anonymously gathered from the official database of the Central Health Administration of Portugal. Results Out of 937,817 individuals, 24,148 patients were identified with COPD, a prevalence of 2.57/100,000. 73.7% were above 65 years of age, and 60.2% were males. BMI was recorded in 60.2% patients, FEV1(%) in 8.0%, and smoking pack-years in 37.1%. Age and BMI were significantly negatively correlated (ρ = -0.032, p < 0.001), with the same occurring between age and FEV1(%) (ρ = -0.073, p < 0.05). A strong association of COPD with male gender and older age groups was found. Conclusions The prevalence of COPD was significantly higher in males, and age was identified as a risk factor for this condition. Higher age was non-significantly associated with lower FEV1(%) and significantly associated with BMI. The lack of e-records calls for an improvement.info:eu-repo/semantics/publishedVersio

Defining Multimorbidity: From English to Portuguese Using a Delphi Technique

Objective. To translate the EuropeanGeneral Practice ResearchNetworkmultimorbidity definition according to Portuguese cultural and linguistic features. Methods. Similar to the process completed in several other European countries, a forward and backward translation of the English multimorbidity definition using the Delphi technique was performed in Portugal. Results. Twenty-three general practitioners (GPs)—14 males and 9 females—agreed to form the Portuguese expert panel for the Delphi process (59% acceptance rate).The Portuguese definition of multimorbidity was achieved after two Delphi rounds with a mean (SD) consensus score for final round of 8.43/9 (0.73). Conclusion. With this paper the definition of multimorbidity is now available in a new language—Portuguese. Its availability in the local language will raise Portuguese GPs’ awareness about multimorbidity and allow future national and international research. The operationalization of the definition will allow an easier identification of patients with multimorbidity.info:eu-repo/semantics/publishedVersio

Patients’ and tutors’ evaluations of medicine students’ consultations in general practice/family medicine in Coimbra

Background 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.info:eu-repo/semantics/publishedVersio

Central Portuguese Doctors’ agreement with the “Ten Commandments for patient-centred treatment”

Background. The “Ten Commandments for patent-centred treatment” suggest a different approach to therapy. Objectves. To ascertain the level of agreement with the “Ten Commandments for patent-centred treatment” by physicians in Central Portugal, exploring differences by age group, sex and medical speciality. Material and methods. An online questonnaire in September of 2016, sent to doctors registered in the Central Regional Secton of the Portuguese Medical Associaton, with weekly reminders to non-respondents. The English wording was translated to Portuguese, a questonnaire with a four-grade answer was created and its reliability determined. Variables such as sex, age group and medical specialty were considered. Descriptve and inferental statstcs were performed. Results. A representatve yet convenient sample of 811 doctors partcipated. Their descripton is as follows: ≤ 35 years n = 203, ≥ 36 and ≤ 55 years n = 217 and ≥ 56 years n = 373, women n = 391 (49.2%), General Practce/Family Medicine (GP/FM) n = 301, medical specialty n = 303 and medico-surgical specialty n = 173. By medical specialty, for commandment 1, there is higher prevalence of “Disagree/Completely Disagree” in the GP/FM specialty (p < 0.001). By gender, for commandment 1, women vs men doctors “Disagree/Completely Disagree” proporton of 11.7% vs 6,4% (p = 0.003). For the younger age groups, there is a greater proporton of “Disagree/Completely Disagree” for Commandment 1 (p = 0.016), for Commandment 4 (p = 0.007), for Commandment 6 (p = 0.001), for Commandment 7 (p = 0.001) and for Commandment 8 (p = 0.020). Conclusions. There is vast agreement with the “Ten Commandments for patent-centred treatment” in central Portugal. For Commandments 1, 3 and 6, the proporton of “Disagree/Completely Disagree” is higher than for the remaining. There is a need for future investgatons to explain the present results.info:eu-repo/semantics/publishedVersio

Breastfeeding and childhood obesity in the Azores

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

Elderly patients and the idea of having medication deprescribed: a mixed method study in Portuguese primary health care

Introduction Deprescribing is the process of tapering or stopping medications aiming at improving patient outcomes and optimising current therapy. Some studies tried to identify which patients will have inappropriate medication deprescribed, but none found any association with sociodemographic and clinical characteristics, number of prescribed medications or time length. Our aim was to determine Portuguese elderly patients’ attitudes and beliefs regarding medication use and their willingness to have regular medications deprescribed. Material and methods We conducted a cross-sectional study in triangulation in primary care centres from mainland Portugal and its autonomous regions. We used a random sample of 386 polymedicated older adult patients that answered the questionnaire between October 2018 and February 2019. For the quantitative analysis, we used sociodemographic characteristics, clinical profile and medication. For the qualitative analysis, we studied an included open-question by coding participants’ answers, common codes were grouped together. Convergent mixed methods design was performed. Results 74.0% expressed the belief that medicines were generally beneficial. 19.9% reported a strong belief that medicines were harmful and 33.4% that they were overused. 61.8% were against the idea of deprescribing and 24.6% were in favour of deprescription. Those against the idea had lower education level (p=0.006) and a higher number of self-perceived morbidities (p=0.001) than those not against it. Conclusions Medication benefits were accepted by the majority of patients who also were against the idea of deprescribing. It is important that doctors are aware of this reality, namely in the primary care setting. Addressing the patients’ fears and beliefs and making the deprescribing process possible.info:eu-repo/semantics/acceptedVersio

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

Use of the Core Content Classification in General Practice (3GCP) for qualitative analysis of context and practice. Ten-year study of undergraduate students’ final works in the Integrated Master's Degree in Medicine at the University of Coimbra

Background: General Practice/Family Medicine includes approaches to the biological, technological, behavioural, sociological and anthropological domains. Objectives: To document the domains addressed in the final assignments of the Integrated Master’s Degree in Medicine at the Faculty of Medicine, University of Coimbra, in the area of GP/FM. Material and methods: Observational study of the titles of final assignments, between 2008 and 2017, granted by the Faculty of Medicine of the University of Coimbra. A domain analysis using as codes the International Classification in Primary Care-2 and the Q-Codes, a context classification in Primary Care, year of elaboration and gender of author was carried out for each title of final assignment. A descriptive and inferential analysis was performed through parametric and nonparametric tests. Results: 169 papers were analysed, 23.1% written by male students, with a positive overall growth dynamics (Δ = +7) between 2008 and 2017. Q-Codes were registered 276 times, while the ICPC-2 codes were used 133 times. Under the Q-Codes, “doctor’s issues” is the most frequently addressed (n = 112; 67.2%), and under the International Classification in Primary Care-2 classifications, the chapter “Psychological” was predominant (n = 35; 21%). Under the Q-Codes, subcategories “primary care setting” (n = 26; 15.6%), “health issue management” (n = 23; 13.8%) and “unable to code, unclear” (22; 13.2%) were dominant. Within the International Classification in Primary Care-2, the subcategories “diabetes noninsulin dependent” (n = 22; 13.2%), “depressive disorder” (8, 4.8%) and “hypertension uncomplicated” (8; 4.8%) were predominantly focused on. Conclusions: The 3CGP may become a professional tool, allowing for more precise identification of final works, for a better communication method in medical activity and for avoiding the loss of previously developed works.info:eu-repo/semantics/acceptedVersio

Prevalence of polypharmacy in the older adult population within primary care in Portugal: a nationwide cross-sectional study

Introduction Polypharmacy is commonly defined as the simultaneous use of five or more medications; however, there is a lack of consensus regarding the most appropriate definition. It is a significant predictor of morbidity and mortality. The aim of this study was to determine the prevalence of polypharmacy in the population of older adults attending primary care in Portugal and to identify associated sociodemographic and clinical factors. Material and methods We conducted a cross-sectional, analytical study in primary care centres from the five Portuguese healthcare administrative regions and the two autonomous regions. We used a random sample of 757 older adult patients provided by the information department of the ministry of health (SPMS) and family doctors from the autonomous regions. Data collection occurred in March 2018. The variables utilised were sociodemographic characteristics, clinical profile and medication. For each patient, polypharmacy was measured either by the concurrent use of ≥ 5 drugs or by the median number of drugs at the time of data collection. Logistic regression analyses were performed to determine associations between polypharmacy and other variables. Results Polypharmacy (≥ 5 drugs) was present in 77% of the sample. A cut-off of over the median number of drugs was present in 55%. The likelihood of having polypharmacy increased significantly with age (OR = 1.05 (1.02–1.08)), number of chronic health problems (OR = 1.24 (1.07–1.45)) and number of prescribers (OR = 4.71 (3.42–6.48)). Cardiovascular, metabolic and musculoskeletal medications were the most commonly involved in polypharmacy. Conclusions Polypharmacy was a very common occurrence in Portugal. Future primary healthcare policies should address polypharmacy.info:eu-repo/semantics/acceptedVersio

Study of dyslipidemia in patients with Obstructive Sleep Apnea Syndrome in primary health care

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