42 research outputs found
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)â14 males and 9 femalesâagreed 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
languageâPortuguese. Its availability in the local language will raise Portuguese GPsâ 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
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 patientsâ 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 (Ï = -0.032, p < 0.001), with the same occurring between age and FEV1(%) (Ï = -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
Patientsâ and tutorsâ evaluations of medicine studentsâ 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 studentsâ 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 2017â2018 and 2018â2019.
Methods
Observational study of the 2017â2018 and 2018â2019 academic years of the assessment grids for tutorâs evaluation of SOAP performance and fluency in consultation and for patientâs evaluation of the student âperformance, 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 2018â2019 (18,38 ±â2,18vs18,54â±â2,11, pâ=â0,005) of the SOAP methodology evaluation. Patientsâ evaluation was not different 19,34 ±â1,70vs19,35â±â1,40, pâ=â0,091. A positive significant correlation was found between tutors and patients marks (Ïâ=â0,278; pâ<â0,001), as well as between tutor mark and final mark (Ïâ=â0,958; pâ<â0,001) and patient and final marks (Ïâ=â0,465; pâ<â0,001). Final marks were not different in both years, 18,61 ±â1,38vs18,78â±â1,15, pâ=â0,158.
Conclusions
This innovative model of evaluation of studentâs performance in medical appointment, showed a significant positive moderate correlation between patientsâ and tutorsâ 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 Doctorsâ agreement with the âTen Commandments for patient-centred treatmentâ
Background. The âTen Commandments for patent-centred treatmentâ suggest a diïŹerent approach to therapy.
Objectves. To ascertain the level of agreement with the âTen Commandments for patent-centred treatmentâ by physicians in Central Portugal, exploring diïŹerences 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, â„ 36 and †55 years n = 217 and â„ 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 âDisagree/Completely Disagreeâ in the GP/FM specialty (p < 0.001). By gender, for commandment 1, women vs men doctors âDisagree/Completely
Disagreeâ proporton of 11.7% vs 6,4% (p = 0.003). For the younger age groups, there is a greater proporton of âDisagree/Completely Disagreeâ 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 âTen Commandments for patent-centred treatmentâ in central Portugal. For Commandments 1, 3 and 6, the proporton of âDisagree/Completely Disagreeâ 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 eïŹect 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 5â10 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-eïŹect 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 eïŹectve, simple and aïŹordable 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 patientsâ 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 participantsâ 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 patientsâ 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. QualiÂŹty 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 studentsâ 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 Masterâs 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 (Î = +7) between 2008 and 2017. Q-Codes were registered 276 times, while the ICPC-2 codes were used 133 times. Under the Q-Codes, âdoctorâs issuesâ is the most frequently addressed (n = 112; 67.2%), and under the International Classification in Primary Care-2 classifications, the chapter âPsychologicalâ was predominant (n = 35; 21%). Under the Q-Codes, subcategories âprimary care settingâ (n = 26; 15.6%), âhealth issue managementâ (n = 23; 13.8%) and âunable to code, unclearâ (22; 13.2%) were dominant. Within the International Classification in Primary Care-2, the subcategories âdiabetes noninsulin dependentâ (n = 22; 13.2%), âdepressive disorderâ (8, 4.8%) and âhypertension uncomplicatedâ (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
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 diïŹerences between patents with mild, moderate and severe OSAS.info:eu-repo/semantics/publishedVersio
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 â„ 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 (â„ 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 (1.02â1.08)), number of chronic health problems (OR = 1.24 (1.07â1.45)) and number of prescribers (OR = 4.71 (3.42â6.48)). 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