Browsing by Author "Ribeiro, Cristina"
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- Chemsex: nem sempre com um final feliz... morte por intoxicação com GHB e CocaínaPublication . Castro, André Lobo; Simón, Antia; Tarelho, Sónia; Ribeiro, Cristina; Franco, João Miguel"Chemsex" tornou-se um problema sério de saúde pública no contexto médico-legal. É sabido que a sua prática envolve um elevado grau de risco para os consumidores, incluindo contextos de intoxicação aguda. No caso apresentado, a vítima do sexo feminino foi encontrada inconsciente pelo seu parceiro. Ambos perderam a consciência no seguimento do consumo de um líquido após o jantar, num parque de estacionamento conhecido por ser um local procurado para a realização de encontros casuais de cariz sexual. Após a autópsia, a análise toxicológica detetou a presença na amostra de sangue total de GHB, cocaína, ecognina metilester, benzoilecgonina e THCCOOH. A avaliação da informação e dos dados recolhidos levou a concluir que a morte se deveu a uma intoxicação por uma mistura de GHB e cocaína. Este caso releva a necessidade de se considerar e avaliar toda a informação obtida na cena, nomeadamente a informação testemunhal. Por outro lado, este caso revela também que a utilização de diferentes substâncias, isoladas ou misturadas, continua a ser praticada com fins de aumento de performance sexual, se bem que nem sempre com um final feliz.
- Differences between Groups of Family Physicians with Different Attitudes towards At-Risk Drinkers: A Post Hoc Study of the ODHIN Survey in PortugalPublication . Rosário, Frederico; Wojnar, Marcin; Ribeiro, CristinaIntroduction. We have recently shown that family physicians can be classified into two groups based on their attitudes towards at-risk drinkers: one with better and the other with worse attitudes. Objective. To compare the two groups regarding demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Methods. A random sample of 234 Portuguese family physicians who answered the Optimizing Delivery of Health Care Interventions survey was included. The questionnaire asked questions on demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Results. Family physicians with better attitudes were younger (p = 0.005) and less experienced (p = 0.04) and with higher male proportion (p = 0.01). This group had more hours of postgraduate training (p < 0.001), felt more prepared to counsel risky drinkers (p < 0.001), and considered themselves to have better counselling efficacy (p < 0.001). More family physicians in the group with worse attitudes considered that doctors cannot identify risky drinkers without symptoms (p = 0.01) and believed counselling is difficult (p = 0.005). Conclusions. Family physicians with better attitudes had more education on alcohol and fewer barriers to work with at-risk drinkers. These differences should be taken into account when designing implementation programs seeking to increase alcohol screening and brief advice.
- 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 FrameworkPublication . Rosário, Frederico; Santos, Maria Inês; Angus, Kathryn; Pas, Leo; Ribeiro, Cristina; Fitzgerald, NiamhBackground 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.
- Implementing alcohol screening and brief interventions in primary health care: study protocol for a pilot cluster randomized controlled trialPublication . Rosário, Frederico; Vasiljevic, Milica; Pas, Leo; Fitzgerald, Niamh; Ribeiro, CristinaBackground Alcohol is one of the most important risk factors contributing to the global burden of disease. Screening and brief interventions in primary care settings are effective in reducing alcohol consumption. However, implementation of such interventions in routine practice has been proven difficult. Most programmes in practice and research have lacked a theoretical rationale for how they would change practitioner behaviour. Objective To determine whether a theory-based behaviour change intervention delivered to primary care practices significantly increases delivery of alcohol screening. Methods We will conduct a two-arm, cluster-randomized controlled, parallel, open trial. Twelve primary care practices will be randomized to one of two groups: training and support; and waiting-list control. Family physicians, nurses and receptionists will be eligible to participate. The intervention will be a training and support programme. The intervention will be tailored to the barriers and facilitators for implementing alcohol screening and brief interventions following the principles of the Behaviour Change Wheel approach. The primary outcome will be the proportion of patients screened with the Alcohol Use Disorders Identification Test. Conclusion This study will test whether a theory-driven implementation programme increases alcohol screening rates in primary care. Results from this trial will provide a useful addition to existing evidence by informing implementation researchers what areas of behaviour change are critical to increasing alcohol screening rates. Trial registration clinicaltrials.gov NCT02968186
- Medicina geral e familiar e atitudes relativas a problemas ligados ao álcool: a importância da formação no âmbito da Escola de Medicina Geral e Familiar (Primavera 2016)Publication . Oliveira, Vânia Maria Novais de; Rosário, Frederico; Ribeiro, CristinaObjetivos: Os cuidados de saúde primários (CSP) são o terreno ideal para rastreio e tratamento de doentes com Problemas Ligados ao Álcool (PLA). Este estudo pretendeu avaliar as atitudes dos participantes da Escola de Medicina Geral e Familiar (Primavera 2016) relativas a PLA e comparar as atitudes dos participantes do curso de Alcoologia com os dos restantes cursos. Métodos: Foram avaliadas as atitudes dos participantes através do Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Foram investigadas as associações entre sexo, idade e local de trabalho e ainda com os resultados do SAAPPQ. Resultados: Obtiveram-se 250 questionários elegíveis. A idade média foi de 28,1 ± 2,2 anos; 86,2% eram do sexo feminino. A Administração Regional de Saúde (ARS) mais representada foi a de Lisboa e Vale do Tejo. Pré-curso, as atitudes dos participantes dos dois grupos foram semelhantes, exceto na Adequação e Segurança. Os participantes do curso de Alcoologia sentem-se seguros ao trabalharem com estes doentes. Contudo, apenas 65% destes pontuaram acima do ponto médio no Compromisso Terapêutico. Pós-curso objetivaram-se valores significativamente superiores em todas as subescalas para os participantes do curso de Alcoologia, tendo a totalidade pontuado acima do ponto médio na Segurança e Compromisso Terapêutico. Conclusões: As atitudes dos participantes do curso de Alcoologia perante doentes com PLA melhoraram significativamente após a formação em todas as subescalas. Cursos que tenham em conta não só conhecimento e capacidade técnica, como outras atitudes, poderão melhorar o rastreio e tratamento de doentes com PLA. Poderá ser necessária uma atenção curricular específica nos domínios da Autoestima e Satisfação para melhorar resultados futuros.