ACeS DL - Artigos Científicos publicados
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- Adequação da formação em saúde do adolescente: opiniões dos médicos e enfermeiros de família que frequentaram uma ação formativaPublication . Santos, Maria Inês; Rosário, Frederico; Santos, ElisabeteObjetivos: Avaliar a perceção que os profissionais de saúde dos cuidados de saúde primários têm sobre a formação recebida em saúde do adolescente e identificar as limitações sentidas e as necessidades de formação adicional. Tipo de estudo: Estudo observacional, transversal e descritivo. Local: Região Centro. População: Médicos e enfermeiros de família da região Centro. Métodos: Os médicos e enfermeiros de família inscritos numa formação de saúde do adolescente foram convidados a responder a um inquérito em que se solicitava a avaliação da sua formação pré e pós-graduada em saúde do adolescente, a necessidade de receber formação adicional e as limitações. Resultados: A maioria dos participantes considerou que a sua formação pré-graduada era insuficiente (médicos: 97%; enfermeiros: 77,2%) e que não se sentia apto para lidar com adolescentes após a licenciatura (médicos: 93,9%; enfermeiros: 87,7%). A maioria dos médicos de família também considerou insuficiente a formação recebida durante o internato (77,5%), não se sentindo aptos a lidar com adolescentes no final do mesmo (68,4%), tendo ainda considerado insuficiente a formação frequentada após o internato (73,0%). Os participantes consideraram ter necessidade de receber formação adicional em saúde do adolescente, apontando áreas com maiores necessidades formativas: as queixas psicossomáticas (82,2%), os problemas familiares (72,9%), a entrevista ao adolescente (69,5%), o consumo de substâncias (62,6%) e os problemas escolares e de comportamento (62,3%). Conclusões: Os médicos e enfermeiros de família inquiridos referiram sentir importantes lacunas formativas em saúde do adolescente na sua formação pré e pós-graduada, bem como a necessidade de obter mais formação nesta área.
- Apresentação atípica de cancro do pulmão num doente jovemPublication . Carvalho, Sofia; Carreira, LianeO cancro do pulmão é a principal causa de morte por cancro nos homens. O diagnóstico pode ser tardio se a primeira apresentação for através de lesões atípicas. Nódulos subcutâneos do couro cabeludo podem representar metástases de diferentes tumores. O carcinoma epidermóide do pulmão, embora raro, deve ser considerado quando essas lesões são encontradas. No caso apresentado, a evolução das lesões e a idade jovem do paciente sugeriram uma abordagem eficaz que levou ao diagnóstico.
- Calcificação cardíaca: um achado acidentalPublication . Lopes, Ana Jorge; Ferreira Santos, Luís; Gama, Pedro
- Um caso clínico de linfoma de células do mantoPublication . Borges, Elisabete Pinto; Pinheiro, Maria João; Moreira, DanielaIntrodução: Os linfomas não Hodgkin constituem um grupo variável de neoplasias do sistema linforreticular que por vezes podem ser difíceis de diagnosticar. Neste caso clínico apresenta-se um tipo raro de linfoma, com forma de apresentação rara, em que o médico de família teve um papel importante no diagnóstico. Descrição de caso: Homem de 73 anos que inicialmente se apresenta com tumefação supra-orbitária e queixas de sensação de pressão ocular, sem outros sintomas. É avaliado por oftalmologia, sendo considerado que as tumefações resultariam de tecido adiposo. Após agravamento de tumefação orbitária, surgimento de edema dos lábios e adenopatias cervicais suspeitou-se de doença linfoproliferativa. O utente é referenciado para consulta de medicina interna e chega-se ao diagnóstico de linfoma de células do Manto, após excisão e análise histológica de adenopatia. Comentário: Este caso clínico ilustra a dificuldade no diagnóstico que pode acarretar um linfoma não Hodgkin, dada a sua grande variabilidade de apresentações. O acompanhamento do doente ao longo das várias consultas foi essencial para se colocar a hipótese de diagnóstico de doença linfoproliferativa.
- Crise Económica em Portugal: Evolução da Incidência de Depressão e Correlação com o DesempregoPublication . Coelho, Inês Laplanche; Sousa-Uva, Mafalda; Pina, Nuno; Marques, Sara; Matias-Dias, Carlos; Rodrigues, Ana PaulaIntroduction: Previous studies have found an increase in the incidence rate of depression between 2007 – 2013 in Portugal, with a positive correlation with the unemployment rate, namely, in men. So, it was hypothesized that this increase is related with the situation of economic crisis. This study aimed to investigate if the correlation between unemployment rates and the incidence of depression is maintained in the post-crisis period of economic recovery in Portugal (2016 – 2018). Material and Methods: An ecological study was carried out, using data from the General Practitioners Sentinel Network concerning depression incidence (first episodes and relapses) and data from the National Statistics Institute on unemployment rates in the Portuguese population. The correlation coefficient was estimated using linear regression and the results were disaggregated by sex. Results: Between 2016 and 2018, there was a consistent decrease in the incidence of depression in both sexes. During the 1995 – 2018 period, a positive correlation was observed between unemployment and depression, with a coefficient of 0.833 (p = 0.005) in males and of 0.742 (p = 0.022) in females. Discussion: The reduction in the incidence of depression in both sexes observed between 2016 – 2018 corroborates a positive correlation between unemployment and depression in the Portuguese population, previously observed between 2007 – 2013. Conclusion: This study highlights the need to monitor the occurrence of mental illness in the Portuguese population, especially in moments of greatest social vulnerability in order to establish preventive measures, as a way to mitigate the impact of future economic crises.
- Depression and unemployment incidence rate evolution in Portugal, 1995–2013: General Practitioner Sentinel Network dataPublication . Rodrigues, Ana Paula; Sousa-Uva, Mafalda; Fonseca, Rita; Marques, Sara; Pina, Nuno; Matias-Dias, CarlosOBJECTIVE: Quantify, for both genders, the correlation between the depression incidence rate and the unemployment rate in Portugal between 1995 and 2013. METHODS: An ecological study was developed to correlate the evolution of the depression incidence rates estimated by the General Practitioner Sentinel Network and the annual unemployment rates provided by the National Statistical Institute in official publications. RESULTS: There was a positive correlation between the depression incidence rate and the unemployment rate in Portugal, which was significant only for males (R2 = 0.83, p = 0.04). For this gender, an increase of 37 new cases of depression per 100,000 inhabitants was estimated for each 1% increase in the unemployment rate between 1995 and 2013. CONCLUSIONS: Although the study design does not allow the establishment of a causal association between unemployment and depression, the results suggest that the evolution of unemployment in Portugal may have had a significant impact on the level of mental health of the Portuguese, especially among men.
- Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational StudiesPublication . Neves, Ana Luisa; Jácome, Cristina; Taveira-Gomes, Tiago; Pereira, Ana Margarida; Almeida, Rute; Amaral, Rita; Alves-Correia, Magna; Mendes, Sandra; Chaves-Loureiro, Cláudia; Valério, Margarida; Lopes, Cristina; Carvalho, Joana; Mendes, Ana; Ribeiro, Carmelita; Prates, Sara; Ferreira, José Alberto; Teixeira, Maria Fernanda; Branco, Joana; Santalha, Marta; Vasconcelos, Maria João; Lozoya, Carlos; Santos, Natacha; Cardia, Francisca; Moreira, Ana Sofia; Taborda-Barata, Luís; Pinto, Cláudia Sofia; Ferreira, Rosário; Morais Silva, Pedro; Monteiro Ferreira, Tania; Câmara, Raquel; Lobo, Rui; Bordalo, Diana; Guimarães, Cristina; Espírito Santo, Maria; Ferraz de Oliveira, José; Cálix Augusto, Maria José; Gomes, Ricardo; Vieira, Inês; da Silva, Sofia; Marques, Maria; Cardoso, João; Morete, Ana; Aroso, Margarida; Cruz, Ana Margarida; Nunes, Carlos; Câmara, Rita; Rodrigues, Natalina; Abreu, Carmo; Albuquerque, Ana Luísa; Vieira, Claúdia; Santos, Carlos; Páscoa, Rosália; Chaves-Loureiro, Carla; Alves, Adelaide; Neves, Ângela; Varanda Marques, José; Reis, Bruno; Ferreira-Magalhães, Manuel; Almeida Fonseca, JoãoBackground: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.
- 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.
- Drug Withdrawal Due to Safety: A Review of the Data Supporting Withdrawal DecisionPublication . Craveiro, Nuno Sales; Lopes, Bruno Silva; Tomás, Lara; Almeida, Sofia FragaIntroduction: Several drugs were withdrawn from the market due to safety. Objective: The aim of this study was to describe data supporting drug withdrawal from the market due to safety reasons in countries belonging to the World Health Organization. Methods: We analyzed drugs withdrawn from the market between 1990 and 2010. All medicine agencies of the countries belonging to the Program for International Drug Monitoring of the World Health Organization were contacted. To complete data, Medline, reference books and available drug databases were also searched. Information sources on which authorities based their withdrawal were categorized and the average time between the first date of exposure and withdrawal was calculated and stratified. Results: A total of 133 drugs that met the inclusion/exclusion criteria were withdrawn from the market due to safety reasons in the period reviewed (1990 - 2010). Hepatotoxicity (n=36, 27.1%), cardiac disorders (n=25, 18.8%), hypersensitivity (n=17, 12.8%) and nephrotoxicity (n=14, 9.8%) were the major reasons responsible for 69.2% of all drugs withdrawn. In most cases, Information Sources for drug withdrawal were spontaneous reports and/or case reports (n=86, 64.7%), followed by clinical trials (n=24, 18.0%). The average time between the introduction of a drug and its withdrawal due to safety reasons was 20.3 years (SD±13.8). Conclusion: According to available and published evidence, there is no gold standard to identify risks associated with drug exposure. These findings strengthen the role of different information sources within the drug safety review process.
- Effect of lifestyle on blood pressure in patients under antihypertensive medication: An analysis from the Portuguese Health Examination SurveyPublication . Salvador, Mário Rui; Cunha Gonçalves, Susana; Quinaz Romana, Guilherme; Nunes, Baltazar; Kislaya, Irina; Matias Dias, Carlos; Rodrigues, Ana PaulaIntroduction and Objectives Hypertension is one of the main risk factors for disability and death from cardiovascular disease. Current guidelines include initiatives to control blood pressure in hypertensive patients that focus on lifestyle changes. The main objective of this study was to analyze the association between lifestyle and blood pressure in patients under antihypertensive medication. Methods Data collected in the Portuguese National Health Examination Survey (INSEF) were analyzed. Individuals who met INSEF inclusion criteria and reported being under antihypertensive medication in the two weeks prior to the questionnaire were studied. Lifestyle variables (alcohol consumption, smoking, added salt intake, fruit and vegetable consumption, and physical activity) were assessed by questionnaire, and systolic and diastolic blood pressure were measured by physical examination. Associations between lifestyle factors and blood pressure, stratified by gender and adjusted for sociodemographic variables and obesity, were estimated through a multiple linear regression model. Results Alcohol consumption (beta=6.31, p=0.007) and smoking (beta=4.72, p=0.018) were positively associated with systolic blood pressure in men. Added salt intake, fruit and vegetable consumption, and physical activity were not associated with blood pressure in men. In women, no association was observed for any behavioral variable. Conclusions These conclusions highlight the need in the population under antihypertensive medication, particularly in men, to focus on the fight against high systolic blood pressure in the two modifiable and preventable behaviors of smoking and alcohol consumption.
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