ABSTRACT
Objectives: The current European crisis in human resources in health has opened the debate about working conditions and fair wages. This is the case with Resident doctors, which have faced challenges throughout Europe. In Portugal, they account for about a third of the doctors in the Portuguese National Health Service. No studies to date objectively demonstrate the working conditions and responsibilities undertaken. This study aims to quantify the residents' workload and working conditions. Methods: Observational, retrospective cross-sectional study which involved a survey on the clinical and training activity of Portuguese residents, actively working in September 2020. The survey was distributed through e-mail to residents' representatives and directly to those affiliated with the Independent Union of Portuguese Doctors. The descriptive analysis assessed current workload, and logistic regression models analyzed associations with geographical location and residency seniority. Results: There were a total of 2,012 participants (19.6% of invited residents). Of the residents giving consultations, 85.3% do so with full autonomy. In the emergency department, 32.1% of the residents work 24â h shifts and 25.1% work shifts without a specialist doctor present. Regarding medical training, 40.8% invest over EUR 1,500 annually. Autonomy in consultations was associated with being a Family Medicine resident (OR 4.219, p < 0.001), being a senior resident (OR 5.143, p < 0.001), and working in the Center (OR 1.685, p = 0.009) and South regions (OR 2.172, p < 0.001). Seniority was also associated with investing over EUR 1,500 in training annually (OR 1.235, p = 0.021). Conclusion: Residents work far more than the contracted 40â h week, often on an unpaid basis. They present a high degree of autonomy in their practice, make a very significant personal and financial investment in medical training, with almost no time dedicated to studying during working hours. There is a need to provide better working conditions for health professionals, including residents, for the sake of the sustainability of health systems across Europe.
ABSTRACT
BACKGROUND: Multiple sclerosis is a chronic neurological disease with increasing incidence and prevalence worldwide being the main cause of non-traumatic disability in young adults. Both acute and chronic pain have been mentioned as the most common symptoms among those patients. OBJECTIVE: This study was designed to evaluate the pain experience among patients with multiple sclerosis by describing its prevalence, characteristics, analgesic treatment and its efficacy, and also the impact of pain on quality of life. METHODS: A cross-sectional observation survey was carried out on patients with multiple sclerosis followed in a tertiary hospital. Data were collected between December 2019 and March 2021 from a structured telephone inquiry, applying two questionnaires, the Brief Pain Inventory and the McGill Pain Questionnaire (MPQ), to evaluate the prevalence of pain and its impact on quality of life (QoL). Clinical records were also consulted to obtain data on disease duration, year of diagnosis, MS type, Expanded Disability Status Scale (EDSS) score. RESULTS: Our sample included 305 patients in a universe of 1500, mainly women, with mean age of 44.27 years, and most of them presented with an outbreak-remission subtype of disease. One hundred twenty-four patients experienced pain which corresponds to 41% of the patients. Considering the patients who experienced pain, 67.7% were under treatment and of these, 64.3% with only one painkiller. Pain significantly interfered with general activity, mood, and regular work. CONCLUSION: Pain was an important symptom in this group of patients with MS and significantly interfered with mood, general activity, and regular work. The maximum intensity of pain felt by patients was significant and only 67.7% of patients were under analgesic treatment with mean pain relief of 54. NSAIDs were the most used drugs followed by gabapentinoids and acetaminophen for the management of pain. Medical community must continue to study this population in order to improve the approach to pain in these patients and improve quality of life.
