Adherence to pharmacological therapy in patients with hypertension: protocol of a qualitative study by focus groups.

INTRODUCTION: Non-adherence to antihypertensive medication significantly contributes to inadequate blood pressure control. Regarding non-pharmacological interventions to improve medication adherence, the question remains of which interventions yield the highest efficacy.Understanding the complementary perspectives of patients and healthcare professionals can be valuable for designing strategies to enhance medication adherence. Few studies explored the perspectives of patients and healthcare professionals regarding medication adherence. None of them focused specifically on adherence to pharmacological therapy for hypertension in Portugal.Considering the high prevalence of non-adherence and its location-specific aspects, the priority should be identifying its barriers and developing tactics to address them.This study aims to gather the perspectives of patients with hypertension and healthcare professionals such as family doctors, nurses and community pharmacists from Portugal, regarding the most effective strategies to enhance antihypertensive medication adherence and to understand the factors contributing to non-adherence. METHODS AND ANALYSES: We will conduct qualitative research through synchronous online focus groups of 6-10 participants. Some groups will involve patients with hypertension, while others will include family doctors, nurses and community pharmacists. The number of focus groups will depend on the achievement of theoretical saturation. A purposive sample will be used. Healthcare participants will be recruited via email, while patients will be recruited through their family doctors.The moderator will maintain neutrality while ensuring interactive contributions from every participant. Participants will be encouraged to express their opinions on the meeting summary. Meetings will be recorded and transcribed.Two researchers will perform content analyses using MAXQDA V.12 through comparative analyses and subsequent consensus. A third researcher will review the analyses. The results will be presented narratively. ETHICS AND DISSEMINATION: The Ethics Committee of the University of Coimbra has approved this study with the number: CE-026/2021. The results will be disseminated via peer-reviewed publications and national and international conferences.

Knowledge about type 2 diabetes: its impact for future management.

Diabetes can cause several long-term complications. Knowledge about this disease can play an important role in reducing diabetes-related complications. In addition, the lack of awareness leads to misconceptions, which joined with inadequate knowledge, are relevant barriers to proper diabetes management. In this study, we aimed to assess the diabetes knowledge of a type 2 diabetes (T2D) population and identify major knowledge gaps, in order to prevent complications and to increase quality of life. In a cross-sectional, observational study in a convenience sample, we identified individuals diagnosed with T2D attending ambulatory visits from five health settings, older than 18 years, with a time diagnosis of at least 1 year, and attending multidisciplinary visits for at least 3 months. To assess the knowledge of T2D individuals, we applied the Portuguese version of the Diabetes Knowledge Test. The sample included a total of 1,200 persons, of whom almost half were female. The age range of the participants varied from 24 to 94 years old, and the mean age was 65.6 ± 11.4 years. Most of the sample had a level of education under secondary and lived with someone. In our sample, 479 (39.9%) were insulin-treated. The percentage of correct answers was 51.8% for non-insulin vs. 58.7% for insulin treated (p < 0.05). There were three items with a percentage of correct answers lower than 15%; the item with the lower value of correct answers was the one related to the identification of signs of ketoacidosis with only 4.4% of correct answers, the errors presented a random pattern; the item related to the identification of which food should not be used to treat low blood glucose with 11.9%, where 56.9% of the sample's participants considered that one cup of skim milk would be the correct answer (53.1% in non-insulin patients and 62.6% in insulin treated patients; p < 0.001). The item regarding the knowledge of free food presented a 13.3% of correct answers (10.8% non-insulin group vs. 17.1% insulin group; p < 0.01). Two of the three items with lower value of correct answers were related to glycemic control and health status monitoring, the other was related to diet and food.

[Evaluation of the Scientific Production in the Field of General Practice and Family Medicine in Portugal]. / Avaliação da Produção Científica na Área da Medicina Geral e Familiar em Portugal.

INTRODUCTION: The Portuguese publications in the field of General Practice and Family Medicine have not yet been assessed in bibliometric studies. The aim of this study was to analyze that production between 2012 and 2022. METHODS: The Web of Science Core Collection was used to gather the number of articles, journals and citations obtained; the Journal Citation Reports to obtain the Impact Factor and quartile of journals; and Scimago Journal & Country Rank, for the comparison of data with other European countries. The search was based on the following query: "usf OR unidade de Saude Familiar OR centro de Saude OR ACeS OR medicina geral familiar OR Gen Practice Family SAME Portugal", and a time window between 2012 and 2022 was defined. The study considered the following quantitative indicators: total number of publications, typology, language, affiliation, co-authors, geographical distribution, thematic areas, and the number of publications/inhabitant and publications/physician from European countries; the qualitative indicators selected were the Impact Factor (IF), the quartile and the number of citations. RESULTS: Between 2012 and 2022, the national scientific production had an average annual growth rate of 36.6%. Of 389 publications, 73.8% were 'Articles' and 11.8% were 'Review Articles', predominantly in English (88.4%). The fields of 'General Internal Medicine' (24.7%) and 'Public Environmental Health' (14.9%) had the highest publication rates among the journals. The 389 publications received 5354 citations, for an average of 13.76 citations per article, and the average yearly citation growth was 115%. According to IF, 22.5% of the 222 journals belonged to Q4, 27.5% to Q3, 29.7% to Q2 and 20.3% to Q1, and therefore no significant bias regarding the journals where Portuguese doctors publish was observed. CONCLUSION: The bibliometric analysis allowed us to examine the evolution of the scientific production in the field of Portuguese General Practice and Family Medicine by observing an increasing publication trend and with a high potential for publication growth.

Introdução: As publicações portuguesas da área de Medicina Geral e Familiar ainda não foram alvo de estudos bibliométricos. Pretendeu-se analisar tal produção no período entre 2012 e 2022. Métodos: Usou-se a Web of Science Core Collection para obter o número de artigos, as revistas de publicação e as respetivas citações; o Journal Citation Reports para obter o Fator de Impacto e o quartil das revistas; e o Scimago Journal & Country Rank para a comparação de dados com outros países europeus. Utilizou-se a equação de pesquisa "usf OR unidade de Saude Familiar OR centro de Saude OR ACeS OR medicina geral familiar OR Gen Practice Family SAME Portugal", e selecionaram-se os resultados obtidos no período entre 2012 e 2022. Os indicadores quantitativos selecionados foram o total de publicações, tipologia, idioma, afiliação, coautorias, distribuição geográfica, áreas temáticas e o número de publicações/habitante e de publicações/médico em países europeus. Como indicadores qualitativos escolheu-se o Fator de Impacto (FI), o quartil das revistas e o número de citações. Resultados: Entre 2012 e 2022, a produção científica nacional teve uma taxa de crescimento médio anual de 36,6%. Em 389 publicações, 73,8% foram de 'Article' e 11,8% de 'Review Article', predominando a publicação em língua inglesa (88,4%). As revistas com maior publicação pertencem às áreas 'General Internal Medicine' (24,7%) e 'Public Environmental Health' (14,9%). As 389 publicações tiveram 5354 citações, com uma média de 13,76 citações por artigo e a taxa de crescimento médio anual de citações foi de 115%. Em função do FI, das 222 revistas, 22,5% pertenciam ao Q4, 27,5% ao Q3, 29,7% ao Q2 e 20,3% ao Q1, não se observando por isso nenhum viés assinalável relativamente às revistas onde os médicos portugueses publicam. Conclusão: A análise bibliométrica permitiu avaliar a evolução e o estado da produção científica da área da Medicina Geral e Familiar por investigadores portugueses, observando-se uma tendência de publicação crescente, e com forte potencial de crescimento.

Validation and Cultural Adaptation of the Problem Areas in Diabetes-5 (PAID-5) Scale to European Portuguese.

INTRODUCTION: Diabetes distress syndrome (DDS) can lead to poor outcomes and should be assessed with adapted and validated tools. One of these tools is the Problem Areas in Diabetes (PAID) scale, which assesses diabetes distress in people suffering from diabetes (PsD). A short five-item form, PAID-5, is an easier and quicker alternative to be used in clinical and research practices, than the previous one with 20-items and has been validated by the original authors. This study intended to perform the cultural adaptation and validation of the PAID-5 scale in European Portuguese. METHODS: To create the Portuguese version of PAID-5, translation-back translation, a clinical review, and a cognitive debriefing panel were performed. A convenience sample of 90 PsD was studied in three primary healthcare units for reliability and validity tests. Reliability was studied by the internal consistency (Cronbach's alpha) and the interval coefficient correlation (ICC) under a test-retest design. Structural validity was studied by principal component analysis. The construct validity was tested by the sensitivity of the PAID-5 total score with age, most recent HbA1c test, and socioeconomic class by the Socio-Economic Deprivation Index (SEDI). Criterion validity was tested by correlating the PAID-5 total score with the psychological distress questions of the Diabetes Health Profile 18 Questions (DHP-PDQ). RESULTS: A Cronbach's alpha coefficient value of 0.905 and an ICC of 0.905 were computed. In a sample of n = 90 PsD, 55.6% were males, 63.3% aged 65 years or more, SEDI was 5.2 ± 0.8 [3 to 6], 44.4% studied for less than 4 years, and 18.9% were living alone. The Spearman correlation between PAID-5 and DHP-PDQ total scores was ρ = 0.382, p < 0.001, between PAID-5 total score and age was ρ = -0.207, p = 0.050 and between PAID-5 total score and most recent HbA1c knowledge was ρ = 0.275, p = 0.040. There was no significant relationship between PAID-5 total score and SEDI ρ = 0.080, p = 0.452. CONCLUSION: DDS can now be assessed in the Portuguese context, accounting for better intervention by primary care teams. PAID-5 has good psychometric properties and is a reliable scale to identify diabetes-specific distress in the Portuguese diabetic population.

Patient-Centered Medicine and Self-Care of Patients with Type 2 Diabetes: A Cross-Sectional Study.

INTRODUCTION: Even though the prevalence rate of diabetes in Portugal is one of the highest in Europe, no studies on the association between patient centered medicine, diabetes self-care, and glycemic control have been published. Assuming that patient centered medicine increases adherence to treatment through the improvement of the doctor-patient relationship, the aim of this study was to assess the influence of patient-centered medicine on the self-care of patients with type 2 diabetes patients' (T2DM) in two Family Health Units in Central Portugal, according to gender and age. MATERIAL AND METHODS: A cross-sectional study was conducted in two Family Health Units in Central Portugal between the 25th November 2021 and the 15th January 2022. Patients with type 2 diabetes were invited to fill in the Patient-Centered Medicine questionnaire, for patients (PCM-p) (where higher values represent worse results) and the Summary of Diabetes Self-Care Activities Measure (SDSCAM), (where higher values represent better results), while healthcare professionals filled in the epidemiologic variables on pre-defined days. RESULTS: A sample of 298 patients with type 2 diabetes was studied. Linear regressions for the association between SDSCAM scale factors and PCM-p showed significant associations for general diet (ß = -0.07, p < 0.001), specific diet (ß = -0.10, p < 0.001), exercise (ß = -0.03, p = 0.008), foot care (ß = -0.11, p < 0.001) and medication adherence in general (ß = -0.06, p = 0.001). Multiple linear regression including the association between glycated hemoglobin (HbA1c) and the SDSCAM scale dimensions showed that specific diet was associated with lower HbA1c levels (ß = -0.01, p = 0.007) and blood sugar testing (ß = 0.01, p < 0.001) and that a higher score in PCMp was associated with higher HbA1c levels (ß = 0.06, p < 0.001). Male patients (ß = -6.93, p = 0.007) and older patients (ß = -0.42, p = 0.001) were associated with lower scores in the specific diet. The male gender was associated with higher scores in exercise (ß = 7.62, p = 0.029), lower scores in foot care (ß = -6.06, p = 0.029) and lower scores in medication adherence to injectable medicines/6.2 (ß = -0.73, p = 0.018). Age was associated with a lower score in medication (ß = -0.03, p = 0.045) and a higher PCMp total score (ß = 0.07, p = 0.030). CONCLUSION: Patient-centered medicine in type 2 diabetics is associated with better self-care behaviors in patients with type 2 diabetes. Gender and age differences were observed in self-care behaviors and age differences were observed in Patient Centered Medicine.

Health Literacy and Complications in People With Type 2 Diabetes: An Exploratory Study.

INTRODUCTION: A person with diabetes is subject to developing micro and macrovascular complications and prevention requires an active role from the person. So, health literacy should have a preponderant role in the health of people with diabetes but this link is yet not fully understood. The objective of this study is to understand the relationship between health literacy and the prevalence of complications in people with diabetes mellitus type 2 (DM2). METHODS: This is a multicentric transversal observational exploratory study. A survey was conducted with two health literacy instruments, the Medical Term Recognition Test (METER) and Newest Vital Sign (NVS), filled out by people with DM2 coming to consultation in primary health centers in three main regions of Portugal.  Results: In this sample (n=141), 50.6% were male, 41 to 88 years old, and 56% earned more than the minimum wage. Using the METER tool, it was found that 57.4% of the diabetic patients had functional literacy. Adequate literacy was found in 24.1% with the NVS tool. Also with the NVS tool it was found that 36.2% of the sample subjects had s high probability of limited literacy. Utilizing the METER tool, a statistically significant decrease in health literacy was observed in individuals with diabetic complications (p=0.001). There was no significant relation between the presence of diabetic complications and present blood pressure values, low-density lipoprotein, and socioeconomic index. CONCLUSION: In this study, we found a significant relation between lower health literacy and the presence of diagnosed DM2 complications (p=0.001).

O desperdício em uma unidade de terapia intensiva na visão dos profissionais pela metodologia de Bardin / Waste in intensive care unit in the view of professionals by Bardin's methodology / Desperdícios en una unidad de cuidados intensivos a la vista de los profesionales según la metodología de Bardin

Objetivo: avaliar a opinião dos profissionais de saúde sobre o desperdício, em uma Unidade de Terapia Intensiva. Método: o método utilizado foi o qualitativo. Foi realizada uma entrevista com 66 profissionais de uma Unidade de Terapia Intensiva e analisados pelo método de Bardin. Resultados: através dos discursos obtidos em cada quadro, foram identificadas e destacadas as unidades de registro que permitiram a criação de dois quadros, o primeiro possibilitou a construção da categoria que denominada "Gestão de custos em saúde: o desperdício de materiais em UTI". Já o quadro 2, possibilitou a obtenção de duas categorias, "Capacitação profissional em saúde: a otimização da gestão de custos em UTI" e "a inserção do processo de gestão de custos em UTI". Conclusão: o primeiro passo para o combate ao desperdício é conhecer a realidade institucional. Os gestores necessitam estudar os percentuais e fontes de desperdício de seu serviço e o impacto desses nos custos

Objective: to evaluate the opinion of health professionals about waste in an Intensive Care Unit. Method: the method used was qualitative. An interview was conducted with 66 professionals from an Intensive Care Unit and analyzed by the Bandin method. Results: through the speeches obtained in each table, were identified and highlighted the units that allowed the creation of two tables, the first made it possible to construct the category called "Health cost management: the waste of materials in ICU". Table 2, on the other hand, made it possible to obtain two categories, "Professional training in health: the optimization of ICU cost management" and "the insertion of the ICU cost management process". Conclusion: the first step in the fight against waste is to know the institutional reality. Managers need to study the percentages and sources of their service waste and their impact on costs

Objetivo: evaluar la opinión de los profesionales de la salud sobre los desechos en una unidad de cuidados intensivos. Método: el método utilizado fue cualitativo. Se realizó una entrevista con 66 profesionales de una Unidad de Cuidados Intensivos y se analizó mediante el método Bandin. Resultados: através de los discursos obtenidos en cada tabla, se identificaron y destacaron las unidades de registro que permitieron la creación de dos tablas, la primera permitió construir la categoría denominada "Gestión de costos de salud: el desperdicio de materiales en la UCI". La Tabla 2, por otro lado, permitió obtener dos categorías, "Capacitación profesional en salud: la optimización de la gestión de costos de la UCI" y "la inserción del proceso de gestión de costos de la UCI". Conclusión: el primer paso en la lucha contra el desperdicio es conocer la realidad institucional. Los gerentes deben estudiar los porcentajes y las fuentes de desperdicio de sus servicios y su impacto en los costos

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. Quality 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-modifiable 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.

Compassion and extracurricular activities of Portuguese Health Sciences students in Portugal.

BACKGROUND: Compassion, one of the items of empathy, is crucial in health care professions. So, the evaluation of the levels of compassion of Medicine, Dentistry and Pharmaceutical Sciences Master Degrees' (M.D.) students of the public Colleges in Portugal according to the type of Master Degree and the participation in extracurricular activities (E.A.) was a task to be performed. METHODS: Cross-sectional study in 2020, applying an on-line questionnaire including the "Compassion" items of the Jefferson Medical Empathy Scale - Students' version and questions about the participation in E.A. RESULTS: A sample of 901 students was studied. Its distribution by participation in E.A. did not differ significantly between M.D. (p = 0,854), most of the students participating in E.A. Using quartile distribution of compassion, the distribution of compassion levels was different among the three I.M. (p < 0.001), between Colleges (p < 0.001), and between curricular years (p < 0.001), with not different between genders (p = 0.036). For 56.4%, 74,6% and 69,5% of the respondents there was "medium-low" and "low" compassion for I.M. in Medicine, Pharmaceutical Sciences and Dentistry. These levels were also more prevalent among students in the 1st and 5th years. Levels of compassion were not different with the participation (p = 0,865), type (p = 0,177) and frequency of E.A. (p = 0,109). CONCLUSIONS: For their importance in future health care professionals, compassion and their differences found among the M.Ds. of this area deserve future studies. Levels of compassion showed differences between the M.D. studied and academic years of frequency. There was no relationship between the participation, type, and frequency of E.A. and the students' levels of compassion. The distribution of the level of compassion did not vary significantly with participation in E.A. (p = 0.865), with the type of E.A. (p = 0.177), with the frequency of E.A. (p = 0.109) or with the answer to the question "The practice of E.A. can make a person more compassionate?" (p = 0.503).

General Practice/Family Medicine Portuguese doctors: “technicists” or “systemics”? / Medicina General/Medicina de Familia. Médicos portugueses: ¿«técnicos» o «sistémicos»?

To study if the consultation's problems classification of a fictitious case by General and Family Medicine doctors, showed the characteristics of being a mechanistic or a systemic approach. Exploratory cross-sectional observational study in a convenience sample of the General Practice/Family Medicine population, internees included, in April 2020, applying a modified real world clinical case. Central Portugal and the Autonomous Region of Azores. General Practice/Family Medicine specialists and internees. Electronic Doctors invitation to participate, anonymously, in specific doctor's social networks. A self-fulfilling questionnaire was used to verify the classification of a clinical case in Subjective, Assessment and Plan (from the SOAP methodology) with the response options of the International Classification of Primary Health Care (ICPC2) in chapters P (Psychological) and Z (Social) possible for this case. “Technicists” doctors, only classifying “P” codes and “Systemics” classifying “P+Z” or only “Z” ICPC2 codes were defined. Differences between genders, work place, being an internee or specialist and being a tutor in specialized formation were studied. A sample of 227 30% (n=68) males, specialists represented 66% (n=149), of whom 49% (n=73) were internee's tutors and 34% (n=78) were internees, was studied. In the Subjective chapter of the SOAP methodology, 44.1% (n=100) were “technicists”, for Assessment n=93 (40.8%) were “technicists” and for P chapter classification 56.8% were “technicists”. For S, A and P chapters classification there was no significant difference between the considered variables. In this sample General Practice/Family Medicine Portuguese doctors were more “systemic” for the S and A chapters of the SOAP model, And “technicists” in the P chapter.(AU)

El enfoque de la medicina centrada en el paciente (MCP) es cada vez más importante debido a su asociación de efectos positivos sobre el médico y el paciente. El presente estudio tuvo como objetivo conocer si el abordaje de un caso clínico, a través de la clasificación de problemas de consulta de un caso ficticio por médicos de Medicina General y de Familia, presenta características de abordaje mecanicista o sistémico. Estudio observacional transversal en una muestra de conveniencia de la población de Medicina General/Medicina Familiar, incluidos los internos, en abril del 2020, aplicando un caso clínico del mundo real modificado de Portugal y los especialistas en Medicina General/Medicina Familiar de Azores y de Portugal central. Especialistas en Medicina General/Medicina Familiar e internados. Los médicos fueron invitados a participar, de forma anónima, mediante invitación electrónica, ya sea en la red oficial de pasantías o en la red social de un médico específico, la red MGFamiliar. Se utilizó un cuestionario autocumplimentable para verificar la clasificación de un caso clínico en subjetivo, evaluación y planificación (de la metodología SOAP) con las opciones de respuesta de la Clasificación Internacional de Atención Primaria de Salud (CIPC2) en los capítulos P (Psicológico) y Z (Social) posible para este caso. Se definieron médicos «técnicos» solo clasificando con códigos «P» y «sistémicos» clasificando «P+Z»’ o solo con códigos ICPC2 «Z». Se estudiaron las diferencias entre géneros, lugar de trabajo, ser interno o especialista, ser tutor en formación especializada. En una muestra de 227 sujetos, 30% (n=68) varones, los especialistas representaron el 66% (n=149), de los cuales el 49% (n=73) fueron tutores internos y el 34% (n=78), internos. Para la clasificación en el capítulo subjetivo de la metodología SOAP, el 44,1% (n=100) eran «técnicos», para la evaluación n=93 (40,8%) eran «técnicos» y para la clasificación del capítulo P el 56,8% eran «técnicos».(AU)

General Practice/Family Medicine Portuguese doctors: "technicists" or "systemics"?

To study if the consultation's problems classification of a fictitious case by General and Family Medicine doctors, showed the characteristics of being a mechanistic or a systemic approach. Exploratory cross-sectional observational study in a convenience sample of the General Practice/Family Medicine population, internees included, in April 2020, applying a modified real world clinical case. Central Portugal and the Autonomous Region of Azores. General Practice/Family Medicine specialists and internees. Electronic Doctors invitation to participate, anonymously, in specific doctor's social networks. A self-fulfilling questionnaire was used to verify the classification of a clinical case in Subjective, Assessment and Plan (from the SOAP methodology) with the response options of the International Classification of Primary Health Care (ICPC2) in chapters P (Psychological) and Z (Social) possible for this case. "Technicists" doctors, only classifying "P" codes and "Systemics" classifying "P+Z" or only "Z" ICPC2 codes were defined. Differences between genders, work place, being an internee or specialist and being a tutor in specialized formation were studied. A sample of 227 30% (n=68) males, specialists represented 66% (n=149), of whom 49% (n=73) were internee's tutors and 34% (n=78) were internees, was studied. In the Subjective chapter of the SOAP methodology, 44.1% (n=100) were "technicists", for Assessment n=93 (40.8%) were "technicists" and for P chapter classification 56.8% were "technicists". For S, A and P chapters classification there was no significant difference between the considered variables. In this sample General Practice/Family Medicine Portuguese doctors were more "systemic" for the S and A chapters of the SOAP model, And "technicists" in the P chapter.

[Alcohol Drinking in Higher Education Students from Coimbra and the Impact of Academic Festivities]. / Consumo de Álcool nos Estudantes do Ensino Superior de Coimbra e o Impacto das Festas Académicas.

INTRODUCTION: The international and national literature as well as studies carried out in universities in Portugal show there is excessive alcohol consumption and binge drinking. However, no relation with alcohol consumption and college parties has yet been established. The aim of this study was to assess the association between alcohol consumption and binge drinking with college parties, and also to understand specific patterns of alcohol consumption by gender and years of university attendance. MATERIAL AND METHODS: A survey comprised of the "Alcohol Use Disorders Identification Test - Consumption" (AUDIT-C) and the question "What is your most consumed drink?" referring to months without and with college parties, was disseminated in the University of Coimbra Facebook® page to students of the University of Coimbra and of the Polytechnic Institute of Coimbra seventeen years old and over. RESULTS: The AUDIT-C score in college party months is higher than in months without such parties with strong, positive and significant correlation (ρ = 0.711; ρ < 0.001). In months without college parties, 41.8% of females and 24.0% of males have a positive AUDIT-C. In months with college parties, 73.8% of females and 56.3% of males have a positive AUDIT-C. In months with college parties, females have higher risk of excessive consumption (ρ< 0.001) and drink a higher amount of spirits / shots. There is a significant difference in the most consumed drinks between genders (ρ < 0.001). DISCUSSION: Alcohol consumption is higher in those with less years in college attendance, but college parties seem to have a proportional impact regardless of the number of years of college attendance. In a month with college parties, there is more binge drinking and higher consumption than the daily maximum recommended amount. Males consume a higher amount of spirits / shots. CONCLUSION: College parties allow for more opportunities of pre-existing binge drinking. The way young people face alcohol consumption is a major problem to be addressed.

Introdução: Na literatura internacional, nacional e em estudos no ensino superior em Portugal os jovens apresentam consumos alcoólicos excessivos e binge drinking. Contudo, não se encontra estabelecida qualquer relação entre o consumo e as festas académicas. O objectivo deste estudo foi compreender a associação entre consumo de bebidas alcoólicas e festas académicas, estabelecendo uma relação entre estes momentos e um padrão específico de consumo, bem como perceber a ocorrência de padrões específicos de consumo de acordo com o sexo e os anos de frequência escolar.Material e Métodos: Foi elaborado um questionário, constituído pelo "Alcohol Use Disorders Identification Test ­ Consumption" (AUDIT-C) e apresentando a questão "Qual a bebida mais consumida?" num mês com festas académicas e num mês sem que se realizassem. O questionário dirigido a alunos da Universidade de Coimbra e do Instituto Politécnico de Coimbra, foi divulgado na página de Facebook® da Universidade de Coimbra.Resultados: Na amostra de estudantes do ensino superior de Coimbra, com idade igual ou superior a dezassete anos (n = 503), o AUDIT-C em mês com festas académicas é superior ao mês sem festas, verificando-se correlação positiva forte e significativa (ρ = 0,711; ρ < 0,001). Em mês sem festas académicas, 41,8% do sexo feminino e 24,0% do sexo masculino apresentam AUDIT-C positivo. Em mês com festas académicas 73,8% do sexo feminino e 56,3% do sexo masculino apresentam AUDIT-C positivo. O sexo feminino apresenta maior risco de consumo excessivo (ρ < 0,001) e bebe mais bebidas espirituosas / shots. Há diferença significativa entre sexos quanto à bebida mais consumida (ρ < 0,001).Discussão: O consumo de alcool é superior nos primeiros anos, embora as festas académicas pareçam ter um impacto proporcional independente do número de matrículas. Em mês com festas académicas, há maior frequência de binge drinking e de consumo superior ao máximo diário recomendado. O sexo masculino revela aumento do consumo de bebidas espirituosas / shots. Conclusão: As festas académicas fomentam as ocasiões de binge drinking pré-existentes, residindo o problema na forma como os jovens abordam o consumo de álcool.

Physician empathy and patient enablement: survey in the Portuguese primary health care.

BACKGROUND: Empathy is the capacity to understand and resonate with the experiences of other people. Patient enablement is the degree to which a patient feels strengthened in terms of being able to deal with, understand and manage their disease. METHODS: Secondary cross-sectional analysis of existing data from 2 independent datasets (456 primary health care patients), with the application of two validated questionnaires, Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and Patient Enablement Instrument (PEI). OBJECTIVE: Evaluate medical empathy and patients' enablement after consultation with their family doctors and to verify if there was an association between these two concepts. RESULTS: The median value of JSPPPE-VP score was 6.60 (interquartile range 1.00) and of PEI/ICC score was of 1.83 (interquartile range 0.67). Regarding empathy (JSPPPE-VP), patients taking chronic medication had a slight but significantly higher median score than patients not taking them (6.70 versus 6.60, P = 0.049), although regression modelling did not confirm any relevant predictor of JSPPPE-VP score. Regarding enablement (PEI/ICC), we found significantly higher scores on younger patients, as well as, on more educated and professionally active ones (P < 0.001). Multivariable linear regression and Poisson regression modelling confirmed such variables as statistically significant potential predictors. CONCLUSIONS: A significant positive association was found between empathy score (JSPPPE-VP) and enablement score (PEI/ICC), when adjusted to sociodemographic cofactors. On this linear regression model, age category and educational level were also significantly associated with empathy score, with the same pattern found on bivariate analysis.

[Knowledge of Palliative Care Among Medical Students of the University of Coimbra]. / Conhecimento sobre Cuidados Paliativos em Estudantes de Medicina da Universidade de Coimbra.

INTRODUCTION: The need for palliative care is increasing. Future doctors must be prepared for this, so it is essential to develop skills during their undergraduate studies. The aim of this study was to evaluate the knowledge of medical students at the Faculty of Medicine of the University of Coimbra regarding palliative care. MATERIAL AND METHODS: An observational and cross-sectional study was performed through the application of a questionnaire answered by fifth year medical students. The collected data were analyzed using IBM® SPSS® Statistics, version 20 for Windows®. RESULTS: All 186 students surveyed were aware of what palliative care is and recognized its importance. From the total, 52.7% of students reported they knew what an informal caregiver is and 96.8% disagreed that palliative care is only provided at the end of life; 88.2% have never had any training on how to deal with palliative care patients. Only 57.5% of students reported that they had been trained to communicate 'bad news', but 70.4% assumed that they were not able to communicate such bad news. On the other hand, 89.8% reported their inability to take care of palliative patients and 98.4% admitted that they needed more training in this area. DISCUSSION: With the increasing number of patients who require palliative care, there is the need to investigate whether medical students are being adequately prepared to care for these patients and assess their knowledge level in this context. CONCLUSION: Fifth-year medical students know what palliative care is and consider it important. However, they do not feel adequately trained and ready to take care of patients who need palliative care. It is essential to reflect on how physicians should be trained and to reconsider the medical syllabus, given the present lack of undergraduate medical training in palliative care.

Introdução: Cada vez mais doentes necessitam de cuidados paliativos. Os futuros médicos têm de estar preparados para esta realidade, pelo que é fundamental que desenvolvam competências ao longo do curso. Este estudo teve como objetivo avaliar o conhecimento sobre cuidados paliativos em estudantes de Medicina da Faculdade de Medicina da Universidade de Coimbra.Material e Métodos: Foi realizado um estudo observacional e transversal, através da aplicação de um questionário a estudantes de Medicina, do quinto ano. Os dados recolhidos foram analisados no IBM® SPSS® Statistics, versão 20 para Windows®.Resultados: Todos os 186 estudantes inquiridos mostraram saber o que são cuidados paliativos e reconheceram a sua importância. Do total, 52,7% afirmaram saber o que é um cuidador informal e 96,8% discordaram que a prestação de cuidados paliativos apenas acontece em fim de vida; 88,2% não receberam formação para lidar com doentes terminais ou dependentes de cuidados permanentes. Somente 57,5% dizem ter recebido formação para comunicar 'más notícias', mas 70,4% assumiram que não eram capazes de o fazer. Por outro lado, 89,8% revelaram não se sentir capacitados para cuidarem de doentes em cuidados paliativos e 98,4% manifestaram necessidade de mais formação nesta área.Discussão: Com o número crescente de doentes a precisar de cuidados paliativos surge a necessidade de investigar se os estudantes de medicina estão a ser adequadamente preparados para cuidarem destes doentes e avaliar o seu grau de conhecimento no âmbito dos cuidados paliativos.Conclusão: Os estudantes do quinto ano de Medicina sabem o que são cuidados paliativos e consideram-nos importantes. No entanto, não se sentem adequadamente preparados para cuidarem de doentes que precisam destes cuidados. É essencial refletir sobre como deverão ser formados os médicos e ponderar o plano de estudos do ensino médico, dada a falta de formação dos estudantes de medicina em cuidados paliativos.

Multimorbidity and consultation time: a systematic review.

BACKGROUND: Multimorbidity (MM) is one of the major challenges health systems currently face. Management of time length of a medical consultation with a patient with MM is a matter of concern for doctors. METHODS: A systematic review was performed to describe the impact of MM on the average time of a medical consultation considering the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. The systematic online searches of the Embase and PubMed databases were undertaken, from January 2000 to August 2018. The studies were independently screened by two reviewers to decide which ones met the inclusion criteria. (Kappa = 0.84 and Kappa = 0.82). Differing opinions were solved by a third person. This systematic review included people with MM criteria as participants (two or more chronic conditions in the same individual). The type of outcome included was explicitly defined - the length of medical appointments with patients with MM. Any strategies aiming to analyse the impact of MM on the average consultation time were considered. The length of time of medical appointment for patients without MM was the comparator criteria. Experimental and observational studies were included. RESULTS: Of 85 articles identified, only 1 observational study was included, showing a clear trend for patients with MM to have longer consultations than patients without MM criteria (p < 0.001). CONCLUSIONS: More studies are required to better assess allocation length-time for patients with MM and to measure other characteristics like doctors' workload.

[Perfectionism, Burnout and Extracurricular Activities Among Medical Students from the University of Coimbra]. / Perfeccionismo, Burnout e as Atividades Extracurriculares nos Estudantes de Medicina da Universidade de Coimbra.

INTRODUCTION: The participation in extracurricular activities reduces the attributed importance to some causes of perfectionism, which influences the prevalence of burnout in medical students. This study aimed to investigate how this relationship occurs and which factors it is dependent on, in order to create strategies directed at these potential targets. MATERIAL AND METHODS: We developed a questionnaire that assesses the participation in extracurricular activities, including a survey regarding the reasons for perfectionism and part of the Copenhagen Burnout Inventory adapted for students. The questionnaire's application to medical students of the Masters Degree in Medicine of the Faculty of Medicine, University of Coimbra was followed by statistical analysis. RESULTS: In a sample of 360 students, 40% ranked highly in personal burnout, and 28.1% in study-related burnout, while 22.2% showed high levels of burnout in both components. Students who participated in extracurricular activities were less frequently associated with simultaneous personal-related and study-related high levels of burnout (p = 0.013). The kind of chosen extracurricular activity was not associated with the prevalence of burnout. DISCUSSION: Only 53.9% of students participate in extracurricular activities. Such participation is associated with a lower prevalence of burnout if it is practiced several times per week. The choice of one kind of activity over another does not seem to influence the prevalence of this syndrome, all of which are associated with benefits in different domains. CONCLUSION: We observed a lower prevalence of burnout among students that engaged in extracurricular activities. Further studiesthat can infer causality in this relationship are needed, in order to establish effective solutions specific to the medical course context.

Introdução: A participação em atividades extracurriculares reduz a importância atribuída a alguns motivos para o perfeccionismo que influenciam a prevalência de burnout nos estudantes de medicina. Este estudo visou investigar de que forma esta relação se processa e de que fatores depende, de forma a pensar estratégias direcionadas a estes potenciais alvos de atuação.Material e Métodos: Elaborou-se um questionário capaz de avaliar a prática de atividades extracurriculares que incluiu um inquérito dos motivos para o perfeccionismo e parte do Copenhagen Burnout Inventory adapted for students. À sua aplicação, via online, aos estudantes do Mestrado Integrado em Medicina da Faculdade de Medicina da Universidade de Coimbra, seguiu-se a análise estatística e inferencial dos dados obtidos.Resultados: Numa amostra de 360 alunos, 40% pontuaram elevados níveis de burnout pessoal e 28,1% de burnout relacionado com os estudos, tendo 22,2% obtido elevados níveis nas duas componentes. Alunos que praticavam atividades extracurriculares estiveram menos frequentemente associados a altos valores de burnout pessoal e relacionado com os estudos, simultaneamente (p = 0,013). O tipo de atividade extracurricular escolhido não mostrou relação com a prevalência de burnout.Discussão: Apenas 53,9% dos alunos participam numa atividade extracurricular, fator associado a uma menor prevalência de burnout, especialmente nos alunos que a realizam várias vezes por semana. A escolha de um tipo de atividade em detrimento de outro não parece influenciar a prevalência desta síndrome, estando todos associados a benefícios em diferentes domínios.Conclusão: Verificou-se menor prevalência de burnout em estudantes que praticavam atividades extracurriculares. Será necessária a realização de estudos que nesta relação permitam inferir causalidade, de forma a formular soluções efetivas e específicas do contexto do curso médico.