[Attitudes, Knowledge and Views of Portuguese Physicians regarding Complementary and Alternative Medicine: A Cross-sectional Study]. / Atitudes, Conhecimentos e Perspetivas dos Médicos Portugueses acerca das Terapêuticas Não Convencionais: Um Estudo Transversal.

INTRODUCTION: The widespread use of complementary and alternative medicine and the fact that these are not innocuous makes it important for physicians to be familiar with it in order to properly advise their patients. The aim of this study was to identify attitudes, knowledge and views of Portuguese physicians about complementary and alternative medicine. MATERIAL AND METHODS: An observational, analytical, cross-sectional study was performed. A questionnaire with dichotomous and multiple-choice answers on a 5-point Likert scale, was sent to all doctors registered in the Portuguese Medical Association. It included beliefs and convictions regarding complementary and alternative medicine; aspects related to the types of complementary and alternative medicine legally approved in Portugal; sources used to obtain information about complementary and alternative medicine; and questions about complementary and alternative medicine in the Portuguese context. The statistical analysis of the data was made using SPSS v.27.0 and all conclusions were taken at a significance level of 5%. RESULTS: From a total sample of 4334 doctors that fully completed the questionnaire, 45.5% reported not feeling comfortable talking, debating, and elucidating their patients about complementary and alternative medicine. The majority, 68.6%, considered that the competence in medical acupuncture of the Portuguese Medical Association should remain available. However, 72.4% believe that complementary and alternative medicine should not be included in the National Health Service. CONCLUSION: Portuguese doctors seem to have a low level of knowledge about complementary and alternative medicine, and a relevantpart of them does not feel prepared to advise their patients about it.

Introdução: A utilização significativa das terapêuticas não convencionais, e o facto de estas não serem inócuas, torna imperativo que os médicos as conheçam, de forma a melhor aconselharem os seus doentes. Este estudo visou identificar as atitudes, conhecimentos e perspetivas dos médicos portugueses relativamente às terapêuticas não convencionais.Material e Métodos: Realizou-se um estudo observacional, analítico e transversal. Os médicos inscritos na Ordem dos Médicos portuguesa responderam a um questionário com respostas em escala de Likert de cinco pontos, dicotómicas e de escolha múltipla. As respostas às questões sobre crenças/convicções a respeito das terapêuticas não convencionais; aspetos relacionados com as terapêuticas não convencionais aprovadas pela Lei portuguesa; fontes usadas para obtenção de informação relativamente às terapêuticas não convencionais; e perguntas sobre as terapêuticas não convencionais no contexto nacional, foram analisadas com recurso ao SPSS v.27.0. Todas as conclusões foram tomadas ao nível de significância de 5%.Resultados: Dos 4334 médicos que responderam na íntegra ao questionário, 45,5% não se sentem confortáveis para conversar, argumentar e esclarecer os doentes a respeito das terapêuticas não convencionais. A maioria, 68,6%, considera que a competência em acupuntura da Ordem dos Médicos deveria permanecer disponível. No entanto, 72,4% dos médicos consideram que as terapêuticas não convencionais não deveriam ser incluídas no Serviço Nacional de Saúde.Conclusão: Os conhecimentos dos médicos portugueses relativamente às terapêuticas não convencionais parecem ser reduzidos, sendo que parte relevante dos inquiridos não se considera preparada para aconselhar os seus doentes.

[Patients' access to their medical records]. / Acesso dos pacientes aos seus processos clínicos.

Until recently, the medical record was seen exclusively as being the property of health institutions and doctors. Its great technical and scientific components, as well as the personal characteristics attributed by each doctor, have been the reasons appointed for that control. However, nowadays throughout the world that paradigm has been changing. In Portugal, since 2007 patients are allowed full and direct access to their medical records. Nevertheless, the Deontological Code of the Portuguese Medical Association (2009) explicitly states that patients' access to their medical records should have a doctor as intermediary and that the records are each physician's intellectual property. Furthermore, several doctors and health institutions, receiving requests from patients to access their medical records, end up requesting the legal opinion of the Commission for access to administrative documents. Each and every time, that opinion goes in line with the notion of full and direct patient access. Sharing medical records with patients seems crucial and inevitable in the current patient-centred care model, having the potential to improve patient empowerment, health literacy, autonomy, self-efficacy and satisfaction with care. With the recent technological developments and the fast dissemination of Personal Health Records, it is foreseeable that a growing number of patients will want to access their medical records. Therefore, promoting awareness on this topic is essential, in order to allow an informed debate between all the stakeholders.

Até muito recentemente, o processo clínico era visto exclusivamente como propriedade das instituições de saúde ou dos médicos que o elaboravam. A sua grande componente técnica e científica, bem como com o forte cunho pessoal por parte do médico, têm sido as razões invocadas para esse controlo. Atualmente, um pouco por todo o mundo, assiste-se a uma mudança neste campo. Em Portugal, desde 2007 que os pacientes podem aceder diretamente à totalidade dos seus processos clínicos. No entanto, o Código Deontológicoda Ordem dos Médicos (2009) defende que o acesso dos pacientes aos seus processos clínicos deverá ser feito através de um médico e que este último é o detentor da propriedade intelectual dos registos que elabora. Além disso, muitos médicos e instituições de saúde confrontados com os pedidos de acesso dos pacientes aos seus processos clínicos acabam por solicitar o parecer da Comissão de Acesso aos Documentos Administrativos. Esse parecer vai, invariavelmente, no sentido do acesso total e direto. A partilha dos processos clínicos com os pacientes parece fulcral e inevitável num modelo de medicina centrada na pessoa, tendo o potencial de melhorar a capacitação, a literacia em saúde, a autonomia, a autoeficácia e a satisfação dos pacientes. Com os progressivos avançostecnológicos e a crescente disseminação dos Sistemas Personalizados de Informação de Saúde, é previsível que cada vez mais pacientes desejem aceder aos seus processos clínicos. Assim, a consciencialização sobre esta matéria é essencial, por forma a que seja possível promover o debate informado entre as várias partes envolvidas.

Correlating Chlamydia trachomatis infectious load with urogenital ecological success and disease pathogenesis.

The association of infectious burden of Chlamydia trachomatis with patient characteristics and clinical disease may have implications for understanding disease pathogenesis. We examined chlamydial load from 171 urine samples where load was based on copy number of organisms per copy number of eukaryotic cells derived by real-time quantitative PCR. High- (E, F, G) and low-prevalence (Ia, H, J, Ja) genotypes in the population had similar loads, suggesting a similar propensity for replicating in vivo, despite their differential ecological success. Symptomatic and asymptomatic patients also had similar chlamydial loads, indicating that virulence differences are likely not associated with variations in replication. There was a significant difference in genotypes by age for F (<31 years; P = 0.031) and for H where the mean age was lower than for the most prevalent genotype, E (P=0.013). Also, men had a significantly lower load than women when the genotype was F (P=0.042), although there was no significant difference in load between partners. Patients with recurrent chlamydial infections had a significant reduction in load with each subsequent episode regardless of genotype (P=0.007), suggesting that immune defenses do not block chlamydial entry but may impact replication. Additionally, the probability of being infected with J was 7.7-fold higher in patients with prior chlamydial infections (P=0.016), and although the loads were lower when compared with patients without prior infection, the results did not reach statistical significance. These findings suggest that chlamydial burden could be an important marker for recurrence and host immune response, which would facilitate pathogenesis research.

Genital infection by Chlamydia trachomatis in Lisbon: prevalence and risk markers.

BACKGROUND: There is little information about the prevalence and risk markers for Chlamydia trachomatis infections in Portugal. OBJECTIVES: Our aim was to assess the prevalence of C. trachomatis genital infection and to study variables associated with this infection in a group of sexually active women aged < or =30 years living in the Lisbon area and to estimate the prevalence of C. trachomatis infection among partners of infected patients. METHODS: A systematic sample of women observed in general practice family planning and teenager clinics was collected. A questionnaire was administered, followed by a pelvic examination. A first-catch urine sample was taken for polymerase chain reaction (PCR) Amplicor assay. When a sample tested positive, the woman was invited to obtain a urine sample from her partner. Socio-demograhic, behavioural and clinical variables were studied and their association with the PCR Amplicor result was assessed. RESULTS: A total of 1108 women, aged between 14 and 30 years, were studied. Fifty-one women (4.6% of total sample) tested positive for C. trachomatis. The prevalence of infection was slightly higher in patients aged < or =19 years (5.3%) than in age groups 20-25 (4.8%) and 26-30 years (3.9%). African ethnicity was related to a higher percentage of infection than European ethnicity: 9.8% versus 3.8%, P= 0.0067. Use of condoms "sometimes/never" was associated with a higher prevalence of infection: 5.2% versus 2.3% in those responding "always/almost always" (P= 0.0447). An altered cervix was associated with a higher prevalence of infection: 7.3% versus 3.7% with a normal cervix (P= 0.0106). Urine samples were obtained from 16 partners of infected patients. Six partners (37.5%) tested positive for C. trachomatis. CONCLUSIONS: A 4.6% prevalence of C. trachomatis genital infection was found. African ethnicity, using condoms "sometimes/never" and an altered cervix were associated with C. trachomatis infection, but showed low positive predictive value for C. trachomatis infection. Younger age may be associated with a slight increase in risk. Contact tracing for diagnosis and treatment remains a difficult issue to approach effectively.