Predictors of physical activity promotion in clinical practice: a cross-sectional study among medical doctors.

BACKGROUND: Physical activity is a major determinant of physical and mental health. International recommendations identify health professionals as pivotal agents to tackle physical inactivity. This study sought to characterize medical doctors' clinical practices concerning the promotion of patients' physical activity, while also exploring potential predictors of the frequency and content of these practices, including doctors' physical activity level and sedentary behaviours. METHODS: A cross-sectional study assessed physical activity promotion in clinical practice with a self-report questionnaire delivered through the national medical prescription software (naturalistic survey). Physical activity and sedentary behaviours were estimated using the International Physical Activity Questionnaire (short form). Indicators of medical doctors' attitudes, knowledge, confidence, barriers, and previous training concerning physical activity promotion targeting their patients were also assessed. Multiple regression analysis was performed to identify predictors of physical activity promotion frequency by medical doctors, including sociodemographic, attitudes and knowledge-related variables, and physical activity behaviours as independent variables. RESULTS: A total of 961 medical doctors working in the Portuguese National Health System participated (59% women, mean age 44 ± 13 years) in the study. The majority of the participants (84.6%) reported to frequently promote patients' physical activity. Five predictors of physical activity promotion frequency emerged from the multiple regression analysis, explaining 17.4% of the dependent variable (p < 0.001): working in primary healthcare settings (p = 0.037), having a medical specialty (p = 0.030), attributing a high degree of relevance to patients' physical activity promotion in healthcare settings (p < 0.001), being approached by patients to address physical activity (p < 0.001), and having higher levels of physical activity (p = 0.001). CONCLUSIONS: The sample of medical doctors approached reported a high level of engagement with physical activity promotion. Physical activity promotion frequency seems to be influenced by the clinical practice setting, medical career position and specialty, attitudes towards physical activity, and perception of patients´ interest on the topic, as well as medical doctors' own physical activity levels.

[Efficacy of the Vaccines Against Human Papillomavirus in Women Older than 24 Years in the Cervix Cancer Prevention]. / Eficácia das Vacinas Contra o Vírus do Papiloma Humano nas Mulheres com mais de 24 Anos na Prevenção do Cancro do Colo do Útero.

INTRODUCTION: Cervix cancer is the fourth most common female cancer and the second most frequent in women aged 15 to 44 years. The infection by the human papillomavirus is a necessary condition in almost all of cervix cancer cases; it is a sexually transmitted disease and all women sexually active are at risk of being infected. There are currently three vaccines against human papillomavirus, and despite of the efficacy being well proven in woman aged up to 25 years, it is not well established in older ages. MATERIAL AND METHODS: It was performed a literature review of the current evidence about the efficacy of the vaccines against human papillomavirus in women older than 24 years in the cervix cancer prevention, and was assessed the evidence quality by the GRADE system. RESULTS: Two randomized controlled trials were identified with a total of 9,571 participants - 4,792 vaccinated and 4,779 at the control group and reported data of 48 months period follow-up. The relative risk reduction was 41% (95% CI: 29 a 50%) - for the vaccinated group. There were no differences in safety and tolerability between the two groups - vaccine and control. CONCLUSION: The actual evidence shows that the vaccines against human papillomavirus 16 and/or 18 in women older than 24 until 45 years have an important efficacy at reducing the risk of having persistent infection and/or to acquire cervix cancer precursor lesions.

Introdução: O cancro do colo do útero é o quarto tipo de cancro feminino mais comum e o segundo mais frequente nas mulheres entre os 15 e os 44 anos. A infeção pelo vírus do papiloma humano é condição necessária na quase totalidade dos casos de cancro do colo do útero; trata-se de uma doença sexualmente transmissível e todas as mulheres sexualmente ativas estão em risco de contrair infeção. Atualmente existem três vacinas contra o vírus do papiloma humano, e apesar da sua eficácia estar bem comprovada nas mulheres até aos 25 anos, não está totalmente estabelecida em idades superiores.Material e Métodos: Realizou-se uma revisão da literatura sobre a evidência atual relativa à eficácia das vacinas contra o vírus do papiloma humano nas mulheres com mais de 24 anos na prevenção do cancro do colo do útero e foi avaliada a qualidade da evidência segundo o sistema GRADE.Resultados: Foram identificados dois estudos controlados randomizados relevantes para a análise que envolveram um total de 9 571 participantes ­ 4 792 no grupo vacinado e 4 779 no grupo controlo ­ e reportaram dados relativos a 48 meses de follow-up. A redução do risco relativo foi de 41% (95% CI: 29 a 50%), ­ favorável para o grupo vacinado. Não existiram diferenças entre a segurança e tolerabilidade das vacinas nos grupos vacina e controlo.Conclusão: A evidência atual demonstra que as vacinas contra o vírus do papiloma humano 16 e/ou 18 nas mulheres com mais de 24 e até aos 45 anos apresentam uma eficácia importante na redução do risco de desenvolver infeção persistente e/ou adquirir lesões precursoras de cancro do colo do útero.