Browsing by Author "Nicola, Paulo"
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- Determinants associated with uncontrolled asthma in Portugal: a national population-based studyPublication . Camarinha, Catarina; Fernandes, Milene; Alarcão, Violeta; Franco, João; Manaças, M. E.; Bárbara, Cristina; Nicola, PauloIntroduction and objectives: Asthma is a chronic and heterogeneous disease that affects people of all ages and has a high estimated increase in prevalence worldwide. Asthma control represents a main goal in the disease management. International studies revealed low levels of disease control resulting in a significant burden for healthcare systems, not only in terms of quality of life, but also in terms of health costs. Modifiable and non-modifiable factors have been identified as relating to poor asthma control level. In this study we evaluated the distribution of asthma control levels in Portuguese adult population and examine the determinants associated with uncontrolled asthma. Materials and methods: Using a similar methodology to the one employed in the Asthma Insights and Reality in Europe (AIRE) survey, 327 active asthmatic patients were identified by random phone number and completed a questionnaire during 2011 to 2012. Asthma control was assessed by the evaluation of GINA based symptom control, by Asthma Control Test.äó (ACT) and by self-perception of control. To examine the relationship between uncontrolled asthma and its determinants, univariate logistic regression analysis, sequential multivariable regression and population attributable risk percentage were determinate. Results: 35.2% active asthmatic patients had uncontrolled asthma, 64.8% partially controlled and none of the individuals had total control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01.Çô1.03), female sex (OR 1.87; 95% CI: 1.15.Çô3.04), educational level (OR 0.5; 95% CI: 0.28.Çô0.89 at high school level or over), occupation (OR 4.92; 95% CI: 2.12.Çô11.42 if looking for a first job or unemployed) (OR 2.51; 95% CI: 1.35.Çô4.65 if being retired), income (OR 0.23; 95% CI: 0.07.Çô0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03.Çô1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56.Çô7.58) and using inhaled corticosteroids (OR 0.44; 95%CI: 0.24.Çô0.82 if used in the past or never used). Looking for a first job or being unemployed, BMI and having rhinitis symptoms remained significant after multivariate adjustments. Conclusions: Uncontrolled asthma was associated with several determinants. Their identification can contribute to improve asthma care both from clinical and from public health perspectives.
- Intervenção PRAdA : efeitos no peso induzidos por proposta de alteração de comportamento alimentar em hipertensos medicados nativos portugueses e imigrantes de origem africanaPublication . Peixoto, Catarina; Carrilho, Gisela; Alarcão, Violeta; Guerra, Filipa; Simões, Rui; Fernandes, Milene; Nicola, Paulo; Guiomar, Sofia; Nogueira, Paulo; Rocha, EvangelistaIntroduction: Blood pressure is significantly improved with weight loss. Behavioral interventions for weight loss seem to be less successful in African immigrants. Our main aims were to assess the effect of a dietary and lifestyle intervention on weight among hypertensive Portuguese natives and immigrants and to identify success factors for weight loss, and also to evaluate changes in knowledge and compliance with food recommendations. Material and Methods: Hypertensive medicated patients followed in primary care setting were randomly enrolled in a two phase study, observational (15-months) and behavioral intervention (six months). Participants were divided in two groups: immigrants from African Countries of Portuguese Official Language and Portuguese natives. Participants were given dietary and life styles recommendations in individual face-to-face and telephone sessions. Results: Of 110 participants with a mean BMI of 31.6 ± 3.7 Kg/m2, 60 were immigrants. The number of dietary recommendations known and followed at the end was significantly greater than at baseline; however natives performed a greater number of recommendations. Weight loss during intervention was in average 1.4 ± 2.7% in natives and 0.8 ± 3.6% in immigrants and was greater than in the observational period. Being male and consuming more than 2 servings of low-fat dairy products/day was associated with higher weight loss, independently of age and ethnicity. Discussion: In general the proposed intervention was efficacious especially in Portuguese natives, confirming other studies. Conclusion: The intervention increased knowledge and adherence to recommendations, highlighting the relevance of nutrition education, culturally adapted in primary care.
- Monitorização à distância versus seguimento convencional presencial em portadores de dispositivos cardíacos implantados : racional e desenho do estudo PORTLink (PORTuguese Research on Telemonitoring with CareLink)Publication . Oliveira, Mário; Fernandes, Milene; Primo, João; Reis, Hipólito; Nicola, PauloWith expanding indications for cardiac implantable electronic devices (CIEDs) capable of treating bradycardias, complex cardiac tachyarrhythmias and heart failure, the number of patients requiring regular long-term specialized care is growing rapidly. Currently, routine face-to-face follow-up consultations for patients with CIEDs are a significant burden on hospital services. Remote telemonitoring appears to offer a safe and effective alternative to conventional follow-up in this area. The Medtronic CareLink Network enables remote monitoring of CIED patients, and thus has the potential to improve the efficiency of medical care in this population. The objective of the PORTLink (PORTuguese Research on Telemonitoring with CareLink) multicenter randomized trial is to assess the safety, efficacy and costs of remote CIED monitoring compared to traditional face-to-face follow-up. It will evaluate aspects such as physicians’ and patients’ acceptance of and satisfaction with reviewing device data via the website, the complexity for troubleshooting calls to the support center, the use of emergency resources by symptomatic patients, the incidence of unscheduled consultations after remote interrogations, levels of anxiety, depression and quality of life, and the main resources used by the CareLink system. Approximately 200 patients will be randomized in up to five centers, with clinical follow-up of 12 months. Enrollment began in 2012 and is expected to be completed in early 2014.
- On evaluating health centers groups in Lisbon and Tagus Valley : efficiency, equity and qualityPublication . Ferreira, Cláudia; Marques, Rui C.; Nicola, PauloBackground: Bearing in mind the increasing health expenses and their weight in the Portuguese gross domestic product, it is of the utmost importance to evaluate the performance of Primary Health Care providers taking into account both efficiency, quality and equity. This paper aims to contribute to a better understanding of the performance of Primary Health Care by measuring it in a Portuguese region (Lisbon and Tagus Valley) and identifying best practices. It also intends to evaluate the quality and equity provided. Methods: For the purpose of measuring the efficiency of the health care centers (ACES) the non-parametric full frontier technique of data envelopment analysis (DEA) was adopted. The recent partial frontier method of order-m was also used to estimate the influence of exogenous variables on the efficiency of the ACES. The horizontal equity was investigated by applying the non-parametric Kruskal-Wallis test with multiple comparisons. Moreover, the quality of service was analyzed by using the ratio between the complaints and the total activity of the ACES. Results: On the whole, a significant level of inefficiency was observed, although there was a general improvement in efficiency between 2009 and 2010. It was found that nursing was the service with the lowest scores. Concerning the horizontal equity, the analysis showed that there is no evidence of relevant disparities between the different subregions(NUTS III). Concerning the exogenous variables, the purchasing power, the percentage of patients aged 65 years old or older and the population size affect the efficiency negatively. Conclusions: This research shows that better usage of the available resources and the creation of a learning network and dissemination of best practices will contribute to improvements in the efficiency of the ACES while maintaining or even improving quality and equity. It was also proved that the market structure does matter when efficiency measurement is addressed.
- Strategies and factors to promote research in primary care in Portugal: a cross-sectional studyPublication . Morgado, Maria Beatriz; Penedo, Carolina; Correia, Rubina; Amaral, Sandra Diniz; Nicola, Paulo; Gil Conde, MargaridaIntroduction: Research is crucial for building an efficient health system care. This reality is particularly evident in primary care, the cornerstone of healthcare services. However, research in primary care is not consistently implemented across Europe. With this study we aimed to: 1) identify the factors and strategies that healthcare professionals consider relevant for promoting research in primary care in Portugal; 2) analyze whether the prioritized strategies vary according to the geographical area, professional group, workplace, interest, and experience in research of the participants. Methods: We conducted an analytical cross-sectional study using an online survey applied in the first semester of 2023. We designed the survey based on strategies identified in a previous qualitative study. We included health professionals working in Primary Care in Portugal (continental and autonomous regions). We intended to obtain at least 200 answers for each professional category and geographical area. The survey was initially sent to a convenience sample to assess the acceptability and interpretation of the questions. We then disseminated the survey through all national Health Center Clusters and through professional associations. We conducted an analysis using a 5% significance level. Results: The sample consisted of 1027 participants: 507 doctors, 377 nurses, 106 diagnostic and therapeutic technicians, and 30 secretaries. The majority worked in the Lisbon and Tagus Valley region (51.9%), followed by the North (22.1%) and Centre (17.1%). Around half of the participants worked in a Family Health Unit, 16.5% worked in a Personalized Healthcare Unit, 11% in a Community Care Unit, and 8.7% in a Public Health Unit. The factors promoting research mentioned by a greater proportion of participants were research training (76%), access to mentors (71%) and grants (56%). As for strategies to promote research, most participants supported the existence of dedicated time for research (82%), public grants (65%), institutional support (51%), access to support services (58%) and research data (57%). Conclusion: There seems to be a consensus on which factors are currently promoting research and what future strategies might be useful for promoting research in primary care in Portugal. Nevertheless, there are some differences between certain sub-groups. This information might be useful to tailor initiatives directed at specific sub-groups. Our intention is to help form policies and strategies to promote research in primary care in Portugal, contributing to the national development on the subject.
- Strategies for research capacity building by family physicians in primary healthcare: a scoping review protocolPublication . Gil Conde, Margarida; Costa, Isabel; Silvério Serra, Sofia; Carmona Ramos, Raquel; Ribeiro, Cristina; Broeiro-Gonçalves, Paula; Penedo, Carolina Reis; Parola, Vitor; Nicola, PauloIntroduction: The qualities of primary healthcare (PHC) make it a very relevant environment for research; however, there is still work to be done to enhance the research capabilities of family physicians in healthcare units. Considering there is no ongoing review that specifically addresses this objective, the proposed goal of this scoping review is to determine the depth of the literature on the current strategies that support research capacity building among family physicians in the context of PHC. Methods and analysis: The scoping review will include studies from PubMed, Scopus, Web of Science, Cochrane Library and grey literature, published from 2008 to 2023, that address strategies to promote research capacity building among family physicians in the context of PHC. Only studies published in English, Portuguese or Spanish will be considered. All study designs, including quantitative, qualitative and mixed-methods studies, will be eligible for inclusion. The literature search will be performed from January to March of 2024 and data charting will employ a descriptive-analytical method, systematically summarising study objectives, methodologies, findings and implications. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols and the review will employ the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Ethics and dissemination: This review does not need ethical approval. Peer-reviewed publications, policy summaries, presentations at conferences and involvement with pertinent stakeholders are all part of our outreach approach.
- Tumor necrosis factor-α–308 genotypes influence inflammatory activity and TNF-α serum concentrations in children with juvenile idiopathic arthritisPublication . Mourão, Ana Filipa; Caetano-Lopes, Joana; Costa, Paula; Canhao, Helena; Santos, Maria José; Pinto, Patrícia; Brito, Iva; Nicola, Paulo; Cavaleiro, João; Teles, José; Sousa, Artur; Gomes, José Melo; Branco, Jaime; Costa, José Teixeira da; Pedro, João Gomes; Queiroz, Mário Viana de; Fonseca, João EuricoOBJECTIVE: Considering the relevance of tumor necrosis factor-α (TNF-α) in the pathophysiology of juvenile idiopathic arthritis (JIA), it is likely that polymorphisms in its promoter area may be relevant in disease susceptibility and activity. We investigated if clinical measures of JIA activity and TNF-α serum concentrations were associated with TNF-α –308 genotypes. METHODS: Portuguese patients with JIA in 5 pediatric rheumatology centers were recruited consecutively, along with a control group of healthy subjects. Demographic and clinical data and blood samples were collected from each patient. DNA was extracted for analysis of TNF-α gene promoter polymorphisms at position –308 by restriction fragment-length polymorphism. RESULTS: One hundred fourteen patients and 117 controls were evaluated; 57% of patients presented the oligoarticular subtype, 25% the polyarticular subtype, 8% the systemic subtype, and 9% had enthesitis-related arthritis and 5% psoriatic arthritis. Twenty-four percent of the patients presented the –308 GA/AA genotypes and 76% the –308 GG genotype, similar to findings in controls. Patients with the –308 GA/AA genotype had higher degree of functional impairment, erythrocyte sedimentation rate, 100-mm visual analog scale score for disease activity, and TNF-α levels compared to those with the –308 GG genotype. CONCLUSION: TNF-α –308 GA/AA genotypes were found to be related to higher inflammatory activity and worse measures of disease activity in Portuguese patients with JIA. They were not associated with susceptibility to JIA.
- Utilização de cuidados médicos associados com a tensão arterial em doentes hipertensos : uma análise longitudinal comparando nativos e imigrantes africanosPublication . Pinheiro, Bernardete; Fernandes, Milene; Alarcão, Violeta; Nicola, Paulo; Antunes, Marília; Rocha, EvangelistaIntroduction: Ethnic and cultural diversity in Portugal has reinforced the importance of adjusting healthcare services to the health needs of different populations. This study aims to analyse longitudinally the factors associated with health care use by native Portuguese and African hypersive patients. Methods: Longitudinal study including treated hypertensive patients followed-up in primary care in the Lisbon region, between September 2010 and March 2012. For this analysis, 233 native Caucasians and 170 African immigrants were included.We applied three face-to-face questionnaires (0, 6 and 12 months) and two by telephone (3 and 9 months). The measure of service use was the number of encounters due to hypertension, in the three months preceding the interview. For the identification of the factors, a longitudinal generalised linear mixed model was estimated for each group. Results: More nativesthan immigrants consulted the GP in the last year (76.0% vs 64.7%, p=0.019), however, more immigrants used urgent health care (12.4% vs 5.2%, p=0.016).The proportion of patients with at least one medical encounter was not different between groups (46.5% vs 41.6%, p=0.387).After adjusting for all variables, the use of medical care among natives was associated with age (eβ =1.036; p=0.021), diabetes(eβ =1.898; p=0.006), hypertension control (eβ =1.036; p=0.007), uncontrolled self-assessed hypertension status (eβ =0.596; p=0.033), and follow-up time. (eβ =0.771; p=0.001). Among immigrants, the use of health services was associated with marital status (eβ =2.228; p=0.025), uncontrolled self-assessed hypertension status (eβ =0.580; p=0.013), time since diagnosis of hypertension (eβ =1.021; p=0.016) and follow-up time (eβ =0.689; p<0.001). Conclusions: There is a need to better understand the differences in the factors associated with the use of hypertension-related health care among natives and immigrants, in order to develop health promotion strategies adapted to target populations.
- Valuing health states : is the MACBETH approach useful for valuing EQ-5D-3L health states?Publication . Oliveira, Mónica Duarte; Agostinho, Andreia; Ferreira, Lara; Nicola, Paulo; Bana e Costa, CarlosBackground: Quality Adjusted Life Years (QALYs) are a key outcome measure widely used within health technology assessment and health service research studies. QALYs combine quantity and quality of life, with quality of life calculations relying on the value of distinct health states. Such health states’ values capture the preferences of a population and have been typically built through numerical elicitation methods. Evidence points to these value scores being influenced by methods in use and individuals reporting cognitive difficulties in eliciting their preferences. Evidence from other areas has further suggested that individuals may prefer using distinct elicitation techniques and that this preference can be influenced by their numeracy. In this study we explore the use of the MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) non-numerical preference elicitation approach for health states’ evaluation. Methods: A new protocol for preference elicitation based on MACBETH (only requiring qualitative judgments) was developed and tested within a web survey format. A sample of the Portuguese general population (n=243) valued 25 EQ-5D-3L health states with the MACBETH protocol and with a variant of the time trade-off (TTO) protocol, for comparison purposes and for understanding respondents’ preference for distinct protocols and differences in inconsistent evaluations. Respondents answered to a short numeracy test, and basic socio-economic information collected. Results: Results show that the mean values derived from MACBETH and the TTO variant are strongly correlated; however, there are substantial differences for several health states’ values. Large and similar numbers of logical inconsistencies were found in respondents’ answers with both methods. Participants with higher levels of numeracy according to the test preferred expressing value judgments with MACBETH, while participants with lower levels were mostly indifferent to both methods. Higher correlations between MACBETH and TTO variant evaluations were observed for individuals with higher numeracy. Conclusion: Results suggest that it is worth researching the use of non-numerical preference elicitation methods. Numeracy tests more appropriate for preference elicitation when no explicit considerations of uncertainty are made need to be explored and used. Further behavioural research is needed to fully understand the potential for using these methods in distinct settings (e.g. in different evaluation contexts and in face-to-face and non-face-to-face environments), as well as to explore the effect of literacy on assessments and on respondents’ preferences.