FM-IMPSP-Artigos em Revistas Nacionais
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- Respiratory syncytial virus vaccination in older adults and patients with chronic disorders: a position paper from the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal MedicinePublication . Alfaro, Tiago; Froes, Filipe; Vicente, Cláudia; Costa, Rui; Gavina, Cristina; Baptista, Rui; Maio, António; da Cunha, Saraiva; Neves, João Sérgio; Leuschner, Pedro; Duque, Sofia; Pinto, PaulaBackground: Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection, hospitalisation and death in adults. Methods: Based on evidence regarding the impact of RSV on adult populations at risk for severe infection and the efficacy and safety of RSV vaccines, the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine endorses this position paper with recommendations to prevent RSV-associated disease and its complications in adults through vaccination. Conclusion: The RSV vaccine is recommended for people aged ≥50 years with risk factors (chronic obstructive pulmonary disease, asthma, heart failure, coronary artery disease, diabetes, chronic kidney disease, chronic liver disease, immunocompromise, frailty, dementia, and residence in a nursing home) and all persons aged ≥60 years. If it cannot be made available to this population, then the vaccine should be prioritised for individuals aged ≥75 years and those aged ≥50 years with risk factors. The vaccine should preferably be given between September and November and can be co-administered with the influenza vaccine. Ongoing studies on RSV vaccines may justify extending these recommendations in the future.
- Aerobic fitness questionnaires: still not enough to estimate VO2 peak in cardiac patients!Publication . Abreu, AnaThe present study by Lima et al. “Validation of an Aerobic Fitness Questionnaire to estimate VO2 peak in a cohort of adult cardiac patients – Is it enough?”, intends to validate the CLINIMEX Aerobic Fitness Questionnaire (C-AFQ),3 comprising a list of activities, in a Portuguese population sample of 124 CV patients (93% male, mean age 61 years old, 61% with heart failure), who were referred for CPET and cardiac rehabilitation. In this prospective study, which enrolled exclusively CV patients (mainly male), C-AFQ was not sufficiently accurate to predict functional capacity measured by VO2 peak. Despite a numerically strong and positive correlation between measured and estimated, by C-AFQ, VO2 peak (r=0.723, p<0.001), high levels of disagreement in the Bland–Altman plot analysis were observed.
- 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.
- Cardiopulmonary exercise testing in clinical practice: principles, applications, and basic interpretationPublication . Dores, Hélder; Mendes, Miguel; Abreu, Ana; Durazzo, Anaí; Rodrigues, Cidália; Vilela, Eduardo; Cunha, Gonçalo; Gomes Pereira, José; Bento, Luísa; Moreno, Luís; Dinis, Paulo; Amorim, Sandra; Clemente, Susana; Santos, MárioCardiopulmonary exercise testing (CPET) provides a noninvasive and integrated assessment of the response of the respiratory, cardiovascular, and musculoskeletal systems to exercise. This information improves the diagnosis, risk stratification, and therapeutic management of several clinical conditions. Additionally, CPET is the gold standard test for cardiorespiratory fitness quantification and exercise prescription, both in patients with cardiopulmonary disease undergoing cardiac or pulmonary rehabilitation programs and in healthy individuals, such as high-level athletes. In this setting, the relevance of practical knowledge about this exam is useful and of interest to several medical specialties other than cardiology. However, despite its multiple established advantages, CPET remains underused. This article aims to increase awareness of the value of CPET in clinical practice and to inform clinicians about its main indications, applications, and basic interpretation.
- Respiratory syncytial virus vaccination in older adults and patients with chronic disorders: a position paper from the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal MedicinePublication . Alfaro, Tiago; Froes, Filipe; Vicente, Cláudia; Costa, Rui; Gavina, Cristina; Baptista, Rui; Maio, António; da Cunha, Saraiva; Neves, João Sérgio; Leuschner, Pedro; Duque, Sofia; Pinto, PaulaBackground: Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection, hospitalisation and death in adults. Methods: Based on evidence regarding the impact of RSV on adult populations at risk for severe infection and the efficacy and safety of RSV vaccines, the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine endorses this position paper with recommendations to prevent RSV-associated disease and its complications in adults through vaccination. Conclusion: The RSV vaccine is recommended for people aged ≥50 years with risk factors (chronic obstructive pulmonary disease, asthma, heart failure, coronary artery disease, diabetes, chronic kidney disease, chronic liver disease, immunocompromise, frailty, dementia, and residence in a nursing home) and all persons aged ≥60 years. If it cannot be made available to this population, then the vaccine should be prioritised for individuals aged ≥75 years and those aged ≥50 years with risk factors. The vaccine should preferably be given between September and November and can be co-administered with the influenza vaccine. Ongoing studies on RSV vaccines may justify extending these recommendations in the future.
- Is the cardiovascular risk SCORE2 globally valid and useful?Publication . Abreu, AnaAtherosclerotic cardiovascular (CV) disease (ASCVD) is known to be a major cause of mortality and morbidity worldwide. There have been many advances in treatment over the years, including invasive percutaneous coronary intervention, and in secondary prevention with widespread use of statins, other lipid-lowering agents and new antiplatelet agents, impacting on prognosis. However, in the population not diagnosed with CV disease (CVD), a major issue remains in practice: how to assess CV risk, which could enable primary prevention of ASCVD, acting upstream. Most CV events can be prevented by control of behavioral risk factors, such as unhealthy diet, smoking, obesity, physical inactivity, and excessive alcohol consumption.
- Effectiveness of neuropsychological rehabilitation in the recovery of executive deficits in patients with alcohol use disorder: a systematic review protocolPublication . Ferreira, Sónia; Virgolino, Ana; Ribeiro, Cristina; Pombo, Samuel; Bacelar-Nicolau, LeonorIntroduction: Changes in executive functions associated with alcohol consumption are frequently found in alcohol use disorder. Neuropsychological rehabilitation can play an essential role as an effective treatment in the recovery from these deficits, leading to the maintenance of abstinence. However, there are still some uncertainties regarding its impact on the recovery of deficits in executive functions. Our purpose is to present a protocol for a systematic review aiming to assess which neuropsychological rehabilitation programs are effective in the recovery of executive deficits in patients with alcohol use disorder. Methods: We will search the following databases: PubMed, Cochrane Library (CENTRAL), Web of Science, and Scopus, as well as the list of references of the identified studies. Screening, data extraction, and synthesis, as well as evaluation of the risk of bias, will be carried out by two reviewers independently, using ROBINS-I and RoB 2. Disagreements will be resolved using a third additional reviewer. Primary outcomes will correspond to changes in executive functions, following a neuropsychological rehabilitation program in patients with alcohol use disorder. The evidence will be synthesized using a narrative description of neuropsychological rehabilitation programs and the indicators of their effectiveness will be identified. The neuropsychological rehabilitation programs for executive functions will be assessed considering their different components and their impact on the recovery of these functions. The review described in this protocol will allow the development of guidelines for the design of more effective rehabilitation programs for clinical populations with alcohol use disorder.
- 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.
- Beyond usual geographical scales of analysis: implications for healthcare management and urban planningPublication . Morais, Liliane; Lopes, António; Rocha, Jorge; Nogueira, Paulo JorgeIntroduction: In the context of climate emergency, advances in geographic information systems, geocoding, and geomedicine allow us to go beyond the conventional usual scales and be aligned with people’s needs, improving knowledge and accuracy of the spatial pattern of health outcomes. This study shows that the geographical scale of analysis affects the interpretation of health outcomes. Methods: All mortality that occurred in Portugal in 2014–2017 was geocoded. From 435,291 addresses, 412,608 were geocoded with success. As an example, we use the spatial patterns of the elderly’s heat-related cardiorespiratory mortality. Results: It is shown: (i) it is possible to have high quality and accuracy of spatial data used in health outcomes analysis; (ii) how geographic scales reveal different degrees of detail in health outcomes analysis; (iii) the neighbourhood scale revealed different patterns of cardiorespiratory mortality from the usually available scale (parish). Discussion: Our findings suggest the relevance of geocoding health outcomes with a finer scale in tackling the challenges of the healthcare sector, and in support of planning decision-making, closely matching citizens’ needs. Without running the risk of losing potentially major prospects, better healthcare management is achievable, with optimal resource allocation, and improved detailed and informed policymaking, allowing enhanced climate health equity in cities promotion.
- Remote versus in-office monitoring for implantable cardioverter defibrillators: results from a randomized pragmatic controlled study in PortugalPublication . Oliveira, Mário; Fernandes, Milene; Reis, Hipólito; Primo, João; Sanfins, Victor; Silva, Vânia; Cunha, Pedro Silva; Silva, Mónica; Nicola, Paulo Jorge Morais ZamithIntroduction: Remote monitoring (RM) is a safe and effective alternative to in-office conventional follow-up. Objective: We aimed to evaluate patient satisfaction with RM and its impact on healthcare resources in a population with cardiac implantable electronic devices. Methods: Randomized, pragmatic, open-label controlled trial, with adult wearers of implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with ICD (CRT-D), eligible for the CareLink® system. Patients newly implanted or with previous conventional follow-up were randomized to RM or conventional follow-up (control), and followed for 12 months, according to the centers' practice. The number of in-office visits and adverse events were compared between groups. Patient and healthcare professionals' satisfaction with RM were described. Results: Of the 134 randomized patients (69 RM; 65 control, aged 60±13 years), 80% were male, 23% employed, 72% ICD wearers and 54% newly implanted. Most patients (70%) reported travel costs less than 15€/visit, and 46% daily routine interference with in-office visits. Median physician/technician time with patient was 15 min/15 min, per in-office visit. Excluding baseline and final visits, control patients had more in-office visits in total: median 1 vs. 0, p<0.001. In 81% of the in-office visits, no clinical measures were taken. There were 10 adverse events, with no differences between groups. At the final visit, 95% of RM patients considered RM easy/very easy to use, and would all prefer to maintain RM and recommend it to others. All professionals found the CareLink website easy/very easy to use and were satisfied with transmission data. Conclusions: In a Portuguese population with ICD and CRT-D, RM safely reduced the burden of in-office visits, with high levels of satisfaction among patients and healthcare professionals.