ISBE - Artigos em Revistas Nacionais
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- Síndromes de fadiga pós-infeção na era da COVID longa: o caso da encefalomielite miálgica/síndrome de fadiga crónicaPublication . Sepulveda, Nuno; Malato, João; Winck, João Carlos; Carneiro, António Vaz; Hoffman, Joan Serra; Branco, JaimeFaz mais de quatro anos que a Organização Mundial da Saúde (OMS) declarou o início da pandemia de COVID-19. Agora, a doença já não é considerada uma prioridade de saúde pública em Portugal. Contudo, este período de maior acalmia tem revelado um outro problema já reconhecido pelo Serviço Nacional de Saúde (SNS) e pela comunidade médica portuguesa: alguns indivíduos continuam a manifestar vários sintomas após a aparente resolução da infeção pelo novo coronavírus. Alguns desses indivíduos parecem entrar numa fase crónica dos seus sintomas. Quando a duração dos sintomas atinge a barreira dos três meses, esses indivíduos recebem um diagnóstico de ‘COVID longa’ ou de ‘condição pós-COVID-19’. O quadro clínico desses pacientes é bastante variável, podendo prevalecer um cansaço persistente e profundo sem razão aparente e um mal-estar após atividades físicas, mentais e emocionais. Em particular, esse mal-estar pós-esforço (post-exertional malaise ou PEM) só desaparece ao fim de mais de 24 horas, o que sugere um processo lento de recuperação por parte do organismo. Os doentes de COVID longa podem também relatar a presença de cefaleias, problemas de concentração, perdas de memória, dispneia, entre outros sintomas.
- Serviços de renovação da terapêutica crónica e comparação com o contexto portuguêsPublication . Castel-Branco, Margarida; Panta Baltazar, Salomé; Mota-Filipe, Hélder; Mota Figueiredo, IsabelOver the past few years, there has been a growing effort to integrate community pharmacists into managing chronic patients with chronic disease, to alleviate the pressure on healthcare systems. Pharmacists are not only experts in medicines but also have clinical skills to promote adherence to therapy and ensure monitoring of the health status of patients with chronic disease, especially in the period between medical appointments. Chronic disease medication renewal in community pharmacies is a pharmacy service that seeks to streamline patients' access to their medication while still receiving adequate healthcare. We conducted a review of the legislation in force in different countries regarding the chronic medication renewal service and compared it with Portuguese legislation, proposing a pharmacy intervention protocol that optimizes the provision of the service. Repeat Dispensing in the United Kingdom is the service that most resembles its counterpart in Portugal: both require a 12-month medical prescription, allow access to the prescribing history (without access to clinical information). In neither of them is notification of the prescriber mandatory, both require informed consent and lead to the creation of written records of the process. Canada's Adapt a Prescription is more comprehensive because it allows prescriptions valid for 24 months, enables access to clinical information, and requires notification of the prescriber within 24 hours. Ireland's Prescription Extension is more limited in that it does not allow for therapeutic substitution, nor does it enable access to prescribing history or clinical information, requiring notification of the prescriber within seven days. In turn, Australia's Continued Dispensing and the United States' Emergency Refills differ significantly in that they do not require a long-term medical prescription, namely in situations when it is not possible to obtain a valid prescription and refusal to dispense the medicine could be life-threatening to the patient. The Chronic Medication Renewal service in Portugal arises as a response to the needs of the healthcare system and has potential in the healthcare provided to the population, specifically in the therapeutic management of patients with chronic disease.
- Expert perspectives on strategic factors for the management and prevention of heart failure in PortugalPublication . Caldeira, Daniel; Brito, Dulce; Aguiar, Carlos; Silva Cardoso, José; Fonseca, Cândida; Franco, Fátima; Macedo, Filipe; Moura, Brenda; Pinto, Fausto J.; Carneiro, António VazIntroduction and objectives: Heart failure (HF) has significant morbidity and mortality, and its prevalence will continue to increase in the future. This unfavorable evolution requires reflection as well as recommendations and decisions based on expert critical and strategic appraisal. Methods: In the Acceleration on Heart Failure Empowerment and Awareness - the Portuguese Challenge (ATHENA-PT) study, a range of strategic factors that represent the strengths, weaknesses, threats, and opportunities (SWOT) of HF in Portugal were established. These factors were assessed quantitatively by experts, to create a final SWOT matrix for the management and prevention of HF in Portugal and to outline recommendations. Results: For HF management, the panel emphasized the following strategic recommendations: (i) reimbursement of natriuretic peptides testing in primary healthcare; (ii) reimbursement of Doppler assessment in echocardiographic studies and promotion of detailed information in reports; (iii) intervention to improve the prognosis of patients with HF with preserved ejection fraction; (iv) ensuring effective healthcare transition between hospital and ambulatory units, using checklists/protocols; and (v) reinforcement and commitment to the training of primary health physicians and to the cardiac rehabilitation of patients. For the prevention of HF, the following recommendations/proposals were proposed: (i) campaigns to raise awareness of cardiovascular disease risk factors; (ii) promotion of physical exercise and healthy eating; and (iii) avoidance of therapeutic inertia in the management of risk factors. Conclusions: The acknowledgment of various strategic factors and their prioritization by experts made it possible to create and reinforce a range of new strategic recommendations for the management and prevention of HF.
- Atherosclerosis in the primary health care setting: a real-word data studyPublication . Ascenção, Raquel; Alarcão, Joana; Araujo, Francisco; Costa, João; Fiorentino, Francesca; Gil, Victor; Gouveia, Miguel; Lourenço, Francisco; Mello e Silva, Alberto; Carneiro, António Vaz; Borges, MargaridaIntroduction and objectives: To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. Methods: A cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. Results: A total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p<0.001). Mean blood pressure, LDL-C and glycated hemoglobin values were lower in the subpopulation with manifestations (142/74 vs. 146/76 mmHg, 101 vs. 108 mg/dl, and 6.80 vs. 6.84%, respectively; p<0.001). Each user with atherosclerosis attended 4.1±2.9 face-to-face medical consultations and underwent 8.6±10.0 laboratory test panels, with differences in subpopulations with and without clinical manifestations (4.4±3.2 vs. 4.0±2.8 and 8.3±10.3 vs. 8.7±9.8, respectively; p<0.001). Conclusions: About one in three adult primary health care users with atherosclerosis have clinical manifestations. The results suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis.
- Atherosclerosis: the cost of illness in PortugalPublication . Costa, João; Alarcão, Joana; Amaral-Silva, Alexandre; Araujo, Francisco; Ascenção, Raquel; Caldeira, Daniel; Cardoso, Marta Ferreira; Correia, Manuel; Fiorentino, Francesca; Gavina, Cristina; Gil, Victor; Gouveia, Miguel; Lourenço, Francisco; Mello E Silva, Alberto; Pedro, Luís M; Morais, João; Carneiro, António Vaz; Veríssimo, Manuel Teixeira; Borges, MargaridaIntroduction and objectives: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease-related costs. Methods: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real-world data from primary care, the 2014 National Health Interview Survey, and expert opinion. Results: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). Conclusions: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.
- O impacto da pandemia COVID-19 na investigação biomédica : uma nova (e pior) realidadePublication . Carneiro, António Vaz; Henriques, Susana OliveiraA pandemia COVID-19 representa um desafio sem precedentes para a humanidade e para a ciência. O estudo do vírus SARS-CoV-2 e da doença COVID-19 atingiu dimensões nunca antes verificadas para uma doença individual, envolvendo o maior financiamento para investigação de que há memória. Em poucos meses, a comunidade científica mobilizou-se num esforço coletivo na procura de soluções de tratamento e prevenção, dando origem a um fenómeno recentemente descrito por Ed Yong no The Atlantic (dezembro 2020), como “COVID-ized science”. Embora reconheçam a necessidade e os benefícios deste investimento, os autores deixam um alerta para o impacto negativo que a concentração quase exclusiva de recursos financeiros, tecnológicos e humanos na investigação COVID-19 poderá ter noutras áreas igualmente críticas, entretanto desaceleradas ou abandonadas.
- Excess mortality estimation during the COVID-19 pandemic : preliminary data from PortugalPublication . Nogueira, Paulo Jorge; Nobre, Miguel de Araújo; Nicola, Paulo Jorge Morais Zamith; Furtado, Cristina; Carneiro, António VazIntroduction: Portugal is experiencing the effects of the COVID-19 pandemic since March 2020. All-causes mortality in Portugal increased during March and April 2020 compared to previous years, but this increase is not explained by COVID-19 reported deaths. The aim of this study was to analyze and consider other criteria for estimating excessive all-cause mortality during the early COVID-19 pandemic period. Material and Methods: Public data was used to estimate excess mortality by age and region between March 1 and April 22, proposing baselines adjusted for the lockdown period. Results: Despite the inherent uncertainty, it is safe to assume an observed excess mortality of 2400 to 4000 deaths. Excess mortality was associated with older age groups (over age 65). Discussion: The data suggests a ternary explanation for early excess mortality: COVID-19, non-identified COVID-19 and decrease in access to healthcare. The estimates have implications in terms of communication of non-pharmaceutical actions, for research, and to healthcare professionals. Conclusion: The excess mortality occurred between March 1 and April 22 was 3 to 5 fold higher than what can be explained by the official COVID-19 deaths.