Policy measures and instruments used in European countries to increase biosimilar uptake: a systematic review.

Introduction: While biosimilar medicines can contribute to the sustainability of healthcare systems, their utilization rate varies across European countries. This study aims to identify and systematize policy measures and instruments used in European countries to increase biosimilar market share. Methods: A systematic review was conducted according to PRISMA 2020 recommendations. Medline-PubMed, Web of Science and ScienceDirect databases were searched using inclusion criteria that required full articles published in English between January 2006 and November 2023. Reviews, letters, reports, editorials and comments or opinion articles were excluded from this study. Results: Of the 1,137 articles, only 13 met the eligibility criteria for analysis, which covered a total of 28 European countries. Pricing regulation measures were found in 27 of these countries with tendering, price-linkage and internal reference price being the most used. Tendering was used by 27 countries to procure biosimilars in inpatient setting. Prescribing guidelines and recommendations were the widely used instrument. Some European countries adopted physician incentives, quotas, and prescription by international non-proprietary name. Conclusion: Automatic substitution was not commonly recommended or applied. Interchangeability and switching will become increasingly relevant issues. It is important that the positive results from some countries serve as an example for the future of these medicines in the European market. Systematic review registration: https://inplasy.com/, Identifier INPLASY2023120032.

Consumption of Non-Prescribed Drugs in Portugal During the Pandemic in 2021.

Objectives: Portugal liberalised the over-the-counter drugs market in 2005 and provides universal healthcare coverage in a mainly Beveridge-type health system. However, the COVID-19 pandemic has forced healthcare to change how services were delivered, especially increasing remote consultations in primary care. This analysis aims to find the drivers for taking non-prescribed drugs during the pandemic in Portugal. Specifically, it seeks to understand the role of taking prescribed drugs and attending remote medical appointments in the self-medication decision. Methods: In this observational study, we used data collected during the pandemic in Centre Region of Portugal and estimated logistic regression for the whole sample and stratified by sex. Results: The main findings show that people taking prescribed medications and attending a remote consultation are more likely to take non-prescribed drugs. Also, reporting unmet healthcare needs seems to motivate people to choose self-medication. Conclusion: Policy implications are pointed out concerning the health risks raised from self-medication, the role of the pharmacist advising non-prescribed drugs, and the related health risks arising from unmet healthcare needs.

Judicialization and cancer: quality of life of patients and caregivers in the COVID-19 pandemic.

BACKGROUND: In Brazil, cancer patients and caregivers of cancer patients seek judicial intervention for free access to medications from the public health system. Indeed, the COVID-19 pandemic potentially affected the health-related quality of life of cancer patients and caregivers of cancer patients. This study aimed to describe the sociodemographic profile and assess the health-related quality of life of patients and caregivers in the state of Goias, Brazil, in 2020. METHODS: A cross-sectional study was conducted using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and a sociodemographic questionnaire. RESULTS: A total of 88 (67,7%) patients and 42 (32,3%) caregivers participated in the study, mostly women (55,5%); aged from 18 to 60 (66%) years old; with up to nine years of education (73,1%) and monthly family income lower than the minimum wage (69,2%); married or in a stable union (92,3%); living with multiple people in the same household (73,8%). The quality of life domains with the best scores were mental health for patients and pain for caregivers. The most affected quality of life domain was physical limitation for patients and caregivers. Factors associated with better quality of life were female gender and age between 18 and 60 years in patients, more than 9 years of education, living with multiple people in the same house, and having a monthly family income higher than US$200 for caregivers. CONCLUSION: The study found evidence of physical and emotional vulnerability during the pandemic, highlighting the need to strengthen public policies of assistance support to this population.

Sociodemographic determinants of digital health literacy: A systematic review and meta-analysis.

INTRODUCTION: Differences in digital health literacy levels are associated with a lack of access to digital tools, usage patterns, and the ability to effectively use digital technologies. Although some studies have investigated the impact of sociodemographic factors on digital health literacy, a comprehensive evaluation of these factors has not been conducted. Therefore, this study sought to examine the sociodemographic determinants of digital health literacy by conducting a systematic review of the existing literature. METHODS: A search of four databases was conducted. Data extraction included information on study characteristics, sociodemographic factors, and the digital health literacy scales used. Meta-analyses for age and sex were conducted using RStudio software with the metaphor package. RESULTS: A total of 3922 articles were retrieved, of which 36 were included in this systematic review. Age had a negative effect on digital health literacy (B = -0.05, 95%CI [-0.06; -0.04]), particularly among older adults, whereas sex appeared to have no statistically significant influence among the included studies (B = - 0.17, 95%CI [-0.64; 0.30]). Educational level, higher income, and social support also appeared to have a positive influence on digital health literacy. DISCUSSION: This review highlighted the importance of addressing the digital health literacy needs of underprivileged populations, including immigrants and individuals with low socioeconomic status. It also emphasizes the need for more research to better understand the influence of sociodemographic, economic, and cultural differences on digital health literacy. CONCLUSIONS: Overall, this review suggests digital health literacy is dependent on sociodemographic, economic, and cultural factors, which may require tailored interventions that consider these nuances.

Measuring loneliness: Psychometric properties of the three-item loneliness scale among community-dwelling adults.

Loneliness is a prevalent set of negative feelings associated with unsatisfactory and reduced social interactions, inadequate social support, poor satisfaction with life and health, negative emotions, and economic burden. Thus, its measurement is of foremost importance. Therefore, this study aimed (i) to devise the Portuguese version of the three-Item Loneliness Scale (T-ILS), which is ideal for epidemiological studies, and (ii) to evaluate its psychometric properties. Three hundred forty-five community-dwelling Portuguese adults with a mean age of 54.6 ± 19.5 years, 61.7% women, recruited door-to-door, were assessed with the Portuguese versions of T-ILS, Satisfaction With Life Scale-SWLS, Lubben Social Network Scale 6-items-LSNS-6, a question regarding Happiness/Unhappiness, and a sociodemographic questionnaire. The T-ILS showed good psychometric properties and correlated moderately with SWLS and LSNS-6, and happiness, and weakly with the number of people in the household. The Portuguese version of the T-ILS proved to be a valid and reliable instrument, easy and quick to administer. It proved to be a valuable tool in screening loneliness in Portugal, being potentially useful to the identification of lonelier people in need of intervention.

Creation and Validation of the European Portuguese Version of the Systemic Lupus Erythematous Quality of Life Questionnaire.

(1) Background: Patients with systemic lupus erythematous (SLE) experience profound effects on health-related quality of life (HRQoL) that cannot be explained by objective indicators of mortality and morbidity. This study aimed to adapt the SLE Quality of Life (SLEQoL) questionnaire to the European Portuguese population and to assess its reliability and validity for patients with SLE. (2) Methods: Two independent translators translated the original version of the SLEQoL questionnaire into Portuguese. A back-translated version was produced. The Portuguese version of the questionnaire was reviewed and tested for validity and reliability. Cronbach's alpha and the internal validity index were calculated to verify the internal reliability and validity of the content. Rheumatologists filled out the SLE Disease Activity Score (SLE-DAS) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index SLICC/ACR-DI questionnaires. (3) Results: This study involved 180 patients, of which 93.8% were females. The results indicated very high internal consistency reliability (α = 0.949), low correlations between the SLEQoL and the SLE-DAS, a correlation between all SLEQoL dimensions and all SF-36 dimensions (except for "response to treatment" and "self-image"), and good correlation scores with both the EQ-5D-5L index and VAS. (4) Conclusion: The Portuguese version of the SLEQoL questionnaire is valid and reliable for the measurement of HRQoL in SLE patients.

Factors Contributing to Self-Medication and Consumption of Non-Prescribed Drugs in Portugal.

Objectives: This work sets out to find the relationship between taking non-prescribed drugs and predisposing, enabling and need factors. Specifically, our main aim is to find the relationship between taking non-prescribed drugs and the lack of health care. Methods: We used data from the last 2019 National Health Survey and estimate logistic regressions for the whole sample and stratified by sex. Results: The most striking finding is that people self-medicating with non-prescribed drugs seem to be replacing health care when this is not used because of financial constraints or distance from provider. This suggests that non-prescribed drugs are a fast, affordable, alternative to health care. Other findings show that income and the financial resources to cope with unexpected expenditure are considerations in taking these drugs. Health and needs are other factors triggering their consumption. Conclusion: Policy measures need to be aimed at improving access to medical care, providing responses to health needs such as those arising from chronic pain, and improving health literacy.

Judicialization of health: profile of demands for oncological medicines in a state in the central region of Brazil.

BACKGROUND: The significant increase in access to oncological medicines through court cases suggests that constitutional guarantees of integral and universal care in the Brazilian public health system are uncertain. METHODS: A retrospective observational study was conducted to analyze data from lawsuits requesting oncological medicines from 2014 to 2020 in the State of Goiás, Brazil, in state and federal courts. Sociodemographic, medical, and legal variables were statistically examined using descriptive, association, and correlation methods. RESULTS: Women brought more than half (54%) of the 301 processes analyzed. The most frequent age group was over 55 years, with income below 3 × the minimum wage (total about USD$600/month), and their cases were promoted through the public minister and public defender's offices. The most requested medications, not on official public health system lists, were indicated for multiple myeloma and brain cancer. CONCLUSIONS: Improved quality of life, frequently used as a justification, could be conceptually confused with increased survival. Finally, judicialization itself indicates that individual health needs arise even with properly defined and adequately implemented public policies. These needs should be considered for the adequate provisioning of services by the state to ensure the right to health.

Chronic wound assessment: Cultural and linguistic adaptation for European Portuguese of RESVECH-2 scale.

INTRODUCTION: In order to assess and to follow up the evolution of chronic wounds, it is advisable to apply measurement scales. This procedure allows clinicians to verify the appropriateness of their activities and whether the healing process is evolving as expected. AIM: To conduct a cross-cultural adaptation and psychometric analysis of Portuguese version of RESVECH 2.0. METHODS: A quantitative and correlational study was designed and, to perform the cross-cultural adaptation of RESVECH 2.0, we followed the classic sequential approach for linguistic equivalence to European Portuguese. The study occurred at a Portuguese oncology hospital and the sample encompassed 281 patients with multiple chronic wounds. RESULTS: RESVECH 2.0 is a practical measurement instrument, easy to use, and well accepted by nurses to know all kinds of wounds' etiologies. The reliability test revealed an acceptable internal consistency and high proportion of agreement between two raters assessing the same patient. Construct validity was considered average/good and the principal component factor analysis with varimax rotation obtained six factors corresponding to 59.5% of explained variance. When comparing the domains from RESVECH 2.0 with those from BWAT we found statistically significant correlations. CONCLUSION: The adapted version of RESVECH 2.0 scale presents a good internal consistency and is valid for the Portuguese language and culture, being useful and effective in clinical practice.

Adverse Drug Reactions and Potentially Inappropriate Medication in Older Patients: Analysis of the Portuguese Pharmacovigilance Database.

Criteria have been developed to identify potentially inappropriate medications that can enhance adverse reactions, highly prevalent in older patient's therapy. This study aimed to identify potentially inappropriate medications within the adverse drug reactions reported in the Portuguese pharmacovigilance system, characterizing the reports where inappropriate medications were identified. INFARMED, I.P. provided all adverse drug reactions reported from January to December 2019 in 65-year-old and older patients. Adverse drug reactions were characterized according to the System Organs Classes, seriousness, and medications with the Anatomical Therapeutical Classification. Potentially inappropriate medications were identified by applying the EU-(7)-PIM and the Beers criteria. A p value < 0.05 was considered statistically significant. From the 2337 reports considered for the analysis, PIMs were found in 12.8% of these, and 64.7% of all adverse reaction reports were classified as serious. Within the group of reports including at least one PIM, 71.4% were classified as serious, with hospitalization the most common criteria (35.1%). From the 3170 suspected medicines identified, 10.6% were classified as PIMs. Amiodarone was the most frequent PIM identified in the study (10.1%). Reports including at least one PIM were more associated with a higher number of ADRs (p = 0.025) reported in the same record, higher number of suspected medicines identified (p < 0.001), seriousness (p = 0.005), and hospitalization (p < 0.001). Potentially inappropriate medications are important enhancers of serious adverse drug reactions, increasing the likelihood of hospitalizations. This reinforces the importance of improving medication appropriateness in the older population.

Adaptation and validation of the Barnes-Jewish Hospital-Stroke Dysphagia Screen for the portuguese version / Adaptação e validação do Barnes-Jewish Hospital-Stroke Dysphagia Screen para versão portuguesa / Adaptación y validación del Barnes-Jewish Hospital-Stroke Dysphagia Screen para la versión portuguesa

ABSTRACT Objective: adapt and validate the Barnes-Jewish Hospital-Stroke Dysphagia Screen (BJH-SDS) instrument to European Portuguese speakers. Method:BJH-SDS underwent a rigorous process of cross-cultural adaptation and was validated with acute stroke patients in five stroke units from February 2018 to April 2019. For data analysis, SPSS 25 was used. Nurses performed the screening on admission, and inter-rater reliability was established. Results of clinical bedside evaluation were compared with those provided by BJH-SDS. Results: cross-cultural adaptation was performed and completed successfully without difficulties. For validation, 226 acute stroke patients were enrolled. The incidence of dysphagia using BJH-SDS was 72.1%, and a highly significant relationship (χ2 = 87.81; p <0.001) was observed compared to clinical bedside evaluation, with an area under the ROC curve of 0,765. Excellent inter-rater reliability (k=0.977) was reached.Conclusion: results suggest that the Portuguese version of the BJH-SDS is a reliable dysphagia screening test. It is straightforward to be administered bedside by nurses with minimal training required. It was also shown to have adequate sensitivity to assist in decision-making to refer stroke patients for a more comprehensive evaluation.

RESUMEN Objetivo: adaptar y validar el Barnes-Jewish Hospital-Stroke Dysphagia Screen (BJH-SDS) para portugués de Portugal. Método: se realizó un riguroso proceso de adaptación transcultural y validación con pacientes con accidente cerebrovascular agudo en cinco hospitales entre febrero de 2018 y abril de 2019. El análisis de datos se realizó con SPSS 25. El cribado fue realizado por enfermeras. Los resultados de la evaluación clínica a pie de cama se compararon con los de BJH-SDS. Resultados: se realizó la adaptación transcultural y completado con éxito sin dificultades. Para la validación, se incluyeron 226 pacientes. La incidencia de disfagia por BJH-SDS fue del 72,1% y se observó una relación muy significativa con la evaluación clínica a pie de cama (χ2 = 81,87; p <0,001), un área bajo la curva ROC de 0,765. La fiabilidad entreexaminadores fue excelente (k = 0,977). Conclusión: los resultados sugieren que la versión portuguesa de la BJH-SDS es una prueba de detección fiable para la disfagia. Es fácil y simple de usar junto a la cama por parte de enfermeras con una formación mínima requerida. Mostró una sensibilidad adecuada para ayudar en la toma de decisiones para derivar a estos pacientes para una evaluación más completa.

RESUMO Objetivo:adaptar e validar o Barnes-Jewish Hospital-Stroke Dysphagia Screen (BJH-SDS) para o português de Portugal. Método:realizado um rigoroso processo de adaptação transcultural e validação com pacientes com acidente vascular cerebral agudo em cinco hospitais entre fevereiro de 2018 e abril de 2019. A análise dos dados foi realizada com SPSS 25. O rastreio foi realizado por enfermeiras na admissão. Os resultados da avaliação clínica à beira do leito foram comparados com os fornecidos pelo BJH-SDS. Resultados:a adaptação transcultural foi realizada e completada com sucesso sem dificuldades. Para validação, 226 pacientes foram incluídos. A incidência de disfagia pelo BJH-SDS foi de 72,1% e uma relação altamente significativa foi observada quando comparada aos resultados da avaliação clínica à beira do leito (χ2 = 81,87; p <0,001), com uma área abaixo da curva ROC de 0,765. A confiabilidade inter examinador alcançada foi excelente (k = 0,977). Conclusão:os resultados sugerem que a versão portuguesa do BJH-SDS é um teste de rastreio da disfagia confiável. É de utilização fácil e simples à beira do leito por enfermeiras com mínimo de treinamento necessário. Demonstrou ter sensibilidade adequada para auxiliar na tomada de decisão de encaminhar estes pacientes para uma avaliação mais abrangente

Validation and cultural adaptation of the Integrated Palliative care Outcome Scale (IPOS) for the Portuguese population.

BACKGROUND: To culturally adapt and validate the Integrated Palliative care Outcome Scale to European Portuguese. METHODS: Multi-centred observational study with 2 assessment points. Data were collected in nine centres using consecutive sampling. All patients were screened for eligibility. INCLUSION CRITERIA: ≥18 years, mentally fit to give consent, diagnosed with an incurable, potentially life-threatening illness, read, write and understand Portuguese. Translation and back translation with independent native speakers blind to the original measure created a Portuguese version, which was culturally adapted using cognitive interviews. For psychometric testing, the COSMIN checklist was followed. Reliability and content validity were assessed for patient and staff versions. Construct and criterion validity were tested for patient version. RESULTS: 1703 individuals were screened between July 1st 2015 and February 2016, 135 (7.9%) were included. Mean age was 66.8 years (SD 12.7), 58 (43%) were female. Most patients (109; 80.7%) had a cancer diagnosis. Cronbach's alpha showed good internal consistency, 0.657 for patient, 0.705 for staff versions. Intraclass correlation coefficient testing reproducibility revealed very good reliability, 0.794-0.950 for patient and 0.456-0.925 for staff versions. There was good content validity and significant results for construct validity. Physical symptoms were better detected by females. IPOS could discriminate: practical issues in different places of care, based on cancer diagnosis, physical and emotional symptoms based on life expectancy both for patient and professional dimensions, physical and emotional symptoms based on phase of illness, for professional dimensions, and physical symptoms from the patients' viewpoint. CONCLUSIONS: The Portuguese IPOS is a reliable and valid measure.

The Use of Antidepressants, Anxiolytics, Sedatives and Hypnotics in Europe: Focusing on Mental Health Care in Portugal and Prescribing in Older Patients.

(1) Background: Mental disorders are a growing concern in the 21st century. The most prevalent common mental disorders include depression and anxiety. It is predicted that half of the population will at some point in their lives experience one or more mental disorders. Although common mental disorders are highly prevalent, some of the most significant related problems are the wide treatment gap and the excessive use of antidepressants, anxiolytics and sedatives/hypnotics, especially among older patients. (2) Methods: This study aimed to analyze mental health care in Portugal, with a focus on the consumption of antidepressants, anxiolytics, sedatives and hypnotics among older patients. (3) Results: The use of antidepressants, anxiolytics, sedatives and hypnotics has increased overall across Europe. In Portugal, a downward trend of sedatives and hypnotics consumption can be observed. Anxiolytics and antidepressants, on the other hand, have been increasing. Patients aged ≥60 years old consume more than half of the aforementioned drugs. (4) Conclusions: Mental health policies should be designed to improve the conscientious use of antidepressants, anxiolytics, sedatives and hypnotics, particularly among older adults.

[Self-Awareness of Performing Patient-Centered Medicine in General Practice / Family Medicine: Development of a Measurement Scale]. / Auto Perceção do Desempenho da Medicina Centrada na Pessoa em Medicina Geral e Familiar: Criação de Um Instrumento de Medição.

INTRODUCTION: Patient Centred Medicine is a method and a model of practicing allowing gains for both the doctor and the patient. Its practice must be evaluated for purposes of continuous professional development and continuous medical education. The aim of this study was to create an instrument focused in measuring the practice based on person centered medicine in general and family medicine, as well as in determining its reliability and validity. MATERIAL AND METHODS: A first version of a questionnaire according to the four dimensions of the patient- centred clinical method was revised in a focus group providing the content validity. The final questionnaire includes 22 items, using a Likert scale with four response options. Factorial analysis made it possible to confirm the dimensions defined by Moira Stewart, and internal consistency, test-retest reproducibility and item-total correlations were determined. The online implementation of the questionnaire to a sample of 905 family doctors guaranteed the construct and criterion validities. RESULTS: The measurement instrument includes four dimensions: (i) exploring health, disease and the illness experience; (ii) investing in the doctor-patient relationship; (iii) seeking understanding; and (iv) understanding the whole person. The internal consistency was demonstrated with a global Cronbach's alpha of 0.892, varying between 0.783 and 0.844 for all dimensions. The test-retest reproducibility obtained an intraclass correlation value between 0.678 and 1.000. The item-total correlations varied between 0.457 and 0.870. Women doctors are more aware than their colleagues about seeking understanding with the person, and young doctors are more susceptible to approach the disease through history and to seek understanding with the patient. Specialist physicians have shown to be more careful with the history and with viewing the patient as a whole and the professionals who work in a Family Health Unit are those who seek a better understanding with the person. Finally, specific training about person centered medicine and about consultation in person centered medicine demonstrated a positive impact in all dimensions of the person-centred medicine and this is acknowledged by professionals. DISCUSSION: The assessment of self-perception of person-centred medicine is now possible. CONCLUSION: The questionnaire presents good reliability and validity, thus allowing doctors to assess their main weaknesses, as well as enabling the development of specific training.

Introdução: A Medicina Centrada na Pessoa é um método e modelo de prática permitindo ganhos para o médico e o paciente, devendo a sua prática ser avaliada para fins de desenvolvimento profissional contínuo e educação médica continuada. O objectivo deste estudo foi construir, determinar a fiabilidade e a validade de um instrumento capaz de aferir a auto perceção genérica da prática médica segundo a medicina centrada na pessoa no ambiente de medicina geral e familiar.Material e Métodos: Uma primeira versão de um questionário segundo as quatro dimensões do método clínico centrado na pessoa foi revista por um grupo focal garantindo a validade de conteúdo. O questionário final engloba 22 itens, utilizando para resposta uma escala de Likert com quatro opções. A análise fatorial permitiu confirmar as dimensões definidas por Moira Stewart, tendo também sido determinada a consistência interna, a reprodutibilidade por teste-reteste e a correlação item-total. A aplicação online a uma amostra de 905 médicos de medicina geral e familiar permitiu testar as validades de constructo e de critério.Resultados: O instrumento de medição inclui quatro dimensões: (i) explorar a saúde, a doença e a experiência de doença, (ii) investir na relação médico-doente; (iii) procurar entendimento; e (iv) compreender a pessoa como um todo. A consistência interna foi demonstrada com um alfa de Cronbach global de 0,892, variando entre 0,783 a 0,844 para todas as dimensões. A reprodutibilidade teste-reteste obteve um valor de correlação intraclasse entre 0,678 e 1,000. As correlações item-total variaram entre 0,457 e 0,870. As mulheres médicas estão mais sensibilizadas do que os seus colegas no que respeita à procura de entendimento com o doente e os médicos mais novos são os mais sensíveis à abordagem da doença através da anamnese e à procura de entendimento com o doente. Os especialistas demonstraram ter mais cuidado com a anamnese e com o facto de encarar o doente como um todo, e os profissionais que trabalham numa unidade de Saúde Familiar são os que procuram um melhor entendimento com a pessoa. Por fim, a formação específica sobre medicina centrada na pessoa e sobre consulta em medicina centrada na pessoa demonstraram ter um impacto positivoem todas as dimensões da medicina centrada na pessoa e isso é reconhecido pelos próprios profissionais.Discussão: A avaliação da auto perceção de desempenhar medicina centrada na pessoa é agora possível.Conclusão: O presente questionário apresenta boa fiabilidade e validade permitindo ao médico verificar quais as principais insuficiências bem como desenvolver formação específica.

Determining the prevalence of palliative needs and exploring screening accuracy of depression and anxiety items of the integrated palliative care outcome scale - a multi-centre study.

BACKGROUND: patients with palliative needs often experience high symptom burden which causes suffering to themselves and their families. Depression and psychological distress should not be considered a "normal event" in advanced disease patients and should be screened, diagnosed, acted on and followed-up. Psychological distress has been associated with greater physical symptom severity, suffering, and mortality in cancer patients. A holistic, but short measure should be used for physical and non-physical needs assessment. The Integrated Palliative care Outcome Scale is one such measure. This work aims to determine palliative needs of patients and explore screening accuracy of two items pertaining to psychological needs. METHODS: multi-centred observational study using convenience sampling. Data were collected in 9 Portuguese centres. INCLUSION CRITERIA: ≥18 years, mentally fit to give consent, diagnosed with an incurable, potentially life-threatening illness. EXCLUSION CRITERIA: patient in distress ("unable to converse for a period of time"), cognitively impaired. Descriptive statistics used for demographics. Receiving Operator Characteristics curves and Area Under the Curve for anxiety and depression discriminant properties against the Hospital Anxiety and Depression Scale. RESULTS: 1703 individuals were screened between July 1st, 2015 and February 2016. A total of 135 (7.9%) were included. Main reason for exclusion was being healthy (75.2%). The primary care centre screened most individuals, as they have the highest rates of daily patients and the majority are healthy. Mean age is 66.8 years (SD 12.7), 58 (43%) are female. Most patients had a cancer diagnosis 109 (80.7%). Items scoring highest (=4) were: family or friends anxious or worried (36.3%); feeling anxious or worried about illness (13.3%); feeling depressed (9.6%). Using a cut-off score of 2/3, Area Under the Curve for depression and anxiety items were above 70%. CONCLUSIONS: main palliative needs were psychological, family related and spiritual. This suggests that clinical teams may better manage physical issues and there is room for improvement regarding non-physical needs. Using the Integrated Palliative care Outcome Scale systematically could aid clinical teams screening patients for distressing needs and track their progress in assisting patients and families with those issues.

Advancing tools to promote health equity across European Union regions: the EURO-HEALTHY project.

BACKGROUND: Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing best, which factors might shape future health outcomes and where there is room for improvement. METHODS: Under the EURO-HEALTHY project, tools combining the technical elements of multi-criteria value models and the social elements of participatory processes were developed to measure health in multiple dimensions and to inform policies. The flagship tool is the Population Health Index (PHI), a multidimensional measure that evaluates health from the lens of equity in health determinants and health outcomes, further divided into sub-indices. Foresight tools for policy analysis were also developed, namely: (1) scenarios of future patterns of population health in Europe in 2030, combining group elicitation with the Extreme-World method and (2) a multi-criteria evaluation framework informing policy appraisal (case study of Lisbon). Finally, a WebGIS was built to map and communicate the results to wider audiences. RESULTS: The Population Health Index was applied to all European Union (EU) regions, indicating which regions are lagging behind and where investments are most needed to close the health gap. Three scenarios for 2030 were produced - (1) the 'Failing Europe' scenario (worst case/increasing inequalities), (2) the 'Sustainable Prosperity' scenario (best case/decreasing inequalities) and (3) the 'Being Stuck' scenario (the EU and Member States maintain the status quo). Finally, the policy appraisal exercise conducted in Lisbon illustrates which policies have higher potential to improve health and how their feasibility can change according to different scenarios. CONCLUSIONS: The article makes a theoretical and practical contribution to the field of population health. Theoretically, it contributes to the conceptualisation of health in a broader sense by advancing a model able to integrate multiple aspects of health, including health outcomes and multisectoral determinants. Empirically, the model and tools are closely tied to what is measurable when using the EU context but offering opportunities to be upscaled to other settings.

Public satisfaction with health system coverage, empirical evidence from SHARE data.

People's satisfaction with the health system, including the coverage provided, has been a concern for some years now but research into the main explanatory factors is in progress. This work focuses on European countries plus Israel, using the SHARE database to find what determines people's satisfaction with the basic coverage provided by the health system of each country. On top of the usual individual socioeconomic characteristics, other explanatory factors were also considered. These include, at individual level, trust in others, political positioning, and risk aversion; at country level, they include access to specialist care and the type of health system financing. Estimation of an ordered logistic model found that the main predictors for satisfaction with a health system's basic coverage include trust in others, unmet health needs, self-assessed health, free access to specialists, health system financed through social insurance, and out-of-pocket payments. These results provide the basis for possible policies designed to improve people's satisfaction.

Protocol for the development and acceptability of a fertility-related decision aid for young women with breast cancer in Portugal.

INTRODUCTION: Young patients with breast cancer may face impaired fertility due to cancer treatments, which often leads to complex fertility decisions. To aid fertility decision-making, it is crucial that women have access to high-quality information; however, their fertility information needs are often unmet. Decision aids (DAs) are educational materials to assist with decision-making, by addressing individual values and preferences. In oncofertility, DAs may constitute a valuable resource to help patients obtain information and make better informed decisions. This paper reports on the protocol of the development and transcreation of a fertility-related DA booklet to support young Portuguese patients with breast cancer, originally developed and validated for an Australian audience. METHODS AND ANALYSIS: Recent literature on clinical guidelines will be reviewed. A summary of these guidelines will be created and will inform the first round of DAs revisions. A forward translation process will translate the DA from Australian English to Portuguese. A multidisciplinary Portuguese experts panel will revise and give feedback on the scientific and cultural aspects of the DA content for Portuguese audience. Next, a backward translation process will assess content equivalence between the original and the final adapted version. Finally, Learner Verification (LV) will be used in a qualitative study of young patients with breast cancer and their partners. Two focus groups with 6-10 participants each will be conducted with: (1) recently diagnosed young patients with breast cancer; (2) breast cancer survivors and (3) their partners. Results from the DA acceptability assessment will inform its final version. Data will be analysed using content analysis and constant comparison method to identify key themes/textual units related to LV. ETHICS AND DISSEMINATION: Ethical approval was granted by the Portuguese Institute of Oncology Porto. Results will be disseminated through peer-reviewed journals and presented at scientific meetings for academic and health professionals audiences.

Scenarios for population health inequalities in 2030 in Europe: the EURO-HEALTHY project experience.

BACKGROUND: Health inequalities have been consistently reported across and within European countries and continue to pose major challenges to policy-making. The development of scenarios regarding what could affect population health (PH) inequalities across Europe in the future is considered critical. Scenarios can help policy-makers prepare and better cope with fast evolving challenges. OBJECTIVE: This paper describes the three 2030 time-horizon scenarios developed under the EURO-HEALTHY project, depicting the key factors that may affect the evolution of PH inequalities across European regions. METHODS: A three-stage socio-technical approach was applied: i) identification of drivers (key factors expected to affect the evolution of PH inequalities across European regions until 2030) - this stage engaged in a Web-Delphi process a multidisciplinary panel of 51 experts and other stakeholders representing the different perspectives regarding PH inequalities; ii) generation of scenario structures - different drivers' configurations (i.e. their hypotheses for evolution) were organized into coherent scenario structures using the Extreme-World Method; and iii) validation of scenario structures and generation of scenario narratives. Stages ii) and iii) were conducted in two workshops with a strategic group of 13 experts with a wide view about PH inequalities. The scenario narratives were elaborated with the participants' insights from both the Web-Delphi process and the two workshops, together with the use of evidence (both current and future-oriented) on the different areas within the PH domain. RESULTS: Three scenarios were developed for the evolution of PH inequalities in Europe until 2030: 'Failing Europe' (worst-case but plausible picture of the future), 'Sustainable Prosperity' (best-case but plausible picture of the future), and an interim scenario 'Being Stuck' depicting a 'to the best of our knowledge' evolution. These scenarios show the extent to which a combination of Political, Economic, Social, Technological, Legal and Environmental drivers shape future health inequalities, providing information for European policy-makers to reflect upon whether and how to design robust policy solutions to tackle PH inequalities. CONCLUSIONS: The EURO-HEALTHY scenarios were designed to inform both policy design and appraisal. They broaden the scope, create awareness and generate insights regarding the evolution of PH inequalities across European regions.

Validation of Portuguese version of the low anterior resection syndrome score / Validação da versão em português do escore da síndrome da ressecção anterior baixa

ABSTRACT Objective: The authors aim to perform a thorough translation with cultural adaptation of the patient reported outcome tool, Low Anterior Resection Syndrome (LARS) Score, to the Portuguese language (LARS-PT) in the Portuguese population with rectal cancer, after proctectomy with anastomosis. Methods: According to the current international recommendations, we designed this study encompassing three main phases: (i) cultural and linguistic validation to European Portuguese; (ii) feasibility and reliability tests of the version obtained in the previous phase; and (iii) validity tests to produce a final version. The questionnaire was completed by 154 patients from six Portuguese Colorectal Cancer Units, and 58 completed it twice. Results: Portuguese version of LARS score showed high construct validity. Regarding the test-retest, the global Intraclass Correlation showed very strong test-retest reliability. Looking at all five items, only items 3 and 5 present a moderate correlation. LARS score was able to discriminate symptoms showing worse quality of life, in patients submitted to preoperative radio and chemotherapy. Conclusions: LARS questionnaire has been properly translated into European Portuguese, demonstrating high construct validity and reliability. This is a precise, reproducible, simple, clear and user-friendly tool for evaluating bowel function in rectal cancer patients after sphincter saving operation.

RESUMO Objetivo: Os autores pretendem fazer uma tradução minuciosa e culturalmente adaptada para a língua portuguesa do escore da Síndrome de Ressecção Anterior Baixa (Low Anterior Resection Syndrome [LARS]), um instrumento de desfecho relatado pelo paciente, na população portuguesa com câncer retal após proctectomia com anastomose. Métodos: De acordo com as recomendações internacionais atuais, o estudo foi projetado abrangendo três fases principais: (i) validação cultural e linguística para o português europeu; (ii) testes de viabilidade e confiabilidade da versão obtida na fase anterior; e (iii) testes de validade para produzir a versão final. O questionário foi preenchido por 154 pacientes de seis unidades portuguesas de câncer colorretal e 58 pacientes completaram duas vezes. Resultados: A versão em português do escore LARS mostrou alta validade de construto. A correlação intra-classe global apresentou confiabilidade muito forte no teste-reteste. Considerando-se todos os cinco itens, apenas os itens 3 e 5 apresentam uma correlação moderada. O escore LARS foi capaz de discriminar sintomas com pior qualidade de vida em pacientes submetidos a radio- e quimioterapia pré-operatória. Conclusões: O questionário LARS foi traduzido corretamente para o português europeu, demonstrando alta validade de construto e confiabilidade. Trata-se de uma ferramenta precisa, reproduzível, simples, clara e fácil de usar para avaliar a função intestinal em pacientes com câncer retal após operações poupando o esfíncter.