[SAIMI Study--Health and Health Care Access by Immigrants from the Indian Subcontinent in Lisbon: What Recommendations for Equitable and Culturally Adequate Health Care?]. / Estudo SAIMI--Saúde e Acesso aos Serviços de Saúde dos Imigrantes do Subcontinente Indiano em Lisboa: Que Recomendações para Cuidados de Saúde Equitativos e Culturalmente Adaptados?

INTRODUCTION: The growth of the immigrant population in Portugal has been consistent over the past decades. Nevertheless, information on the health of immigrant populations is scarce. This research uses data collected from the population from the Indian subcontinent living in the district of Lisbon to produce recommendations for the provision of culturally adapted health services. MATERIAL AND METHODS: Cross-sectional study with the immigrant community of the Indian subcontinent (Bangladesh, India and Pakistan) living in Lisbon, selected based on a snowball sampling technique and using privileged access interviewers. The questionnaire focused on health, health care access, lifestyle and attitudes towards death. The data were subject to a descriptive analysis and an age-standardized comparison between the three nationalities was made. RESULTS: Surveys were administered to 1011 individuals with a participation rate of 97%. Most participants were adult males. Indian immigrants most frequently reported barriers to use of health services and had a higher frequency of chronic diseases. Pakistani immigrants had worse lifestyle indicators. DISCUSSION: The immigrant population from the Indian subcontinent tends to report more language difficulties in health care access when compared with other immigrant populations. Based on recommendations of the World Health Organization, it was possible to adapt this knowledge to produce recommendations adapted to the Portuguese context. CONCLUSION: There are several aspects in the management of health services in Portugal that can be better adapted to the immigrant population from the Indian subcontinent.

Introdução: O crescimento da população imigrante em Portugal tem sido consistente nas últimas décadas. Apesar disto, a informação sobre a saúde das populações imigrantes é escassa. Esta investigação utiliza dados recolhidos junto da população oriunda do subcontinente indiano a residir no distrito de Lisboa para produzir recomendações para a prestação de serviços de saúde culturalmente adaptados.Material e Métodos: Estudo transversal junto da comunidade imigrante do subcontinente indiano (Bangladesh, Ãçndia e Paquistão) a residir em Lisboa, selecionada com base numa técnica de amostragem bola de neve e recorrendo a inquiridores com acesso privilegiado à população-alvo. O questionário inquiriu sobre a saúde, o acesso aos cuidados de saúde, estilos de vida e atitudes perante a morte. Foi feita uma análise descritiva dos dados e uma comparação entre as três nacionalidades padronizada para a idade.Resultados: Foram administrados questionários a 1011 indivíduos com uma taxa de adesão de 97%. A maioria dos participantes eram adultos do sexo masculino. Os imigrantes indianos relataram mais frequentemente barreiras na utilização dos serviços de saúde e tinham uma maior frequência de doenças crónicas. Os imigrantes paquistaneses tinham piores indicadores de estilos de vida.Discussão: A população imigrante do subcontinente indiano tende a relatar mais dificuldades linguísticas no acesso aos cuidados de saúde quando comparada com outras populações imigrantes. Com base em recomendações da Organização Mundial da saúde, foi possível adaptar este conhecimento para produzir recomendações adaptadas ao contexto português.Conclusão: Existem diversos aspetos na gestão dos serviços de saúde em Portugal que podem ser melhor adaptados à população imigrante do subcontinente indiano.

General practitioners' procedures for sexual history taking and treating sexual dysfunction in primary care.

INTRODUCTION: Good history-taking skills are the first step towards achieving a correct diagnosis of sexual dysfunction (SD). However, studies show most general practitioners (GPs) do not take the initiative to ask the patient about SD, and when diagnosing a condition, they tend to give preference to their own criteria over clinical guidelines. AIM: The aim of this study is to characterize GPs' attitudes towards taking sexual history, identifying its frequency and focus, and to describe GPs' diagnostics and therapeutic approaches including the use of clinical guidelines, exploring patients' and doctor-related differences. METHODS: Cross-sectional study using confidential self-administrated questionnaires applied to GPs working in primary healthcare units in the Lisbon region. MAIN OUTCOME MEASURES: Data concerning GPs' consultation of guidelines, active exploration of SD in male and in female patients, and focus on sexual history taking was collected. RESULTS: Of the 50 participants (73.5% response rate), 15.5% actively ask their patients about SD. The main reasons for asking patients about their sexuality are diabetes (84.0%), prescription of medication with adverse effects on sexuality (78.0%), and family planning (72.0%), the latter being a significantly more frequent reason for GPs with 20 or less years of practice. Routine sexual history taking (22.0%) appears as one of the least mentioned motives. The percentage of appointments with active exploration of SD was positively associated with guidelines' consultation, as well as considering the specialty as a good source of information and having longer appointments when SD is mentioned. However, 76.0% report not having consulted any guidelines in the previous year. Lack of time (31.6%) and low accessibility (25.0%) were referred to as the main reasons for not consulting guidelines. CONCLUSIONS: Routine sexual history taking and consultation of guidelines about SD are not yet a generalized practice in primary care. Data should be interpreted with caution as they are self-reported. Further objective measurement such as direct observation or clinical files consultation should be implemented.

General practitioners' knowledge, attitudes, beliefs, and practices in the management of sexual dysfunction-results of the Portuguese SEXOS study.

INTRODUCTION: Evidence shows that sexual dysfunctions (SDs) are very prevalent in both sexes and that they share risk factors with many other conditions. It is known that only a minority of people experiencing sexual problems seek treatment, but the role of the general practitioner (GP) in SD diagnosis and treatment is relatively unexplored. No study has been conducted in Portugal in order to identify GPs' knowledge, attitudes, beliefs, and practices regarding SD and only a small amount of similar studies from other countries have been published. AIM: To characterize GPs' knowledge, attitudes, and beliefs concerning SD; practices of SD management in daily practice; self-perceived competence in discussing and treating SD; and need for training. METHODS: Cross-sectional study using confidential self-administered questionnaires applied to GPs working in Primary Health Care Units in the Lisbon region. MAIN OUTCOME MEASURES: The questionnaire collected information concerning GPs' knowledge and perceptions regarding SD, training and practice in sexual health, criteria for initiating discussion and treatment, and the adoption of guidelines. RESULTS: A total of 50 questionnaires (30 females) were obtained (73.5% response rate). On average, the 50 participants were 52±8.6 years old, had 21±8.2 years of family practice, and followed 1,613±364 patients. The degree in medicine was never considered as an extremely adequate source of information both for male and female SD. Lack of time to obtain relevant information for clinical practice and to deal with sexual health issues were perceived as important barriers in initiating a discussion with the patient, as well as lack of academic training and experience in this area. CONCLUSIONS: GPs expressed a high need for continuous training in this area and more than half considered that their degree was not an adequate source of training. These results indicate that there is a need for both pregraduate and postgraduate training in this area.

Prevalence, severity, and risk factors for erectile dysfunction in a representative sample of 3,548 portuguese men aged 40 to 69 years attending primary healthcare centers: results of the Portuguese erectile dysfunction study.

INTRODUCTION: Many studies of the prevalence of erectile dysfunction have been conducted in several countries. This is the first Portuguese study that provides current and comparative data on the prevalence of erectile dysfunction. AIM: The main objective was to estimate the prevalence of erectile dysfunction in men aged 40 to 69 years and correlate erectile dysfunction to certain risk factors. MAIN OUTCOME MEASURES: Evaluation of erectile dysfunction was achieved using the International Index of Erectile Function (IIEF), a 15-item questionnaire that has been developed and validated as a brief and reliable self-administered scale for accessing erectile function. METHODS: The Portuguese Erectile Dysfunction Study was based on a questionnaire that included socio-demographic variables, information on lifestyle and risk factors, and the IIEF. In total, 3,548 questionnaires were administered to men aged 40 to 69 years in 50 primary healthcare centers between July 2004 and January 2005 in a combination of both self-administration and interviews. Erectile dysfunction was defined as the inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse. RESULTS: The response rate was 81.3%. The total prevalence of erectile dysfunction was 48.1% (age-adjusted). Prevalence increases with age: 29%, 50%, and 74% in men aged 40 to 49 years, 50 to 59 years, and 60 to 69 years, respectively. Severity of erectile dysfunction also increases with age: 1%, 2%, and 10% of complete erectile dysfunction in men aged 40 to 49 years, 50 to 59 years, and 60 to 69 years, respectively. CONCLUSIONS: The prevalence of erectile dysfunction is strongly related to age. There is also a correlation with the health status of participants.