Optimizing Contraceptive Prescription in Smoking Women: A Quality Improvement Study.

Introduction Family planning is fundamental in primary care (PC), and informed counseling helps to guide contraceptive choices. Combined hormonal contraceptives (CHC) pose cardiovascular risks, particularly when combined with smoking. According to the World Health Organization, the recommended global clinical decision is to refrain from employing CHC in female smokers aged 35 or older. This study aimed to improve contraception prescription for female smokers aged 35-54 in PC. Methods This study was conducted in a Portuguese Family Health Unit (FHU) from October 2021 to August 2022, and it followed the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines and the Plan-Do-Study-Act approach. Female smokers aged 35-54 were included and evaluated in three moments: baseline evaluation (October 2021), intermediate evaluation (February 2022), and post-intervention evaluation (August 2022). Interventions involved educating medical staff, creating patient awareness campaigns, and evaluating contraceptive methods. The established quality-defining goal was to decrease the prevalence of female smokers aged 35 or above using CHC to ≤5%. Results CHC prevalence among smoking women aged 35-54 decreased from 16.4% to 8.5% after nine months of the initial intervention. There was an increase in progestogen-only methods usage over time, from 25.7% to 34.0%. Discussion Despite not fully achieving the predefined goal, interventions led to a substantial reduction of CHC use among smoking women aged 35-54. Collaborative efforts between healthcare professionals and patients played a pivotal role in optimizing care and reducing cardiovascular risk. This study underscores the importance of continuous quality improvement, collaborative interventions, and knowledge updates in Family Medicine practice. While conducted in a single FHU, the intervention's multidimensional approach holds the potential for broader applicability. Conclusion In the future, healthcare teams should continue to reflect on achieved results, maintain knowledge, and empower patients in contraceptive method choices. The study contributes to improved care quality and highlights the positive impact on medical practice and patient outcomes.

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self-report and physician assessment.

BACKGROUND: Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. METHODS: This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100). RESULTS: A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118-0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). CONCLUSIONS: Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.

[The Impact of the COVID-19 Pandemic on the Healthcare System and on the Mental Health of Primary Health Care Providers]. / Repercussão da Pandemia de COVID-19 nos Serviços de Saúde e na Saúde Mental dos Profissionais dos Cuidados de Saúde Primários.

INTRODUCTION: The COVID-19 pandemic forced the reorganization of primary health care services. The aim of this study was to describe how the health services responded to organizational requests; how the health services involved and supported their employees; how professionals perceived their involvement in the procedures and what support was provided to them. Additions aims included assessing the levels of anxiety and depression of professionals and their association with the perceived support, availability of personal protective equipment and involvement in pandemic-related tasks. MATERIAL AND METHODS: Cross-sectional, analytical study directed at professionals from three health center groups using an online questionnaire. We collected information from sociodemographic data, access to personal protective equipment, perceived support, workload and levels of anxiety and depression. Between each variable and the levels of anxiety and depression, multivariate logistic regression was applied. RESULTS: There were responses from 237 professionals (83.8% women; mean age 43.7 years; 43.2% physicians). Almost 60% worked with COVID-19 patients. The availability of personal protective equipment in March versus June 2020 increased (17.7% vs 55.3%). There was a risk management plan in 86% of the workplaces. A high workload (90%) and time pressure (74.6%) were identified. Physicians and nurses had a higher prevalence of depression associated with workload and fatigue (p < 0.001). Protective anxiety factors were having space to talk about problems, support in face of these problems and having a place to relax in the health unit. A lower risk of depression was found in the administrative staff group, in those who felt supported, and in those who actively participated in the contingency plans. CONCLUSION: The COVID-19 pandemic led to considerable changes in the dynamics of primary health care. The time pressure to carry out tasks and the level of concentration required were associated with a higher risk of mental disease. The support felt by healthcare professionals regarding their problems and concerns and the existence of places to relax in the health units were identified as protective factors. Health promotion, the maintenance of the social contacts of healthcare professionals and their involvement in the processes should be taken into account in the organizational dynamics of the institutions.

Introdução: A pandemia de COVID-19 forçou a reorganização dos serviços dos cuidados de saúde primários. Com este estudo pretendemos descrever como responderam os serviços de saúde às solicitações organizacionais, como envolveram e apoiaram os seus colaboradores; como os profissionais percecionaram o seu envolvimento nos procedimentos e que apoio lhes foi fornecido. Pretendemos também avaliar os níveis de ansiedade e depressão dos profissionais e a sua associação não só com o apoio sentido pelos profissionais, mas também com a disponibilidade de equipamentos de proteção individual e com o seu envolvimento nas tarefas relacionadas com a pandemia.Material e Métodos: Estudo transversal analítico dirigido aos profissionais de três agrupamentos de centros de saúde usando um questionário online. Colhemos dados sociodemográficos, informação sobre o acesso a equipamento de proteção individual, apoio percecionado, carga de trabalho e níveis de ansiedade e depressão. Entre cada variável e os níveis de ansiedade e depressão aplicou-se regressão logística multivariada.Resultados: Responderam 237 profissionais (83,8% mulheres; idade média 43,7 anos; 43,2% de médicos). Quase 60% trabalhou com doentes COVID-19. A disponibilidade de equipamento de proteção individual em março versus junho de 2020 aumentou (17,7% vs 55,3%). Existia plano de gestão do risco em 86% dos locais. Identificou-se uma alta carga de trabalho (90%) e pressão do tempo (74,6%). Médicos e enfermeiros apresentavam maior prevalência de depressão associada à carga de trabalho e fadiga (p < 0,001). Ter espaço para falar dos problemas, apoio sentido perante esses problemas e dispor na unidade de saúde de um espaço para relaxar foram alguns fatores protetores de ansiedade. Foi encontrado menor riso de depressão no grupo do secretariado clínico, nos profissionais que se sentiram apoiados, e nos que tiveram participação ativa nos planos de contingência.Conclusão: A pandemia de COVID-19 levou a grandes alterações na dinâmica dos CSP. A pressão do tempo para realização de tarefas e a concentração exigida associaram-se a maior risco de desenvolvimento de patologia mental. O apoio sentido pelos profissionais perante os seus problemas e preocupações, e a existência de espaços para relaxar nas USF foram identificados como fatores protetores. A promoção da saúde, a manutenção dos contactos sociais dos profissionais e o seu envolvimento nos processos deverão ser tidos em conta na dinâmica organizacional das instituições.

Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies.

BACKGROUND: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. OBJECTIVE: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. METHODS: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. RESULTS: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). CONCLUSIONS: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.

Eating disorders-Related hospitalizations in Portugal: A nationwide study from 2000 to 2014.

INTRODUCTION: Recent evidence suggests that incidence of Anorexia nervosa (AN) has remained stable over the last decades in Western Europe, while decreasing for Bulimia nervosa (BN). It is well-known that most individuals with an ED (Eating disorder) do not seek medical treatment. OBJECTIVE: The present study analyses hospitalizations related with EDs held in mainland Portuguese public hospitals between 2000 and 2014. METHOD: A retrospective observational study was performed gathering all inpatient episodes with primary or secondary diagnosis of ED. Number of patients, gender, mean age at discharge, suicide-attempts related hospitalizations, in-hospital mortality, length of stay, and mean charges were analyzed. RESULTS: There were a total of 4,485 hospitalizations with an associated ED. AN was the most frequent ED (n = 2,806). Suicide attempt-related hospitalizations were most common among patients with BN (10.1% of BN hospitalizations) or AN (5.2% of AN hospitalizations). DISCUSSION: AN has higher in-hospital mortality than BN. We observed a higher proportion of suicide related hospitalizations in BN when compared to AN. Although pica, rumination disorder, and psychogenic vomiting represent a smaller portion of all EDs, this study was the first to describe hospitalization trends for this set of EDs for a 15-year period, to the best of our knowledge.

Asthma control, quality of life, and the role of patient enablement: a cross-sectional observational study.

BACKGROUND: Self-assessment of asthma and a stronger doctor-patient relationship can improve asthma outcomes. Evidence for the influence of patient enablement on quality of life and the control of asthma is lacking. AIMS: To assess asthma severity, medication use, asthma control, and patient enablement in patients with asthma treated in primary care and to study the relationship between these variables and quality of life. METHODS: A cross-sectional study was conducted in an urban clinic in northern Portugal. Data were collected from both clinical records and questionnaires from a random sample of asthma patients. The modified Patient Enablement Instrument, the Asthma Quality of Life Questionnaire, and the Asthma Control Questionnaire were used. Peak expiratory flow and forced expiratory volume in one second (FEV1) were measured. Receiver operating characteristic curve analysis was performed to establish cut-off values for the quality of life measurements. The associations between enablement, asthma control, and quality of life were tested using logistic regression models. RESULTS: The study sample included 180 patients. There was a strong correlation between asthma control and quality of life (r=0.81, p<0.001). A weak association between patient enablement and asthma control and quality of life was found in the logistic regression models. Poor control of asthma was associated with female gender, concomitant co-morbidities, reduced FEV1, and increased severity of asthma. CONCLUSIONS: The weak correlation between enablement and asthma control requires further study to determine if improved enablement can improve asthma outcomes independent of gender, severity, and concomitant co-morbidities. This study confirms the strong correlation between asthma control and quality of life.

Presencia de pediculosis en conviventes con niños positivos a Pediculus capitis (Anoplura: Pediculidae) / Presence of pediculosis in people living with children positive to Pediculus capitis (Anoplura: Pediculidae)

In order to determine the frequency of pediculosis in persons living with children diagnosed as positive to Pediculus capitis in educational institutions of the "Carmelo" People's Council, the houses of 58 children who repeatedly had pediculosis from May to September, 1997 were visited. 14.54 of the 237 examined persons were positive (40 individuals). 82.5 were females. The mother was the most affected relative (32.5). 30 positive children were matched by age, sex and grade with 30 negative children. People living together with the cases had a higher frequency of pediculosis (12.4) than those living with the controls (1.8) (t = 3.49; p < 0.001). The examination and treatment, if necessary, of those persons living together with the school children with pediculosis was recommended.