Multimorbidity and consultation time: a systematic review.

BACKGROUND: Multimorbidity (MM) is one of the major challenges health systems currently face. Management of time length of a medical consultation with a patient with MM is a matter of concern for doctors. METHODS: A systematic review was performed to describe the impact of MM on the average time of a medical consultation considering the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. The systematic online searches of the Embase and PubMed databases were undertaken, from January 2000 to August 2018. The studies were independently screened by two reviewers to decide which ones met the inclusion criteria. (Kappa = 0.84 and Kappa = 0.82). Differing opinions were solved by a third person. This systematic review included people with MM criteria as participants (two or more chronic conditions in the same individual). The type of outcome included was explicitly defined - the length of medical appointments with patients with MM. Any strategies aiming to analyse the impact of MM on the average consultation time were considered. The length of time of medical appointment for patients without MM was the comparator criteria. Experimental and observational studies were included. RESULTS: Of 85 articles identified, only 1 observational study was included, showing a clear trend for patients with MM to have longer consultations than patients without MM criteria (p < 0.001). CONCLUSIONS: More studies are required to better assess allocation length-time for patients with MM and to measure other characteristics like doctors' workload.

[Perfectionism, Burnout and Extracurricular Activities Among Medical Students from the University of Coimbra]. / Perfeccionismo, Burnout e as Atividades Extracurriculares nos Estudantes de Medicina da Universidade de Coimbra.

INTRODUCTION: The participation in extracurricular activities reduces the attributed importance to some causes of perfectionism, which influences the prevalence of burnout in medical students. This study aimed to investigate how this relationship occurs and which factors it is dependent on, in order to create strategies directed at these potential targets. MATERIAL AND METHODS: We developed a questionnaire that assesses the participation in extracurricular activities, including a survey regarding the reasons for perfectionism and part of the Copenhagen Burnout Inventory adapted for students. The questionnaire's application to medical students of the Masters Degree in Medicine of the Faculty of Medicine, University of Coimbra was followed by statistical analysis. RESULTS: In a sample of 360 students, 40% ranked highly in personal burnout, and 28.1% in study-related burnout, while 22.2% showed high levels of burnout in both components. Students who participated in extracurricular activities were less frequently associated with simultaneous personal-related and study-related high levels of burnout (p = 0.013). The kind of chosen extracurricular activity was not associated with the prevalence of burnout. DISCUSSION: Only 53.9% of students participate in extracurricular activities. Such participation is associated with a lower prevalence of burnout if it is practiced several times per week. The choice of one kind of activity over another does not seem to influence the prevalence of this syndrome, all of which are associated with benefits in different domains. CONCLUSION: We observed a lower prevalence of burnout among students that engaged in extracurricular activities. Further studiesthat can infer causality in this relationship are needed, in order to establish effective solutions specific to the medical course context.

Introdução: A participação em atividades extracurriculares reduz a importância atribuída a alguns motivos para o perfeccionismo que influenciam a prevalência de burnout nos estudantes de medicina. Este estudo visou investigar de que forma esta relação se processa e de que fatores depende, de forma a pensar estratégias direcionadas a estes potenciais alvos de atuação.Material e Métodos: Elaborou-se um questionário capaz de avaliar a prática de atividades extracurriculares que incluiu um inquérito dos motivos para o perfeccionismo e parte do Copenhagen Burnout Inventory adapted for students. À sua aplicação, via online, aos estudantes do Mestrado Integrado em Medicina da Faculdade de Medicina da Universidade de Coimbra, seguiu-se a análise estatística e inferencial dos dados obtidos.Resultados: Numa amostra de 360 alunos, 40% pontuaram elevados níveis de burnout pessoal e 28,1% de burnout relacionado com os estudos, tendo 22,2% obtido elevados níveis nas duas componentes. Alunos que praticavam atividades extracurriculares estiveram menos frequentemente associados a altos valores de burnout pessoal e relacionado com os estudos, simultaneamente (p = 0,013). O tipo de atividade extracurricular escolhido não mostrou relação com a prevalência de burnout.Discussão: Apenas 53,9% dos alunos participam numa atividade extracurricular, fator associado a uma menor prevalência de burnout, especialmente nos alunos que a realizam várias vezes por semana. A escolha de um tipo de atividade em detrimento de outro não parece influenciar a prevalência desta síndrome, estando todos associados a benefícios em diferentes domínios.Conclusão: Verificou-se menor prevalência de burnout em estudantes que praticavam atividades extracurriculares. Será necessária a realização de estudos que nesta relação permitam inferir causalidade, de forma a formular soluções efetivas e específicas do contexto do curso médico.

Impact of written information on control and adherence in type 2 diabetes.

INTRODUCTION: Diabetes therapeutic education and information by leaflets is important. This study aimed to understand the effectiveness of written information to diabetic patients, after six months, in the control of diabetes and medication adherence. METHOD: Non-pharmacological clinical trial. Randomized sample of diabetic patients of 65 volunteer doctors, distributed among the five health regions in Portugal. At the first appointment, patients were randomized in four groups (three intervention with validated leaflets and one control), leaflet reading being reinforced at the follow-up appointments in a 6-months period. Variables collected: HbA1c, home blood glucose, weight, waist circumference, blood pressure, cigarettes smoked, physical activity level, adherence to medication, medication, height, diabetes progression, age, sex and educational background. Descriptive and inferential statistics. RESULTS: From the 709 patients recruited, 702 were studied in this 6-months period with no statistical differences in the baseline variables studied. After six months of intervention, the adherence to medication improved in the leaflet group (p=0.034). This was noticed in those under 65 years of age (p=0.027), with diabetes for ≤ 5 years (p=0.010), with educational background up to 4 years (p=0.030) and 9 years (p=0.006) and with HbA1c ≥ 7% at the beginning of the study. CONCLUSION: Interventions with leaflets handed in primary healthcare to people with diabetes type 2 can bring benefits in what concerns adherence to therapeutics, namely in younger people with a less studies.

Impact of written information on control and adherence in type 2 diabetes / Impacto da informação escrita no controle e adesão na diabetes tipo 2

Summary Introduction: Diabetes therapeutic education and information by leaflets is important. This study aimed to understand the effectiveness of written information to diabetic patients, after six months, in the control of diabetes and medication adherence. Method: Non-pharmacological clinical trial. Randomized sample of diabetic patients of 65 volunteer doctors, distributed among the five health regions in Portugal. At the first appointment, patients were randomized in four groups (three intervention with validated leaflets and one control), leaflet reading being reinforced at the follow-up appointments in a 6-months period. Variables collected: HbA1c, home blood glucose, weight, waist circumference, blood pressure, cigarettes smoked, physical activity level, adherence to medication, medication, height, diabetes progression, age, sex and educational background. Descriptive and inferential statistics. Results: From the 709 patients recruited, 702 were studied in this 6-months period with no statistical differences in the baseline variables studied. After six months of intervention, the adherence to medication improved in the leaflet group (p=0.034). This was noticed in those under 65 years of age (p=0.027), with diabetes for ≤ 5 years (p=0.010), with educational background up to 4 years (p=0.030) and 9 years (p=0.006) and with HbA1c ≥ 7% at the beginning of the study. Conclusion: Interventions with leaflets handed in primary healthcare to people with diabetes type 2 can bring benefits in what concerns adherence to therapeutics, namely in younger people with a less studies.

Resumo Introdução: A educação terapêutica e a informação dada à pessoa com diabetes parece ser importante nesta doença de prevalência crescente. Estudar a efetividade da informação escrita dada ao utente diabético, após 6 meses, no controle e na adesão terapêutica. Método: Ensaio clínico não farmacológico. Amostra aleatorizada de diabéticos de 65 médicos de família voluntários, distribuídos pelas cinco regiões de Portugal continental. Na primeira consulta, as pessoas foram aleatorizadas (em grupos de intervenção com folhetos validados e grupo controle) e foi reforçada a leitura do folheto nas consultas de seguimento até 6 meses. Foram recolhidas as seguintes informações: HbA1c, glicemias em domicílio, peso, altura, perímetro abdominal, pressão arterial, cigarros fumados, atividade física praticada, adesão terapêutica, medicamentos tomados, tempo de evolução da diabetes, idade, sexo e educação. Estatística descritiva e inferencial. Resultados: Das 709 pessoas recrutadas, foram estudadas 702, sem diferenças significativas para as variáveis epidemiológicas medidas. Aos seis meses da intervenção, a adesão à terapêutica farmacológica melhorou mais no grupo que recebeu folheto (p=0,034), nas pessoas com menos de 65 anos (p=0,027), com diabetes há cinco anos ou menos (p=0,010), com formação de até quatro anos (p=0,030) e até nove anos (p=0,006) e com a HbA1c ≥ 7% no início do estudo (p=0,008). Conclusão: Folhetos dados nos cuidados de saúde primários a pessoas com diabetes tipo 2 podem beneficiar a adesão terapêutica a curto prazo, nomeadamente em pessoas mais novas e com menor formação.