Adherence to pharmacological therapy in patients with hypertension: protocol of a qualitative study by focus groups.

INTRODUCTION: Non-adherence to antihypertensive medication significantly contributes to inadequate blood pressure control. Regarding non-pharmacological interventions to improve medication adherence, the question remains of which interventions yield the highest efficacy.Understanding the complementary perspectives of patients and healthcare professionals can be valuable for designing strategies to enhance medication adherence. Few studies explored the perspectives of patients and healthcare professionals regarding medication adherence. None of them focused specifically on adherence to pharmacological therapy for hypertension in Portugal.Considering the high prevalence of non-adherence and its location-specific aspects, the priority should be identifying its barriers and developing tactics to address them.This study aims to gather the perspectives of patients with hypertension and healthcare professionals such as family doctors, nurses and community pharmacists from Portugal, regarding the most effective strategies to enhance antihypertensive medication adherence and to understand the factors contributing to non-adherence. METHODS AND ANALYSES: We will conduct qualitative research through synchronous online focus groups of 6-10 participants. Some groups will involve patients with hypertension, while others will include family doctors, nurses and community pharmacists. The number of focus groups will depend on the achievement of theoretical saturation. A purposive sample will be used. Healthcare participants will be recruited via email, while patients will be recruited through their family doctors.The moderator will maintain neutrality while ensuring interactive contributions from every participant. Participants will be encouraged to express their opinions on the meeting summary. Meetings will be recorded and transcribed.Two researchers will perform content analyses using MAXQDA V.12 through comparative analyses and subsequent consensus. A third researcher will review the analyses. The results will be presented narratively. ETHICS AND DISSEMINATION: The Ethics Committee of the University of Coimbra has approved this study with the number: CE-026/2021. The results will be disseminated via peer-reviewed publications and national and international conferences.

[Evaluation of the Scientific Production in the Field of General Practice and Family Medicine in Portugal]. / Avaliação da Produção Científica na Área da Medicina Geral e Familiar em Portugal.

INTRODUCTION: The Portuguese publications in the field of General Practice and Family Medicine have not yet been assessed in bibliometric studies. The aim of this study was to analyze that production between 2012 and 2022. METHODS: The Web of Science Core Collection was used to gather the number of articles, journals and citations obtained; the Journal Citation Reports to obtain the Impact Factor and quartile of journals; and Scimago Journal & Country Rank, for the comparison of data with other European countries. The search was based on the following query: "usf OR unidade de Saude Familiar OR centro de Saude OR ACeS OR medicina geral familiar OR Gen Practice Family SAME Portugal", and a time window between 2012 and 2022 was defined. The study considered the following quantitative indicators: total number of publications, typology, language, affiliation, co-authors, geographical distribution, thematic areas, and the number of publications/inhabitant and publications/physician from European countries; the qualitative indicators selected were the Impact Factor (IF), the quartile and the number of citations. RESULTS: Between 2012 and 2022, the national scientific production had an average annual growth rate of 36.6%. Of 389 publications, 73.8% were 'Articles' and 11.8% were 'Review Articles', predominantly in English (88.4%). The fields of 'General Internal Medicine' (24.7%) and 'Public Environmental Health' (14.9%) had the highest publication rates among the journals. The 389 publications received 5354 citations, for an average of 13.76 citations per article, and the average yearly citation growth was 115%. According to IF, 22.5% of the 222 journals belonged to Q4, 27.5% to Q3, 29.7% to Q2 and 20.3% to Q1, and therefore no significant bias regarding the journals where Portuguese doctors publish was observed. CONCLUSION: The bibliometric analysis allowed us to examine the evolution of the scientific production in the field of Portuguese General Practice and Family Medicine by observing an increasing publication trend and with a high potential for publication growth.

Introdução: As publicações portuguesas da área de Medicina Geral e Familiar ainda não foram alvo de estudos bibliométricos. Pretendeu-se analisar tal produção no período entre 2012 e 2022. Métodos: Usou-se a Web of Science Core Collection para obter o número de artigos, as revistas de publicação e as respetivas citações; o Journal Citation Reports para obter o Fator de Impacto e o quartil das revistas; e o Scimago Journal & Country Rank para a comparação de dados com outros países europeus. Utilizou-se a equação de pesquisa "usf OR unidade de Saude Familiar OR centro de Saude OR ACeS OR medicina geral familiar OR Gen Practice Family SAME Portugal", e selecionaram-se os resultados obtidos no período entre 2012 e 2022. Os indicadores quantitativos selecionados foram o total de publicações, tipologia, idioma, afiliação, coautorias, distribuição geográfica, áreas temáticas e o número de publicações/habitante e de publicações/médico em países europeus. Como indicadores qualitativos escolheu-se o Fator de Impacto (FI), o quartil das revistas e o número de citações. Resultados: Entre 2012 e 2022, a produção científica nacional teve uma taxa de crescimento médio anual de 36,6%. Em 389 publicações, 73,8% foram de 'Article' e 11,8% de 'Review Article', predominando a publicação em língua inglesa (88,4%). As revistas com maior publicação pertencem às áreas 'General Internal Medicine' (24,7%) e 'Public Environmental Health' (14,9%). As 389 publicações tiveram 5354 citações, com uma média de 13,76 citações por artigo e a taxa de crescimento médio anual de citações foi de 115%. Em função do FI, das 222 revistas, 22,5% pertenciam ao Q4, 27,5% ao Q3, 29,7% ao Q2 e 20,3% ao Q1, não se observando por isso nenhum viés assinalável relativamente às revistas onde os médicos portugueses publicam. Conclusão: A análise bibliométrica permitiu avaliar a evolução e o estado da produção científica da área da Medicina Geral e Familiar por investigadores portugueses, observando-se uma tendência de publicação crescente, e com forte potencial de crescimento.

Patient-Centered Medicine and Self-Care of Patients with Type 2 Diabetes: A Cross-Sectional Study.

INTRODUCTION: Even though the prevalence rate of diabetes in Portugal is one of the highest in Europe, no studies on the association between patient centered medicine, diabetes self-care, and glycemic control have been published. Assuming that patient centered medicine increases adherence to treatment through the improvement of the doctor-patient relationship, the aim of this study was to assess the influence of patient-centered medicine on the self-care of patients with type 2 diabetes patients' (T2DM) in two Family Health Units in Central Portugal, according to gender and age. MATERIAL AND METHODS: A cross-sectional study was conducted in two Family Health Units in Central Portugal between the 25th November 2021 and the 15th January 2022. Patients with type 2 diabetes were invited to fill in the Patient-Centered Medicine questionnaire, for patients (PCM-p) (where higher values represent worse results) and the Summary of Diabetes Self-Care Activities Measure (SDSCAM), (where higher values represent better results), while healthcare professionals filled in the epidemiologic variables on pre-defined days. RESULTS: A sample of 298 patients with type 2 diabetes was studied. Linear regressions for the association between SDSCAM scale factors and PCM-p showed significant associations for general diet (ß = -0.07, p < 0.001), specific diet (ß = -0.10, p < 0.001), exercise (ß = -0.03, p = 0.008), foot care (ß = -0.11, p < 0.001) and medication adherence in general (ß = -0.06, p = 0.001). Multiple linear regression including the association between glycated hemoglobin (HbA1c) and the SDSCAM scale dimensions showed that specific diet was associated with lower HbA1c levels (ß = -0.01, p = 0.007) and blood sugar testing (ß = 0.01, p < 0.001) and that a higher score in PCMp was associated with higher HbA1c levels (ß = 0.06, p < 0.001). Male patients (ß = -6.93, p = 0.007) and older patients (ß = -0.42, p = 0.001) were associated with lower scores in the specific diet. The male gender was associated with higher scores in exercise (ß = 7.62, p = 0.029), lower scores in foot care (ß = -6.06, p = 0.029) and lower scores in medication adherence to injectable medicines/6.2 (ß = -0.73, p = 0.018). Age was associated with a lower score in medication (ß = -0.03, p = 0.045) and a higher PCMp total score (ß = 0.07, p = 0.030). CONCLUSION: Patient-centered medicine in type 2 diabetics is associated with better self-care behaviors in patients with type 2 diabetes. Gender and age differences were observed in self-care behaviors and age differences were observed in Patient Centered Medicine.

Validation and Cultural Adaptation of the Problem Areas in Diabetes-5 (PAID-5) Scale to European Portuguese.

INTRODUCTION: Diabetes distress syndrome (DDS) can lead to poor outcomes and should be assessed with adapted and validated tools. One of these tools is the Problem Areas in Diabetes (PAID) scale, which assesses diabetes distress in people suffering from diabetes (PsD). A short five-item form, PAID-5, is an easier and quicker alternative to be used in clinical and research practices, than the previous one with 20-items and has been validated by the original authors. This study intended to perform the cultural adaptation and validation of the PAID-5 scale in European Portuguese. METHODS: To create the Portuguese version of PAID-5, translation-back translation, a clinical review, and a cognitive debriefing panel were performed. A convenience sample of 90 PsD was studied in three primary healthcare units for reliability and validity tests. Reliability was studied by the internal consistency (Cronbach's alpha) and the interval coefficient correlation (ICC) under a test-retest design. Structural validity was studied by principal component analysis. The construct validity was tested by the sensitivity of the PAID-5 total score with age, most recent HbA1c test, and socioeconomic class by the Socio-Economic Deprivation Index (SEDI). Criterion validity was tested by correlating the PAID-5 total score with the psychological distress questions of the Diabetes Health Profile 18 Questions (DHP-PDQ). RESULTS: A Cronbach's alpha coefficient value of 0.905 and an ICC of 0.905 were computed. In a sample of n = 90 PsD, 55.6% were males, 63.3% aged 65 years or more, SEDI was 5.2 ± 0.8 [3 to 6], 44.4% studied for less than 4 years, and 18.9% were living alone. The Spearman correlation between PAID-5 and DHP-PDQ total scores was ρ = 0.382, p < 0.001, between PAID-5 total score and age was ρ = -0.207, p = 0.050 and between PAID-5 total score and most recent HbA1c knowledge was ρ = 0.275, p = 0.040. There was no significant relationship between PAID-5 total score and SEDI ρ = 0.080, p = 0.452. CONCLUSION: DDS can now be assessed in the Portuguese context, accounting for better intervention by primary care teams. PAID-5 has good psychometric properties and is a reliable scale to identify diabetes-specific distress in the Portuguese diabetic population.

Health Literacy and Complications in People With Type 2 Diabetes: An Exploratory Study.

INTRODUCTION: A person with diabetes is subject to developing micro and macrovascular complications and prevention requires an active role from the person. So, health literacy should have a preponderant role in the health of people with diabetes but this link is yet not fully understood. The objective of this study is to understand the relationship between health literacy and the prevalence of complications in people with diabetes mellitus type 2 (DM2). METHODS: This is a multicentric transversal observational exploratory study. A survey was conducted with two health literacy instruments, the Medical Term Recognition Test (METER) and Newest Vital Sign (NVS), filled out by people with DM2 coming to consultation in primary health centers in three main regions of Portugal.  Results: In this sample (n=141), 50.6% were male, 41 to 88 years old, and 56% earned more than the minimum wage. Using the METER tool, it was found that 57.4% of the diabetic patients had functional literacy. Adequate literacy was found in 24.1% with the NVS tool. Also with the NVS tool it was found that 36.2% of the sample subjects had s high probability of limited literacy. Utilizing the METER tool, a statistically significant decrease in health literacy was observed in individuals with diabetic complications (p=0.001). There was no significant relation between the presence of diabetic complications and present blood pressure values, low-density lipoprotein, and socioeconomic index. CONCLUSION: In this study, we found a significant relation between lower health literacy and the presence of diagnosed DM2 complications (p=0.001).

Compassion and extracurricular activities of Portuguese Health Sciences students in Portugal.

BACKGROUND: Compassion, one of the items of empathy, is crucial in health care professions. So, the evaluation of the levels of compassion of Medicine, Dentistry and Pharmaceutical Sciences Master Degrees' (M.D.) students of the public Colleges in Portugal according to the type of Master Degree and the participation in extracurricular activities (E.A.) was a task to be performed. METHODS: Cross-sectional study in 2020, applying an on-line questionnaire including the "Compassion" items of the Jefferson Medical Empathy Scale - Students' version and questions about the participation in E.A. RESULTS: A sample of 901 students was studied. Its distribution by participation in E.A. did not differ significantly between M.D. (p = 0,854), most of the students participating in E.A. Using quartile distribution of compassion, the distribution of compassion levels was different among the three I.M. (p < 0.001), between Colleges (p < 0.001), and between curricular years (p < 0.001), with not different between genders (p = 0.036). For 56.4%, 74,6% and 69,5% of the respondents there was "medium-low" and "low" compassion for I.M. in Medicine, Pharmaceutical Sciences and Dentistry. These levels were also more prevalent among students in the 1st and 5th years. Levels of compassion were not different with the participation (p = 0,865), type (p = 0,177) and frequency of E.A. (p = 0,109). CONCLUSIONS: For their importance in future health care professionals, compassion and their differences found among the M.Ds. of this area deserve future studies. Levels of compassion showed differences between the M.D. studied and academic years of frequency. There was no relationship between the participation, type, and frequency of E.A. and the students' levels of compassion. The distribution of the level of compassion did not vary significantly with participation in E.A. (p = 0.865), with the type of E.A. (p = 0.177), with the frequency of E.A. (p = 0.109) or with the answer to the question "The practice of E.A. can make a person more compassionate?" (p = 0.503).

General Practice/Family Medicine Portuguese doctors: “technicists” or “systemics”? / Medicina General/Medicina de Familia. Médicos portugueses: ¿«técnicos» o «sistémicos»?

To study if the consultation's problems classification of a fictitious case by General and Family Medicine doctors, showed the characteristics of being a mechanistic or a systemic approach. Exploratory cross-sectional observational study in a convenience sample of the General Practice/Family Medicine population, internees included, in April 2020, applying a modified real world clinical case. Central Portugal and the Autonomous Region of Azores. General Practice/Family Medicine specialists and internees. Electronic Doctors invitation to participate, anonymously, in specific doctor's social networks. A self-fulfilling questionnaire was used to verify the classification of a clinical case in Subjective, Assessment and Plan (from the SOAP methodology) with the response options of the International Classification of Primary Health Care (ICPC2) in chapters P (Psychological) and Z (Social) possible for this case. “Technicists” doctors, only classifying “P” codes and “Systemics” classifying “P+Z” or only “Z” ICPC2 codes were defined. Differences between genders, work place, being an internee or specialist and being a tutor in specialized formation were studied. A sample of 227 30% (n=68) males, specialists represented 66% (n=149), of whom 49% (n=73) were internee's tutors and 34% (n=78) were internees, was studied. In the Subjective chapter of the SOAP methodology, 44.1% (n=100) were “technicists”, for Assessment n=93 (40.8%) were “technicists” and for P chapter classification 56.8% were “technicists”. For S, A and P chapters classification there was no significant difference between the considered variables. In this sample General Practice/Family Medicine Portuguese doctors were more “systemic” for the S and A chapters of the SOAP model, And “technicists” in the P chapter.(AU)

El enfoque de la medicina centrada en el paciente (MCP) es cada vez más importante debido a su asociación de efectos positivos sobre el médico y el paciente. El presente estudio tuvo como objetivo conocer si el abordaje de un caso clínico, a través de la clasificación de problemas de consulta de un caso ficticio por médicos de Medicina General y de Familia, presenta características de abordaje mecanicista o sistémico. Estudio observacional transversal en una muestra de conveniencia de la población de Medicina General/Medicina Familiar, incluidos los internos, en abril del 2020, aplicando un caso clínico del mundo real modificado de Portugal y los especialistas en Medicina General/Medicina Familiar de Azores y de Portugal central. Especialistas en Medicina General/Medicina Familiar e internados. Los médicos fueron invitados a participar, de forma anónima, mediante invitación electrónica, ya sea en la red oficial de pasantías o en la red social de un médico específico, la red MGFamiliar. Se utilizó un cuestionario autocumplimentable para verificar la clasificación de un caso clínico en subjetivo, evaluación y planificación (de la metodología SOAP) con las opciones de respuesta de la Clasificación Internacional de Atención Primaria de Salud (CIPC2) en los capítulos P (Psicológico) y Z (Social) posible para este caso. Se definieron médicos «técnicos» solo clasificando con códigos «P» y «sistémicos» clasificando «P+Z»’ o solo con códigos ICPC2 «Z». Se estudiaron las diferencias entre géneros, lugar de trabajo, ser interno o especialista, ser tutor en formación especializada. En una muestra de 227 sujetos, 30% (n=68) varones, los especialistas representaron el 66% (n=149), de los cuales el 49% (n=73) fueron tutores internos y el 34% (n=78), internos. Para la clasificación en el capítulo subjetivo de la metodología SOAP, el 44,1% (n=100) eran «técnicos», para la evaluación n=93 (40,8%) eran «técnicos» y para la clasificación del capítulo P el 56,8% eran «técnicos».(AU)

General Practice/Family Medicine Portuguese doctors: "technicists" or "systemics"?

To study if the consultation's problems classification of a fictitious case by General and Family Medicine doctors, showed the characteristics of being a mechanistic or a systemic approach. Exploratory cross-sectional observational study in a convenience sample of the General Practice/Family Medicine population, internees included, in April 2020, applying a modified real world clinical case. Central Portugal and the Autonomous Region of Azores. General Practice/Family Medicine specialists and internees. Electronic Doctors invitation to participate, anonymously, in specific doctor's social networks. A self-fulfilling questionnaire was used to verify the classification of a clinical case in Subjective, Assessment and Plan (from the SOAP methodology) with the response options of the International Classification of Primary Health Care (ICPC2) in chapters P (Psychological) and Z (Social) possible for this case. "Technicists" doctors, only classifying "P" codes and "Systemics" classifying "P+Z" or only "Z" ICPC2 codes were defined. Differences between genders, work place, being an internee or specialist and being a tutor in specialized formation were studied. A sample of 227 30% (n=68) males, specialists represented 66% (n=149), of whom 49% (n=73) were internee's tutors and 34% (n=78) were internees, was studied. In the Subjective chapter of the SOAP methodology, 44.1% (n=100) were "technicists", for Assessment n=93 (40.8%) were "technicists" and for P chapter classification 56.8% were "technicists". For S, A and P chapters classification there was no significant difference between the considered variables. In this sample General Practice/Family Medicine Portuguese doctors were more "systemic" for the S and A chapters of the SOAP model, And "technicists" in the P chapter.

[Alcohol Drinking in Higher Education Students from Coimbra and the Impact of Academic Festivities]. / Consumo de Álcool nos Estudantes do Ensino Superior de Coimbra e o Impacto das Festas Académicas.

INTRODUCTION: The international and national literature as well as studies carried out in universities in Portugal show there is excessive alcohol consumption and binge drinking. However, no relation with alcohol consumption and college parties has yet been established. The aim of this study was to assess the association between alcohol consumption and binge drinking with college parties, and also to understand specific patterns of alcohol consumption by gender and years of university attendance. MATERIAL AND METHODS: A survey comprised of the "Alcohol Use Disorders Identification Test - Consumption" (AUDIT-C) and the question "What is your most consumed drink?" referring to months without and with college parties, was disseminated in the University of Coimbra Facebook® page to students of the University of Coimbra and of the Polytechnic Institute of Coimbra seventeen years old and over. RESULTS: The AUDIT-C score in college party months is higher than in months without such parties with strong, positive and significant correlation (ρ = 0.711; ρ < 0.001). In months without college parties, 41.8% of females and 24.0% of males have a positive AUDIT-C. In months with college parties, 73.8% of females and 56.3% of males have a positive AUDIT-C. In months with college parties, females have higher risk of excessive consumption (ρ< 0.001) and drink a higher amount of spirits / shots. There is a significant difference in the most consumed drinks between genders (ρ < 0.001). DISCUSSION: Alcohol consumption is higher in those with less years in college attendance, but college parties seem to have a proportional impact regardless of the number of years of college attendance. In a month with college parties, there is more binge drinking and higher consumption than the daily maximum recommended amount. Males consume a higher amount of spirits / shots. CONCLUSION: College parties allow for more opportunities of pre-existing binge drinking. The way young people face alcohol consumption is a major problem to be addressed.

Introdução: Na literatura internacional, nacional e em estudos no ensino superior em Portugal os jovens apresentam consumos alcoólicos excessivos e binge drinking. Contudo, não se encontra estabelecida qualquer relação entre o consumo e as festas académicas. O objectivo deste estudo foi compreender a associação entre consumo de bebidas alcoólicas e festas académicas, estabelecendo uma relação entre estes momentos e um padrão específico de consumo, bem como perceber a ocorrência de padrões específicos de consumo de acordo com o sexo e os anos de frequência escolar.Material e Métodos: Foi elaborado um questionário, constituído pelo "Alcohol Use Disorders Identification Test ­ Consumption" (AUDIT-C) e apresentando a questão "Qual a bebida mais consumida?" num mês com festas académicas e num mês sem que se realizassem. O questionário dirigido a alunos da Universidade de Coimbra e do Instituto Politécnico de Coimbra, foi divulgado na página de Facebook® da Universidade de Coimbra.Resultados: Na amostra de estudantes do ensino superior de Coimbra, com idade igual ou superior a dezassete anos (n = 503), o AUDIT-C em mês com festas académicas é superior ao mês sem festas, verificando-se correlação positiva forte e significativa (ρ = 0,711; ρ < 0,001). Em mês sem festas académicas, 41,8% do sexo feminino e 24,0% do sexo masculino apresentam AUDIT-C positivo. Em mês com festas académicas 73,8% do sexo feminino e 56,3% do sexo masculino apresentam AUDIT-C positivo. O sexo feminino apresenta maior risco de consumo excessivo (ρ < 0,001) e bebe mais bebidas espirituosas / shots. Há diferença significativa entre sexos quanto à bebida mais consumida (ρ < 0,001).Discussão: O consumo de alcool é superior nos primeiros anos, embora as festas académicas pareçam ter um impacto proporcional independente do número de matrículas. Em mês com festas académicas, há maior frequência de binge drinking e de consumo superior ao máximo diário recomendado. O sexo masculino revela aumento do consumo de bebidas espirituosas / shots. Conclusão: As festas académicas fomentam as ocasiões de binge drinking pré-existentes, residindo o problema na forma como os jovens abordam o consumo de álcool.

Physician empathy and patient enablement: survey in the Portuguese primary health care.

BACKGROUND: Empathy is the capacity to understand and resonate with the experiences of other people. Patient enablement is the degree to which a patient feels strengthened in terms of being able to deal with, understand and manage their disease. METHODS: Secondary cross-sectional analysis of existing data from 2 independent datasets (456 primary health care patients), with the application of two validated questionnaires, Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and Patient Enablement Instrument (PEI). OBJECTIVE: Evaluate medical empathy and patients' enablement after consultation with their family doctors and to verify if there was an association between these two concepts. RESULTS: The median value of JSPPPE-VP score was 6.60 (interquartile range 1.00) and of PEI/ICC score was of 1.83 (interquartile range 0.67). Regarding empathy (JSPPPE-VP), patients taking chronic medication had a slight but significantly higher median score than patients not taking them (6.70 versus 6.60, P = 0.049), although regression modelling did not confirm any relevant predictor of JSPPPE-VP score. Regarding enablement (PEI/ICC), we found significantly higher scores on younger patients, as well as, on more educated and professionally active ones (P < 0.001). Multivariable linear regression and Poisson regression modelling confirmed such variables as statistically significant potential predictors. CONCLUSIONS: A significant positive association was found between empathy score (JSPPPE-VP) and enablement score (PEI/ICC), when adjusted to sociodemographic cofactors. On this linear regression model, age category and educational level were also significantly associated with empathy score, with the same pattern found on bivariate analysis.

[Knowledge of Palliative Care Among Medical Students of the University of Coimbra]. / Conhecimento sobre Cuidados Paliativos em Estudantes de Medicina da Universidade de Coimbra.

INTRODUCTION: The need for palliative care is increasing. Future doctors must be prepared for this, so it is essential to develop skills during their undergraduate studies. The aim of this study was to evaluate the knowledge of medical students at the Faculty of Medicine of the University of Coimbra regarding palliative care. MATERIAL AND METHODS: An observational and cross-sectional study was performed through the application of a questionnaire answered by fifth year medical students. The collected data were analyzed using IBM® SPSS® Statistics, version 20 for Windows®. RESULTS: All 186 students surveyed were aware of what palliative care is and recognized its importance. From the total, 52.7% of students reported they knew what an informal caregiver is and 96.8% disagreed that palliative care is only provided at the end of life; 88.2% have never had any training on how to deal with palliative care patients. Only 57.5% of students reported that they had been trained to communicate 'bad news', but 70.4% assumed that they were not able to communicate such bad news. On the other hand, 89.8% reported their inability to take care of palliative patients and 98.4% admitted that they needed more training in this area. DISCUSSION: With the increasing number of patients who require palliative care, there is the need to investigate whether medical students are being adequately prepared to care for these patients and assess their knowledge level in this context. CONCLUSION: Fifth-year medical students know what palliative care is and consider it important. However, they do not feel adequately trained and ready to take care of patients who need palliative care. It is essential to reflect on how physicians should be trained and to reconsider the medical syllabus, given the present lack of undergraduate medical training in palliative care.

Introdução: Cada vez mais doentes necessitam de cuidados paliativos. Os futuros médicos têm de estar preparados para esta realidade, pelo que é fundamental que desenvolvam competências ao longo do curso. Este estudo teve como objetivo avaliar o conhecimento sobre cuidados paliativos em estudantes de Medicina da Faculdade de Medicina da Universidade de Coimbra.Material e Métodos: Foi realizado um estudo observacional e transversal, através da aplicação de um questionário a estudantes de Medicina, do quinto ano. Os dados recolhidos foram analisados no IBM® SPSS® Statistics, versão 20 para Windows®.Resultados: Todos os 186 estudantes inquiridos mostraram saber o que são cuidados paliativos e reconheceram a sua importância. Do total, 52,7% afirmaram saber o que é um cuidador informal e 96,8% discordaram que a prestação de cuidados paliativos apenas acontece em fim de vida; 88,2% não receberam formação para lidar com doentes terminais ou dependentes de cuidados permanentes. Somente 57,5% dizem ter recebido formação para comunicar 'más notícias', mas 70,4% assumiram que não eram capazes de o fazer. Por outro lado, 89,8% revelaram não se sentir capacitados para cuidarem de doentes em cuidados paliativos e 98,4% manifestaram necessidade de mais formação nesta área.Discussão: Com o número crescente de doentes a precisar de cuidados paliativos surge a necessidade de investigar se os estudantes de medicina estão a ser adequadamente preparados para cuidarem destes doentes e avaliar o seu grau de conhecimento no âmbito dos cuidados paliativos.Conclusão: Os estudantes do quinto ano de Medicina sabem o que são cuidados paliativos e consideram-nos importantes. No entanto, não se sentem adequadamente preparados para cuidarem de doentes que precisam destes cuidados. É essencial refletir sobre como deverão ser formados os médicos e ponderar o plano de estudos do ensino médico, dada a falta de formação dos estudantes de medicina em cuidados paliativos.

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.

[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.

Comparing empathy in medical students of two Portuguese medicine schools.

BACKGROUND: Empathy is paramount in the doctor-patient relationship being a comprehensive and multidimensional concept. Self-ratings of empathy change across the years of medical education only when the Jefferson Scale of Physicians Empathy is used, with a worrying decrease being found throughout the years in Medicine Schools. As there are only few studies on the factors influencing medical student's empathy, particularly of the curricular model, this study aimed to compare the levels of empathy of medicine students of two Schools with different curricular models in central Portugal, the Faculty of Medicine - University of Coimbra (FMUC) and the Faculty of Health Sciences - University of Beira Interior (FCS-UBI). METHODS: Cross-sectional observational study with the Jefferson Scale of Physician Empathy - students' Portuguese version (JSPE - spv) to 1st, 3rd and 6th year students of the 2017/2018 academic year with descriptive and inferential statistical analysis (p < 0.05). RESULTS: Size representative sample of 795 students. Higher total empathy score (TES) (p = 0.008) and "Perspective taking" (p = 0.001) in FCS-UBI were found. JSPE-TES was higher in FCS-UBI, 3rd year (p = 0.038). Higher FCS-UBI "Perspective taking" in the 1st year (p = 0.030) and 6th year (p = 0.044), for "Compassionate care" in the 3rd (p = 0.019) and for "Standing in the patient's shoes" in the 1st year (p = 0.018) and in FMUC for "Compassionate care" in the 1st year (p = 0.037) and the "Standing in the patient's shoes" in year 3 (p = 0.002) were found. Higher levels of empathy were found in FCS-UBI female students, for JSPE-TES (p = 0.045) and "Perspective taking" (p = 0.001). CONCLUSION: Higher empathy levels in FCS-UBI were found, with different results in the third year suggesting influence of the medical course teaching characteristics between the two Medicine schools, student's empathy levels being higher when earlier and more intense contact with patients accompanied by skilled tutors was developed.

Patients' and tutors' evaluations of medicine students' consultations in general practice/family medicine in Coimbra.

BACKGROUND: Undergraduate teaching of General Practice/Family Medicine (GP/FM) must ensure students acquire the necessary competencies and skills to perform an adequate GP/FM consultation with adequate annotations (the SOAP model) and classifications. So aimed to study and to correlate students' evaluation by tutors and patients in specific consultations in the formal practical evaluation of GP/FM Curricular Unit of the Integrated Masters on Medicine at the Faculty of Medicine of the University of Coimbra (IMM-FMUC) in the academic years of 2017-2018 and 2018-2019. METHODS: Observational study of the 2017-2018 and 2018-2019 academic years of the assessment grids for tutor's evaluation of SOAP performance and fluency in consultation and for patient's evaluation of the student 'performance, in the convenience sample of those who chose to be so evaluated. RESULTS: We studied a population of 435 (67,7%) out of a universe of 646 students, 125 (28,7%) males, ns by sex and academic year who performed this evaluation. In a mark up to 20 from tutors, difference was found for Plan (P) mark, higher in 2018-2019 (18,38 ± 2,18vs18,54 ± 2,11, p = 0,005) of the SOAP methodology evaluation. Patients' evaluation was not different 19,34 ± 1,70vs19,35 ± 1,40, p = 0,091. A positive significant correlation was found between tutors and patients marks (ρ = 0,278; p < 0,001), as well as between tutor mark and final mark (ρ = 0,958; p < 0,001) and patient and final marks (ρ = 0,465; p < 0,001). Final marks were not different in both years, 18,61 ± 1,38vs18,78 ± 1,15, p = 0,158. CONCLUSIONS: This innovative model of evaluation of student's performance in medical appointment, showed a significant positive moderate correlation between patients' and tutors' marks in the setting of GP/FM at the IMM-FMUC, and was not different between years. Yearly evaluation must be continued.