Effectiveness of a Referral Program for rheumatoid arthritis and axial spondyloarthritis Diagnosis at Primary Care Centers in Portugal - SIARA STUDY.

OBJECTIVES: Early diagnosis and treatment of Rheumatoid Arthritis (RA) and axial Spondylarthritis (axial SpA) can limit the impact of disease outcomes. This study evaluated the effectiveness of a referral program on the identification of patients with RA and axial SpA. METHODS: This was an observational, prospective, randomized (by clusters) study conducted in Portugal to evaluate the impact of the implementation of a set of referral support actions (RSA). The study was divided in two sub-studies, the RA sub-study and the axial SpA sub-study. 28 participating primary care units were randomly (by clusters) assigned to RSA or control group (with no intervention). Both RSA and control groups identified and referred patients with suspected RA or axial SpA to the rheumatology unit of the reference hospital. The primary objective was to evaluate the correct diagnosis of RA or axial SpA cases confirmed by the rheumatologist of the reference hospital. RESULTS: RA-Substudy: A total of 340 patients were recruited (144 in the RSA-exposed group; 196 in the control). RA diagnosis confirmation was 7.3% (95%CI, 2.1-12.5%) in RSA group versus 2.7% (95%CI, 0.0-5.7%) in control group RSA effect was positive but moderate (4.6%) and not statistically significant (95% CI, 0.0%-11.8%; p=0.222, adjusted for clustering effect). Rate of confirmed arthritis of any type was 16.9% (n=14/83) in the RSA group and 6.0% (n=5/83) in the control group. This difference was statistically significant and favorable to RSA group (OR=3.2; 95% CI 1.1-9.2; p=0.028). Axial SpA-Substudy: A total of 231 patients were recruited (108 in the RSA-exposed group; 123 in the control). Axial SpA diagnosis confirmation was 8.7% (95% CI, 2.1-15.4%) in RSA group versus 5.6% (95% CI, 0.0-11.73%) in control group. RSA effect was positive (3.1%) but not statistically significant (95% CI, -7.5- 12.9%; p=0.568, adjusted for clustering effect). CONCLUSIONS: This study showed a positive tendency for the RSA program, most relevantly on the diagnosis of patients with any type of arthritis in the RA sub-study. It is possible that a referral program more comprehensive than the one herein tested might improve early diagnosis of RA and SpA.

[Smoking and cardiovascular risk factors in Barão do Corvo Health Center]. / Tabagismo e factores de risco cardiovascular no Centro de Saúde de Barão do Corvo.

INTRODUCTION: Smoking is the leading cause of preventable death and is associated with an increased risk of various diseases. The 2005-2006 National Health Survey revealed a national prevalence of 19.6% of active smokers. As a cardiovascular risk factor (CVRF), it as an independent role, for sudden death as for myocardial infarction. GOALS: To assess the prevalence and characteristics of smoking behavior of users using the Barão do Corvo Health Center (BCHC), and its relationship with other CVRF. MATERIALS AND METHODS: Observational study, cross-sectional analysis. Collection of data through survey applied to 502 users users CSBC, aged = 18 years. Non-random sample of convenience. RESULTS: In the sample we found 17.9% active smokers and 17.3% ex-smokers. In active smokers, 80% smoked between 1 to 25 cigarettes per day. 48% of respondents started smoking between 15 and 19 years. The abandonment of consumption occurred mainly between 35 and 44 years (24.7%) and was earlier in women (41.7% stopped smoking between 25 and 34 years). As for CVRF, there was a prevalence of smoking in hypertensive patients of 12.9%, 9.4% in diabetic patients, 12.3% of users with hypercholesterolaemia, 13.9% of users who had BMI > or = 25 and 20.5 % in sedentary. DISCUSSION: Compared with data from the population, the prevalence of active smokers is lower in the BCHC and ex-smokers is higher, the daily consumption of tobacco is also lower. The age of initiation of consumption was similar to national data, and age of abandonment was delayed, which is mostly between 35 and 44 years. The women left the tobacco earlier, and the most prevalent age group here was of 25 to 34 years, leading to think about a possible relationship with motherhood or reproductive age. For other CVRF studied, there was a lower prevalence of smokers in the groups of hypertension, diabetes, users with hypercholesterolaemia and overweight and obese users - this relationship was statistically significant. Is the promotion of healthy lifestyle in these groups taking effect?