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Barbosa PM, Szrek H, Ferreira LN, Cruz VT, Firmino-Machado J. Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals. Ann Phys Rehabil Med 2024; 67:101824. [PMID: 38518399 DOI: 10.1016/j.rehab.2024.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Stroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways. OBJECTIVE To determine the most cost-effective rehabilitation pathway during the first 12 months after a first-ever stroke. METHODS A cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were conducted on model input values. RESULTS From the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual's perspective and between €10992 and €31319 from the healthcare service perspective. CONCLUSION Assuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles.
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Affiliation(s)
- Pedro Maciel Barbosa
- Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Rua de Alfredo Cunha 365, 4450-021 Matosinhos, Portugal; Centro de Investigação em Reabilitação, Escola Superior de Saúde, Instituto Politécnico do Porto, R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
| | - Helena Szrek
- Centre for Economics and Finance, University of Porto, R. Dr. Roberto Frias, 4200-464 Porto, Portugal
| | - Lara Noronha Ferreira
- ESGHT, Universidade do Algarve, Estr. da Penha 139, 8005-246 Faro, Portugal; Centre for Health Studies and Research of the University of Coimbra, Avenida Dias da Silva 165, 3004-512 Coimbra, Portugal; Research Centre for Tourism, Sustainability and Well-Being (CinTurs), Portugal.
| | - Vitor Tedim Cruz
- Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Rua de Alfredo Cunha 365, 4450-021 Matosinhos, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal
| | - João Firmino-Machado
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; Centro Académico Clínico Egas Moniz, 810-193 Aveiro, Portugal; Centro Hospitalar Vila Nova de Gaia/Espinho, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
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Fonseca A, Antunes M, Firmino-Machado J, Barroso A, Dias M. Characteristics and patient-reported outcomes of long-term lung cancer survivors. J Thorac Dis 2024; 16:1087-1096. [PMID: 38505031 PMCID: PMC10944758 DOI: 10.21037/jtd-23-1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/08/2023] [Indexed: 03/21/2024]
Abstract
Background Due to advances in screening and treatment of lung cancer, there has been increased interest in long-term lung cancer survivors (LTLCS). The aim of this study was to evaluate the prevalence of LTLCS, their characteristics and patient-reported outcomes (PROs) of LTLCS. Methods Cross-sectional study that included patients diagnosed with primary lung cancer between Jan 2012 and Dec 2016 whose overall survival (OS) was greater than 5 years. A self-administered questionnaire was applied, including European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30), Patient Health Questionnaire-4 (PHQ-4) and two open questions regarding quality of life (QoL) and suggestions for improvements. Factors potentially related to QoL were analysed. Results Of 767 lung cancer patients, 158 (20.6%) were LTLCS and LTLCS' proportion increased yearly. Most patients were male (70.9%) with median age of 65 [interquartile range (IQR), 56-71] years. Fifty-seven percent had adenocarcinoma, 66.2% were diagnosed at early stages but 8.9% were at stage IV. During follow-up, 77.1% quitted smoking, 31.8% had disease progression/relapse and 15.2% developed other tumours. Of all living LTLCS, 100 (85%) patients answered the PROs questionnaire. The median Global Health score was 66.67 (IQR, 50-83), social functioning had the best score and emotional functioning the worst. Pain and fatigue were the symptoms with the worst impact on QoL. PHQ-4 identified mental distress in 36% and patients with a lower QoL were more likely to present anxiety (35.3% vs. 9.4%, P=0.007) or depression (27.9% vs. 3%, P=0.006). In the open questions, patients reported pain (17%), lack of familiar/financial support (16%), dyspnoea (14%), depression (8%), concern for the future (8%) and limitations performing daily activities (8%) as the aspects with most impact in QoL. The most suggested measures were improvement of care provided by health institutions (25%) and better social support (16%). Conclusions Prevalence of LTLCS is increasing and survivors may experience a high prevalence of anxiety and depression as well as a high disease burden affecting QoL. Therefore, it's important to provide multidisciplinary continuous patient-centred care and a careful follow-up for all lung cancer patients, including LTLCS.
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Affiliation(s)
- Ana Fonseca
- Multidisciplinary Thoracic Tumours Unit, Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - João Firmino-Machado
- Epidemiology Research Unit, Public Health Institute of University of Porto, Porto, Portugal
- Medical Science Department of University of Aveiro, Aveiro, Portugal
| | - Ana Barroso
- Multidisciplinary Thoracic Tumours Unit, Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Margarida Dias
- Multidisciplinary Thoracic Tumours Unit, Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Maciel Barbosa P, Firmino-Machado J, Ferreira LN, Tedim Cruz V, Szrek H. From healthcare system to individuals through stroke rehabilitation pathways.Outcomes, information, and satisfaction along 12 months prospective cohort in Portugal. Top Stroke Rehabil 2023; 30:727-737. [PMID: 36651648 DOI: 10.1080/10749357.2023.2165266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The nature and quality of stroke survivor rehabilitation varies throughout Europe, including in Portugal, having not been widely monitored or benchmarked. OBJECTIVES This study analyses the stroke care pathway from three perspectives: healthcare system, process, and patient. METHODS The study uses data from a one-year single-center prospective cohort of first stroke patients, assessed at baseline, 3, 6, and 12 months. Care pathways and settings were described in terms of organizational model, funding, patient involvement, frequency and intensity and multidisciplinary team. Patient-level information and satisfaction were evaluated using a 10-point numeric rating scale. Kruskal - Wallis and post-hoc tests were used to compare EQ-5D-3 L, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Barthel Index, Mini-Mental State Examination scores between pathways and settings. RESULTS A total of 391 acute stroke patients, with a mean disability of 3.7 (mRS) and severity of 11.7 (NIHSS) participated. Six pathways and eight settings were described. A lack of compliance between guidelines and care was identified. There were significant differences in the four outcomes between the six pathways (p-values 0.007 to 0.020) suggesting inefficiency and inequalities, with an inadequate level of information and patient satisfaction. After post-hoc analysis, pathways 1 and 2 showed highest outcomes (p-values 0.001 to 0.002). Within settings, short-term units showed high scores, followed by rehabilitation center, outpatient hospital, and community clinic (p-values 0.001 to 0.040). CONCLUSION A multilevel characterization of the post-stroke rehabilitation pathway showed a more complete perspective on stroke management which may contribute to future rehabilitation and stroke policies.
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Affiliation(s)
- Pedro Maciel Barbosa
- Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Portugal
- Centro de Investigação em Reabilitação, Escola Superior de Saúde, Politécnico do Porto, Portugal
| | - João Firmino-Machado
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Centro Académico Clínico Egas Moniz, Aveiro, Portugal
- Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Lara Noronha Ferreira
- Universidade do Algarve - ESGHT, Portugal
- Centre for Health Studies and Research of the University of Coimbra/Centre for Innovative Biomedicine and Biotechnology, Portugal
- Research Centre for Tourism, Portugal
| | - Vitor Tedim Cruz
- Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Helena Szrek
- Centre for Economics and Finance, University of Porto, Porto, Portugal
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Araújo N, Silva I, Campos P, Correia R, Calejo M, Freitas P, Seco M, Ribeiro L, Costa AR, Morais S, Pereira S, Firmino-Machado J, Rodrigues R, Pais J, Ruano L, Lunet N, Tedim-Cruz V. Long-term neurological complications in COVID-19 survivors: study protocol of a prospective cohort study (NeurodegCoV-19). BMJ Open 2023; 13:e072981. [PMID: 37518072 PMCID: PMC10387627 DOI: 10.1136/bmjopen-2023-072981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Evidence suggests an association between SARS-CoV-2 infection and worse performance on cognitive tests, and a higher risk of Parkinson's disease (PD) and dementia up to 6 and 12 months after infection, respectively. Longer follow-ups with comparison groups are needed to clarify the potentially increased risk of neurodegenerative diseases in COVID-19 survivors, namely those infected before mass vaccination. METHODS A prospective study started in July 2022 with four cohorts of 150 individuals each, defined according to SARS-CoV-2 infection and hospitalisation status between March 2020 and February 2021: cohort 1-hospitalised due to SARS-CoV-2 infection; cohort 2-hospitalised, COVID-19-free; cohort 3-infected, not hospitalised; cohort 4-not infected, not hospitalised. Cohort 2 will be matched to cohort 1 according to age, sex, level of hospitalisation care and length of stay; cohort 4 will be age-matched and sex-matched to cohort 3. Baseline, 1-year and 2-year follow-up evaluations will include: cognitive performance assessed with the Montreal Cognitive Assessment (MoCA) and neuropsychological tests; the assessment of prodromal markers of PD with Rapid Eye Movement Sleep Behaviour Disorder single-question Screen and self-reported olfactory and gustative alterations; screening of PD with the 9-item PD screening questionnaire; gait evaluation with Timed Up&Go test. Suspected cases of cognitive impairment and PD will undergo a clinical evaluation by a neurologist. Frequency measures of neurological complications, prodromal markers and diagnoses of dementia and PD, will be presented. The occurrence of cognitive decline-the difference between baseline and 1-year MoCA scores 1.5 SD below the mean of the distribution of the variation-will be compared between cohorts 1 and 2, and cohorts 3 and 4 with OR estimated using multivariate logistic regression. ETHICS AND DISSEMINATION This study received ethics approval from the Ethics Committees of the health units Unidade Local de Saúde de Matosinhos and Centro Hospitalar de Entre Douro e Vouga, and informed consent is signed for participating. Results will be disseminated among the scientific community and the public.
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Affiliation(s)
- Natália Araújo
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Isa Silva
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Patrícia Campos
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Rita Correia
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Margarida Calejo
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos, Senhora da Hora, Portugal
| | - Pedro Freitas
- Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
| | - Mariana Seco
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos, Senhora da Hora, Portugal
| | - Luís Ribeiro
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos, Senhora da Hora, Portugal
| | - Ana Rute Costa
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Samantha Morais
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Susana Pereira
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Serviço de Neurologia, Instituto Português de Oncologia do Porto, Dr. Francisco Gentil, E.P.E, Porto, Portugal
| | - João Firmino-Machado
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Departamento de Ciências Médicas, Universidade de Aveiro, Aveiro, Portugal
| | - Rita Rodrigues
- Serviço de Neurologia, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Joana Pais
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Luís Ruano
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Serviço de Neurologia, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Nuno Lunet
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Vítor Tedim-Cruz
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos, Senhora da Hora, Portugal
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Santiago M, Cardoso-Teixeira P, Pereira S, Firmino-Machado J, Moreira S. A Hybrid-Telerehabilitation Versus a Conventional Program for Urinary Incontinence: a Randomized Trial during COVID-19 Pandemic. Int Urogynecol J 2023; 34:717-727. [PMID: 35596802 PMCID: PMC9123872 DOI: 10.1007/s00192-022-05108-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/19/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study aimed to compare the effectiveness of a hybrid telerehabilitation program with a traditional face to face model in women with stress urinary incontinence (SUI) and mixed incontinence (MUI) with a predominance of SUI. The authors hypothesized that home pelvic floor muscle training (PFMT) would have a similar benefit to outpatient PFMT. METHODS Parallel randomized controlled trial including 58 patients consecutively admitted to a tertiary academic hospital for pelvic floor rehabilitation consultation from 1 January to 30 April 2021 for conservative treatment of UI. Participants randomized to the intervention were submitted to a 12-week PFMT program: (1) a hybrid telerehabilitation program of two individual face-to-face sessions followed by 2-weekly sessions of video-telerehabilitation with a follow-up by a specialized physiotherapist, including one individual face-to-face session at 8 weeks; (2) a re-evaluation teleconsultation at 6 and 16 weeks; (3) a face-to-face consultation at 12 weeks. The control group had two initial individual sessions followed by twice-weekly group classes, and consultations were face to face. The primary outcome measure (at baseline and 12 weeks) was UI-related quality of life using the Portuguese Version of the King's Health Questionnaire. RESULTS At baseline the intervention (n = 18) and control (n = 17) groups were similar. UI-related quality of life significantly improved in both the intervention and control groups betweenbaseline (T0) and the end of the 12-week PFMT program (T12) (p = 0.002, p < 0.001, respectively), although the magnitude of the improvement was not significantly different between groups (-10.0 vs. -9.5 points, p = 0.918, respectively). CONCLUSION This hybrid telerehabilitation protocol showed effectiveness comparable to the traditional model in improving UI-related quality of life. Trial registration at www. CLINICALTRIALS gov , no. NCT05114395.
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Affiliation(s)
- Mariana Santiago
- Serviço de Medicina Física e de Reabilitação, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | | | - Sofia Pereira
- Serviço de Medicina Física e de Reabilitação, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Firmino-Machado
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.,Centro Académico Clínico - Egas Moniz Health Alliance, Aveiro, Portugal
| | - Susana Moreira
- Serviço de Medicina Física e de Reabilitação, Centro Hospitalar Universitário de São João, Porto, Portugal
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Ferreira JP, Leite-Moreira A, Da Costa-Pereira A, Soares AJ, Robalo-Cordeiro C, Jerónimo C, Gavina C, J Pinto F, Schmitt F, Saraiva F, Vasques-Nóvoa F, Canhão H, Cyrne-Carvalho H, Palmeirim I, Pimenta J, Cabral da Fonseca JE, Firmino-Machado J, Correia Pinto J, Lino, Castelo Branco M, Sousa N, Fontes de Carvalho R, Machado Luciano T, Gil Oliveira T, Resende Oliveira C. [Investigator-Led Clinical Research in Portugal: Problem Identification and Proposals for Improvement]. ACTA MEDICA PORT 2023; 36:305-308. [PMID: 36854257 DOI: 10.20344/amp.19333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/31/2023] [Indexed: 03/02/2023]
Affiliation(s)
- João Pedro Ferreira
- UnIC@RISE. Departamento de Cirurgia e Fisiologia. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Adelino Leite-Moreira
- UnIC@RISE. Departamento de Cirurgia e Fisiologia. Faculdade de Medicina. Universidade do Porto. Porto; Faculdade de Medicina. Universidade do Porto. Porto; Departamento de Cirurgia Cardiotorácica. Centro Hospitalar Universitário São João. Porto. Portugal
| | - Altamiro Da Costa-Pereira
- Faculdade de Medicina. Universidade do Porto. Porto; CINTESIS@RISE. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - António José Soares
- CINTESIS@RISE. Faculdade de Medicina. Universidade do Porto. Porto; Unidade de Gestão do Conhecimento. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | | | - Cármen Jerónimo
- Cancer Biology and Epigenetics Group. Instituto Português de Oncologia. Porto. Portugal
| | - Cristina Gavina
- Serviço de Cardiologia. Hospital Pedro Hispano. Unidade Local de Saúde de Matosinhos. Porto; UnIC@RISE. Departamento de Medicina. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia. Departamento de Coração e Vasos. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa; CCUL@RISE. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Fernando Schmitt
- Laboratório Associado RISE. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Francisca Saraiva
- UnIC@RISE. Departamento de Cirurgia e Fisiologia. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Francisco Vasques-Nóvoa
- UnIC@RISE. Departamento de Cirurgia e Fisiologia. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Helena Canhão
- Faculdade de Ciências Médicas & Comprehensive Health Research Centre. NOVA Medical School. Universidade NOVA de Lisboa. Lisboa; Unidade de Reumatologia. Hospital de Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | | | - Isabel Palmeirim
- Faculdade de Medicina e Ciências Biomédicas. Universidade do Algarve. Algarve. Portugal
| | - Joana Pimenta
- UnIC@RISE. Departamento de Cirurgia e Fisiologia. Faculdade de Medicina. Universidade do Porto. Porto; Serviço de Medicina Interna. Centro Hospitalar Gaia-Espinho. Porto. . Portugal
| | - João Eurico Cabral da Fonseca
- Faculdade de Medicina. Universidade de Lisboa. Lisboa; Serviço de Reumatologia. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | | | - Jorge Correia Pinto
- Escola de Medicina. Universidade do Minho. Braga; Serviço de Cirurgia Pediátrica. Hospital de Braga. Braga. Portugal
| | - Lino
- Faculdade de Medicina. Universidade de Coimbra. Coimbra; Serviço de Cardiologia. Centro Hospitalar Universitário de Coimbra. Coimbra. Portugal
| | | | - Nuno Sousa
- ICVS/3B's. Escola de Medicina. Universidade do Minho. Braga; Centro Clínico Académico (2CA). Hospital de Braga. Braga. Portugal
| | - Ricardo Fontes de Carvalho
- UnIC@RISE. Departamento de Cirurgia e Fisiologia. Faculdade de Medicina. Universidade do Porto. Porto; Serviço de Cardiologia. Centro Hospitalar Gaia-Espinho. Porto. Portugal
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Luís C, Fernandes R, Dias J, Pereira D, Firmino-Machado J, Baylina P, Fernandes R, Soares R. Bilateral breast cancer and the influence of body mass index in clinicopathological features and overall survival. Breast Dis 2023; 42:407-414. [PMID: 38108338 DOI: 10.3233/bd-230014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Breast cancer (BC) and obesity are two closely associated pathologies with increasing incidence and mortality rates. Bilateral Breast Cancer (BBC) displays a low incidence rate within BC and obesity represents a major risk factor. OBJECTIVE The aim of this study is to analyzed BBC clinicopathological features distribution and determine the potential influence of obesity in BBC in these same features and overall survival. METHODS Clinicopathological information was obtained from 42 cases of women with BBC diagnosed in IPO-Porto. To evaluate the frequency distribution of the clinicopathological data, a chi-square goodness of fit test was performed for BBC cases. A chi-square test of independence was applied for BMI stratification. Cox regression was performed for overall survival. Statistical significance was set at p-value < 0.05. RESULTS Distribution of BBC clinicopathological features was found to be statistically significant in family history (p-value < 0.001), BBC type (p-value < 0.001), stage (p-value = 0.005), differentiation grade (p-value < 0.001), receptor expression (p-value < 0.001) and histological type (p-value = 0.031). In comparison to the statistical expected results, we observed an increased cases of absence of family history and less cases of metachronous BBC. Histological types between tumours of BBC were mostly concordant. All cases presented concordant receptor expression. Analysis stratified by BMI revealed that obese women were diagnosed later, although without statistical significance. All obese women presented poor differentiation grade (n = 6). Overweight patients display a tendency to a better overall survival with lower tumour stages and lower differentiation grades. CONCLUSIONS Our results reveal the same receptor expression between contralateral tumours. Also, most tumours share the same histological type. When stratified by BMI, we observed a tendency for overweight women to have improved overall survival.
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Affiliation(s)
- Carla Luís
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- i3S - Instituto de Inovação e Investigação em Saúde, University of Porto, Porto, Portugal
| | | | - João Dias
- Portuguese Oncology Institute of Porto, Porto, Portugal
| | | | - João Firmino-Machado
- EPIUnit, Instituto de Saúde Pública, University of Porto, Porto, Portugal
- Departamento de Ciências Médicas, University of Aveiro, Aveiro, Portugal
- Centro Académico Clínico Egas Moniz, Aveiro, Portugal
| | - Pilar Baylina
- i3S - Instituto de Inovação e Investigação em Saúde, University of Porto, Porto, Portugal
- School of Health, Polytechnic of Porto, Porto, Portugal
| | - Rúben Fernandes
- i3S - Instituto de Inovação e Investigação em Saúde, University of Porto, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Fernando Pessoa Hospital-School, Porto, Portugal
| | - Raquel Soares
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- i3S - Instituto de Inovação e Investigação em Saúde, University of Porto, Porto, Portugal
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8
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Vilas-Boas F, Lopes S, Teixeira M, Rodrigues C, Teixeira M, Frias-Bulhosa J, Teixeira S, Pinto M, Carvalho T, Pinheiro E, Nunes C, Portugal R, Duarte R, Firmino-Machado J. COVID-19 collaborative screening: An action-research project for large scale contact tracing in Northern Portugal. Prev Med Rep 2022; 29:101926. [PMID: 35892121 PMCID: PMC9304078 DOI: 10.1016/j.pmedr.2022.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/14/2022] Open
Abstract
In late November 2020, when Europe reached the highest 14-day incidence of COVID-19 cases, the resource-intensive and time-consuming traditional contact tracing performed by Public Health was challenged. In this context, innovative approaches were necessary to guarantee a timely interruption of disease transmission. “COVID-19 Collaborative Screening” Project was developed as a faster solution, not only because the contact tracing process is simpler for the operator, but mainly because it is possible to quickly scale up the number of operators involved. It was designed to interrupt family and social transmission chains, in a partnership with the Local Public Health Services – allowing these services to dedicate to scenarios of more complex risk assessment, using the traditional contact tracing. To perform contact tracing, this method involves Public Servants, Armed Forces and Medical Dentists. The Project also promotes participatory citizenship, by delegating to the citizen the responsibility of registering his/hers contacts with high-risk exposure in an online form, in contrast to the traditional contact tracing method which is more health professional-dependent. Until the end of January 2021, the Project has trained eight teams, enrolling a total of 213 professionals, and was implemented in eight Health Regions (with an estimated population of 1,346,150 inhabitants). The Project was successful at facing the delays in case interview and contact tracing. The strategy implemented by ColabCOVID is assembled as a sustainable, reproducible and scalable platform and is ready to be re-implemented to face the emergence of more contagious variants, as well as an eventual forthcoming health threat.
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Affiliation(s)
| | - Sofia Lopes
- Northern Regional Health Administration, Porto, Portugal
| | | | | | - Marta Teixeira
- Northern Regional Health Administration, Porto, Portugal
| | - José Frias-Bulhosa
- Northern Regional Health Administration, Porto, Portugal.,Oral Public Health Department - Public Health Institute, University of Porto, Porto, Portugal
| | - Sara Teixeira
- Northern Regional Health Administration, Porto, Portugal
| | - Marta Pinto
- Clinical Research Unit of the Northern Regional Health Administration, Porto, Portugal.,Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Tiago Carvalho
- Northern Regional Health Administration, Porto, Portugal
| | - Eduardo Pinheiro
- Secretary of State - Coordinator for the Execution of State of Emergency Proclamation in the Northern Region of Portugal, Lisboa, Portugal
| | - Carlos Nunes
- Northern Regional Health Administration, Porto, Portugal.,Head of the North Regional Health Administration, Porto, Portugal
| | - Rui Portugal
- Deputy Director-General of Health, Directorate-General of Health, Lisboa, Portugal
| | - Raquel Duarte
- Northern Regional Health Administration, Porto, Portugal.,Clinical Research Unit of the Northern Regional Health Administration, Porto, Portugal.,EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Public Health, Forensic Sciences and Medical Education Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Firmino-Machado
- Northern Regional Health Administration, Porto, Portugal.,EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Public Health, Forensic Sciences and Medical Education Department, Faculty of Medicine of the University of Porto, Porto, Portugal
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9
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Frio GS, Russo LX, de Albuquerque CP, da Mota LMH, Barros-Areal AF, Oliveira APRA, Firmino-Machado J, da Silva EN. The disruption of elective procedures due to COVID-19 in Brazil in 2020. Sci Rep 2022; 12:10942. [PMID: 35768482 PMCID: PMC9243075 DOI: 10.1038/s41598-022-13746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
Elective procedures were temporarily suspended several times over the course of the pandemic of COVID-19. Monthly data from the Unified Health System (SUS) were used for the period between January 2008 and December 2020 and the interrupted time series method was used to estimate the effect of the pandemic on the number of elective surgeries and elective procedures that were not performed. Considering a 9-month period, a reduction of 46% in the number of elective procedures carried out in the SUS could be attributed to COVID-19, corresponding to about 828,429 elective procedures cancelled, ranging from 549,921 to 1,106,936. To a full recovery of pre-pandemic performance, SUS would need to increase about 21,362 hospital beds, ranging from 12,370 to 36,392 hospital beds during a 6 month-period. This effort would represent an increase of 8.48% (ranging from 4.91 to 14.45%) in relation to the total number of SUS’s hospital beds in 2019. As a result, the pandemic will leave a large number of elective procedures to be carried out, which will require efforts by health agencies to meet this demand.
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Affiliation(s)
- Gustavo Saraiva Frio
- Graduate Program in Collective Health, Faculty of Health Science, University of Brasilia, Brasília, Brazil.,Catholic University of Pelotas, Pelotas, Brazil
| | - Letícia Xander Russo
- Department of Economics, Federal University of Grande Dourados, Dourados, Brazil.
| | - Cleandro Pires de Albuquerque
- Graduate Program in Medical Science, Faculty of Medicine, University Hospital of Brasília, University of Brasilia, Brasília, Brazil
| | | | - Adriana Ferreira Barros-Areal
- Graduate Program in Medical Science, Health Department of the Federal District (SES/DF), Faculty of Medicine, University of Brasilia, Brasília, Brazil
| | | | - João Firmino-Machado
- Faculty of Medicine, Institute of Public Health (ISPUP), University of Porto, Porto, Portugal
| | - Everton Nunes da Silva
- Graduate Program in Collective Health, Faculty of Health Science, Faculty of Ceilândia, University of Brasilia, Brasília, Brazil
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10
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Nuno J, Fernandes S, Silva TR, Guimarães AC, Pereira BM, Laureano-Alves S, de Sousa ICV, Brito D, Firmino-Machado J. What attributes do patients prefer in a family physician? A cross-sectional study in a northern region of Portugal. BMJ Open 2021; 11:e035130. [PMID: 33514569 PMCID: PMC7849883 DOI: 10.1136/bmjopen-2019-035130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To determine which modifiable and non-modifiable attributes patients prefer in a family physician, as well as to analyse participants' characteristics associated with their choices. DESIGN Cross-sectional study. SETTING Family healthcare units (FHU) in the city of Braga and Barcelos (Northern Portugal). PARTICIPANTS Adults aged 18 years or more, enrolled in the selected FHU. MAIN OUTCOME MEASURES The preferred attributes were assessed with a questionnaire delivered in the FHU. These attributes included gender, age and nationality and the importance of being Portuguese, of greeting with a handshake, of welcoming in the waiting area, of using an identification badge and of wearing a white coat. RESULTS A total of 556 questionnaires were included in the analysis; 66% and 58% of the participants had no preference for the gender or age of the family physician, respectively. Using a multinomial logistic regression, male participants were 3.8 times more likely to have a preference for a male physician than having no preference, in comparison to female participants (OR 3.864, 95% CI 1.96 to 7.61). More than 69% of the participants considered greeting with a handshake, using an identification badge and wearing a white coat important or very important. There was a statistically significant association between being Portuguese and the major importance given to the use of an identification badge (β=0.68, 95% CI 0.23 to 1.12). CONCLUSIONS Our data show that modifiable attributes of the family physician (greeting, presence of an identification badge and wearing a white coat) are important for patients. Potential changes in family physician attitude in consultation could ultimately affect patient-physician relationship.
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Affiliation(s)
- Joana Nuno
- Family Health Unit 7fontes, Northern Regional Health Administration, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Susana Fernandes
- Family Health Unit 7fontes, Northern Regional Health Administration, Braga, Portugal
| | - Teresa Rei Silva
- Family Health Unit Gualtar, Northern Regional Health Administration, Braga, Portugal
| | | | | | - Sara Laureano-Alves
- Family Health Unit Ruães, Northern Regional Health Administration, Braga, Portugal
| | | | - Dinis Brito
- Family Health Unit 7fontes, Northern Regional Health Administration, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - João Firmino-Machado
- EPIUnit -The Epidemiology Research Unit, University of Porto, Porto, Portugal
- Western Oporto Public Health Unit, Northern Regional Health Administration, Porto, Portugal
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11
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Brandão M, Guisseve A, Bata G, Firmino-Machado J, Alberto M, Ferro J, Garcia C, Zaqueu C, Jamisse A, Lorenzoni C, Piccart-Gebhart M, Leitão D, Come J, Soares O, Gudo-Morais A, Schmitt F, Tulsidás S, Carrilho C, Lunet N. Survival Impact and Cost-Effectiveness of a Multidisciplinary Tumor Board for Breast Cancer in Mozambique, Sub-Saharan Africa. Oncologist 2021; 26:e996-e1008. [PMID: 33325595 DOI: 10.1002/onco.13643] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/13/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite the international endorsement of multidisciplinary tumor boards (MTBs) for breast cancer care, implementation is suboptimal worldwide, and evidence regarding their effectiveness in developing countries is lacking. We assessed the impact on survival and the cost-effectiveness of implementing an MTB in Mozambique, sub-Saharan Africa. MATERIALS AND METHODS This prospective cohort study included 205 patients with breast cancer diagnosed between January 2015 and August 2017 (98 before and 107 after MTB implementation), followed to November 2019. Pre- and post-MTB implementation subcohorts were compared for clinical characteristics, treatments, and overall survival. We used hazard ratios and 95% confidence intervals (CI), computed by Cox proportional hazards regression. The impact of MTB implementation on the cost per quality-adjusted life year (QALY) was estimated from the provider perspective. RESULTS We found no significant differences between pre- and post-MTB subcohorts regarding clinical characteristics or treatments received. Among patients with early breast cancer (stage 0-III; n = 163), the 3-year overall survival was 48.0% (95% CI, 35.9-59.1) in the pre-MTB and 73.0% (95% CI, 61.3-81.6) in the post-MTB subcohort; adjusted hazard ratio, 0.47 (95% CI, 0.27-0.81). The absolute 3-year mean cost increase was $119.83 per patient, and the incremental cost-effectiveness ratio was $802.96 per QALY, corresponding to 1.6 times the gross domestic product of Mozambique. CONCLUSION The implementation of a MTB in Mozambique led to a 53% mortality decrease among patients with early breast cancer, and it was cost-effective. These findings highlight the feasibility of implementing this strategy and the need for scaling-up MTBs in developing countries, as a way to improve patient outcomes. IMPLICATIONS FOR PRACTICE Currently, more than half of the deaths from breast cancer in the world occur in developing countries. Strategies that optimize care and that are adjusted for available resources are needed to improve the outcomes of patients with breast cancer in these regions. The discussion of cases at multidisciplinary tumor boards (MTBs) may improve survival outcomes, but implementation is suboptimal worldwide, and evidence regarding their effectiveness in developing countries is lacking. This study evaluated the impact of implementing an MTB on the care and survival of patients with breast cancer in Mozambique, sub-Saharan Africa and its cost-effectiveness in this low-income setting.
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Affiliation(s)
- Mariana Brandão
- EPIUnit - Instituto de Saúde Pública, Porto, Portugal.,Departamentos de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Assucena Guisseve
- Department of Pathology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Genoveva Bata
- Oncology, Maputo Central Hospital, Maputo, Mozambique
| | - João Firmino-Machado
- EPIUnit - Instituto de Saúde Pública, Porto, Portugal.,Departamentos de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Matos Alberto
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Josefo Ferro
- Department of Pathology, Beira Central Hospital, Beira, Mozambique
| | - Carlos Garcia
- Department of Pathology, Beira Central Hospital, Beira, Mozambique
| | - Clésio Zaqueu
- Department of Pathology, Nampula Central Hospital, Nampula, Mozambique
| | | | - Cesaltina Lorenzoni
- Department of Pathology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,National Cancer Control Programme, Ministry of Health, Maputo, Mozambique
| | | | - Dina Leitão
- Patologia e Oncologia, Faculdade de Medicina, da Universidade do Porto, Porto, Portugal.,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jotamo Come
- Surgical, Maputo Central Hospital, Maputo, Mozambique
| | - Otília Soares
- Oncology, Maputo Central Hospital, Maputo, Mozambique
| | - Alberto Gudo-Morais
- Oncology, Maputo Central Hospital, Maputo, Mozambique.,Radiotherapy, Maputo Central Hospital, Maputo, Mozambique
| | - Fernando Schmitt
- Patologia e Oncologia, Faculdade de Medicina, da Universidade do Porto, Porto, Portugal.,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Satish Tulsidás
- EPIUnit - Instituto de Saúde Pública, Porto, Portugal.,Departamentos de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Oncology, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- EPIUnit - Instituto de Saúde Pública, Porto, Portugal.,Department of Pathology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Porto, Portugal.,Departamentos de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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12
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Firmino-Machado J, Soeteman DI, Lunet N. Cost-effectiveness of a stepwise intervention to promote adherence to cervical cancer screening. Eur J Public Health 2020; 30:401-410. [PMID: 31848592 DOI: 10.1093/eurpub/ckz222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cervical cancer screening is effective in reducing mortality, but adherence is generally low. We aimed to investigate the cost-effectiveness of a stepwise intervention to promote adherence to cervical cancer screening in Portugal. METHODS We developed a decision tree model to compare the cost-effectiveness of four competing interventions to increase adherence to cervical cancer screening: (i) a written letter (standard-of-care); (ii) automated short message service text messages (SMS)/phone calls/reminders; (iii) automated SMS/phone calls/reminders + manual phone calls; (iv) automated SMS/phone calls/reminders + manual phone calls + face-to-face interviews. The main outcome measure was cost per quality-adjusted life year (QALY) measured over a 5-year time horizon. Costs were calculated from the societal and provider perspectives. RESULTS From the societal perspective, the optimal strategy was automated SMS/phone calls/reminders, below a threshold of €8171 per QALY; above this and below €180 878 per QALY, the most cost-effective strategy was automated SMS/phone calls/reminders + manual phone calls and above this value automated SMS/phone calls/reminders + manual phone calls + face-to-face interviews. From the provider perspective, the ranking of the three strategies in terms of cost-effectiveness was the same, for thresholds of €2756 and €175 463 per QALY, respectively. CONCLUSIONS Assuming a willingness-to-pay threshold of one time the national gross domestic product (€22 398/QALY), automated SMS/phone calls/reminders + manual phone calls is a cost-effective strategy to promote adherence to cervical cancer screening, both from the societal and provider perspectives.
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Affiliation(s)
- João Firmino-Machado
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Unidade de Saúde Pública, ACeS Porto Ocidental, Porto, Portugal
| | - Djøra I Soeteman
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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13
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Silva Lopes B, Craveiro N, Firmino-Machado J, Ribeiro P, Castelo-Branco M. Hemodynamic differences among hypertensive patients with and without heart failure using impedance cardiography. Ther Adv Cardiovasc Dis 2019; 13:1753944719876517. [PMID: 31554488 PMCID: PMC6764032 DOI: 10.1177/1753944719876517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Impedance cardiography is a reliable, well-tolerated, and non-invasive method used to obtain hemodynamic measurements and could potentially be useful in heart failure (HF) diagnosis, hemodynamic monitoring of critically ill patients, and help in the choice of antihypertensive therapy. The objective of this study was to determine the differences between hemodynamic parameters in a study population of hypertensive patients with and without HF, using impedance cardiography. Methods: A case-control study was designed and named the TARGET study. Participants were enrolled in two study groups: control group C, hypertensive patients without HF and the HF group, hypertensive patients with HF. A descriptive analysis was carried out to characterize the sample and differences in continuous variables were tested for statistical significance by independent sample t test. Results: The study included 102 hypertensive outpatients. The control group consisted of 77 individuals (58.4% males; mean age 63.9 ± 12.5 years old) and the HF group consisted of 25 individuals (44.0% males; mean age 74.2 ± 8.7 years old). The mean Cardiac Index (CI) was 2.70 ± 1.02 L.min.m−2 (2.89 ± 1.04 versus 2.12 ± 0.70; p < 0.001), mean Stroke Index (SI) was 35.5 ± 14.7 mL.m−2 (37.7 ± 15.2 versus 28.5 ± 10.8; p = 0.006), mean Ejection Phase Contractility Index (EPCI) was 33.7 ± 12.7 1000 s−2 (35.8 ± 13.1 versus 27.2 ± 9.2; p = 0.003), mean Inotropic State Index (ISI) was 74.3 ± 28.2 100 s−2 (78.8 ± 28.9 versus 60.6 ± 20.7; p = 0.005), and mean Left Stroke Work Index (LSWI) was 51.3 ± 23.1 g.min.m−2 (55.4 ± 23.5 versus 38.9 ± 16.6; p = 0.002). Conclusions: In this study, hypertensive patients with HF had significantly lower values of blood flow parameters, contractility, and left work indices compared with hypertensive patients without HF. These differences reflected the incorrect hemodynamic pattern (mostly hypodynamic) of these patients. Impedance cardiography (ICG) seems to be an adequate method to reflect these differences.
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Affiliation(s)
- Bruno Silva Lopes
- Tondela-Viseu Hospital Center, Physical and Rehabilitation Medicine Department, Avenida Rei D. Duarte, Viseu, 3504-509, Portugal
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14
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Firmino-Machado J, Mendes R, Moreira A, Lunet N. Translating Evidence into Practice: Insights on the Reporting of Trial Results to Health Professionals and Institutions. ACTA MEDICA PORT 2019; 32:683-685. [PMID: 31703179 DOI: 10.20344/amp.11593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 07/10/2019] [Indexed: 11/20/2022]
Affiliation(s)
- João Firmino-Machado
- EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Unidade de Saúde Pública. Agrupamento de Centros de Saúde do Porto Ocidental. Porto. Portugal
| | - Romeu Mendes
- EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto. Unidade de Saúde Pública. Agrupamento de Centros de Saúde do Marão e Douro Norte. Vila Real. Portugal
| | - Amélia Moreira
- Unidade de Saúde Pública. Agrupamento de Centros de Saúde do Porto Ocidental. Porto. Portugal
| | - Nuno Lunet
- EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto. Departamento de Ciências da Saúde Pública e Forenses e Educação Médica. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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15
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Pinto I, Firmino-Machado J, Castro E, Alves S, Helena D, Condé A. The effects on the acoustic parameters and auditory-perceptive characteristics of voice in children submitted to adenoidectomy with or without tonsillectomy. Int J Pediatr Otorhinolaryngol 2019; 125:51-55. [PMID: 31254913 DOI: 10.1016/j.ijporl.2019.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyse the possible changes on the acoustic parameters and auditory-perceptive characteristics of children's voice after adenoidectomy with or without tonsillectomy. METHODS Prospective cohort study of children aged 5-12 years at one month before surgery (t0) and one (t1), three (t3) and six (t6) months after adenoidectomy with or without tonsillectomy. On each assessment the acoustic parameters (fundamental frequency, jitter %, shimmer % and harmonics-to-noise ratio) and auditory-perceptive analysis (nasal resonance, loudness, pitch, GRBAS scale and maximum phonation time) were recorded. RESULTS A total of 51 children were considered for data analysis. Nasal resonance revealed a significant decrease in the number of cases with hyponasality, from 86.3% at t0 to 12.8% at t1 (p < 0.001), 2.3% at t3 (p < 0.001) and 2.8% at t6 (p < 0.001). This improvement was maintained during the late follow-up time with no significant difference on nasal resonance between t0 and t3 (p = 0.250) and t3 and t6 (p = 0.250). All children with alteration on the GRBAS scale before the procedure showed a normal voice quality after the surgery. Regarding the acoustic parameters none showed a significant change with the surgery. CONCLUSIONS The results suggest that adenoidectomy with or without tonsillectomy is a safe procedure concerning voice alterations and can improve voice quality and nasal resonance in a sustained manner.
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Affiliation(s)
- Isabel Pinto
- ENT Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
| | | | - Eugénia Castro
- ENT Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Sandra Alves
- ENT Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Diamantino Helena
- ENT Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Artur Condé
- ENT Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
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16
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Firmino-Machado J, Varela S, Mendes R, Moreira A, Lunet N. A 3-step intervention to improve adherence to cervical cancer screening: The SCAN randomized controlled trial. Prev Med 2019; 123:250-261. [PMID: 30936001 DOI: 10.1016/j.ypmed.2019.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/06/2019] [Accepted: 03/16/2019] [Indexed: 11/17/2022]
Abstract
The aim of this study was to test the effectiveness of a stepwise intervention with an increasing level of complexity and cost to increase adherence to organized cervical cancer screening. This was a randomized (1: 1) controlled trial, conducted among 13 Portuguese primary health care units. Participants (n = 1220) were women aged 25-49 years, eligible for cervical cancer screening, with a mobile phone number available. The tested intervention was a 3-step invitation to screening, based on automated text messages/phone calls (step 1), manual phone calls (step 2) and face-to-face interviews (step 3), applied sequentially to non-adherent women after each step. Participants in the control group were invited through a written letter (standard of care). The primary outcome was the proportion of women screened, which was assessed after step 1 (45 days after the initial invitation), steps 1 + 2 (90 days after the initial invitation) and steps 1 + 2 + 3 (150 days after the initial invitation). Adherence to cervical cancer screening was significantly higher among women assigned to the intervention than those in the control group for step 1 (39.9% vs. 25.7%, p < 0.001), steps 1 + 2 (48.6% vs. 30.7%, p < 0.001) and steps 1 + 2 + 3 (51.2% vs. 34.0%, p < 0.001). In conclusion, adherence to cervical cancer screening was higher by 17% among women invited through the 3-step intervention, compared to those receiving the standard invitation letter. The former strategy has the potential to be broadly implemented due to the low requirements of technology and training. Clinical Trial Registration: NCT03122275.
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Affiliation(s)
- João Firmino-Machado
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Unidade de Saúde Pública, ACeS Porto Ocidental, Porto, Portugal.
| | - Sofia Varela
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Romeu Mendes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Unidade de Saúde Pública, ACeS Marão e Douro Norte, Porto, Portugal
| | - Amélia Moreira
- Unidade de Saúde Pública, ACeS Porto Ocidental, Porto, Portugal
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
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Guimarães B, Firmino-Machado J, Tsisar S, Viana B, Pinto-Sousa M, Vieira-Marques P, Cruz-Correia R, Ferreira MA. The Role of Anatomy Computer-Assisted Learning on Spatial Abilities of Medical Students. Anat Sci Educ 2019; 12:138-153. [PMID: 29762903 DOI: 10.1002/ase.1795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/07/2018] [Accepted: 04/09/2018] [Indexed: 06/08/2023]
Abstract
Currently, medical education context poses different challenges to anatomy, contributing to the introduction of new pedagogical approaches, such as computer-assisted learning (CAL). This approach provides insight into students' learning profiles and skills that enhance anatomy knowledge acquisition. To understand the influence of anatomy CAL on spatial abilities, a study was conducted. A total of 671 medical students attending Musculoskeletal (MA) and Cardiovascular Anatomy (CA) courses, were allocated to one of three groups (MA Group, CA Group, MA + CA Group). Students' pre-training and post-training spatial abilities were assessed through Mental Rotations Test (MRT), with scores ranging between 0-24. After CAL training sessions, students' spatial abilities performance improved (9.72 ± 4.79 vs. 17.05 ± 4.57, P < 0.001). Although male students in both MA Group and CA Group show better baseline spatial abilities, no sex differences were found after CAL training. The improvement in spatial abilities score between sessions (Delta MRT) was correlated with Musculoskeletal Anatomy training sessions in MA Group (r = 0.333, P < 0.001) and MA + CA Group (r = 0.342, P < 0.001), and with Cardiovascular Anatomy training sessions in CA Group (r = 0.461, P = 0.001) and MA + CA Group (r = 0.324, P = 0.001). Multiple linear regression models were used, considering the Delta MRT as dependent variable. An association of Delta MRT to the amount of CAL training and the baseline spatial abilities was observed. The results suggest that CAL training in anatomy has positive dose-dependent effect on spatial abilities.
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Affiliation(s)
- Bruno Guimarães
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS). Faculty of Medicine, University of Porto, Porto, Portugal
- Physical and Rehabilitation Medicine Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - João Firmino-Machado
- Unidade de Saúde Pública, ACeS Porto Ocidental, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública (ISPUP), University of Porto, Porto, Portugal
| | - Stanislav Tsisar
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS). Faculty of Medicine, University of Porto, Porto, Portugal
| | - Benedita Viana
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marco Pinto-Sousa
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Vieira-Marques
- Center for Research in Health Technologies and Information Systems (CINTESIS). Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricardo Cruz-Correia
- Center for Research in Health Technologies and Information Systems (CINTESIS). Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria Amélia Ferreira
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
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Arieira C, Dias de Castro F, Rosa B, Moreira MJ, Firmino-Machado J, Cotter J. Can we rely on inflammatory biomarkers for the diagnosis and monitoring Crohn's disease activity? Rev Esp Enferm Dig 2018; 109:828-833. [PMID: 28950707 DOI: 10.17235/reed.2017.5126/2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Small bowel capsule endoscopy (SBCE) is a very important tool in the diagnosis and monitoring of Crohn's disease (CD). The Lewis score (LS) and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) are used to quantify and standardize inflammatory activity observed in the SBCE. AIM To evaluate the correlation between the LS and CECDAI scores and inflammation biomarkers (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]). A secondary goal was to define thresholds for CECDAI based on thresholds already established for LS. METHODS This was a retrospective study of 110 patients with suspect or known CD, with involvement of small bowel. Linear regression was used to calculate thresholds of CECDAI corresponding to the thresholds already established for LS. A Pearson correlation (r) was used to calculate the correlation between the LS and CECDAI scores and biomarker levels. Only patients with exclusive involvement of the small bowel were selected (n = 78). RESULTS A moderate correlation was found between the endoscopic scores (r = 0.59, p < 0.001). CECDAI scores of 5.57 and 7.53 corresponded to scores of 135 and 790 in LS, respectively. There was a statistically significant correlation between CRP and the LS (r = 0.28, p = 0.014) and CECDAI (r = 0.29, p = 0.009). There was also a significant correlation between ESR and CECDAI (r = 0.29, p = 0.019), but not with LS. CONCLUSION There is a moderate correlation between the two scores. This study allowed the calculation of thresholds for CECDAI based on those defined for LS. We found a weak correlation between SBCE endoscopic activity and inflammatory biomarkers.
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Affiliation(s)
- Cátia Arieira
- Gastrenterologia, Hospital da Senhora da Oliveira- Guimarães, Portugal
| | | | - Bruno Rosa
- Gastrenterologia, Hospital da Senhora da Oliveira -Guimarães, Portugal
| | | | | | - José Cotter
- Gastrenterologia, Hospital da Senhora da Oliveira -Guimarães, Portugal
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Oliveira MJP, Rodrigues F, Firmino-Machado J, Ladeira IT, Lima R, Conde SD, Guimarães M. Assessment of Respiratory Muscle Weakness in Subjects With Neuromuscular Disease. Respir Care 2018; 63:1223-1230. [DOI: 10.4187/respcare.06136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rebelo S, Velho Rua S, d’Orey Leça J, Couto A, Teixeira R, Firmino-Machado J. Is healthy children surveillance being duplicated by family physicians and paediatricians? A cross-sectional study in Portugal. BMJ Open 2018; 8:e015902. [PMID: 29496894 PMCID: PMC5855303 DOI: 10.1136/bmjopen-2017-015902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To determine if children attend the family physician (FP) or the FP/paediatrician for their surveillance medical appointments, as well as analyse the variables associated with the parents' choice between the two physicians. DESIGN Cross-sectional study. SETTING Public, semiprivate and private kindergartens in the city of Vila Nova de Famalicão (Portugal). PARTICIPANTS Parents of children aged 6 years or less without chronic diseases, enrolled in the selected kindergartens. MAIN OUTCOME MEASURES Proportion of children attending the FP or FP/paediatrician for their surveillance appointments; association between the chosen physician and sociodemographic and household variables (parents' age, educational level, professional situation and marital status; household net income; number of children; the child's age; presence of private health insurance), assessment of the parents' perception of clinical knowledge and accessibility regarding the FP and the paediatrician. RESULTS A total of 697 children were included in the analysis: 30.6% attended only the FP and 69.4% attended both the FP and the paediatrician. Using a Poisson regression, the mother's age (PR=1.02, 95% CI 1.00 to 1.03), higher educational level (prevalence ratio (PR=1.15, 95% CI 1.00 to 1.33), private health insurance (PR=1.30, 95% CI 1.15 to 1.46), number of children (PR=0.86, 95% CI 0.78 to 0.94) and the child's age (PR=0.95, 95% CI 0.91 to 0.98) were statistically associated with attending both the FP and the paediatrician; parents of children who attended only FP rated the FP with a higher accessibility and knowledge mean score than those who consulted both physicians (2.91vs2.38, P<0.001, and 4.11vs3.85, P<0.001). CONCLUSIONS Our data show that 70% of our sample simultaneously attended an FP and a paediatrician. FPs are equally qualified to provide medical care to healthy children but this information is not properly transmitted to the general population.
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Affiliation(s)
- Susana Rebelo
- Family Health Unit Ribeirão, Northern Regional Health Administration, Vila Nova de Famalicão, Portugal
| | - Sofia Velho Rua
- Family Health Unit Ribeirão, Northern Regional Health Administration, Vila Nova de Famalicão, Portugal
| | - Joana d’Orey Leça
- Family Health Unit Terras do Ave, Northern Regional Health Administration, Vila Nova de Famalicão, Portugal
| | - Ana Couto
- Personalized Health Care Unit Chaves A, Northern Regional Health Administration, Chaves, Portugal
| | - Rute Teixeira
- Family Health Unit Serzedelo, Family Health Unit Ribeirão, Guimarães, Portugal
| | - João Firmino-Machado
- Western Oporto Public Health Unit, Northern Regional Health Administration, Porto, Portugal
- EPIUnit -The Epidemiology Research Unit, University of Porto, Porto, Portugal
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21
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Firmino-Machado J, Mendes R, Moreira A, Lunet N. Stepwise strategy to improve Cervical Cancer Screening Adherence (SCAN-CC): automated text messages, phone calls and face-to-face interviews: protocol of a population-based randomised controlled trial. BMJ Open 2017; 7:e017730. [PMID: 28982833 PMCID: PMC5639987 DOI: 10.1136/bmjopen-2017-017730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/14/2017] [Accepted: 08/21/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Screening is highly effective for cervical cancer prevention and control. Population-based screening programmes are widely implemented in high-income countries, although adherence is often low. In Portugal, just over half of the women adhere to cervical cancer screening, contributing for greater mortality rates than in other European countries. The most effective adherence raising strategies are based on patient reminders, small/mass media and face-to-face educational programmes, but sequential interventions targeting the general population have seldom been evaluated. The aim of this study is to assess the effectiveness of a stepwise approach, with increasing complexity and cost, to improve adherence to organised cervical cancer screening: step 1a-customised text message invitation; step 1b-customised automated phone call invitation; step 2-secretary phone call; step 3-family health professional phone call and face-to-face appointment. METHODS A population-based randomised controlled trial will be implemented in Portuguese urban and rural areas. Women eligible for cervical cancer screening will be randomised (1:1) to intervention and control. In the intervention group, women will be invited for screening through text messages, automated phone calls, manual phone calls and health professional appointments, to be applied sequentially to participants remaining non-adherent after each step. Control will be the standard of care (written letter). The primary outcome is the proportion of women adherent to screening after step 1 or sequences of steps from 1 to 3. The secondary outcomes are: proportion of women screened after each step (1a, 2 and 3); proportion of text messages/phone calls delivered; proportion of women previously screened in a private health institution who change to organised screening. The intervention and control groups will be compared based on intention-to-treat and per-protocol analyses. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the Northern Health Region Administration and National Data Protection Committee. Results will be disseminated through communications in scientific meetings and peer-reviewed journals. TRIAL NUMBER NCT03122275.
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Affiliation(s)
- João Firmino-Machado
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Unidade de Saúde Pública, ACeS Porto Ocidental, Porto, Portugal
| | - Romeu Mendes
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Unidade de Saúde Pública, ACeS Douro I - Marão e Douro Norte, Vila Real, Portugal
- Universidade de Trás os Montes e Alto Douro, Vila Real, Portugal
| | - Amélia Moreira
- Unidade de Saúde Pública, ACeS Porto Ocidental, Porto, Portugal
| | - Nuno Lunet
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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22
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Côrte FC, Firmino-Machado J, Moura CP, Spratley J, Santos M. Acute pediatric neck infections: Outcomes in a seven-year series. Int J Pediatr Otorhinolaryngol 2017; 99:128-134. [PMID: 28688554 DOI: 10.1016/j.ijporl.2017.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/18/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to analyse the epidemiology, clinical presentation, diagnostic clues, as biochemical parameters and imaging studies, of children with acute neck infections (ANI) to identify possible independent prognostic factors leading to complications and prolonged hospitalization. METHODS Records of children admitted to a tertiary university hospital from January 2008 to December 2014 with a diagnosis of ANIs were reviewed retrospectively. Diseases were categorized according to the site of infection and patients were divided into two groups: children (aged<10 years) and adolescents (aged 10-18 years). RESULTS A total of 102 patients belonged to the children's group and 57 were adolescents. Forty-nine patients (27.2%) received antibiotics prior to presentation. The most frequent ANI was peritonsillar abscess (n = 72). Four peritonsillar abscesses progressed to parapharyngeal and retropharyngeal abscesses (n = 2 respectively). An association between age and type of abscess was found, with most of the retropharyngeal abscesses occurring in children (p = 0.05), and the submandibular abscesses in adolescents (p < 0.001). The most frequent symptoms/signs were fever (63.9%) and odynophagia (50.6%). Upon admission, all patients received intravenous antibiotics and 86.8% underwent drainage of the abscess. Cultures were harvested in 87 abscesses and the most frequent pathogen isolated was Streptococcus pyogenes. Signs of airway obstruction occurred in two patients with submandibular abscess, one with peritonsillar and one with parapharyngeal abscess. There were no cases of death or severe sequelae. Recurrent ANIs were observed in eight patients including two infected branchial cysts. Children, presence of multiple abscesses and palpable cervical mass on admission, absence of odynophagia and pharyngeal bulging, surgery with general anaesthesia and surgery after 24 h, were associated with prolonged hospitalization. Presence of toothache and neck pain on admission were identified as predictors of complications. CONCLUSIONS The present study found, that often, the diagnosis and treatment of neck abscesses in paediatric patients is not straightforward, but can achieve a favourable outcome. The primary location of the ANI appears to vary in different paediatric age groups. Younger age, presence of multiple abscesses or a palpable cervical mass on admission, were associated with prolonged hospitalization. Presence of toothache and neck pain on admission was identified as possible predictors of complications.
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Affiliation(s)
- Filipa Camacho Côrte
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal.
| | | | - Carla Pinto Moura
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal; Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Jorge Spratley
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal; University of Porto Medical School, Porto, Portugal
| | - Margarida Santos
- Department of Otorhinolaryngology, Hospital de São João EPE, Porto, Portugal
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Oliveira M, Ferreira M, Azevedo MJ, Firmino-Machado J, Santos PC. Pelvic floor muscle training protocol for stress urinary incontinence in women: A systematic review. Rev Assoc Med Bras (1992) 2017; 63:642-650. [DOI: 10.1590/1806-9282.63.07.642] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/01/2017] [Indexed: 04/28/2023] Open
Abstract
Summary Introduction: Strengthening exercises for pelvic floor muscles (SEPFM) are considered the first approach in the treatment of stress urinary incontinence (SUI). Nevertheless, there is no evidence about training parameters. Objective: To identify the protocol and/or most effective training parameters in the treatment of female SUI. Method: A literature research was conducted in the PubMed, Cochrane Library, PEDro, Web of Science and Lilacs databases, with publishing dates ranging from January 1992 to March 2014. The articles included consisted of English-speaking experimental studies in which SEPFM were compared with placebo treatment (usual or untreated). The sample had a diagnosis of SUI and their age ranged between 18 and 65 years. The assessment of methodological quality was performed based on the PEDro scale. Results: Seven high methodological quality articles were included in this review. The sample consisted of 331 women, mean age 44.4±5.51 years, average duration of urinary loss of 64±5.66 months and severity of SUI ranging from mild to severe. SEPFM programs included different training parameters concerning the PFM. Some studies have applied abdominal training and adjuvant techniques. Urine leakage cure rates varied from 28.6 to 80%, while the strength increase of PFM varied from 15.6 to 161.7%. Conclusion: The most effective training protocol consists of SEPFM by digital palpation combined with biofeedback monitoring and vaginal cones, including 12 week training parameters, and ten repetitions per series in different positions compared with SEPFM alone or a lack of treatment.
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Affiliation(s)
| | | | | | | | - Paula Clara Santos
- Instituto Politécnico do Porto, Portugal; Universidade do Porto, Portugal
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Firmino-Machado J, Magalhães I, Rodrigues J, Ramos V, Baptista S, Vilas-Boas B. [Health Governance and Proximity Management: The Need for Autonomy in Management in Primary Health Care Systems]. ACTA MEDICA PORT 2017; 30:431-433. [PMID: 28898608 DOI: 10.20344/amp.8274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 05/08/2017] [Indexed: 11/20/2022]
Affiliation(s)
- João Firmino-Machado
- Unidade de Saúde Pública. Agrupamentos de Centros de Saúde Porto Ocidental. Porto. Portugal; Unidade de Investigação em Epidemiologia. Instituto de Saúde Pública. Universidade do Porto. Porto. Portugal
| | - Inês Magalhães
- Unidade de Saúde Familiar Serpa Pinto. Agrupamentos de Centros de Saúde Porto Ocidental. Porto. Portugal
| | - João Rodrigues
- Unidade de Saúde Familiar Serra da Lousã. Agrupamentos de Centros de Saúde Pinhal Interior Norte. Lousã. Portugal
| | - Victor Ramos
- Unidade de Saúde Familiar São João do Estoril. Agrupamentos de Centros de Saúde Cascais. Cascais. Portugal; Departamento de Medicina Geral e Familiar. Escola Nacional de Saúde Pública. Lisboa. Portugal
| | - Sofia Baptista
- Unidade de Saúde Pública. Agrupamentos de Centros de Saúde Porto Ocidental. Porto. Portugal
| | - Bernardo Vilas-Boas
- Unidade de Saúde Familiar Serpa Pinto. Agrupamentos de Centros de Saúde Porto Ocidental. Porto. Portugal
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Firmino-Machado J, Machado V, Matos C, Felício M. Forecasting Mortality: North Portugal. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw166.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ferreira M, Firmino-Machado J, Marques EA, Santos PC, Simões AD, Duarte JA. Prognostic factors for recovery in Portuguese patients with Bell’s palsy. Neurol Res 2016; 38:851-6. [DOI: 10.1080/01616412.2016.1209620] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Margarida Ferreira
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure, University of Porto, Porto, Portugal
- Department of Physiotherapy, CESPU, North Polytechnic Institute of Health, Gandra and Vila Nova de Famalicão, Portugal
| | | | - Elisa A. Marques
- Research Center in Sports Sciences, Health and Human Development (CIDESD), University Institute of Maia (ISMAI), Maia, Portugal
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Paula C. Santos
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure, University of Porto, Porto, Portugal
- Department of Physical Therapy, School of Health Technology of Porto, Polytechnic Institute of Porto, Vila Nova de Gaia, Portugal
| | - Ana Daniela Simões
- Department of Physiotherapy, CESPU, North Polytechnic Institute of Health, Gandra and Vila Nova de Famalicão, Portugal
| | - José A. Duarte
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure, University of Porto, Porto, Portugal
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Vale C, Menezes C, Firmino-Machado J, Rodrigues P, Lume M, Tenedório P, Menéres P, Brochado MDC. Astigmatism management in cataract surgery with Precizon(®) toric intraocular lens: a prospective study. Clin Ophthalmol 2016; 10:151-9. [PMID: 26855559 PMCID: PMC4727514 DOI: 10.2147/opth.s91298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the visual and refractive outcomes and rotational stability of the new aspheric Precizon® toric intraocular lens (IOL) for the correction of corneal astigmatism in cataract surgery. Setting Department of Ophthalmology, Hospital Geral de Santo António – Centro Hospitalar do Porto, EPE and Hospital de Pedro Hispano, Matosinhos, Portugal. Design This was a prospective clinical study. Patients and methods A total of 40 eyes of 27 patients with corneal astigmatism greater than 1.0 diopter (D) underwent cataract surgery with implantation of Precizon® toric IOL. IOL power calculation was performed using optical coherence biometry (IOLMaster®). Outcomes of uncorrected (UDVA) and best-spectacle corrected distance visual acuities (BCDVA), refraction, and IOL rotation were analyzed at the 1st week, 1st, 3rd, and 6th month’s evaluations. Results The median postoperative UDVA was better than preoperative best-spectacle corrected distance visual acuity (0.02 [0.06] logMAR vs 0.19 [0.20] logMAR, P<0.001). At 6 months, postoperative UDVA was 0.1 logMAR or better in 95% of the eyes. At last follow-up, the mean spherical equivalent was reduced from −3.35±3.10 D to −0.02±0.30 D (P<0.001) with 97.5% of the eyes within ±0.50 D of emmetropia. The mean preoperative keratometric cylinder was 2.34±0.95 D and the mean postoperative refractive cylinder was 0.24±0.27 D (P<0.001). The mean IOL rotation was 2.43°±1.55°. None of the IOLs required realignment. Conclusion Precizon® toric IOL revealed very good rotational stability and performance regarding predictability, efficacy, and safety in the correction of preexisting regular corneal astigmatism associated with cataract surgery.
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Affiliation(s)
- Carolina Vale
- Department of Ophthalmology, Hospital Geral de Santo António - Centro Hospitalar do Porto, EPE, Porto, Portugal
| | - Carlos Menezes
- Department of Ophthalmology, Hospital de Pedro Hispano, Matosinhos, Portugal
| | | | - Pedro Rodrigues
- Department of Ophthalmology, Hospital de Pedro Hispano, Matosinhos, Portugal
| | - Miguel Lume
- Department of Ophthalmology, Hospital Geral de Santo António - Centro Hospitalar do Porto, EPE, Porto, Portugal
| | - Paula Tenedório
- Department of Ophthalmology, Hospital de Pedro Hispano, Matosinhos, Portugal
| | - Pedro Menéres
- Department of Ophthalmology, Hospital Geral de Santo António - Centro Hospitalar do Porto, EPE, Porto, Portugal
| | - Maria do Céu Brochado
- Department of Ophthalmology, Hospital Geral de Santo António - Centro Hospitalar do Porto, EPE, Porto, Portugal
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Dias de Castro F, Boal Carvalho P, Monteiro S, Rosa B, Firmino-Machado J, Moreira MJ, Cotter J. Lewis Score--Prognostic Value in Patients with Isolated Small Bowel Crohn's Disease. J Crohns Colitis 2015; 9:1146-51. [PMID: 26377028 DOI: 10.1093/ecco-jcc/jjv166] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/10/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Small bowel capsule endoscopy (SBCE) allows mapping of small bowel inflammation in Crohn's disease (CD). We aimed to assess the prognostic value of the severity of inflammatory lesions, quantified by the Lewis score (LS), in patients with isolated small bowel CD. METHODS A retrospective study was performed in which 53 patients with isolated small bowel CD were submitted to SBCE at the time of diagnosis. The Lewis score was calculated and patients had at least 12 months of follow-up after diagnosis. As adverse events we defined disease flare requiring systemic corticosteroid therapy, hospitalization and/or surgery during follow-up. We compared the incidence of adverse events in 2 patient subgroups, i.e. those with moderate or severe inflammatory activity (LS ≥790) and those with mild inflammatory activity (135 ≤ LS < 790). RESULTS The LS was ≥790 in 22 patients (41.5%), while 58.5% presented with LS between 135 and 790. Patients with a higher LS were more frequently smokers (p = 0.01), males (p = 0017) and under immunosuppressive therapy (p = 0.004). In multivariate analysis, moderate to severe disease at SBCE was independently associated with corticosteroid therapy during follow-up, with a relative risk (RR) of 5 (p = 0.011; 95% confidence interval [CI] 1.5-17.8), and for hospitalization, with an RR of 13.7 (p = 0 .028; 95% CI 1.3-141.9). CONCLUSION In patients with moderate to severe inflammatory activity there were higher prevalences of corticosteroid therapy demand and hospitalization during follow-up. Thus, stratifying the degree of small bowel inflammatory activity with SBCE and LS calculation at the time of diagnosis provided relevant prognostic value in patients with isolated small bowel CD.
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Affiliation(s)
- F Dias de Castro
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Sara Monteiro
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | | | - Maria João Moreira
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal. ICVS/3B's, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
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Araújo R, Firmino-Machado J, Correia P, Leitão-Marques M, Carvalho J, Silva M, Nogueira A, Nunes C. The plantar reflex: A study of observer agreement, sensitivity, and observer bias. Neurol Clin Pract 2015; 5:309-316. [PMID: 29443235 DOI: 10.1212/cpj.0000000000000155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The utility of the plantar reflex in modern neurology is controversial. We studied the Babinski, Chaddock, and Oppenheim reflexes in terms of intraobserver, interobserver, and intertest agreement; sensitivity; positive predictive value (PPV); and observer bias. Sixty-two patients and 1,984 reflexes were analyzed. Intraobserver and interobserver agreement were weak (median κ <0.4). Intertest agreement was weak (median κ < 0.4) for all paired reflexes, although highest for the Babinski/Chaddock (0.30) (p < 0.05). There was no evidence of observer bias. Sensitivity was 59.7% for the Babinski, 55.3% for the Chaddock, and 30.0% for the Oppenheim. PPV was 70.3% for the Babinski, 66.5% for the Chaddock, and 61.3% for the Oppenheim. Our results show consistently low observer agreement for the plantar reflex. The Babinski and the Chaddock demonstrated comparable sensitivity and PPV.
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Affiliation(s)
- Rui Araújo
- Department of Neurology (RA, PC, ML-M, JC, MS, CN) and Department of Internal Medicine (AN), Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; and Centro Hospitalar do Alto Ave (CHAA) (JF-M), Creixomil, Portugal
| | - João Firmino-Machado
- Department of Neurology (RA, PC, ML-M, JC, MS, CN) and Department of Internal Medicine (AN), Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; and Centro Hospitalar do Alto Ave (CHAA) (JF-M), Creixomil, Portugal
| | - Pedro Correia
- Department of Neurology (RA, PC, ML-M, JC, MS, CN) and Department of Internal Medicine (AN), Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; and Centro Hospitalar do Alto Ave (CHAA) (JF-M), Creixomil, Portugal
| | - Mariana Leitão-Marques
- Department of Neurology (RA, PC, ML-M, JC, MS, CN) and Department of Internal Medicine (AN), Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; and Centro Hospitalar do Alto Ave (CHAA) (JF-M), Creixomil, Portugal
| | - João Carvalho
- Department of Neurology (RA, PC, ML-M, JC, MS, CN) and Department of Internal Medicine (AN), Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; and Centro Hospitalar do Alto Ave (CHAA) (JF-M), Creixomil, Portugal
| | - Marta Silva
- Department of Neurology (RA, PC, ML-M, JC, MS, CN) and Department of Internal Medicine (AN), Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; and Centro Hospitalar do Alto Ave (CHAA) (JF-M), Creixomil, Portugal
| | - Ana Nogueira
- Department of Neurology (RA, PC, ML-M, JC, MS, CN) and Department of Internal Medicine (AN), Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; and Centro Hospitalar do Alto Ave (CHAA) (JF-M), Creixomil, Portugal
| | - Carla Nunes
- Department of Neurology (RA, PC, ML-M, JC, MS, CN) and Department of Internal Medicine (AN), Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; and Centro Hospitalar do Alto Ave (CHAA) (JF-M), Creixomil, Portugal
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Sá AP, Teixeira-Pinto C, Veríssimo R, Vilas-Boas A, Firmino-Machado J. Looking for the Perfect Mentor. ACTA MEDICA PORT 2015; 28:486-493. [PMID: 26574985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/18/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The authors established the profile of the Internal Medicine clinical teachers in Portugal aiming to define a future interventional strategy plan as adequate as possible to the target group and to the problems identified by the residents. MATERIAL AND METHODS Observational, transversal, analytic study. An online anonymous questionnaire was defined, evaluating the demographic characteristics of the clinical teachers, their path in Internal Medicine and their involvement in the residents learning process. RESULTS We collected 213 valid questionnaires, making for an estimated response rate of 28.4%. Median global satisfaction with the clinical teacher was 4.52 (± 1.33 points) and the classification of the relationship between resident and clinical teacher was 4.86 ± 1.04 points. The perfect clinical teacher is defined by high standards of dedication and responsibility (4.9 ± 1.37 points), practical (4.8 ± 1.12 points) and theoretical skills (4.8 ± 1.07 points). The multiple linear regression model allowed to determine predictors of the residentâs satisfaction with their clinical teacher, justifying 82,5% of the variation of satisfaction with the clinical teacher (R2 = 0.83; R2 a = 0.82). DISCUSSION Postgraduate medical education consists of an interaction between several areas of knowledge and intervening variables in the learning process having the clinical teacher in the central role. Overall, the pedagogical abilities were the most valued by the Internal Medicine residents regarding their clinical teacher, as determinants of a quality residentship. CONCLUSION This study demonstrates the critical relevance of the clinical teacher in the satisfaction of residents with their residentship. The established multiple linear regression model highlights the impact of the clinical and pedagogical relantionship with the clinical teacher in a relevant increase in the satisfaction with the latter.
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Affiliation(s)
- Ana Pinheiro Sá
- Departamento de Medicina Interna. Unidade de Faro. Centro Hospitalar do Algarve. Faro. Portugal
| | - Cristina Teixeira-Pinto
- Departamento de Medicina Interna. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Rafaela Veríssimo
- Departamento de Medicina Interna. Hospital de Gaia. Centro Hospitalar Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Andreia Vilas-Boas
- Departamento de Medicina Interna. Unidade Local de Saúde de Matosinhos. Hospital Pedro Hispano. Matosinhos. Portugal
| | - João Firmino-Machado
- Departamento de Saúde Pública. Unidade de Saúde Pública Porto Ocidental. Porto. Portugal
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