Search Results (13)

Background/Objectives: The Portuguese NHS has embarked on an administrative restructuring aimed at enabling healthcare professionals, particularly family doctors, to focus on direct patient care and improve overall healthcare outcomes. This article details these measures, their initial benefits for patients and professionals, and explores future strategies to further integrate levels of care and leverage technology to enhance efficiency, patient-centeredness, and ultimately, population health. Methods: Each measure was evaluated to estimate its potential impact on the four pillars of the value-based healthcare (VBHC) framework. Results: We found that most measures aimed at reducing bureaucracy had an estimated impact on more than two of the four pillars. Conclusions: Thus, we conclude that the reduction in bureaucracy will tend to address several of the pillars of the VBHC framework and should be considered as a steppingstone in the process of increasing VBHC. Full article

Obstetric violence (OV) is a form of gender-based violence (GBV) that arises from the medicalisation of childbirth and the systematic devaluation of women’s bodies during pregnancy, childbirth, and the postpartum period. Recognised as a violation of sexual and reproductive rights, OV reflects historically constructed power relations and highlights the need for public authorities to provide guarantees. In Portugal, OV has historical roots and continues to be an obstacle to the realisation of constitutional principles such as human dignity. Based in an intersectional feminist epistemology and the social constructionist approach, this study was conducted using an exploratory qualitative approach. Ten r7495/2006 acialised Brazilian women were interviewed to examine their experiences of OV during pregnancy, childbirth, and the postpartum period in the Portuguese NHS, through the lens of reproductive and sexual rights. The interviews revealed dehumanising and discriminatory treatment, highlighting the lack of respect for these women’s autonomy, dignity, and rights. These experiences of OV during pregnancy, childbirth, and the postpartum period affected the participants, leading to trauma and significant negative impacts on their mental, sexual, and reproductive health. This research on OV is crucial to advancing global reproductive justice, as it challenges structural inequalities and places racialised Brazilian women at the heart of the struggle for universal human rights and equality in sexual and reproductive healthcare. Full article

Cancer pain is a highly prevalent problem and one of the most distressing symptoms in cancer patients. The management of cancer pain is one of the most significant challenges in the care of these patients. Cancer pain must be treated quickly and effectively as it affects the quality of life and reduces the patient’s life expectancy. Major opioids are recognized by the World Health Organization (WHO) as first-line treatment for moderate to severe cancer pain, but their use is often hampered by individual variations, comorbidities, and complications associated with cancer. Since the simultaneous use of two major opioids has become frequent, a narrative review was conducted, whose main objectives were to evaluate whether the combination of two major opioids improves pain and quality of life in cancer patients, considering their pharmacodynamic and pharmacokinetic properties and evaluate the impact of this combination on the frequency and intensity of side effects. The search for information was carried out in evidence-based medicine databases, namely PubMed/MEDLINE, Cochrane Library, Database of Abstracts of Reviews of Effects, National Guideline Clearinghouse, NHS Evidence and Index das Revistas Médicas Portuguesas using the MeSH terms “opioids” and “quality of life”. Articles and documents published between 1 January 2010 and 1 June 2023, in English, Portuguese and Spanish, were considered, including original articles, meta-analyses, systematic reviews and clinical guidelines. A total of 342 articles were retrieved and of these, only 13 were selected for full reading. The combination of opioids is based on the principle that different opioids act through different mechanisms, which can reduce dose-related adverse effects. Simultaneous use of two major opioids may allow for more modest increases in the equivalent dose of the second opioid, providing better pain control and reduced side effects such as nausea, vomiting, and constipation. More studies on the combination of opioids are needed to improve cancer pain treatment. The lack of personalized therapies limits the effectiveness of opioids, and variability in treatment responses requires individualized approaches. Personalized medicine, based on pharmacogenomics, is one of the most promising strategies to optimize pain relief and reduce adverse effects. Full article

(1) Background: Nursing homes (NHs) face unique challenges in end-of-life care for their residents. High rates of hospitalization at the end of life are frequent, often for preventable conditions. The increased clinical uncertainty during the pandemic, the high symptom burden of the COVID-19 disease, and the challenges in communication with families and between care teams might impact the option to hospitalize NH residents at the end of life. (2) Materials and methods: The study covered a 3-year period and compared the hospitalization rates of the NH residents of a sample of Portuguese NH during the last year of life before and during the pandemic. A total of 387 deceased residents were included in the study. (3) Results: There were fewer hospitalizations in the last year of life during the pandemic period, although the proportion of deaths at hospitals was the same. Hospitalizations occurred closer to death, and with more serious clinical states. The lower rate of hospitalization was due to lower hospitalization due to infection; (4) Conclusions: The data suggest an improvement in end-of-life care practices during the pandemic period, with the decrease in hospitalizations being due to potentially burdensome hospitalizations. The importance of the role of physicians, nurses, and caregivers in this setting may be relatively independent of each other, and each may be targeted in end-of-life care training. Further study is recommended to clarify the implications of the results and if the changes can be sustained in the long term. Full article

According to the latest data, Spain (19.4%) and Portugal (21.8%) are the two European countries with the highest percentage of older adults. Concerns about diet quality are increasing, especially among institutionalized older people, who are at the greatest risk of malnutrition. To assess the adequacy of dietary intake of 186 older adults (>65 y) institutionalized in public nursing homes (NH) in Galicia (Northwest Spain) and the Porto district (Northern Portugal), a cross-sectional study has been carried out. The double-weighing method and a country-specific food composition database were employed for nutritional assessment. Nutritional adequacy was assessed based on the recommendations of the EFSA and WHO. Caloric intake in Spanish NHs was higher than in Portuguese facilities; 20.3% and 35.8% of Spanish and Portuguese residents, respectively, had a protein intake below the EFSA recommendation, and 46.2% and 44.9% of residents in Portugal and Spain, respectively, had lipid intakes below the reference intake range. Further, 45.5% of the residents in Portugal and 66.9% in Spain had a carbohydrate intake within the recommended range. Salt intake was higher than the recommendation for 67.0% and 32.3% of the residents in Spain and Portugal, respectively. This study supports the notion that institutionalized older adults are prone to significant nutritional inadequacies. Full article

Demographic ageing has emphasized the need to adapt current healthcare systems to the comorbidity profile of older adults. In 2004, the World Health Organization (WHO) developed the Age-Friendly Principles, but the approach to their implementation in the health systems still remains uncertain. This article intends to address this gap by assessing how the Principles are perceived and implemented in the Portuguese National Health Service (NHS), where this topic has recently been placed on the political agenda. A questionnaire survey was administered to primary care directors and hospital administrators, covering a total of 173 health units. Findings show that most respondents are unaware of the WHO Principles (71%) and do not identify the current organizational structure of care as a problem for the provision of care (80%). However, the implementation of the WHO Principles is lower than desired, especially regarding professional training and the management system (50% and 28% of the criteria are implemented, respectively). These criteria defined by the WHO are implemented in a reduced number of health units, as opposed to the physical environment where implementation is more widespread (64%). Accordingly, further dissemination and implementation support in the national territory are needed in order to improve the health outcomes of older adults and increase the performance of health units. Full article

The emergence of the novel coronavirus (COVID-19) generated a need to quickly and accurately assemble up-to-date information related to its spread. In this research article, we propose two methods in which Twitter is useful when modelling the spread of COVID-19: (1) machine learning algorithms trained in English, Spanish, German, Portuguese and Italian are used to identify symptomatic individuals derived from Twitter. Using the geo-location attached to each tweet, we map users to a geographic location to produce a time-series of potential symptomatic individuals. We calibrate an extended SEIRD epidemiological model with combinations of low-latency data feeds, including the symptomatic tweets, with death data and infer the parameters of the model. We then evaluate the usefulness of the data feeds when making predictions of daily deaths in 50 US States, 16 Latin American countries, 2 European countries and 7 NHS (National Health Service) regions in the UK. We show that using symptomatic tweets can result in a 6% and 17% increase in mean squared error accuracy, on average, when predicting COVID-19 deaths in US States and the rest of the world, respectively, compared to using solely death data. (2) Origin/destination (O/D) matrices, for movements between seven NHS regions, are constructed by determining when a user has tweeted twice in a 24 h period in two different locations. We show that increasing and decreasing a social connectivity parameter within an SIR model affects the rate of spread of a disease. Full article

(1) Background: Nursing Home (NH) residents are a population with health and social vulnerabilities, for whom emergency department visits or hospitalization near the end of life can be considered a marker of healthcare aggressiveness. With the present study, we intend to identify and characterize acute care transitions in the last year of life in Portuguese NH residents, to characterize care integration between the different care levels, and identify predictors of death at hospital and potentially burdensome transitions; (2) Methods: a retrospective after-death study was performed, covering 18 months prior to the emergence of the COVID-19 pandemic, in a nationwide sample of Portuguese NH with 614 residents; (3) Results: 176 deceased patients were included. More than half of NH residents died at hospital. One-third experienced a potentially burdensome care transition in the last 3 days of life, and 48.3% in the last 90 days. Younger age and higher technical staff support were associated with death at hospital and a higher likelihood of burdensome transitions in the last year of life, and Palliative Care team support with less. Advanced Care planning was almost absent; (4) Conclusions: The studied population was frail and old without advance directives in place, and subject to frequent hospitalization and potentially burdensome transitions near the end of life. Unlike other studies, staff provisioning did not improve the outcomes. The results may be related to a low social and professional awareness of Palliative Care and warrant further study. Full article

The Portuguese health system has a universal, public, general National Health Service (NHS), tending towards free healthcare access. Created in 1979, this delivery model developed from the integration and complementarity between the different response levels (primary, hospital, continuing, and palliative care). However, over the last 40 years, the initially centralized system underwent a decentralization process with the creation of Regional Health Administrations in the five mainland administrative regions. Since then, the entire NHS has settled around this new organization. The most recent step started in 2018 with the decentralization of primary healthcare skills to 190 municipalities. This paper presents the various critical issues involved in the latest gradual decentralization process in health, intending to bring services closer to the citizens, and to be more focused on their needs. The article identifies and discusses the implications of this experience based on the steps foreseen in the already-published legal texts. Full article

Background: The goal of this study is to identify geographic areas for priority actions in order to control COVID-19 among the elderly living in Residential Care Homes (RCH). We also describe the evolution of COVID-19 in RHC throughout the 278 municipalities of continental Portugal between March and December 2020. Methods: A spatial population analysis of positive COVID-19 cases reported by the Portuguese National Health Service (NHS) among the elderly living in RCH. The data are for COVID-19 testing, symptomatic status, comorbidities, and income level by municipalities. COVID-19 measures at the municipality level are the proportion of positive cases of elderly living in RCH, positive cases per elderly living in RCH, symptomatic to asymptomatic ratio, and the share of comorbidities cases. Spatial analysis used the Kernel density estimation (KDE), space-time statistic Scan, and geographic weighted regression (GWR) to detect and analyze clusters of infected elderly. Results: Between 3 March and 31 December 2020, the high-risk primary cluster was located in the regions of Braganca, Guarda, Vila Real, and Viseu, in the Northwest of Portugal (relative risk = 3.67), between 30 September and 13 December 2020. The priority geographic areas for attention and intervention for elderly living in care homes are the regions in the Northeast of Portugal, and around the large cities, Lisbon and Porto, which had high risk clusters. The relative risk of infection was spatially not stationary and generally positively affected by both comorbidities and low-income. Conclusion: The regions with a population with high comorbidities and low income are a priority for action in order to control COVID-19 in the elderly living in RCH. The results suggest improving both income and health levels in the southwest of Portugal, in the environs of large cities, such as Lisbon and Porto, and in the northwest of Portugal to mitigate the spread of COVID-19. Full article

Olive seeds have been considered as a new nutritionally healthy food supplement. They are rich in monounsaturated n-9 and essential polyunsaturated n-6 lipids. However, little is known about their polar lipids, potentially bioactive and chemical identity markers for olive pulp and oil. This work aimed to identify the polar lipidome of olive seeds to find possible bioactive compounds and markers of geographic origin, by studying samples from six Portuguese sub-regions. Polar lipids were obtained by solid/liquid extraction, NH₂-solid-phase extraction, and identified by hydrophilic interaction liquid chromatography (HILIC)-HR-ESI-MS and MS/MS. Ninety-four compounds were identified, including phospholipids, glycolipids, sphingolipids, and acyl sterol glycosides, several of which bear polyunsaturated fatty acids. Multivariate statistical analysis found unique profiles within each sub-region and markers of geographic identity, primarily phosphatidylcholines, phosphatidylethanolamines, and lysophosphatidylethanolamines. Therefore, polar lipid signatures should be further investigated, to assess their bioactivity, nutritional value, and chemical identity for valuing olive seeds and their oil. Full article

In recent years, natural thermal mineral waters have been gaining the special attention of the scientific community, namely in the prevention and treatment of some diseases, due to the microbial properties that exist in these habitats. The aim of this work was to characterize the physicochemical composition and the microbial taxonomic communities present in three thermal waters of the Galician region in Spain and two samples of the northern region in Portugal. These collected water samples were analyzed for physicochemical characterization and the respective hydrogenome of the waters using next generation sequencing together with 16S rRNA gene sequencing. The sequencing showed a high diversity of microorganisms in all analyzed waters; however, there is a clear bacterial predominance of Proteobacteria phylum, followed by Firmicutes, Deinococcus-Thermus, Aquificae and Nitrospira. The main physicochemical parameters responsible for the clustering within the Spanish waters were sulfur compounds (SO₃²⁻ and S²⁻), CO₃²⁻ and neutral pH, and in the Portuguese waters were Mg, Ca and Sr, nitrogen compounds (NO₃⁻ and NH₄⁺), Na, Rb, conductivity and dry residue. This work will allow for a better understanding of the microbial community’s composition and how these microorganisms interfere in the physicochemical constitution of these waters often associated with medicinal properties. Furthermore, the hydrogenome may be used as an auxiliary tool in the practice of medical hydrology, increasing the likelihood of safe use of these unique water types. Full article

Background: This paper aims to discuss how physical activity (PA) brief assessment, brief counseling, and self-monitoring tools were designed and implemented in the Portuguese National Health Service (NHS), and to report on their current use by health professionals and citizens. Methods: Three digital tools to facilitate PA promotion in primary health care (PHC) were developed: 1) a PA brief assessment tool was incorporated in the electronic health record platform “SClínico Cuidados de Saúde Primários“; 2) a brief counseling tool was developed in the software “PEM—Prescrição Eletrónica Médica” (electronic medical prescription); and 3) a “Physical Activity Card” was incorporated in an official NHS smartphone app called “MySNS Carteira”. Results: From September 2017 to June 2019, 119,386 Portuguese patients had their PA assessed in PHC. Between December 2017 and June 2019, a total of 7957 patients received brief intervention for PA by a medical doctor. Regarding the app “MySNS Carteira”, 93,320 users activated the “Physical Activity Card”, between February 2018 and December 2018. Conclusions: These tools represent key actions to promote PA among Portuguese citizens using PHC as a priority setting. Further initiatives will follow, including proper assessment of their clinical impact and training programs for health care professionals on PA promotion. Full article