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Abstract Background Translation into practice of effective physical activity interventions in primary care is difficult, due to a complex interaction of implementation determinants. We aimed to identify implementation barriers and facilitators of four primary care interventions: physical activity assessment, counselling, prescription, and referral. Methods A systematic review of qualitative, quantitative and mixed-methods studies published since 2016 was conducted. The “Tailored Implementation for Chronic Diseases” (TICD) framework was adapted to extract and synthesize barriers and facilitators. Results Sixty-two studies met the inclusion criteria. Barriers (n = 56) and facilitators (n = 55) were identified across seven domains, related to characteristics of the intervention, individual factors of the implementers and receivers, organizational factors, and political and social determinants. The five most frequently reported determinants were: professionals’ knowledge and skills; intervention feasibility/compatibility with primary health care routine; interventions’ cost and financial incentives; tools and materials; and professionals’ cognitions and attitudes. “Social, political and legal factors” domain was the least reported. Physical activity counselling, prescription, and referral were influenced by determinants belonging to all the seven domains. Conclusion The implementation of physical activity interventions in primary care is influenced by a broader range of determinants. Barriers and facilitators related with health professionals, intervention characteristics, and available resources were the most frequently reported. A deep understanding of the local context, with particularly emphasis on these determinants, should be considered when preparing an intervention implementation, in order to contribute for designing tailored implementation strategies and optimize the interventions’ effectiveness.

Abstract Background Physical activity is a major determinant of physical and mental health. International recommendations identify health professionals as pivotal agents to tackle physical inactivity. This study sought to characterize medical doctors’ clinical practices concerning the promotion of patients’ physical activity, while also exploring potential predictors of the frequency and content of these practices, including doctors’ physical activity level and sedentary behaviours. Methods A cross-sectional study assessed physical activity promotion in clinical practice with a self-report questionnaire delivered through the national medical prescription software (naturalistic survey). Physical activity and sedentary behaviours were estimated using the International Physical Activity Questionnaire (short form). Indicators of medical doctors’ attitudes, knowledge, confidence, barriers, and previous training concerning physical activity promotion targeting their patients were also assessed. Multiple regression analysis was performed to identify predictors of physical activity promotion frequency by medical doctors, including sociodemographic, attitudes and knowledge-related variables, and physical activity behaviours as independent variables. Results A total of 961 medical doctors working in the Portuguese National Health System participated (59% women, mean age 44 ± 13 years) in the study. The majority of the participants (84.6%) reported to frequently promote patients’ physical activity. Five predictors of physical activity promotion frequency emerged from the multiple regression analysis, explaining 17.4% of the dependent variable (p

INTRODUÇÃO: A Rede CUF em 18 de março, disponibilizou o Hospital CUF Infante Santo (HCIS) como hospital de referência para os doentes com COVID-19 na área da grande Lisboa. O internamento do doente não crítico (IDNC) ficou a cargo de uma equipa médica dedicada (EMD) constituída por médicos do Cluster Tejo, sob coordenação da Medicina Interna. Este estudo reporta as principais características demográficas e clínicas da população internada no IDNC. MATERIAL E MÉTODOS: Estudo retrospetivo analisando os doentes admitidos entre 27 de março e 7 de maio de 2020, no IDNC. Os critérios para diagnóstico de COVID-19 basearam-se na confirmação laboratorial e/ou critérios de diagnóstico imagiológicos. Excluíram-se da análise os doentes inicialmente suspeitos, mas cujo diagnóstico final encontrado foi outro. Clinicamente, o doente não crítico foi definido como tendo um Modified Early Warning Score (MEWS) entre 0-2. Os dados foram coletados do processo clínico eletrónico e da base de dados criada para seguimento destes doentes. Apresentam-se as características demográficas, clínicas, exames complementares, terapêutica e resultados. RESULTADOS: Incluíram-se 44 doentes, média de idades 67 anos, 52,3% homens. Divididos em grupos de acordo com a apresentação, com pneumonia em 75%, os restantes com outra apresentação. Proveniência: domicílio 81,8%, residência sénior 11,4% e outro hospital 8%. Fatores de risco para doença mais grave foram: Idade > 65 anos, 56,8%, hipertensão arterial 59%, doença respiratória crónica 15,9%, obesidade 15,9%, neoplasia ativa 13,6%, diabetes 11,4%, cardiopatia isquémica 11,4%, insuficiência cardíaca 6,8%, imunossupressão 6,8%, com índice de comorbilidades de Charlson média de 3.6. Agravamento clínico significativo com necessidade de escalar cuidados em três doentes (6,8%), em dois (4,5%) com ventilação mecânica invasiva, adicionalmente registado um óbito (2,3%). Demora média de internamento 10 dias, três (6,8%) doentes foram transferidos para outro hospital e 40 (91%) tiveram alta. DISCUSSÃO: A casuística apresentada representa o primeiro grupo de doentes não críticos internados com COVID-19 na Rede CUF da Região de Lisboa. Houve evolução e mortalidade intra-hospitalar abaixo do expectável para as características desta população, nomeadamente perante a presença de fatores de risco para doença mais grave e elevado índice de comorbilidades. CONCLUSÃO: A interpretação dos resultados obtidos fica condicionada ao pequeno tamanho da amostra e às incertezas ainda existentes nesta nova doença.

Abstract BackgroundThe use of a smartphone built-in microphone for auscultation is a feasible alternative to the use of a stethoscope, when applied by physicians. ObjectiveThis cross-sectional study aims to assess the feasibility of this technology when used by parents—the real intended end users. MethodsPhysicians recruited 46 children (male: n=33, 72%; age: mean 11.3, SD 3.1 y; children with asthma: n=24, 52%) during medical visits in a pediatric department of a tertiary hospital. Smartphone auscultation using an app was performed at 4 locations (trachea, right anterior chest, and right and left lung bases), first by a physician (recordings: n=297) and later by a parent (recordings: n=344). All recordings (N=641) were classified by 3 annotators for quality and the presence of adventitious sounds. Parents completed a questionnaire to provide feedback on the app, using a Likert scale ranging from 1 (“totally disagree”) to 5 (“totally agree”). ResultsMost recordings had quality (physicians’ recordings: 253/297, 85.2%; parents’ recordings: 266/346, 76.9%). The proportions of physicians' recordings (34/253, 13.4%) and parents' recordings (31/266, 11.7%) with adventitious sounds were similar. Parents found the app easy to use (questionnaire: median 5, IQR 5-5) and were willing to use it (questionnaire: median 5, IQR 5-5). ConclusionsOur results show that smartphone auscultation is feasible when performed by parents in the clinical context, but further investigation is needed to test its feasibility in real life.