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AIM: To estimate the disease specific prevalence of undiagnosed rheumatic and musculoskeletal diseases (RMDs) in Portugal and determine if people with undiagnosed RMDs have worse quality of life, physical function and higher health resources consumption, than people without RMDs. METHODS: A subgroup analysis of EpiReumaPt was made that included all participants≥18 years evaluated by a rheumatologist. Participants were stratified into three groups: undiagnosed RMDs; previously diagnosed RMDs; non-RMDs. A descriptive analysis of the three groups was performed. To estimate the prevalence of undiagnosed RMDs, weighted proportion were computed considering the sample design. The three groups were compared (Undiagnosed RMDs vs non-RMDs; Previously diagnosed RMDs vs non-RMDs) for health related quality of life (HRQoL) (EQ5D), physical function (HAQ), mental health (HADS) and health resources consumption. The effect of being undiagnosed for these outcomes was assessed in multivariable models adjusted for age, gender, geographical region and years of education (reference: non-RMD). RESULTS: A total of 3877 participants were included. The prevalence of undiagnosed RMDs was 29%. Compared to participants without RMDs, undiagnosed participants had lower HRQoL (EQ-5D: β (95% CI)=-0.07 (-0.103,-0.043)) and physical function (HAQ: β (95% CI)=0.10 (0.05, 0.15)), more anxiety (OR (95% CI)=2.3 (1.4, 3.7)) and depression symptoms (OR (95% CI)=1.4 (0.8, 2.4)). Undiagnosed RMDs participants were more likely to visit an orthopedist (OR (95% CI)=2.0 (1.1, 3.5)) and had a higher number of orthopedic appointments (IRR (95% CI)=2.5 (1.3, 4.9)) than participants without RMDs. CONCLUSION: Patients with undiagnosed RMDs are frequent in Portugal, have worse HRQoL, physical function and mental health than people without RMDs. Undiagnosed patients are nonetheless consumers of health resources and tend to seek help from specialties other than rheumatology. Increasing the awareness of RMDs might promote their early identification and treatment leading to both personal and societal benefits. publishersversion epub_ahead_of_print

Background: The excessive prescription of benzodiazepines (BZD) has long been considered a worldwide public health issue. Despite the existence of a large body of literature regarding interventions to change BZD prescription patterns, most fail to report significant or long-term effects. Objective: To study the effect of the implementation of a Digital Behaviour Change Intervention (DBCI) online platform - named ePrimaPrescribe - on the BZD prescription pattern. Secondarily, to determine the effect of the platform implementation on diagnosis registration coded in the same months as BZD prescription and the costs for the NHS with co-payment. Methods: We followed a cluster-randomised design to allocate 18 primary healthcare units, from a region in Portugal. The study included BZD prescriptions from 250 general practitioners (GP) for a period of 12 months before and after intervention implementation. Results: BZD was more frequently prescribed to elders and females. The most frequently prescribed BZD was alprazolam. Most prescribed BZD had a medium half-life. In most analyses, we did not find any significant change in the BZD prescription pattern. Regarding secondary outcomes, the depressive disorder was the first, anxiety disorder the second, and dementia the fifth most frequently registered diagnosis associated with BZD prescription. BZD’s co-payment represented an average expenditure of approximately 1,300 € per unit per month. Conclusion: We could not find any significant difference in the BZD prescription pattern after ePrimaPrescribe implementation. Further work is required to explore the factors influencing resistance to BZD prescription patterns.

Funding Information: This project was awarded with the Academic Excellence Scholarship 2016-2017 (Bolsa de Excelência Académica 2016-2017) from Fundação Eugénio de Almeida. Publisher Copyright: © 2022 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health. Introduction: Excessive benzodiazepine (BZD) prescription has long been considered a serious mental health concern in many countries. Many interventions using different methodologies have been implemented to change BZD prescription patterns in primary health care settings, with limited positive results. Objectives: The primary objective of our study was to analyse the effectiveness and implementation process of an intervention aimed at changing BZD prescription patterns in a primary health care setting in Portugal. Methodology: We chose as methodology an effectiveness-implementation hybrid type 1 intervention. Our intervention was based on the development of an online platform, named ePrimaPrescribe, which was delivered using a Digital Behaviour Change Intervention (DBCI), using a two-arm cluster-randomised clinical trial. Results: We primarily aimed to evaluate the effectiveness of our DBCI in changing BZD prescription patterns using the frequency of BZD prescriptions issued per month as an outcome measure. Secondarily, we aimed to analyse the effect of ePrimaPrescribe on antidepressant prescriptions, to study the effect of the platform on diagnosis registration associated with BZDs and antidepressant prescription, and to perform a cost analysis considering the monthly National Health Service spending on BZD co-payments. Finally, we aimed to analyse the implementation process using quantitative and qualitative methods. Conclusion: With this study, we expect to contribute with a cost-effective intervention to change the complex matter of excessive BZD prescriptions, and also to improve insight into the challenges to intervention implementation processes in primary health care settings. We believe that our findings are relevant not only to the specific setting where the study was implemented, but also to all countries where primary health care plays a central role in care provision. publishersversion published

Introdução: A formação específica em Cirurgia Geral tem aumentado em complexidade, principalmente devido à difusão da laparoscopia. A Comissão de Internos em Formação Específica em Cirurgia Geral, Capítulo da Sociedade Portuguesa de Cirurgia (CIFECG-SPCir), teve o objetivo de caraterizar a população nacional de Internos da especialidade de Cirurgia Geral em 2015 e avaliar a sua formação específica. Métodos: Foi realizado um questionário, confidencial e anónimo, com 40 perguntas enviado por email com submissão automática após o preenchimento. Para análise estatística foi utilizado o software SPSS Statistics for Windows®, Version 21.0. Resultados e Discussão: Foram contactados 183 Internos e obtidas 105 respostas (57,4% de adesão). A amostra é maioritariamente feminina, com idade média de 29 anos, solteira e sem filhos. A maioria dos Internos desempenha 56 a 85 horas/semanais de serviço hospitalar devido aos turnos de urgência, com prejuízo do seu tempo de estudo. Frequentam anualmente cursos e congressos maioritariamente autofinanciados. A produção de trabalho científico difere geograficamente com Internos mais envolvidos em projetos de investigação no norte do país. A maioria dos serviços está organizada em unidades funcionais, de estrutura variável e sem condicionar o maior número de cirurgias ou a maior realização de laparoscopia. A generalidade dos Internos tem pelo menos dois dias de bloco operatório/semana, operando mais frequentemente como Cirurgião na cirurgia programada do que em urgência. A laparoscopia é quase totalmente realizada pelos Assistentes e escolhida em menos de metade dos procedimentos. A maioria dos Internos participa na consulta externa de forma autónoma. Vinte e quatro horas semanais de urgência é o mais frequente entre os Internos. É mais provável cumprir os objetivos propostos na Portaria nº 48/2011, de 26 de janeiro num internato em hospital distrital. A noção de estar à altura das suas exigências futuras está diretamente relacionada com o número de cirurgias realizadas e não com as horas de estudo ou urgência. Conclusão: Existe uma grande variabilidade na formação em Cirurgia Geral nacional. Há necessidade de alterar a estrutura da avaliação e formação específica de maneira a ir ao encontro das novas expetativas do Interno e da sociedade. Introduction: The general surgery residency training program has gained complexity, particularly due to laparoscopy. The Comission of General Surgery Residents (Comissão de Internos em Formação Específica em Cirurgia Geral), a chapter of Portuguese Society of Surgery (CIFECG-SPCir), aimed to characterize national general surgery residents in 2015 and evaluate their training program, through a survey. Methods: A survey regarding the subject, consisting of 40 questions, confidential and anonymous was sent via email. The statistical analysis was made with software software SPSS Statistics for Windows®, Version 21.0. Results and Discussion: The online survey was sent to 183 residents and obtained 105 answers (57,4%). The sample is mainly feminine, mean age 29 years, single and childless. The majority of residents dedicates 56 to 85 weekly hours to hospital duty, with prejudice of study time. Annually participation in courses and scientific events is almost always self-financing. There is a geographic variability of scientific work production, with more investigation involved residents in the north. The majority of surgery departments are already structured in functional units, with great organization variability without that translating to more surgeries or laparoscopic procedures. The vast majority of residents have 2 or more operating room days per week, operating more as main surgeon in elective than emergency surgeries. Laparoscopy is mainly executed by assistants and only in less than half of the procedures. The majority of the residents actively participates in outpatients assistance, mainly autonomously. A 24hours emergency rotation is the most frequent period of time per week. The probability to accomplishment the goals set by law (Portaria nº48/2011, January 26th) if higher in a secondary care hospital. The feeling of being prepared for the demands of the future is related to the number of surgeries but not emergency room shifts or study time. Conclusion: There is a wide variability of the national general surgery residency training program. An evaluation and training adequacy is being needed to face the resident and society new expectations.

Relatório de estágio de mestrado em Educação (área de especialização em Educação de Adultos e Intervenção Comunitária), O presente relatório apresenta um projeto de estágio no âmbito do Mestrado em Educação, área de especialização Educação de Adultos e Intervenção Comunitária. O projeto foi desenvolvido na valência do Serviço de Apoio Domiciliário da Cruz Vermelha Portuguesa da delegação de Braga, tendo como destinatários alguns dos seus utentes, as pessoas idosas. A sua finalidade passou pela promoção do envelhecimento ativo dos participantes, colocando ao dispor atividades que os tornassem mais dinâmicos e ativos. A escolha do nome do projeto recaiu no facto de se pretender conferir mais vitalidade, dinamismo e sentido à vida desta população. Como tal, utilizou-se como metodologias a Investigação- Ação Participativa e a Animação Sociocultural. A primeira, permite conhecer, estudar e investigar o contexto, por forma a delinear uma intervenção mais adequada ao público-alvo. A segunda, pressupõe a implicação e o envolvimento do público-alvo em todas as fases do processo de intervenção, sendo o seu foco as pessoas, pois são elas as protagonistas dos projetos. Foram delineadas, planeadas e implementadas atividades que fossem de encontro aos interesses, motivações e expectativas dos idosos. As atividades passaram pela animação cognitiva/mental, pela animação através de expressão plástica, pela animação promotora do desenvolvimento pessoal e social, pela animação lúdica e por atividades de formação. No presente relatório concluiu-se que os participantes se sentiram satisfeitos com a participação no projeto. Partindo dos depoimentos dos próprios, constatou-se que, através das atividades, descobriram capacidades e habilidades que desconheciam ter, tiveram acesso a novas experiências que, inclusivamente, contribuíram para o seu bem-estar. Os resultados foram obtidos através da análise do inquérito por questionário passado aos idosos no final do projeto., The present report is a presentation of the internship project referent to a Master's degree in Education, with a specialization in Education of Adults and Communitarian Intervention. The project was developed at the Home Support Service of the Portuguese Red Cross, Braga delegation, having as a target group some of its users, the senior citizens. The objective was the promotion of an active ageing process in the participants, by making available activities that help them become more dynamic and active. The choice of the project title has to do with the intention of giving this population a life with more vitality, dynamism and purpose. Therefore, the methodologies used were Participative Investigation-Action and Sociocultural Animation. The first allows to know, to study and to research the context which permits to design an intervention more suitable to the population. The second entails the implication and involvement of the target population in every stage of the intervention process, being that the people are its focus because they are the project protagonists. The activities were design, planned and implemented to meet the interests, motivation and expectations of the elderly. The activities implemented were based on cognitive/mental animation, animation through art, animation which promoted social and personal development, playful animation and educational activities. In the present report it was concluded that the participants were satisfied with their participation in the project. Taking in account the participants own report, through the activities they realized abilities and skills unknown to them, they had new experiences that contributed to their wellbeing. The results were obtained by analyzing the questionnaire filled by the participants at the end of the project.