Portuguese Journal of Public Health最新文献

Objectives: This work attempted to determine the unmet dental treatment needs and self-reported barriers to continued care, in patients with special needs, attending a dental teaching hospital in the English-speaking Caribbean.

Methods: A chart audit of patients who were planned for comprehensive treatment for the period from August 1, 2015 to July 31, 2017 was used to determine the types of treatment required for the sample of patients. Treatment was classified as either urgent, preventive, or restorative. Restorative treatment was further divided into operative, endodontic, periodontic, and prosthodontic treatment. Reasons for not returning to the clinic to complete planned treatment care were ascertained via a telephone interview. A non-parametric McNemar change test for related samples at an alpha level of 0.05 was used to compare planned treatment with completed treatment.

Results: 34% of patients with special needs had comprehensive treatment plans developed for the period under investigation. Preventive dental treatment was included in most comprehensive plans (96.1%). Large proportions of patients also required care for periodontal disease (65.7%) and operative management of caries (52.9%). While there was no significant difference between preventive treatment planned and received, there were significant differences in treatment planned and received for all types of restorative care. Major identified barriers included cost, accessibility, and psychosocial issues.

Conclusions: There was an unmet need for restorative and periodontal treatment. Major self-reported barriers to dental care included cost, accessibility to care in terms of transportation issues, and psychosocial issues.

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.

Introduction: Portugal is one of the countries in Western Europe with the highest prevalence of tuberculosis (TB) and human immunodeficiency virus (HIV). The prevalence among migrants is estimated to be higher than among non-migrants, which suggests a greater vulnerability of this population.

Aim: To describe the distribution of TB, HIV and HIV-TB co-infection and socio-behavioural factors associated with immigrants that lived in the metropolitan area of Lisbon and used the services of a Non-Governmental Organization (NGO).

Methods: Quantitative, cross-sectional and descriptive pilot study. An anonymous and structured questionnaire developed specifically for the study was applied by NGO employees duly trained for this purpose to a purposeful sample of 100 immigrants attending health services in an NGO in the metropolitan area of Lisbon, Portugal.

Results: The prevalence of HIV-TB extrapulmonary coinfection and HIV infection was 1% (n = 1) and 17% (n = 17), respectively. Only 1 immigrant had 4 out of the 5 symptoms suggestive of TB. No cases of pulmonary TB were identified, although 3 of the immigrants reported having been treated for pulmonary TB in the past. The participants were young, mainly female and some were male-to-female transsexuals. Most were from the community of Portuguese-speaking countries, especially from Brazil, and almost half of them had not regularized their immigration status. Additionally, almost one-fifth of immigrants were unemployed (17%), and one-sixth performed sex work (14%). Most of the participants (71%) sometimes used or never used a condom during sexual intercourse. Additionally, 40% revealed using illicit drugs and 1% said that they had shared injection material in the last 12 months.

Discussion: Being non-employed, with a low income and a lower level of education, consumption of illicit drugs and regular tobacco consumption were common characteristics in the immigrants studied, which points out social and economic disadvantages that could influence the risk of acquiring HIV and TB. Policies on latent TB infection and TB diagnosis are urgently needed, mainly aimed at vulnerable groups and culturally diverse populations.

Dysphagia is frequent after stroke, and it increases the risk of respiratory infection, dehydration and malnutrition, resulting in worse outcomes. Different clinical guidelines present recommendations for the assessment and management of dysphagia in stroke patients in a scattered way. These best practice recommendations address seven clinical questions on the assessment and management of dysphagia in stroke patients, gathering the best-updated evidence. A systematic literature review using the PICO strategy was performed. The recommendations draft was then appraised by a multidisciplinary panel of experts (nutritionists, physiatrists, speech-language pathologists and rehabilitation nurses) in a total of 3 Delphi rounds. A minimum of 80% consensus was established, and the final version offers a total of 21 recommendations for use in clinical practice for stroke patients. These clinical recommendations are an overview of the most recent evidence combined with experts' consensus and translated into clinically relevant statements. In implementing recommendations at the local level, health professionals should identify facilitators and barriers to evidence-based practice within their contexts and determine the best strategies to address local needs. Where the change is needed, initial and continuing training on all recommendations is essential and relevant.

Introduction: Health professionals face higher occupational exposure to SARS-CoV-2. We aimed to estimate the risk of COVID-19 test positivity in health professionals compared to non-health professionals.

Methods: We conducted a test-negative case-control study using Portuguese national surveillance data (January to May 2020). Cases were suspected cases who tested positive for SARS-CoV-2; controls were suspected cases who tested negative. We used multivariable logistic regression modelling to estimate the odds ratio of a positive COVID-19 test (RT-PCR; primary outcome), comparing health professionals and non-health professionals (primary exposure), and adjusting for the confounding effect of demographic, clinical, and epidemiological characteristics, and the modification effect of the self-reported epidemiological link (i.e., self-reported contact with a COVID-19 case or person with COVID-19-like symptoms).

Results: Health professionals had a 2-fold higher risk of a positive COVID-19 test result (aOR = 1.89, 95% CI 1.69-2.11). However, this association was strongly modified by the self-report of an epidemiological link such that, among cases who did report an epidemiological link, being a health professional was a protective factor (aOR = 0.90, 95% CI 0.82-0.98).

Conclusion: Our findings suggest that health professionals might be primarily infected by unknown contacts, plausibly in the healthcare setting, but also that their occupational exposure does not systematically translate into a higher risk of transmission. We suggest that this could be interpreted in light of different types and timing of exposure, and variability in risk perception and associated preventive behaviours.