Acta medica portuguesa最新文献

Introduction: Early detection and referral of patients with mild cognitive impairment or early-stage dementia can contribute to improved outcomes for both patients and caregivers. Few studies explore the quality and underlying context of referral decision-making by Primary Care Clinicians. This study aimed to explore the perspectives of healthcare professionals from Northern Portugal regarding the facilitators, barriers, and solutions within the referral process to the Neurology service for patients suspected of having mild cognitive impairment.

Methods: Two face-to-face focus groups were conducted with 11 primary and secondary care professionals from Northern Portugal, with experience in the field of dementia, selected and recruited through an email invitation. The discussion focused on the benefits of referrals, the strengths and challenges faced at different levels of care, and possible improvement strategies. Data were analyzed using inductive and deductive thematic analysis, with triangulation employed to ensure research rigor.

Results: The study identified facilitators and barriers at the levels of patients and caregivers, healthcare professionals, and the healthcare system. This process is influenced by interconnected factors, including the sociodemographic and literacy context of patients and caregivers, clinical practice regarding the application of referral criteria, and the organizational and research context of the local healthcare system concerning dementia. Solutions were proposed to overcome the highlighted barriers, whose implementation is supported by many of the facilitators described.

Conclusion: A deeper understanding of the interplay between sociodemographic, clinical, and organizational factors can lead to more objective and effective referral decisions, ultimately supporting timely diagnosis and enhancing quality of life. The findings of this study are valuable for optimizing local referral processes and may be useful in similar healthcare contexts. It is recommended that future research include the perspectives of patients and caregivers to enhance the approach to the national dementia strategy.

Introduction: Huntington's disease is a progressive neurodegenerative disorder characterized by motor, cognitive, and behavioral symptoms. While psychiatric comorbidity is common and may influence disease outcomes, there is a lack of data on its prevalence and impact in Portugal. This study aimed to analyze the frequency and impact of a diagnosis of psychiatric comorbidities among Huntington's disease hospitalized patients in Portugal.

Methods: A retrospective observational study was conducted using administrative data from Portuguese public hospitals within the National Health Service between 2000 and 2016. All hospitalization episodes of patients with a diagnosis of Huntington's disease (International Classification of Diseases, Ninth Revision, Clinical Modification code 333.4) were analyzed. Comorbid psychiatric diagnoses registered as primary or secondary diagnoses were identified and defined using the Clinical Classification Software codes 650-670. Age at admission, length of hospital stay, admission type, in-hospital mortality, and estimated hospital charges were analyzed according to psychiatric comorbidity categories and adjusting for age and sex.

Results: A total of 1667 hospitalizations with a diagnosis of Huntington's disease occurred between 2000 and 2016, of which 28.97% had a psychiatric comorbidity. These patients were more likely to be younger (adjusted odds ratio = 1.32, 95% confidence interval 1.07 - 1.64; p = 0.011) and to have longer hospitalizations (adjusted odds ratio = 1.88, 95% confidence interval 1.52 - 2.34; p < 0.001) than those with no psychiatric comorbidity. No association was found between psychiatric comorbidity in general and in-hospital mortality, admission type or hospitalization costs. An upward trend was observed in Huntington's disease admissions and the percentage of those with psychiatric comorbidity over the study period.

Conclusion: Psychiatric comorbidity in Huntington's disease was associated with younger age at admission and longer hospitalizations. These results highlight the importance of psychiatric care in the management of these patients. Early screening and intervention could improve outcomes and optimize healthcare resource allocation.

Introduction: The increasing demand for emergency services has challenged healthcare systems, largely due to patients whose needs are not urgent, which account for 40.3% of admissions in Portugal.

Methods: A cross-sectional study was conducted over five weeks in the emergency room (ER) of São Sebastião Hospital, Local Health Unit of Entre Douro e Vouga, involving adult patients. Data collection included the review of electronic medical records and the implementation of patient surveys in the ER. The study aimed to identify predictors of non-urgent visits to the ER, using a logistic regression model.

Results: Of the 10 333 patients who visited the ER, 12.3% were classified as non-urgent. The main reasons for seeking the ER included self-perception of symptom severity, undergoing medical tests or immediate treatments, proximity to the hospital, and the perception of higher quality care. Factors such as exemption from co-payment (OR = 0.888), proximity to the hospital (OR = 0.990), having a family doctor (OR = 0.190), knowledge of acute consultations in primary care (OR = 0.428) and telephone line SNS24 (OR = 0.089) were associated with lower odds of unnecessary emergencies. Non-urgent patients were more likely to visit the ER on weekdays (OR = 1.179) and in the morning (OR = 1.637). The probability of a non-urgent episode was 1.8% higher for each additional visit to the ER (OR = 1.018).

Conclusion: Inappropriate use of the ER is influenced by socioeconomic and behavioral factors. The exemption from co-payment was associated with a lower probability of unnecessary emergencies, raising questions about the effectiveness of this co-payment as a moderator of demand. Despite the availability of primary care, the ER was preferred during weekdays and in the morning. The association between awareness of alternatives to the ER and the presence of a family doctor with a lower probability of unnecessary emergencies highlights the need to improve patient health literacy and strengthen primary healthcare services.

Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of systemic autoimmune rheumatic disorders in which chronic inflammation of skeletal muscle leads to muscle weakness. Many other organs, including the skin, heart, lungs, and joints, may be affected. Patients with IIM may be positive for myositis antibodies (MAs), including myositis-specific and/or associated antibodies. Although helpful for establishing the diagnosis of IIM in the appropriate clinical setting, the presence of MAs does not always predict the occurrence of connective tissue diseases. Additionally, commonly used techniques such as line blot are known to have high rates of false positivity, especially for rare MAs. The accuracy of MAs tests such as line blot may be improved by cross-checking their results with antinuclear antibody (ANA) patterns on HEp-2 indirect immunofluorescence (IIF). This study aims to examine the concordance between ANA IIF patterns and myositis-specific antibodies in a Portuguese cohort of patients with IIM. We will assess whether concordance between methods is associated with increased fulfillment of IIM classification criteria, greater disease severity, or distinct patterns of organ involvement among affected patients.