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Pharmacovigilance stands out for its importance in obtaining existing knowledge about medicine and patient safety and should be recognized as a continuous line of study. It constitutes a highly relevant component in the activities of health professionals, with spontaneous notification of suspected adverse drug reactions being its main emphasis. The underreporting that persists can be overcome through continuous professional development programs, reinforcing theoretical and practical knowledge in the curricular plans of health courses. As a result, more educated professionals will also allow citizens to recognize the importance of pharmacovigilance. The main objective of this study was to describe and characterize the teaching-learning process of pharmacovigilance in Portugal, analyzing the knowledge, perceptions and attitudes of students and health professionals. In total, ninety-three curricular unit forms of the seventeen healthcare courses included were analyzed, among which only three referred to pharmacovigilance as mandatory and thirty-nine did not address any keywords. The questionnaire applied was answered by 650 participants, both students (62%) and professionals (38%). Approximately 84.4% of the students and 54.7% of the professionals affirmed that they had never spontaneously reported an adverse drug reaction. Only 24.6% of the students and 17.8% of professionals referred to the existence of specific course content dedicated to pharmacovigilance in their coursework. In view of these results, it is evident that there is a need for a wider reflection regarding the further training and constant update of practicing professionals as well as in diverse health institutions, investing in the creation of an academic curriculum that integrates pharmacovigilance in healthcare courses. Key findings: • Teaching pharmacovigilance in healthcare courses is needed. • Greater reflection on professional training is needed. • Community-based programs on pharmacovigilance are recommended. [ABSTRACT FROM AUTHOR]

Background: Studies of drug utilization in patients with diabetes, a chronic disease that can be treated with a wide range of available medicines, have attracted substantial social and clinical interest. Objective: To characterize antidiabetic medicine consumption between 2005 and 2017, to evaluate the trends of these medicines in mainland Portugal, and to compare district consumption. An additional objective was to perform a statistical analysis on drug consumption in different regions of Portugal. Methods: A descriptive, longitudinal observational study; the setting was mainland Portugal (excluding Azores and Madeira). Each medicine has a respective defined daily dose (DDD). The sum of the DDD, provides the annual consumption in terms of the DDD for each district each year. When calculating the annual average for the resident district population and the number of days in a year, the denominator is expressed as 1000 inhabitants per day (TID). Main outcome measure: The DDD/TID for mainland Portugal (for all districts) between 2005 and 2017 for antidiabetic medicines. Information was obtained from the official database of prescription medicine invoices with reimbursement in mainland Portugal. Results: In mainland Portugal, the antidiabetic medicine consumption was 49.3 DDD/TID in 2005 and 88.2 DDD/TID in 2017. The consumption of insulins and their analogs increased from 10.8% to 17.4% compared to the total consumption of antidiabetic medicines. In 2017, the level of biguanide consumption was 23.1 DDD/TID, that of sulphonylurea consumption was 15.8 DDD/TID, that of DPP-4 inhibitor consumption was 6.8 DDD/TID, and that of SGLT2 inhibitor consumption was 3.0 DDD/TID. The oral consumption of fixed-dose combinations reached 21.4 DDD/TID. After employing a geographical division between north and south and between coastal and inland regions, the consumption of several different drugs showed statistically significant differences. Conclusions: When comparing 2017 with 2005, the panorama was quite different, with higher levels of consumption of antidiabetic medicines, insulins and their analogs, noninsulin medicines, long-acting and fast-acting insulins and their analogs, metformin, DPP-4 inhibitors and, mainly, metformin combined with a DPP-4 inhibitor. The SGLT2 inhibitors achieved a representative consumption. Different consumption patterns may be related to sociodemographic factors or to clinical practices. [ABSTRACT FROM AUTHOR]

The article presents a case of Kretschmer's sensory delusion related to the COVID-19 pandemic. It describes the case of a 45-year-old woman who developed a brief psychotic disorder due to the health measures imposed at her workplace. The patient experienced delusions of guilt and ruin, auditory hallucinations, and severe anxiety. She was hospitalized and treated with risperidone, and after 13 days of hospitalization, she was discharged with complete resolution of psychotic symptoms. The article highlights the importance of a thorough evaluation of the premorbid character and early intervention to improve the prognosis of patients. [Extracted from the article]

Aims: To compare the temporal trends in the consumption patterns of glucose lowering drugs (GLD) between Portugal and the Netherlands from 2004 to 2013 and to examine possible reasons behind the cross-national variation found.Methods: All GLD (ATC pharmacological subgroup A10B) were selected for analysis. Consumption data were obtained for the 10-year period. Portuguese and Dutch drug estimates were obtained from nationwide databases.Results: The consumption of GLD increased in Portugal from 52.9 defined daily dose per 1000 inhabitants per day (DHD) in 2004 to 70.0 DHD in 2013 and in the Netherlands from 44.9 DHD in 2004 to 50.7 DHD in 2013. In Portugal, the use of fixed-dose combinations, especially with dipeptidyl peptidase-4 inhibitors (DPP-4) increased remarkably and in 2013 represented almost a quarter of total GLD consumption. In the Netherlands, the use of combinations was residual.Conclusions: The consumption of GLD rose over the 10-year period in both countries. However, Portuguese overall consumption and costs of GLD were higher. The differentially rapid uptake of DPP-4 inhibitors in Portugal was the main driver of the cost difference. [ABSTRACT FROM AUTHOR]

Background Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research. Objective To use the MRCI to assess medication regimen complexity in institutionalized elderly people. Setting Five nursing homes in mainland Portugal. Methods A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day. Main outcome measure Medication regimen complexity index. Results The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females ( p < 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742). Conclusion Medication regimen complexity proved to be high. There is certainly potential for the pharmacist's intervention to reduce it as part as the medication review routine in all the patients. [ABSTRACT FROM AUTHOR]

A new Arbitration Act was published in Portugal on 14 December 2011. Besides providing Portugal with a more modern law, in line with the UNCITRAL Model-Law and with the solutions adopted by the most modern legislations and arbitral institutions, the new law aims to give a new boost to arbitration in Portugal, making the country more appealing as a potential seat of arbitration in international arbitrations, notably in respect of conflicts between Portuguese speaking countries, as well as to facilitate the recognition and enforcement of foreign arbitral awards. The purpose of the present article is, as such, to publicize the main innovations set out in the new arbitration rules in Portugal, in the hope that Portugal may come to be considered by practitioners as a valid alternative when electing the seat of arbitration or when choosing the jurisdiction for the recognition and enforcement of arbitral awards [ABSTRACT FROM AUTHOR]

El artículo presenta un análisis de la decisión del Tribunal Constitutucional de Portugal con respecto a la inconstitucionalidad del artículo 398°, n° 1 del Código das Sociedades Comerciais de Portugal, el cual presenta un conflicto de leyes con respecto al despido de trabajadores sin causa justa. Los autores discuten las bases del conflicto de leyes, así como la idoneidad de la decisión del Tribunal Constitutucional.

El artículo presenta un análisis de la Directiva 2002/92/CE del Parlamento Europeo, que regula la prestación de servicios de seguros y financieros por operadores intermediarios. El autor opina que la Directiva discutida deja un excesivo margen de adaptación a las regulaciones nacionales de los Estados miembros, lo cual podría contribuir a un trato desigual de esta actividad en los distintos países. Se discute la adaptación de la Directiva en Portugal.

Maturity-onset diabetes of the young (MODY) is a frequently misdiagnosed type of diabetes, which is characterized by early onset, autosomal dominant inheritance, and absence of insulin dependence. The most frequent subtypes are due to mutations of the GCK (MODY 2), HNF1A (MODY 3), and HNF4A (MODY 1) genes. We undertook the first multicenter genetic study of MODY in the Portuguese population. The GCK, HNF1A, and HNF4A genes were sequenced in 46 unrelated patients that had at least two of the three classical clinical criteria for MODY (age at diagnosis, family history, and clinical presentation). The functional consequences of the mutations were predicted by bioinformatics analysis. Mutations were identified in 23 (50%) families. Twelve families had mutations in the GCK gene, eight in the HNF1A gene, and three in the HNF4A gene. These included seven novel mutations (GCK c.494T>C, GCK c.563C>G, HNF1A c.1623G>A, HNF1A c.1729C>G, HNF4A c.68delG, HNF4A c.422G>C, HNF4A c.602A>C). Mutation-positive patients were younger at the time of diagnosis when compared to mutation-negative patients (14.3 vs. 23.0 years, p = 0.011). This study further expands the spectrum of known mutations associated with MODY, and may contribute to a better understanding of this type of diabetes and a more personalized clinical management of affected individuals. [ABSTRACT FROM AUTHOR]

Objectives: Access to innovative and effective medication is a citizen's right. The main objectives of this study were to build an indicator to measure access to medicines within hospitals, the Global Medicines Access Index, and to identify the main existing barriers., Methods: Cross-sectional study carried out in Portuguese National Health Service hospitals. A consensus methodology (expert panel of 7 members) was used to define which dimensions should be included in the index and the weighting that each should take. The panel identified 6 dimensions: access to innovative medicines, proximity distribution, shortages, access to medicines before financing decision, value-based healthcare, and access to medication depending on cost/funding. Data were collected through an electronic questionnaire (September 2021)., Results: The response rate was 61.2%. Most hospitals used medicines with and without marketing authorization before the funding decision. Monitoring and generating evidence of new therapies results is still insufficient. The identified barriers were the administrative burden as the major barrier in purchasing medicines, with a relevant impact on shortages of medicines. Most respondents (87%) had a proximity distribution program, mainly implemented in the pandemic context, and the price/funding model was only identified by 10% as a barrier to access. The 2021 Global Medicines Access Index was 66%. Shortages and value-based use of medicines were the dimensions that had more influence in lowering the index value., Conclusions: The new formula used to obtain a unique and multidimensional index for access to hospital medicines seems to be more sensitive and objective and will be used to monitor access., Competing Interests: Author Disclosures Author disclosure forms can be accessed in the Supplemental Material section., (Copyright © 2023 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Objective: To estimate the prevalence, treatment and control of hypertension, and to identify factors associated in community pharmacy users., Methods: A cross-sectional study was conducted with 1,042 pharmacy users, aged between 40 and 65 years, in 60 community pharmacies of continental Portugal, between October 2005 and January 2006. Data were obtained with the application of a questionnaire and measurement of biological parameters. A total of three sequential logistic regressions were performed to verify an association among variables., Results: Mean age was 53.7 years and the male/female ratio was 0.68. Prevalence of arterial hypertension was 54.8%. Approximately 70% of hypertensive individuals were undergoing antihypertensive treatment and, of these, 47.7% were controlled. Hypertension was positively associated with older age, male sex, being married, higher body mass index and higher total cholesterol level, being a diabetic, having a family or personal history of premature cardiovascular disease, and reporting more medical visits per year. When treated, hypertension was found to be positively associated with the female sex, not being married, being a diabetic, living in an urban area, and reporting more than three medical visits per year. In hypertensive users who were treated, being controlled was positively associated with self-reporting adherent behavior towards antihypertensive treatment, perceiving the effect of these drugs and having a low cardiovascular risk. The predictive models showed areas under the respective ROC curves between 0.72 and 0.78, with an acceptable discriminatory power., Conclusions: The prevalence of hypertension was high, although similar to that found in other studies conducted in Portugal. The proportion of hypertensive individuals under treatment was satisfactory, in contrast to an insufficient level of control.

Objective: To characterize the use of medicines and to evaluate the inappropriateness of drugs in elderly outpatient population., Setting: Twelve community pharmacies in different districts of Lisbon-Portugal., Method: Observational cross-sectional survey, in a sample of 213 elderly outpatients (age>or=65-years-old) presenting a prescription with two or more drugs, for their own use., Main Outcome Measures: Drug use pattern and prevalence of potentially inappropriate medication., Results: We have studied 213 outpatients, who were taking a total of 1,543 drugs, with an average of 7.23 per patient. The drugs were distributed mainly in the following 3 ATC (Anatomical Therapeutic Chemical Classification) classes: C (cardiovascular system), N (nervous system) and A (alimentary tract). Using the 1997 Beers Explicit criteria, 75 occurrences of inappropriate medicines were detected in 59 patients (27.7%), while with the 2003 Beers Explicit criteria we detected 114 cases of inappropriate medication in 82 patients (38.5%). The occurrence of inappropriate medicines was significantly associated with the consumption of a high number of drugs. According to the ATC Classification, more than one half of the cases of inappropriateness were related with long acting benzodiazepines and with ticlopidine. The 2003 version detected a significantly higher prevalence of inappropriate drug use having potentially adverse outcomes of high severity., Conclusions: The application of the updated Beers criteria lead to higher rates of potentially inappropriate medication, and especially those responsible for more severe adverse outcomes. The results suggest that there is a need for interventions to improve instructions for safe drug use in the elderly patients and to decrease the number of medications whenever it is possible. This study suggests a high prevalence of potentially inappropriate drug use by the elderly patients of Lisbon region, Portugal.