Search

Introduction: Polypharmacy is commonly defined as the simultaneous use of five or more medications; however, there is a lack of consensus regarding the most appropriate definition. It is a significant predictor of morbidity and mortality. The aim of this study was to determine the prevalence of polypharmacy in the population of older adults attending primary care in Portugal and to identify associated sociodemographic and clinical factors. Material and methods: We conducted a cross-sectional, analytical study in primary care centres from the five Portuguese healthcare administrative regions and the two autonomous regions. We used a random sample of 757 older adult patients provided by the information department of the ministry of health (SPMS) and family doctors from the autonomous regions. Data collection occurred in March 2018. The variables utilised were sociodemographic characteristics, clinical profile and medication. For each patient, polypharmacy was measured either by the concurrent use of = 5 drugs or by the median number of drugs at the time of data collection. Logistic regression analyses were performed to determine associations between polypharmacy and other variables. Results: Polypharmacy (= 5 drugs) was present in 77% of the sample. A cutoff of over the median number of drugs was present in 55%. The likelihood of having polypharmacy increased significantly with age (OR = 1.05 (1.02-1.08)), number of chronic health problems (OR = 1.24 (1.07-1.45)) and number of prescribers (OR = 4.71 (3.42-6.48)). Cardiovascular, metabolic and musculoskeletal medications were the most commonly involved in polypharmacy. Conclusions: Polypharmacy was a very common occurrence in Portugal. Future primary healthcare policies should address polypharmacy. [ABSTRACT FROM AUTHOR]

Background. COPD is a common worldwide condition associated with morbidity and mortality. Its symptoms can be easily overlooked, accounting for an elevated level of under-recognition and under-diagnosis. Knowledge of the prevalence of COPD and the significance of its associated factors in the population enables better management of medical resources. Objectives. To establish the prevalence of COPD in General Practice patients in the Central Region of Portugal and analyze the correlation with associated factors. Methods. Cross-sectional study of patients’ data with COPD (R95, International Classification for Primary Care 2), anonymously gathered from the official database of the Central Health Administration of Portugal. Results. Out of 937,817 individuals, 24,148 patients were identified with COPD, a prevalence of 2.57/100,000. 73.7% were above 65 years of age, and 60.2% were males. BMI was recorded in 60.2% patients, FEV1(%) in 8.0%, and smoking pack-years in 37.1%. Age and BMI were significantly negatively correlated (ρ = -0.032, p < 0.001), with the same occurring between age and FEV1(%) (ρ = -0.073, p < 0.05). A strong association of COPD with male gender and older age groups was found. Conclusions. The prevalence of COPD was significantly higher in males, and age was identified as a risk factor for this condition. Higher age was non-significantly associated with lower FEV1(%) and significantly associated with BMI. The lack of e-records calls for an improvement. [ABSTRACT FROM AUTHOR]

Background. Obstructive Sleep Apnea Syndrome (OSAS) is associated with several morbidities. The most important ones are obesity, hypertension and diabetes mellitus. A clear relationship of OSAS and dyslipidemia is yet to be demonstrated. Objectives. To evaluate the prevalence of dyslipidemia as a morbidity associated with OSAS and to understand its relationship with the severity of OSAS. Material and methods. We randomly selected 92 patients diagnosed until the end of May 2016 with OSAS from two primary health care units and 184 patients as controls (no OSAS diagnosed) from random lists of patients matched in age and gender with patients with OSAS. We calculated the prevalence of the classified comorbidities (overweight, hypertension, type 2 diabetes mellitus and dyslipidemia) in both groups. We used logistic regression to check the association between them. We evaluated the relationship between dyslipidemia and OSAS severity by using the Apnea/Hypopnea Index (AHI). Results. The prevalence of dyslipidemia was 80% in patients with OSAS. Patients with OSAS were diagnosed as overweight (97%), had arterial hypertension (89%) and type 2 diabetes mellitus (43%). OSAS was not independently related to type 2 diabetes mellitus (p = 0.101) and to dyslipidemia (p = 0.389). However, overweight and arterial hypertension were related independently to OSAS (p < 0.001) with a risk for OSAS. The prevalence of dyslipidemia in patients with mild, moderate and severe OSAS was 22%, 13% and 25%, respectively. Conclusions. Patients with OSAS have a high prevalence of dyslipidemia despite not being independently related. There were no statistical differences between patients with mild, moderate and severe OSAS. [ABSTRACT FROM AUTHOR]

Background. The hypothesis that breastfeeding has a protective effect in childhood obesity is not new; however, controversial results have been published. Since the Azores reported the lowest rate of breastfeeding in Portugal and a high prevalence of childhood obesity, it becomes important to understand whether these facts are related or not. Objectives. To investigate the relationship between breastfeeding and childhood obesity in a population of Azorean children. Material and methods. A cross-sectional study was carried out on 183 Azorean children between 5–10 years of age between September and December 2016. The weight and height of the children were measured at the consultation and other variables were investigated through a questionnaire. The association between breastfeeding and childhood obesity was tested using logistic regression models. Results. 18.6% of the children were obese and 74.3% were breastfed. The exclusive breastfeeding rate at 6 months was 3.3%. Complementary breastfeeding was present in 39.3% at 6 months and 7.1% at 2 years. Obese children were breastfed less time than non-obese children, suggesting a dose-effect relationship (p = 0.025). We found a significant and independent relationship between infant obesity and total time of breastfeeding (RR = 0.906; 95% CI [0.842, 0.974]; p = 0.008), physical activity (RR = 0.883; 95% CI [0.801, 0.972]; p = 0.012) and maternal nutritional status (RR = 3.452; 95% CI [1.361, 8.755]; p = 0.009). Conclusions. Breastfeeding and physical activity behaved as protective factors for childhood obesity, while the nutritional status of the mother acted as a risk factor. Childhood obesity is a current problem in the Azores, and breastfeeding can be an effective, simple and affordable tool to reduce this. [ABSTRACT FROM AUTHOR]

Introduction Polypharmacy is commonly defined as the simultaneous taking of five or more drugs. Deprescribing is the process of tapering or stopping medications with the aim of improving patient outcomes and optimising current therapy, and there are several tools aiming at identifying potentially inappropriate medications, especially in the elderly. The direct involvement of patients and their caregivers in the choice and administration of drugs has long been known to be very important, but it is not usually applied. The aim of this study is to assess the knowledge of older adults about deprescription, the effect on willingness to have regular medications deprescribed and its quality-of-life outcome. Methods and analysis This study protocol comprises three phases. The first two phases will be nationwide and aim to evaluate the prevalence and patterns of polypharmacy and assess the barriers and facilitators of deprescribing perceived by older adults, as well as their willingness to have regular medications deprescribed and to self-medicate. The third and last phase will be a non-pharmacological randomised clinical study to measure older patients' acceptance to have regular medications deprescribed and related quality of life. Ethics and dissemination The study will be conducted in accordance with the principles expressed in the Declaration of Helsinki. It has been approved by the Ethics Committee of the University of Beira Interior and Portuguese National Data Protection Commission. Study results will be published in peer-reviewed journals and presented at national and international conferences. In short, no action will be taken without written consent from patients and doctors. [ABSTRACT FROM AUTHOR]