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Catarina João1 *, Cristina Jácome1,2 *, Dinis Brito,3 Pedro Teixeira,3,4 Janete Quelhas-Santos,1 Liliana Amorim,4 Maria João Barbosa,3,5 Cláudia Bulhões,3,6 Filipa Lopes,7 Marisa Pardal,8 Filipa Bernardo,9 João Almeida Fonseca,1,2,7,9 Jaime Correia de Sousa3 1Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; 2Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; 3Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, ICVS/3Bs, PT Government Associate Laboratory, Braga, PortugaI; 4Association P5 Digital Medical Center (ACMP5), Braga, Portugal; 5Gualtar Family Health Unit, Braga, Portugal; 6Vila Verde (VIDA+) Family Health Unit, Braga, Portugal; 7MEDIDA Lda, Porto, Portugal; 8AstraZeneca, Lisboa, Portugal; 9Allergy Unit, Hospital and Institute CUF, Porto, Portugal*These authors contributed equally to this workCorrespondence: Cristina Jácome, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal, Email cjacome@med.up.ptObjective: To assess the feasibility of the procedures of EPI-ASTHMA. EPI-ASTHMA is a population-based multicentre stepwise study about the prevalence and characterisation of patients with asthma based on disease severity in Portugal.Methods: A pilot study of EPI-ASTHMA was conducted with adults from three primary care centres. We followed a stepwise approach comprising 4 stages: stage 0—invitation phone call (n ~1316); stage 1—telephone interview (n ~658); stage 2—clinical assessment with physical examination, diagnostic tests, and patient-reported outcome measures, to confirm the diagnosis of those with possible asthma at stage 1 (n ~160); stage 3—characterization of a subgroup of asthma patients by collecting data through a telephone interview, patient file review and CARATm app (n ~40), after 3-months. The frequency of asthma was calculated in relation to the entire study population (stage 1) and the frequency of difficult-to-treat/severe asthma in relation to the number of asthma patients (stage 3).Results: From 1305 adults invited, 892 (68%) accepted to participate (stage 0) and 574 (64%; 53[42– 67] y; 43% male) were interviewed (stage 1). From those, 148 (26%; 60[46– 68] y; 43% male) were assessed at stage 2, and 46 (31%; 51[39– 67] y; 44% male) were diagnosed with asthma. Half of these patients (n = 23) accepted to install the app. Stage 3 was completed by 41 (93%) patients, of whom 31 (83%) had asthma confirmed by their file review. A total of 8% of participants had asthma, of those 17% had difficult-to-treat and 5% severe asthma.Conclusion: Attained recruitment rates and the quality of the results confirmed the feasibility of the EPI-ASTHMA stepwise approach. This pilot study provided insight into the improvement of the procedures to be generalized across the country.Keywords: asthma, prevalence, epidemiology, severe asthma, difficult-to-treat asthma

Resumo A pandemia de COVID-19 fez-nos questionar práticas diárias até então instituídas, como o simples aperto de mão. Levantou também outras questões, algumas de índole ético-legal. Estarão a ser cumpridos os princípios éticos que devem orientar a prestação de cuidados individualizados? Conseguiremos nós, profissionais de saúde, fornecer instrumentos aos doentes para que possam usufruir plenamente do seu direito de autonomia? A garantia de soluções de segurança necessárias, para diminuir o risco de contágio na prestação de cuidados, salvaguarda o princípio da não maleficiência. Todavia, o risco de contágio é impossível de eliminar na totalidade, existindo um residual associado à utilização das instalações físicas dos serviços de saúde. Mas, não deverá a decisão de assumir esse risco ser alvo do arbítrio livre, informado e esclarecido do doente? A diminuição da atividade assistencial presencial motivou a incorporação de outras ferramentas de comunicação como telefone, correio eletrónico e videochamada. Poderá o paciente realmente decidir sobre a forma como prefere ser consultado, ou estaremos nós a impor o modelo de consulta? Nos últimos meses ocorreram mudanças profundas na forma de trabalho em Saúde, que permanecerão. Não existirão, contudo, princípios éticos da biomedicina, que deverão sempre prevalecer?

Asthma brings considerable challenges for family doctors because of its variety of shapes, different levels of severity, a wide age range, and the fact that in the last decades clinicians are able to offer much better treatment options with a better level of disease control and a higher quality of life. The objectives of the current review article are to provide an up-to-date review by primary care respiratory leaders from different countries of the most significant challenges regarding asthma diagnosis and management, the importance of team work and the problems in recognizing and dealing with difficult-to-manage and severe asthma in primary care. The article provides a short review of the main challenges faced by family physicians and other primary health care professionals in supporting their patients in the management of asthma, such as asthma diagnosis, promoting access to spirometry, the importance of a multiprofessional team for the management of asthma, how to organize an asthma review, the promotion of patient autonomy and shared decision-making, improving the use of inhalers, the importance of the personalized asthma action plan, dealing with difficult-to-manage and severe asthma in primary care and choosing when, where and how to refer patients with severe asthma. The article also discusses the development of an integrated approach to asthma care in the community and the promotion of Asthma Right Care.

espanolEl erythema palmare hereditarium (EPH), tambien conocido como enfermedad de Lane o red palms es un trastorno dermatologico benigno y poco frecuente caracterizado clinicamente por un eritema bien delimitado y permanente de las superficies palmares y, menos a menudo, de las superficies plantares. Se puede presentar de forma congenita o adquirida. A pesar de que lo describio por primera vez John E. Lane en 1929 en dos pacientes varones, existen escasos informes e investigaciones sobre el tema. Se presenta el caso clinico de una nina de tres anos, quien sufre un eritema permanente de las superficies palmares. EnglishErythema palmare hereditarium (EPH) also known as Lane’s disease or Red Palms Disease, is a rare, benign skin condition presenting as a persistent and asymptomatic erythema involving the palms and, less frequently, involving the soles. It can be presented as a congenital or acquired form. Although, it was first described by John E. Lane in 1929, in two male patients, there are few reports and research on the subject. We present a case of a girl, 3 years old, with a permanent erythema of the palms.

Coronavirus disease 2019 made us question daily practices, such as the simple handshake. It also raised some ethical and legal issues. Are the ethical principles, that should guide the provision of individualized care, being fulfilled? Will we, as health professionals, be able to provide patients with instruments so that they can fully exercise their autonomy? The guarantee of necessary security solutions, to reduce the risk of contagion in the provision of care, safeguards the principle of non-maleficence. However, the risk of contagion is impossible to completely eliminate, and there is a residual risk associated with the use of physical facilities in healthcare services. But, shouldn't the decision to take that risk be the subject of the patient's free and informed will? The incorporation of telemedicine platforms is ideal for managing several challenges posed by COVID-19, such as the decrease in face-to-face health care assistance. Can the patient really decide how he prefers to be consulted, or are we imposing the consultation model? There have been profound changes in healthcare systems. However, one must remember that there are ethical principles of biomedicine, that should always prevail?A pandemia de COVID-19 fez-nos questionar práticas diárias até então instituídas, como o simples aperto de mão. Levantou também outras questões, algumas de índole ético-legal. Estarão a ser cumpridos os princípios éticos que devem orientar a prestação de cuidados individualizados? Conseguiremos nós, profissionais de saúde, fornecer instrumentos aos doentes para que possam usufruir plenamente do seu direito de autonomia? A garantia de soluções de segurança necessárias, para diminuir o risco de contágio na prestação de cuidados, salvaguarda o princípio da não maleficiência. Todavia, o risco de contágio é impossível de eliminar na totalidade, existindo um residual associado à utilização das instalações físicas dos serviços de saúde. Mas, não deverá a decisão de assumir esse risco ser alvo do arbítrio livre, informado e esclarecido do doente? A diminuição da atividade assistencial presencial motivou a incorporação de outras ferramentas de comunicação como telefone, correio eletrónico e videochamada. Poderá o paciente realmente decidir sobre a forma como prefere ser consultado, ou estaremos nós a impor o modelo de consulta? Nos últimos meses ocorreram mudanças profundas na forma de trabalho em Saúde, que permanecerão. Não existirão, contudo, princípios éticos da biomedicina, que deverão sempre prevalecer?