Portuguese Medical Association Research Articles

Survey on selenium clinical supplementation in autoimmune thyroid disease.

Previous trials show that selenium could be a very useful tool in the control and treatment of autoimmune thyroid diseases. In this cross-sectional study, through a survey, we aim to evaluate Portuguese endocrinologists' perception and pattern of prescription of selenium supplements in these diseases and verify its agreement with current guidelines. The endocrinologists registered in the Portuguese Medical Association were sent an email with a web-based questionnaire, regarding their knowledge and use of selenium supplements in thyroid autoimmune pathology. A total of 105 physicians (33% of the total) submitted the survey. The selenium serum concentration in the general population was unknown to 80% of respondents. Over a third of respondents have never prescribed selenium for autoimmune thyroid disease. However, 89% are not afraid of recommending it, and 61% indicate Graves' orbitopathy as the pathology they would supplement. In Hashimoto's thyroiditis, 36% of respondents use selenium occasionally or frequently, and this percentage rises to 60% in Graves' disease. Although recommendations only encompass mild Graves' orbitopathy, selenium is prescribed across the spectrum of autoimmune thyroid diseases, probably due to recent studies that consistently show improvement of biochemical hallmarks in these patients. Further investigation is required on the impact of selenium supplements on primarily clinical outcomes and to identify disorders and/or patients who will benefit the most. Also, there is still insufficient knowledge of this field in the medical community, and evidence-based practice should continue to be promoted by endocrinology societies.

COVID-19 Vaccination in the Portuguese Medical Community: An Unprecedented Campaign Coordinated by the Portuguese Medical Association

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A multiple criteria approach for building a pandemic impact assessment composite indicator: The case of COVID-19 in Portugal

The COVID-19 pandemic has caused major damage and disruption to social, economic, and health systems (among others). In addition, it has posed unprecedented challenges to public health and policy/decision-makers who have been responsible for designing and implementing measures to mitigate its strong negative impact. The Portuguese health authorities have used decision analysis techniques to assess the impact of the pandemic and implemented measures for counties, regions, or across the entire country. These decision tools have been subject to some criticism and many stakeholders requested novel approaches. In particular, those which considered the dynamic changes in the pandemic’s behaviour due to new virus variants and vaccines. A multidisciplinary team formed by researchers from the COVID-19 Committee of Instituto Superior Técnico at the University of Lisbon (CCIST analyst team) and physicians from the Crisis Office of the Portuguese Medical Association (GCOM expert team) collaborated to create a new tool to help politicians and decision-makers to fight the pandemic. This paper presents the main steps that led to the building of a pandemic impact assessment composite indicator applied to the specific case of COVID-19 in Portugal. A multiple criteria approach based on an additive multi-attribute value theory aggregation model was used to build the pandemic assessment composite indicator. The parameters of the additive model were devised based on an interactive socio-technical and co-constructive process between the CCIST and GCOM team members. The deck of cards method was the adopted technical tool to assist in the assessment the value functions as well as in the assessment of the criteria weights. The final tool was presented at a press conference and had a powerful impact on the Portuguese media and on the main health decision-making stakeholders in the country. In this paper, a completed mathematical and graphical description of this tool is presented.

Attitudes toward end-of-life decisions other than assisted death amongst doctors in Northern Portugal

Background Doctors often deal with end-of-life issues other than assisted death, such as incompetent patients and treatment withdrawal, including food and fluids. Methods A link to a questionnaire was sent by email three times, at one-week intervals, to the doctors registered in the Northern Section of the Portuguese Medical Association. Results The questionnaire was returned by 1148 (9%) physicians. This study shows that only a minority of Portuguese doctors were willing to administer drugs in lethal doses to cognitively incompetent patients at the request of a family member or other close person, and even less would do it on their initiative. Most doctors favored the withdrawal of life support measures in advanced and progressive diseases at the patient’s request. Still, much fewer doctors agreed with the suspension of supportive life measures at the request of a family member, another close person, or by their own unilateral decision. However, fewer agreed with that action concerning the rest of the food and fluids. Portuguese doctors favor the administration of drugs for suffering control, even foreseeing they could shorten life. Conclusion Most doctors in this study respect patients’ autonomy but disagree with measures decided by others that have an impact on patients’ survival. They also agree with the administration of drugs for suffering control, even considering the possibility of shortening life.

[Gender Distribution in Medical Leadership Roles in Portugal: The Example of Candidacy to Bodies of the Portuguese Medical Association 2017-2019].

Gender equality is one of the sustainable development goals. Low participation of women in leadership roles is an example of gender inequality. In Portugal, there are few studies regarding gender inequality in medical leadership roles. Therefore, we aimed to analyse gender distribution of candidates to regional bodies of the Portuguese Medical Association. We extracted data from the candidates to the regional bodies of the Portuguese Medical Association (2017 - 2019 mandate) from the Association's magazine (issue number 175). We calculated the percentage of women candidates, overall and stratified by list, region and roles. We obtained observed-vs-expected ratios overall and by region, and respective 95% confidence intervals, assuming a Poisson distribution. Finally, we conducted a sensitivity analysis, excluding substitute candidates. Women accounted for 37% of the candidates (regional variation: 29% - 51%). The national observed-vs-expected ratio was 0.74 (95% confidence interval: 0.58; 0.92), mainly driven by the ratio from the South Region: 0.58 (95% confidence interval: 0.41; 0.80). Women ran mainly for alternate candidates and secretary positions (56% and 54% respectively). Gender differences were identified, particularly in the South, regarding the frequency and type of candidacy. Previous works have identified maternity, the social role of women and perceptions regarding the leadership roles as possible reasons to explain such differences. Our analysis is limited to specific leadership roles and an election moment; further studies should be pursued. We identified a lower than expected participation of women in the elections for the Portuguese Medical Association. When they run, women are found mainly in less relevant positions or with less potential to be elected (secretary or alternate candidate). A deeper understanding and measures to fight gender inequality in leadership roles are required.

[How to Resume Elective Orthopaedic Surgical Procedures during the COVID-19 Pandemic?]

This document was prepared by the College of Orthopedics of the Portuguese Medical Association with the aim of developing the guidelines on the resumption of elective surgical activity in Orthopedics during the COVID-19 pandemic. It sets the criteria that allow the prioritization of surgeries according to the severity of the clinical situation, based on existing and published classifications. Moreover, it provides an organizational model for patient preparation and describes the patient pathways in the preoperative, intraoperative and postoperative periods. It also describes safety rules for elective surgery and a model for monitoring patients after discharge according to scientific evidence.

Attitudes toward assisted death amongst doctors in Northern Portugal

Introduction Context: In Portugal assisted death was approved in February 2020 by the Parliament, although the law is not yet in force. Objectives To find out what doctors think about those practices. Methods A link to a questionnaire was sent by email three times, at intervals of one week, to the doctors registered in the Northern Section of the Portuguese Medical Association, before the Parliamentary approval. Results The questionnaire was returned by 1148 (9%) physicians. A minority of doctors would practice a form of assisted death under the present law or if it was legalized, but a higher percentage think that euthanasia should be legalized, and more would like to have that option if they themselves were in a terminal phase of a disease. Religion has a strong influence on the attitudes of doctors, so too does their contact with patients in a terminal phase, as doctors who deal with more patients with far advanced diseases are more likely to be unfavorable to assisted death. On the other hand, younger doctors are more in favor of these practices. Conclusion The small percentage of questionnaires sent back is a weakness in this study and casts doubts on the generalizability of the conclusions. However, this is, so far, the best approximation to the opinions of Portuguese doctors on assisted death.

PROFESSOR DOUTOR AMADEU PIMENTA: O HOMEM E O ENGENHO

Amadeu Pinto de Araujo Pimenta was born on November 29, 1943 in Ponte de Lima, district of Viana do Castelo. He was Professor of Surgery at the Faculty of Medicine of the University of Porto (FMUP), Director of the Service of General Surgery of the Hospital de Sao Joao, President of the Portuguese Society of Surgery, Senior Researcher at the Institute of Pathology and Molecular Immunology at the University of Porto (IPATIMUP) and Member of the Northern and National Disciplinary Councils of the Portuguese Medical Association. He graduated in 1968 at FMUP. A few months after starting the Surgery Complementary Internship, in 1971, he was mobilized to Angola, where he served in the Military Service as a Surgeon’s Assistant. Returning from Angola, between 1973 and 1976, he resumed and completed his internship at the Service of Surgical Propaedeutics of the Hospital de Sao Joao. In 1977, he did an internship at the Service of Surgical Clinic of the Hospital Beaujon, in Paris, where he perfected his surgical technique, mainly in esophagogastric pathology, with Professors J. L. Lortat-Jacob (1908-1982) and F. Fekete (b. 1929). He started his teaching activity in 1974. In 1985, he presented his doctoral thesis, entitled “Contribution to the Study of the Automatic Suture”, where he described the development of a new eversion automatic digestive suture device and its clinical applicability. Ingenious surgeon, he also developed other important surgical devices. In 2007, he was appointed Full Professor of Surgery at FMUP. From 1990, he was in charge of the development of the Unit of Esophagogastric Surgery of the Service of Surgery 4 (Hospital de Sao Joao). He left a vast and rich scientific, filmographic and bibliographic contribution. He was the creator and main organizer of several editions of the “International Updating Meeting on Esophagus and Stomach Surgery”. In 2007, he was appointed Full Professor of Surgery of the FMUP and, in 2008, Director of the Service of General Surgery of the Hospital de Sao Joao and President of the Portuguese Society of Surgery, whose term, unfortunately, he did not end. He died on February 17, 2010, having courageously dedicated his life to esophagogastric pathology. He stood out for his Character, for his Humanity and for the Excellence of his journey.

Physicians\u2019 beliefs and attitudes about Benzodiazepines: a cross-sectional study

BackgroundIn 2015, Portugal was the OECD country with the highest reported consumption of BZD. Physician’s perceptions and attitudes regarding BZD are main determinants of related prescription habits. This study aimed to characterize beliefs and attitudes of Portuguese physicians regarding the prescription, management challenges, benefits, risks and withdrawal effects of BZD.MethodsA cross-sectional, observational study with online data collection through anonymous self-administered questionnaire. Physicians registered with the Portuguese Medical Association were invited to participate through direct e-mail message. Physicians were asked to give their opinion (using a 5-points Likert scale) regarding the prescription of BZD, their benefits and risks in the management of insomnia and anxiety, the possible adverse effects of chronic use and alternative non-pharmacologic approaches. Descriptive statistics were used and groups were compared through logistic regression.ResultsA total of 329 physicians participated in the study (56% family physicians). Mean age was 44.10 ± 15.2 years, with 19.03 ± 14.9 years of clinical experience. Fifty eight percent of participants were female. Physicians reported BZD’s negative impact on cognitive function (89%), association with road traffic accidents (88%) and falls (79%). Also, 58% shared the belief that chronic use is justified if the patient feels better and without adverse events. Although 68% reported to feel capable of helping patients to reduce or stop BZD, 55% recognized difficulties in motivating them. Compared to other medical specialists (altogether), family physicians were significantly more aware about the adverse effects of BZD and considered that chronic use may not be justified. Conversely, more family physicians expressed concerns about their skills to motivate patients engaging in withdrawal programs and to support them during the process.ConclusionOur results show that physicians’ awareness about risks of BZD chronic use is adequate though their attitudes and self-perceived skills towards promoting BZD withdrawal can be improved. Interventions in primary care are needed to capacitate physicians to better motivate patients for BZD withdrawal.

[Medical Student Secrecy, its Link to the Duty of Confidentiality and the Right to Access and Reuse Health Information].

The authors address the legal void that exists regarding medical student access to clinical records and health information that local healthcare organizations hold under legal and institutional custody. They develop a legal thesis that configures the creation of medical student professional secrecy and its connection with the duty of confidentiality as assumptions that underlie the medical student's right to access and reuse health information. Medical students have the legitimacy to access health information and clinical records, as they bear an unequivocal informational, legitimate, constitutionally protected and sufficiently relevant need. They conclude that the legislature must work together with universities and hospital institutions to legally establish the concept of Medical Student Professional Secrecy, its link to the duty of confidentiality and the right of the medical student to access and reuse health information. Furthermore, it must do so in a specific legal act and in the precise terms of the text approved unanimously by the Council of Portuguese Medical Schools, by the National Council of Medical Ethics and Deontology, by the National Council of the Portuguese Medical Association and by its President.

A Endocrinologia em Portugal - Censo 2016. Direção do Colégio de Endocrinologia e Nutrição da Ordem dos Médicos

On September 2016, the Board of the College of Endocrinology and Nutrition of the Portuguese Medical Association carried out a national survey, about all Endocrinology, Diabetes and Metabolism Departments of the public hospitals included in the Portuguese National Health Service and a simplified version of this survey was sent to all endocrinologists working in Portugal and registered with the Portuguese Medical Association. Data related to organizational and human resources were collected, reporting the situation by the end of year 2015. The census registered 107 individuals and 27 Departments. The ratio of endocrinologists-population was 1.4, much lower than in the other European countries (varies between 2 to 4), resulting in alarming shortages of services in some areas of Portugal and in worse quality indicators. These data suggest that actions should be taken to increase the number of endocrinologists and departments in the country. In recent years, the number of residents has significantly increased, which will make it possible to correct this situation.

HP-02-003 Gender dysphoria: A portuguese experience

In Portugal, surgical and hormonal treatments to gender dysphoria were forbidden by Portuguese Medical Association until 1995. Since then, several changes took place in the Portuguese social, cultural, medical and political background, moving towards a new perspective in the way society understands this condition and this population’s needs. In the Sexual Medicine Unit of São João Hospital Centre, there is a specific evaluation and treatment protocol to assist individuals with gender identity issues since 2008. We intend to characterize the patients who attend the Sexual Medicine Unit of São João Hospital Centre for sex reassignment surgery and compare our results with similar studies in other countries. Results were analyzed regarding the Portuguese reality and its particularities. We designed a transversal study carried out at the Sexual Medicine Unit of São João Hospital Centre (Porto, Portugal). Users enrolling this study started the process of changing sex between 2008 and 2016. They were asked to fulfill an investigation questionnaire designed to collect socio-demographic and clinical data.

Acesso dos Pacientes aos seus Processos Clínicos

Until recently, the medical record was seen exclusively as being the property of health institutions and doctors. Its great technical and scientific components, as well as the personal characteristics attributed by each doctor, have been the reasons appointed for that control. However, nowadays throughout the world that paradigm has been changing. In Portugal, since 2007 patients are allowed full and direct access to their medical records. Nevertheless, the Deontological Code of the Portuguese Medical Association (2009) explicitly states that patients' access to their medical records should have a doctor as intermediary and that the records are each physician's intellectual property. Furthermore, several doctors and health institutions, receiving requests from patients to access their medical records, end up requesting the legal opinion of the Commission for access to administrative documents. Each and every time, that opinion goes in line with the notion of full and direct patient access. Sharing medical records with patients seems crucial and inevitable in the current patient-centred care model, having the potential to improve patient empowerment, health literacy, autonomy, self-efficacy and satisfaction with care. With the recent technological developments and the fast dissemination of Personal Health Records, it is foreseeable that a growing number of patients will want to access their medical records. Therefore, promoting awareness on this topic is essential, in order to allow an informed debate between all the stakeholders.

Stress and burnout among Portuguese anaesthesiologists

Anaesthesiology is considered a stressful occupation. Our purpose was to assess stress and burnout among Portuguese anaesthesiologists. A cross-sectional survey based on an anonymous questionnaire was sent to all Portuguese anaesthesiologists registered by the Portuguese Medical Association. Data on patient characteristics and professional variables, perceived stress (Perceived Stress Scale), the subscale of work satisfaction of the Pressure Management Indicator scale, burnout (Maslach Burnout Inventory) and main stress factors were collected. The proportion of participation was 31.8%. The average value of perceived stress scale was 24.0 (range: 0-56). Among the 263 anaesthesiologists, 57.9% experienced emotional exhaustion, 44.8% lack of personal accomplishment and 90.9% depersonalisation. Lack of personal accomplishment increased with number of children among women but not among men; depersonalisation was more frequent among anaesthesiologists working in community hospitals and anaesthesiologists with leadership functions experienced less professional stress. There are stress conditions and burnout amongst Portuguese anaesthesiologists. The prevalence of depersonalisation was extremely high in the studied sample. Emotional exhaustion is partially explained by high perceived-stress and low satisfaction with organisation in the job according to Pressure Management Indicator scale.

[Postgraduate training in gynecology and obstetrics. Results of an individual national survey of interns].

The national survey on the trainees in this specialty was conducted to find out the trainees' opinions and expectations regarding postgraduated in Gynecology and Obstetrics and professional opportunities. A total of 320 questionnaires were send to all the trainees registered with the Portuguese Medical Association. Some of the topics of this survey were: structure and quality; curriculum requirements; assessment and professional opportunities. We received a total of 109 replies, which are presented in this article.

[The credit system. Post-graduate medical education and continuous medical education].

The author examines the objectives behind the possible adoption of a Credit System by the Portuguese Medical Association. Credits are units that allow physicians to keep a record of their educational and professional undertaking. The paper defines Postgraduate Medical Education and Continuing Medical Education and specifies to which group of physicians each term applies. It describes the types of activities and objectives of each form of medical education and explains the philosophy underlying both. The author also urges that the Portuguese Medical Association set up essential structures to ensure the efficient functioning of the system. The paper outlines the criteria to be used for awarding Credits and discusses the natures of credit-granting institutions. The Credits are grouped into pre-defined Categories of differing weight. The author also recommends a credit value for each activity and, taking into account the nature of each activity, assigns it to a specific Category. Several types of Forms for Applying for and Registering Credits are shown. The information on these Forms is to go on the physicians record, to be filed on a database with the Portuguese Medical Association at a place set aside for the purpose.