As crises convulsivas têm habitualmente grande impacto nos doentes e seus cuidadores, constituindo assim, quer, pela sua frequência, quer pelo seu potencial de gravidade, uma urgência em cuidados paliativos. O nosso objetivo foi identificar os anticonvulsivantes utilizados em cuidados paliativos, suas características farmacodinâmicas e vias de administração. Elaborar um algoritmo de tratamento da crise convulsiva, segundo o estado da arte, para doentes em internamento e ambulatório. Trata-se de um estudo de revisão da literatura, desenvolvido com a finalidade de reunir e sintetizar a informação sobre o uso de anticonvulsivantes no adulto em cuidados paliativos. A sumarização, em modo consulta rápida, das indicações, vias de administração e dosagem relativamente ao uso de anticonvulsivantes permite em formato prático auxiliar as equipas no âmbito dos cuidados de saúde primários e hospitalares na abordagem da crise epiléptica no doente paliativo. Como resultado desta revisão, realça-se o algoritmo de atuação e a sumarização dos anticonvulsivantes mais utilizados em cuidados paliativos e do uso do levetiracetam e da lacosamida por via subcutânea. Mais estudos são necessários para avaliar a segurança e a viabilidade técnica na administração dos anticonvulsivantes de nova geração no doente paliativo por vias alternativas à oral.

As crises convulsivas têm habitualmente grande impacto nos doentes e seus cuidadores, constituindo assim, quer, pela sua frequência, quer pelo seu potencial de gravidade, uma urgência em cuidados paliativos. O nosso objetivo foi identificar os anticonvulsivantes utilizados em cuidados paliativos, suas características farmacodinâmicas e vias de administração. Elaborar um algoritmo de tratamento da crise convulsiva, segundo o estado da arte, para doentes em internamento e ambulatório. Trata-se de um estudo de revisão da literatura, desenvolvido com a finalidade de reunir e sintetizar a informação sobre o uso de anticonvulsivantes no adulto em cuidados paliativos. A sumarização, em modo consulta rápida, das indicações, vias de administração e dosagem relativamente ao uso de anticonvulsivantes permite em formato prático auxiliar as equipas no âmbito dos cuidados de saúde primários e hospitalares na abordagem da crise epiléptica no doente paliativo. Como resultado desta revisão, realça-se o algoritmo de atuação e a sumarização dos anticonvulsivantes mais utilizados em cuidados paliativos e do uso do levetiracetam e da lacosamida por via subcutânea. Mais estudos são necessários para avaliar a segurança e a viabilidade técnica na administração dos anticonvulsivantes de nova geração no doente paliativo por vias alternativas à oral.

Resumo Objetivos: A COVID-19 é a primeira pandemia severa do mundo moderno, tendo já colapsado diversos sistemas de saúde, obrigando-os a adaptar-se. Este artigo pretende analisar a atividade médica numa unidade de cuidados de saúde primários durante o primeiro pico da pandemia, de modo a avaliar os impactos desta no acompanhamento clínico da população. Métodos: Estudo retrospetivo que analisou os dados de todas as consultas efetuadas numa unidade de cuidados primários entre 1 de março e 31 de julho de 2020 e em período homólogo de 2019 e 2018. Resultados: Em 2020 registou-se um aumento de consultas quando comparado com igual período de 2019 e 2018 (14.871, 14.326 e 12.996, respetivamente), sendo a maioria não presencial, ao contrário de anos anteriores (71,6% em 2020, 42,6% em 2019 e 35,2% em 2018). Verificou-se também uma diminuição da maioria das consultas de vigilância e de rotina (2.562 em 2020, 3.067 em 2019 e 2.975 em 2018) e um aumento das consultas por patologia psiquiátrica, destacando-se a ansiedade (362 em 2020, 252 em 2019 e 238 em 2018). Conclusões: Apesar da pandemia, o número total de consultas aumentou em 2020, embora à custa de consultas não presenciais e com uma diferente prevalência de diagnósticos. Ocorreram menos consultas de vigilância e aumentaram as consultas por patologia psiquiátrica, possivelmente decorrentes do impacto socioeconómico da pandemia. Trata-se da primeira casuística da atividade médica de cuidados primários registada durante a primeira vaga da pandemia em Portugal.

Objectives: COVID-19 is the first severe pandemic of the modern world, having already collapsed several health systems, forcing them to adapt. This article intends to review the medical activity in a primary care unit during the first pandemic outbreak to assess its impact on the population. Methods: Retrospective study. Data were retrieved from all medical appointments carried out in a primary care unit between 1 March and 31 July 2020 and in the same period of 2019 and 2018. Results: There was an increase in the number of medical appointments in 2020 compared to the same period of 2019 and 2018 (14,871, 14,326, and 12,996, respectively), the majority being teleconsultations by e-mail or phone in contrast to previous years (71.6% in 2020, 42.6% in 2019 and 35.2% in 2018). There was also a decrease in most follow-up and routine appointments (2,562 in 2020, 3,067 in 2019, and 2,975 in 2018) and an increment in psychiatric diagnosis, mainly anxiety-related disorders (362 in 2020, 252 in 2019, and 238 in 2018). Conclusions: Despite the pandemic, the total number of medical appointments increased in 2020, mostly due to teleconsultations and with a different prevalence of diagnostics. There were fewer follow-up and routine appointments but more diagnoses of psychiatric disorders, probably related to the socio-economic impact of the pandemic. This is the first case series of primary care activity recorded during the first pandemic outbreak in Portugal.

Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13–17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities.

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.