Frederico Rosário

Childhood obesity, thyroid function, and insulin resistance – is there a link? A longitudinal study

Abstract Background: Serum thyroid stimulating hormone (TSH) levels are frequently elevated in obese children and are most likely to be associated with insulin resistance. However, clinical relevance of this association remains unclear. Objectives: To assess the prevalence of hyperthyrotropinemia; to analyze the relationship between TSH and homeostasis model assessment – insulin resistance (HOMA-IR); and to verify whether TSH levels and HOMA-IR vary with weight loss in obese children. Subjects and Methods: Retrospective longitudinal study with data from baseline and 1 year after lifestyle intervention in a pediatric obese group (344 children were recruited and 100 among them completed follow-up). For postintervention analysis, three groups were considered according to body mass index-standard deviation score (BMI-SDS) variations: ≤–0.5 (significant weight loss); 0.5–0 (weight loss); and >0 (weight gain). Statistical analysis was performed using SPSS 19.0®. Results: The prevalence of increased TSH levels was 9.3%. At baseline TSH (p=0.007), fT4 (p=0.006), and HOMA-IR (p<0.001) were positively correlated to BMI-SDS (n=344). Weight reduction was verified in 67 out of 100 cases but significant loss was present in only 21 cases. Decreases in both TSH and BMI-SDS were independently associated with decreases in HOMA-IR (p=0.005 and p=0.016, respectively). There was no correlation between TSH and BMI-SDS variation. Significant decreases in the HOMA-IR (p=0.006) were only achieved in the significant weight loss group. Conclusions: The prevalence of hyperthyrotropinemia was lower than previously reported. However, cutoff values were adjusted to pubertal stage, suggesting an over report in other studies. Insulin resistance and TSH were positively correlated, independent of body status. Although weight loss was not associated with TSH variation, a decrease in TSH levels was independently associated with decreases in HOMA-IR.

Differences between Groups of Family Physicians with Different Attitudes towards At-Risk Drinkers: A Post Hoc Study of the ODHIN Survey in Portugal

Introduction. We have recently shown that family physicians can be classified into two groups based on their attitudes towards at-risk drinkers: one with better and the other with worse attitudes. Objective. To compare the two groups regarding demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Methods. A random sample of 234 Portuguese family physicians who answered the Optimizing Delivery of Health Care Interventions survey was included. The questionnaire asked questions on demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Results. Family physicians with better attitudes were younger (p = 0.005) and less experienced (p = 0.04) and with higher male proportion (p = 0.01). This group had more hours of postgraduate training (p < 0.001), felt more prepared to counsel risky drinkers (p < 0.001), and considered themselves to have better counselling efficacy (p < 0.001). More family physicians in the group with worse attitudes considered that doctors cannot identify risky drinkers without symptoms (p = 0.01) and believed counselling is difficult (p = 0.005). Conclusions. Family physicians with better attitudes had more education on alcohol and fewer barriers to work with at-risk drinkers. These differences should be taken into account when designing implementation programs seeking to increase alcohol screening and brief advice.

Working with hazardous and harmful drinkers: derivation and validation of a model for predicting distinct general practitioners groups

Effectiveness of training in increasing general practitioners’ (GPs) screening and brief intervention rates is influenced by their attitudes towards working with hazardous and harmful drinkers.

Improving the attitudes of primary care practitioners toward adolescent care: a pre-post intervention pilot study

Abstract Background Investing in adolescent health is among the most cost-effective health measures. Primary care practitioners are ideally positioned to deliver such interventions. However, several barriers hinder them from engaging with adolescents. Objective To pilot test the impact of a 1-day training session on adolescent health on the attitudes of primary care practitioners toward adolescent care. Subjects Participants were family physicians and nurses enrolled in a 1-day training session on adolescent health. Methods A non-randomized, pre-post intervention study with no control group. Data on barriers for providing care to adolescents, preferred pediatric age group and attitudes toward adolescent care were collected immediately prior. Participants’ attitudes were measured again immediately after training. Results Most participants reported they preferred to attend pediatric groups other than adolescents. The most frequently reported barriers were: excessive amount of time needed and lack of training. Participants reported positive pre-training attitudes, with mean scores above the midpoint of the scale in all dimensions. Significant positive improvements were observed after training in Adequacy, Self-esteem and Satisfaction. Subgroup analysis showed that at baseline, professionals who preferred to work with adolescents had significantly more positive attitudes in Adequacy, Self-esteem and Satisfaction. After training there was a general improvement in attitudes in both groups, with attenuation of the differences between them. Conclusion Participation in a 1-day tailored educational intervention on adolescent health had a positive impact on the attitudes of primary care practitioners, regardless of their preferred age group. This improvement may lead to more active engagement with adolescents and substantial health gains.

Implementing alcohol screening and brief interventions in primary health care: study protocol for a pilot cluster randomized controlled trial

BACKGROUND Alcohol is one of the most important risk factors contributing to the global burden of disease. Screening and brief interventions in primary care settings are effective in reducing alcohol consumption. However, implementation of such interventions in routine practice has been proven difficult. Most programmes in practice and research have lacked a theoretical rationale for how they would change practitioner behaviour. OBJECTIVE To determine whether a theory-based behaviour change intervention delivered to primary care practices significantly increases delivery of alcohol screening. METHODS We will conduct a two-arm, cluster-randomized controlled, parallel, open trial. Twelve primary care practices will be randomized to one of two groups: training and support; and waiting-list control. Family physicians, nurses and receptionists will be eligible to participate. The intervention will be a training and support programme. The intervention will be tailored to the barriers and facilitators for implementing alcohol screening and brief interventions following the principles of the Behaviour Change Wheel approach. The primary outcome will be the proportion of patients screened with the Alcohol Use Disorders Identification Test. CONCLUSION This study will test whether a theory-driven implementation programme increases alcohol screening rates in primary care. Results from this trial will provide a useful addition to existing evidence by informing implementation researchers what areas of behaviour change are critical to increasing alcohol screening rates. TRIAL REGISTRATION clinicaltrials.gov NCT02968186.

Gone with the Fire: How Family Physicians in Central Portugal Experienced the Aftermath of the Great Fire of October 15, 2017

1. Unidade de Cuidados de Saúde Personalizados Tomaz Ribeiro. Tondela. Portugal. 2. Equipa Projeto em Cuidados Paliativos. Agrupamento de Centros de Saúde Dão Lafões. Viseu. Portugal. 3. Equipa Projeto Piloto em Problemas Ligados ao Álcool. Agrupamento de Centros de Saúde Dão Lafões. Viseu. Portugal.  Autor correspondente: Frederico Rosário. fredmbr@gmail.com Recebido: 03 de janeiro de 2018 Aceite: 05 de janeiro de 2018 | Copyright

Obesity and thyroid function in children: cross-sectional study

To estimate the prevalence of hyperthyrotropinemia in obese children; To analyze the influence of BMI-SDS and TSH in other metabolic variables. Obesity in children has been increasing dramatically, with a significant increase in cardiovascular and metabolic diseases risk. The role of thyroid dysfunction has been extensively analyzed in obese adults, but to a limited extent in children. Serum TSH values ​​are often elevated in obese children and may be associated with modifications in lipid and glucose metabolism. However, the clinical relevance of these associations remains unclear.