Portuguese Journal of Family Medicine and General Practice
type: channel
description: The Portuguese Journal of General and Family Medicine is the official organ of the Portuguese Association of General Family Medicine. It aims to contribute to the development of the specialty of General and Family Medicine and Primary Health Care, through an impartial, rigorous and up-to-date scientific publication. It has been published since 1984 with a bimonthly periodicity.
publisher: Associação Portuguesa de Medicina Geral e Familiar
language: en
publication name: Portuguese Journal of Family Medicine and General Practice
issn: 2182-5173
copyright: The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith. The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.
items: Silva Henriques – Family doctor and ideals
items: Ciência dos Fatores Humanos: colocando as pessoas no centro dos cuidados de saúde
items: Para além da consulta de MGF: porque o futuro da saúde começa na comunidade
items: Pré-Conferência WONCA 2025: um encontro que transforma
items: Luís Rebelo's legacy: family health and smoking cessation in general and family medicine
items: Prevalência e preditores de doença renal diabética: um estudo transversal nos cuidados de saúde primários
items: WONCA World Conference – Lisbon, September 2025
items: Gender dysphoria: when no one is paying attention
items: Livro Resumos 42º ENMGF 2025 - Troia
items: Mourning: medical attitudes and a person’s expectations in the general practice/family medicine ambience
items: Treatment of patients at high risk of osteoporotic fracture in a USF: the importance of FRAX®Port
items: The future of general and family medicine in Portugal
items: The legacy of Professor Isabel Santos: the people
items: Jaime Correia de Sousa: master, leader, and visionary
items: Self-assessment of professional satisfaction with general practice consultations: a reflection on the Patient Satisfaction Questionnaire
items: Diabetes in times of a pandemic: the impact of COVID-19 in different Family Health Units across the country
items: Sperm vs COVID-19: an unexpected case of male infertility
items: Agradecimento a Revisores 2024
items: Perception and valuing of clinical ethics issues by health professionals: an observational study in Administração Regional de Saúde de Lisboa e Vale do Tejo
items: Antimicrobial prescription at the end of life
items: O papel do médico de família no cuidado das famílias monoparentais
items: Osteoporosis: the forgotten disease
items: Approach to fears and concerns of type 2 diabetes mellitus patients in consultation: doctor and patient perspectives
items: Enablement according to communication in the type 2 diabetes mellitus patient
items: VoluntariaMente: o impacto do papel social individual na melhoria da saúde mental
items: Migration of an inguinal hernia prosthesis: case report
items: The impostor phenomenon and the psychological distress in the general practice / family medicine doctors in Portugal
items: Rapid antigenic diagnostic test: determinants of use, clinical orientation and economic impact in primary health care
items: Bisalbuminaemia, a family trait: case report
items: The importance of the family approach in family medicine

Silva Henriques – Family doctor and ideals
type: item
description: A revista da APMGF tem dedicado este espaço a testemunhar a vida de médicos que contribuem para o nosso legado em Medicina Geral e Familiar, seja pelo seu testemunho de vida, seja na ajuda da construção de conjunto de processos doutrinais, que recriam e renovem o saber instituído e as práticas vigentes. Considero que José Maria Silva Henriques é um deles.
subject: Legado de Medicina Geral e Familiar
  topic: section
subject: Legacy
  topic: keywords
subject: General practice
  topic: keywords
subject: Family practice
  topic: keywords
subject: Primary health care
  topic: keywords
creator: Luciana Couto
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-11-03
publication date: 2025-11-03
starting page: 459
ending page: 60
doi: 10.32385/rpmgf.v41i5.14371

Ciência dos Fatores Humanos: colocando as pessoas no centro dos cuidados de saúde
type: item
description: .
subject: Editorial
  topic: section
subject: Ciência dos Fatores Humanos
  topic: keywords
creator: Richard Roberts
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-11-03
publication date: 2025-11-03
starting page: 382
ending page: 3
doi: 10.32385/rpmgf.v41i5.14352

Para além da consulta de MGF: porque o futuro da saúde começa na comunidade
type: item
description: .
subject: Editorial
  topic: section
subject: Community
  topic: keywords
subject: Family medicine
  topic: keywords
creator: Tracey Naledi
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-09-05
publication date: 2025-09-05
starting page: 292
ending page: 3
doi: 10.32385/rpmgf.v41i4.14321

Pré-Conferência WONCA 2025: um encontro que transforma
type: item
subject: Editorial
  topic: section
subject: WONCA
  topic: keywords
creator: Inês Castro
creator: Madalena Leite Rio
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-27
publication date: 2025-06-27
starting page: 198
ending page: 198
doi: 10.32385/rpmgf.v41i3.14313

Luís Rebelo's legacy: family health and smoking cessation in general and family medicine
type: item
description: x
subject: Legado de Medicina Geral e Familiar
  topic: section
subject: Legacy
  topic: keywords
subject: General and family medicine
  topic: keywords
subject: Smoking cessation
  topic: keywords
creator: Cristina Ribeiro
creator: Sara Madeira
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-27
publication date: 2025-06-27
starting page: 283
ending page: 6
doi: 10.32385/rpmgf.v41i3.14308

Prevalência e preditores de doença renal diabética: um estudo transversal nos cuidados de saúde primários
type: item
description: Introdução: A doença renal diabética (DRD) é uma das principais causas de doença renal em estádio terminal. Os cuidados de saúde primários são fulcrais para o diagnóstico precoce e a gestão da doença. Objetivos: Avaliar a prevalência e a precisão do diagnóstico de DRD. Adicionalmente, identificar potenciais fatores de risco para a DRD e avaliar a prescrição de medicamentos nefroprotetores. Métodos: Estudo transversal numa amostra aleatória de 387 utentes com diabetes tipo 2 num centro de cuidados primários no norte de Portugal. Foram recolhidos dados demográficos e laboratoriais dos doentes, bem como evidências de prescrição de IECA ou ARAII e/ou iSGLT2. O diagnóstico de DRD foi baseado nas guidelines KDIGO 2012. Os códigos ICPC-2 U-99 e U-88 foram considerados adequados para identificar a DRD codificada. Uma regressão logística multivariável foi usada para investigar associações entre a DRD e potenciais fatores de risco como idade, sexo, IMC, hipertensão, dislipidemia, tabagismo e duração, controlo e complicações macrovasculares ou microvasculares da diabetes. Resultados: Foram incluídos 338 utentes, dos quais 58% eram do sexo masculino, com uma idade média (±DP) de 71,4 (±10,2) anos. A prevalência de DRD foi de 42,6% [IC 95%, 37,4-48,0%], com apenas 9,5% devidamente codificada. A maioria dos doentes encontrava-se nos estadios G2 (33,3%), G3a (30,6%) e G3b (14,6%) e, em relação à albuminúria, no estádio A2 (68,8%). Entre os doentes com DRD, 77,1% [69,6-83,2%], 60,4% [52,3-68,0%] e 43,1% [35,3-51,2%] estavam medicados com IECA/ARA, iSGLT2 e ambos, respetivamente. O sexo masculino (OR=1,89), idade avançada (OR=1,08), maior IMC (OR=1,06), complicações macrovasculares da DM (OR=1,90) e dislipidemia (OR=4,95) foram identificados como fatores de risco independentes para a DRD. Conclusões: Este estudo destaca a elevada prevalência e subdiagnóstico da DRD, identificando áreas para melhoria na prática clínica.
subject: Original Research
  topic: section
subject: Nefropatia diabética
  topic: keywords
subject: Prevalência
  topic: keywords
subject: Fatores de risco
  topic: keywords
subject: Cuidados de saúde primários
  topic: keywords
creator: Ana Rita Queirós
creator: Rafael Figueiredo
creator: Ana Pinho
creator: Clara Fonseca
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-11-03
publication date: 2025-11-03
starting page: 407
ending page: 13
doi: 10.32385/rpmgf.v41i5.14156

WONCA World Conference – Lisbon, September 2025
type: item
description: .
subject: Editorial
  topic: section
subject: WONCA
  topic: keywords
creator: Nina Monteiro
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-05-15
publication date: 2025-05-15
starting page: 114
ending page: 114
doi: 10.32385/rpmgf.v41i2.14288

Gender dysphoria: when no one is paying attention
type: item
description: Introduction: Transgender health remains a challenge for healthcare professionals, given the fast evolution of concepts related to gender roles and sexual identity, with frequent updates to definitions and nomenclature. Also, being a delicate and divisive theme in society, it generates distress, suffering, and stigmatization for people experiencing these processes. Besides, there is often significant inaction by primary health care professionals when addressing these topics, thus failing to identify and help people in distress who are sometimes incapable of asking for help. Case description: A person assigned male at birth, 56 years old, single, unemployed, living with her parents, who financially support her. The patient booked an appointment with the Family Physician, presenting frequent panic attacks. After the clinical interview, the patient revealed that she identifies as a woman, and not with her natal gender. She admitted feeling this way since adolescence, only now having the courage and determination to come out and engage in gender-affirming treatments. A careful clinical history allowed the identification of the distress this person experienced throughout her life, permitting a referral to secondary care facilities and psychological support. Comment: A person suffering from knowing who they are but not knowing how to act or seek help generates severe problems for their biopsychosocial well-being. Primary healthcare workers, being the frontline of healthcare systems, need to be alert to signs of struggle and distress and must be available to actively explore the gender and sexual dimensions of people’s lives. On the other hand, they also have a fundamental role in managing comorbidities and coordinating with secondary health care and other supportive entities, providing personalized and integrated care throughout the transition process.
subject: Case Reports
  topic: section
subject: Primary health care
  topic: keywords
subject: Health care management
  topic: keywords
subject: Transgender health, Prevention
  topic: keywords
subject: Gender dysphoria
  topic: keywords
creator: Ricardo Silva
creator: Ema Santos
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-11-03
publication date: 2025-11-03
starting page: 446
ending page: 54
doi: 10.32385/rpmgf.v41i5.14026

Livro Resumos 42º ENMGF 2025 - Troia
type: item
description: Livro de Resumos 42º ENMGF 2025 - Troia
subject: Abstracts Congress
  topic: section
subject: APMGF
  topic: keywords
creator: APMGF
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-05-23
publication date: 2025-05-23
doi: 10.32385/rpmgf.v41i.14

Mourning: medical attitudes and a person’s expectations in the general practice/family medicine ambience
type: item
description: Introduction: Grief, a personalized response to the loss of a significant other, often leads to seeking medical consultation. Objective: To evaluate and compare the attitudes to be used by family medicine doctors (m-FM) and the expectations of bereaved individuals. Methods: An exploratory, cross-sectional observational study was conducted on a sample of m-GP, chosen conveniently, and on individuals who have been in mourning for less than a year, applying a specifically designed clinical case and response to similar medical attitudes and expectations in closed multiple-choice and open-ended options. The application process took place after consultation and was also conducted remotely, following an invitation from the m-MGF, by the inclusion criteria. Readability analysis of the text and descriptive and inferential statistics of the data were performed. Results: In a sample of 21 m-MGF, 13 (46.4%) women and n=12 (57.1%) specialists, and from 20 people, n=15 (75.0%) were women. Significant differences were found in the responses of m-MGF and people (p<0.001), with empathetic counseling being the most chosen option by m-MGF, 69.6%, and people, 27.5%. For 91.7% of the specialists, only empathetic counseling was selected, with specialty interns responding with more options (p=0.014). People significantly chose more associations of therapeutic attitudes, 31.7% (n=13), than GPs, 2.4% (n=1, p<0.001). Discussion: The differences found in this unprecedented study, simultaneously academic and practice-oriented, regarding medical attitudes and the expectations of people in the face of a bereavement case, suggest the need for a more comprehensive approach by doctors in managing people in mourning, such as the use of empathy, person-centered medicine, and social prescription. Conclusion: In this sample, despite the same attitudes and expectations, differences were observed between m-MGF and people. Doctors predominantly opted for empathetic counseling (69.6%), while people chose o…
subject: Original Research
  topic: section
subject: Mourning
  topic: keywords
subject: Prolonged grief disorder
  topic: keywords
subject: Family doctor
  topic: keywords
subject: Therapeutics
  topic: keywords
subject: Empathy
  topic: keywords
subject: Person-centred medicine
  topic: keywords
creator: Beatriz Leitão Domingos
creator: Luiz Miguel Santiago
creator: Carlos Seiça Cardoso
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-09-05
publication date: 2025-09-05
starting page: 316
ending page: 24
doi: 10.32385/rpmgf.v41i4.14012

Treatment of patients at high risk of osteoporotic fracture in a USF: the importance of FRAX®Port
type: item
description: Introduction: Osteoporosis is a bone disease whose prevalence has been increasing, particularly in elderly females. The main clinical consequence is the fragility fracture, leading to increased morbidity and mortality, and a decreased quality of life for the patient, representing a significant socioeconomic burden. The current challenge is the early identification of individuals at higher risk of fracture who require therapeutic intervention to prevent future fractures. Objectives: To study the beginning of anti-osteoporotic therapy in female patients at high risk of osteoporotic fracture. Methods: A cross-sectional study based on the review of medical records and telephone interviews of 50-year-old and older female patients from a Family Health Unit in the Western Lisbon area. The sample size was calculated using the SurveyMonkey website, and the population sample was randomly selected. Fracture risk was calculated using FRAX®Port. The population was stratified based on fracture risk, and therapy initiation was verified in high-risk patients. Results: A sample of 250 patients was obtained, of which 20.8% (n=52) had a high risk of fracture, 9.2% (n=23) had intermediate fracture risk, and 70% (n=175) had low fracture risk, according to FRAX calculation. Among the patients identified as having a high risk of fracture, 28.8% (n=15) were receiving anti-osteoporotic therapy. Conclusion: It was found that only 28.8% of patients at high risk of fracture were receiving treatment, highlighting the importance of raising awareness among healthcare professionals for the assessment of osteoporotic fracture risk in Family Medicine appointments and implementing a change in the diagnostic and therapeutic approach to osteoporosis.
subject: Original Research
  topic: section
subject: Osteoporosis
  topic: keywords
subject: Osteoporotic fractures
  topic: keywords
subject: Fracture risk
  topic: keywords
subject: FRAX
  topic: keywords
subject: Anti-osteoporotic therapy
  topic: keywords
creator: Carolina Sotana
creator: Daniela Ribeiro
creator: Joana Azeredo
creator: Margarida Peixoto
creator: Joana Chagas
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-09-05
publication date: 2025-09-05
starting page: 338
ending page: 43
doi: 10.32385/rpmgf.v41i4.13963

The future of general and family medicine in Portugal
type: item
description: Like medicine in general, general and family medicine is at an inflection point. Digital transformation, artificial intelligence, and demographic changes require a redefinition of the family doctor's role. Portugal faces urgent challenges: a growing shortage of professionals in the National Health Service, an ageing population, and the need to ensure equity in access to health care. How can we ensure that general and family medicine adapt to this reality without compromising its fundamental principles?
subject: Editorial
  topic: section
subject: General and family medicine
  topic: keywords
subject: Primary health care
  topic: keywords
subject: Innovation
  topic: keywords
subject: Leadership
  topic: keywords
subject: Ethics
  topic: keywords
creator: Paulo Santos
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-03-05
publication date: 2025-03-05
starting page: 6
ending page: 7
doi: 10.32385/rpmgf.v41i1.14245

The legacy of Professor Isabel Santos: the people
type: item
description: Professor Isabel Santos determined the direction of the specialty of General and Family Medicine in Portugal. Few people have thought of such drastic changes, so based on the foundations of the specialty: undergraduate and graduate training, continuing education, and research. Her mentoring resulted in hundreds of disciples, including students, interns, specialists, doctoral students, senior researchers, leaders, and those responsible for health organizations and public policies. Due to its direct and indirect action, we now have more doctors in Portugal, especially more family doctors.
subject: Legado de Medicina Geral e Familiar
  topic: section
subject: Legacy
  topic: keywords
subject: Primary healthcare
  topic: keywords
subject: Family and general medicine
  topic: keywords
subject: Medical education
  topic: keywords
creator: Bruno Heleno
creator: Daniel Pinto
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-03-05
publication date: 2025-03-05
starting page: 103
ending page: 5
doi: 10.32385/rpmgf.v41i1.14228

Jaime Correia de Sousa: master, leader, and visionary
type: item
description: Honor and challenge! These are two ideas that represent what I feel when writing these words. It is an honor to talk about someone I admire so much. Challenged by the fear that words will become too small to describe the scope of your person and your journey. Jaime Correia de Sousa, as a family doctor, professor, researcher, and visionary, has become an essential figure in General and Family Medicine (GFM) in Portugal, inspiring generations of doctors and other professionals to embrace the values ​​of humanism, dedication, resilience, and empathetic leadership.
subject: Legado de Medicina Geral e Familiar
  topic: section
subject: Legacy
  topic: keywords
subject: Family medicine
  topic: keywords
subject: Primary health care
  topic: keywords
creator: Cláudia Bulhões
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-03-05
publication date: 2025-03-05
starting page: 106
ending page: 7
doi: 10.32385/rpmgf.v41i1.14227

Self-assessment of professional satisfaction with general practice consultations: a reflection on the Patient Satisfaction Questionnaire
type: item
description: Introduction: The Portuguese version of the Patient Satisfaction Questionnaire (PSQ-PT) involves the physician's self-assessment perception of their consultation. Objectives: To verify the reliability of the Medical Satisfaction Questionnaire (MSQ) and to validate it convergently with the self-assessment of satisfaction with the consultation in General and Family Medicine. Methods: The PSQ-PT was adapted to QSM and a survey was conducted with QSM, with a lower score indicating a better result, the question "How do you rate your satisfaction with your consultations, in general?", on a scale of 1-10, with 10 being the best, and contextual questions on sex, career category, and type of Health Unit of work, in December 2023 and December 2024, online on specific social media conversation platforms, with a minimum sample size of n=71 responses, without duplicates, in each application. Results: The reliability verified equal results. A sample of n=265 was studied, 67.2% women, 76.6% Specialists, 83.4% in the USF model, n=149 in 2023, and n=116 in 2024. The reliability was 0.675, Cronbach’s alpha, and if an item was excluded, it ranged between [0.634 and 0.685], and the Intraclass Correlation Coefficient was 0.298 [0.161 to 0.420], with a 95% confidence interval. The Kendall correlation between the sum of QSM and satisfaction with the consultations was r=-0.384, p<0.001. Only by sex, the QSM was significantly different, p<0.001, with men scoring 16.3±3.1 and women 18.3±3.1. Discussion: An unprecedented study on a scale of good internal consistency and reliability, which will allow for future improvement in quality by adjusting some of the poorly answered premises. Conclusion: The QSM allows for the evaluation of professional satisfaction with the consultation in general practice, enabling the identification of areas for improvement.
subject: Original Research
  topic: section
subject: Job satisfaction
  topic: keywords
subject: General and family medicine
  topic: keywords
subject: Primary health care
  topic: keywords
subject: Consultation
  topic: keywords
subject: Self-assessment
  topic: keywords
creator: Rita Vilaça Torres
creator: Luiz Miguel Santiago
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-11-03
publication date: 2025-11-03
starting page: 386
ending page: 95
doi: 10.32385/rpmgf.v41i5.14221

Diabetes in times of a pandemic: the impact of COVID-19 in different Family Health Units across the country
type: item
description: Introduction: Diabetes mellitus (DM) is a chronic disease associated with significant morbidity and mortality, and its management is multifactorial. Evidence remains scarce and contradictory regarding the impact of the COVID-19 pandemic on glycaemic control in people with DM. This study aimed to assess changes in glycated haemoglobin (HbA1c) values in individuals with DM during the COVID-19 pandemic. Methods: Data were extracted from electronic medical records of three patient panels with DM, belonging to three primary care units in the Northern and Central regions of Portugal. HbA1c values from the pre-pandemic period were compared with those recorded during the pandemic. Results: A total of 296 participants were included (51% female): 85 from Unit A, 76 from Unit B, and 135 from Unit C. At baseline, participants had a mean age of 65.8 ± 11.0 years and had been diagnosed with DM for 5.4 ± 3.3 years. Compared with the pre-pandemic period, HbA1c values decreased during the pandemic. An inverse association was identified between HbA1c and age. No significant sex-related differences were observed. Conclusion: This study was pioneering in Portugal in exploring glycaemic control in primary care patients with DM during different COVID-19 pandemic phases. Although statistically significant improvements in HbA1c were observed in some semesters, the magnitude of these changes was small and clinically negligible, aligning with international evidence reporting a neutral effect. Further research is required better to understand the pandemic’s impact on diabetes care.
subject: Original Research
  topic: section
subject: Diabetes mellitus
  topic: keywords
subject: Metabolic control
  topic: keywords
subject: COVID-19
  topic: keywords
subject: Pandemic
  topic: keywords
creator: Adriana Arantes Pinheiro
creator: Patrícia Antunes
creator: Inês Garcia Moreira
creator: Frederico Rosário
creator: Joana Fernandes
creator: Lígia Martins
creator: Carla Correlo
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-11-03
publication date: 2025-11-03
starting page: 415
ending page: 21
doi: 10.32385/rpmgf.v41i5.14090

Sperm vs COVID-19: an unexpected case of male infertility
type: item
description: Introduction: Azoospermia is defined by the complete absence of spermatozoa in the ejaculate, resulting in the impossibility of conceiving with the male partner’s sperm. It is one of the most impactful forms of male infertility for couples. An increase in infertility cases reported after SARS-CoV-2 infection suggests a potential correlation between the virus and impaired spermatogenesis. Case description: A 42-year-old male, living with his wife and daughter, had a SARS-CoV-2 infection in 2022. He had no relevant past medical history or regular medication use. In January 2024, he consulted his family doctor (FD) due to secondary infertility, after 14 months of unsuccessful attempts to conceive, despite normal fertility studies in his wife. A spermogram revealed a complete absence of sperm and immature germ cells. A second analysis at a specialized clinic in March 2024 confirmed azoospermia. He was referred to urology, where further hormonal and ultrasound evaluations in May 2024 showed normal results. A testicular biopsy was suggested but refused by the patient. The couple decided not to pursue additional investigations or assisted reproduction techniques. At the follow-up appointment in July 2024, the FD offered psychological support due to the diagnosis’s potential emotional and social impact. Comment: Considering the patient's clinical history and current literature, SARS-CoV-2 infection appears to be the most plausible cause of his azoospermia. Although the couple has come to terms with the diagnosis, it remains a life-altering condition. This case highlights the critical role of the FD in providing not only clinical guidance but also emotional and psychological support and alternative options tailored to the couple’s preferences and needs. Introduction: Azoospermia is a medical condition defined by the total absence of spermatozoids in the sperm and by the impossibility of conceiving a pregnancy with those spermatozoids, being the type of infertility that affec…
subject: Case Reports
  topic: section
subject: Azoospermia
  topic: keywords
subject: COVID-19
  topic: keywords
subject: Infertility
  topic: keywords
subject: SARS-CoV-2
  topic: keywords
creator: Inês Silva
creator: Inês Trindade
creator: Antonieta Barbosa
creator: Sara Leite
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-27
publication date: 2025-06-27
starting page: 257
ending page: 61
doi: 10.32385/rpmgf.v41i3.14149

Agradecimento a Revisores 2024
type: item
description: -
subject: Editorial
  topic: section
subject: Revisão por pares
  topic: keywords
creator: Paulo Santos
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-01-07
publication date: 2025-01-07
starting page: 621
ending page: 2
doi: 10.32385/rpmgf.v40i6.14205

Perception and valuing of clinical ethics issues by health professionals: an observational study in Administração Regional de Saúde de Lisboa e Vale do Tejo
type: item
description: Introduction: Clinical ethics involves identifying, analyzing, and resolving ethical problems that arise in healthcare practice. This study aimed to describe how health professionals identify and manage clinical ethics issues and to identify which tools and support structures they consider useful. Methods: A cross-sectional, observational study was conducted among health professionals working in primary care in the Administração Regional de Saúde de Lisboa e Vale do Tejo (ARSLVT). A one-stage, stratified, simple cluster random sampling method was used to select a total of 400 professionals. A self-administered questionnaire, previously applied in four European countries, was adapted and pilot-tested for this context. Results: A total of 204 questionnaires were collected. Ninety-six percent of participants reported experience with at least one of seven types of ethical problems described. The most frequently identified issues were caring for adults whose decision-making capacity regarding their health was unknown or impaired (94%), and situations where resource management required professionals to make choices different from those they desired (81%). Only 16% of professionals had used any of the described ethical support resources. The most valued resources for resolving ethical conflicts were those providing help in clarifying ethical issues for themselves and other professionals involved (42%). Conclusion: Ethical problems are an inherent part of the complexity of healthcare, highlighting the need for adequate ethical support in decision-making. However, the low use of such resources among professionals stands out as a key finding. This should be considered when designing organizational models for ethical decision support.
subject: Original Research
  topic: section
subject: Clinical ethics
  topic: keywords
subject: Ethical problems
  topic: keywords
subject: Ethical decision support in healthcare
  topic: keywords
subject: Ethical consultant
  topic: keywords
creator: Ivone Gonçalves Gaspar
creator: Catarina Viegas Dias
creator: Hélder Raposo
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-11-03
publication date: 2025-11-03
starting page: 423
ending page: 30
doi: 10.32385/rpmgf.v41i5.14022

Antimicrobial prescription at the end of life
type: item
description: Infections and febrile episodes are common complications in patients in the terminal phase. The literature shows that about 29% of patients admitted to the hospital are in their last year of life. Although there is no data on the prevalence and impact of infections during this period, European and international studies indicate a high prevalence with a significant impact on quality of life, length of hospitalization, and the use of hospital diagnostic and therapeutic resources, without any benefit or impact on survival or quality of life. These infections also contribute to the emergence of resistant microorganisms. Therefore, the adverse effects associated with the use of antimicrobials should not be neglected. The syndrome of impending death is not always correctly identified, leading to the adoption of disproportionate attitudes and treatments, particularly antimicrobial prescriptions without clear benefit in terms of prognostic impact or quality of life. This could even worsen symptom control, potentially becoming a threat to quality of life due to the symptoms they can cause and the potential for iatrogenesis when care approaches involve attempting to treat it. Given the lack of guidelines for antimicrobial prescriptions for this specific population, it is recommended that both diagnosis and therapeutic decisions be rigorous and carefully considered, prioritizing patient well-being and respecting the advanced care plan. It is recommended that, in defining the therapeutic ceiling, the discussion about the use of antimicrobials be given equal importance to the discussion of other invasive measures. The prescription of antimicrobials in palliative care should, therefore, be an individualized model, shared with the patient and family, resulting from a multidisciplinary decision, and requiring regular reassessment, focusing on symptomatic relief rather than survival. It is essential to promote training in palliative care and the inclusion of end-of-life themes in an…
subject: Letter to Director
  topic: section
subject: Antibiotherapy
  topic: keywords
subject: End-of-life
  topic: keywords
subject: Palliative care
  topic: keywords
creator: Raquel Flores
creator: Rodrigo Duarte
creator: João Borralho
creator: Miguel Teles
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-05-15
publication date: 2025-05-15
starting page: 191
ending page: 2
doi: 10.32385/rpmgf.v41i2.14204

O papel do médico de família no cuidado das famílias monoparentais
type: item
description: Objetivos: Perceber as perspetivas de médicos de família (MF) e de médicos internos de formação específica (MIFE) nos cuidados de saúde a famílias monoparentais. Métodos: Estudo observacional transversal por questionário anónimo, especificamente construído, aplicado online a MF e MIFE entre 28 de dezembro/2023 e 24 de março/2024, recolhendo-se duas variáveis de contexto e as opiniões acerca do “Impacto de viver numa família monoparental” (cinco perguntas) e da “Prática médica em famílias monoparentais” (sete perguntas). Efetuou-se a análise estatística descritiva e inferencial dos dados. Calculou-se como dimensão amostral um n=31. Discussão: A reduzida dimensão da amostra e os diferentes vieses associados à utilização de dados autorreportados foram algumas limitações deste estudo. Não havendo outros trabalhos portugueses nesta temática, o desempenho da função assistencial dos médicos com famílias monoparentais parece depender de conhecimentos e treino a obter em formação médica e desenvolvimento médico contínuos. Conclusão: MF e MIFE consideram importante intervir nas necessidades das famílias monoparentais e não se sentem totalmente preparados para prestar cuidados satisfatórios a estas famílias.
subject: Original Research
  topic: section
subject: Famílias monoparentais
  topic: keywords
subject: Medicina geral e familiar
  topic: keywords
subject: Médico de família
  topic: keywords
subject: Formação médica
  topic: keywords
creator: Carmen Cristina Brito Silva
creator: Luiz Miguel de Mendonça Soares Santiago
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-09-05
publication date: 2025-09-05
starting page: 196
ending page: 302
doi: 10.32385/rpmgf.v41i4.14097

Osteoporosis: the forgotten disease
type: item
description: x
subject: Letter to Director
  topic: section
subject: Osteoporosis
  topic: keywords
subject: Therapeutic inertia
  topic: keywords
creator: Paula Miranda
creator: Vânia Oliveira
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-03-05
publication date: 2025-03-05
starting page: 100
ending page: 2
doi: 10.32385/rpmgf.v41i1.14199

Approach to fears and concerns of type 2 diabetes mellitus patients in consultation: doctor and patient perspectives
type: item
description: Introduction: Type 2 diabetes mellitus is a chronic disease that requires special medical follow-up, which involves understanding the stress of living with it. Objectives: To study the concerns and fears of individuals with type 2 diabetes mellitus (T2DM) and to compare their approach by the general and family medicine physician (GFM) to T2DM expectations. Methods: Multifaceted observational study, qualitative-quantitative, initially interviewing PDM2 and questioning in specific conversation networks to understand concerns and fears. Using Excel, a thematic content analysis was conducted inductively, with all issues resolved by consensus. A similar questionnaire was conducted in MGF in specific conversation networks and to PDM2 in four Family Health Units (USF), PMD2s, and USF conveniently chosen. Results: From interviews with 40 PDM2 52.5% women, 35.0% over 65 years old, and 32.5% under 50 years old, four main themes emerged: fear of complications, stress, concerns about medical care, and worries regarding medication. The second phase, with interviews conducted by the same researcher in 44 PMD2, showed no significant differences in the themes according to the studied sociodemographic variables. For 97.7% of the PDM2, addressing these topics in consultations would improve the control of diabetes. All interviewed PDM2 stated no questioning about the complications/consequences of the disease, stress from T2DM, and concerns related to medical care. For the same questions, 44.3%, 62.5%, and 70.5% of FDs reported not being asked about them. In concerns about medication, 93.2% of the PDM2 expressed not being questioned, and 25.0% of the FDs stated not asking about it. Discussion and Conclusion: The approach in the consultation of FDs regarding the four main themes—concerns about complications, factors of stress/suffering, worries about medical follow-up, and fears regarding medication—has not yet been studied in the Person-Centered Medicine perspective. This approach by G…
subject: Original Research
  topic: section
subject: Type 2 diabetes mellitus
  topic: keywords
subject: Complications
  topic: keywords
subject: Distress
  topic: keywords
creator: Camila Faria Lopes Faria Lopes
creator: Luiz Miguel Santiago
creator: João Carlos Alves
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-27
publication date: 2025-06-27
starting page: 232
ending page: 41
doi: 10.32385/rpmgf.v41i3.13994

Enablement according to communication in the type 2 diabetes mellitus patient
type: item
description: Objectives: To assess the enablement of Person suffering from type 2 diabetes mellitus (PsT2DM), using the Patient Enablement Instrument (PEI), and the doctor communication, evaluated by the Communication Assessment Tool (CAT), according to context variables. Methods: Observational cross-sectional study, as an academic and clinical issue, at the Mondego and Manuel Cunha Family Medicine Units in Coimbra, Central Portugal, in a convenience sample representative of the population, recruited between July and October 2023. PEI and CAT were applied, along with context variables such as age, gender, educational level, monthly income, and type of family. The last three were used to calculate the Socio-economic Deprivation Index (SEDI). Chi-square tests, non-parametric statistics, and correlation analyses were used. Results: A n=110 sample, mostly male (57.3%) and old (65.5% aged ≥65 years), living in company (76.4%), with education (52.7%) and monthly income (62.7%) above the minimum, was studied. The last diabetes appointment occurred three to six months ago for 51.8%, and 51.8% judged their disease not to be controlled. Significant differences were found between age and gender (p=0.027), education level (p=0.001), and income (p=0.002). Spearman correlations between SEDI and PEI were weakly significant and negative (ρ=-0.197, p=0.039); between SEDI and CAT were weak, positive, and not significant (ρ=0.084, p=0.382), and between PEI and CAT were negative, weak, and not significant (ρ=-0.119, p=0.217). Discussion: In a younger male and older female sample, a low level of education and lower income were observed for individuals aged ≥65 years. A higher socioeconomic index was associated with a higher perception of communication quality by the doctor. Higher enablement was noted for lower socio-economic status enablement was. These communication matters are core to health results and well-played by doctors. Conclusion: General practice doctors must be attentive to the socioeco…
subject: Original Research
  topic: section
subject: Type 2 diabetes mellitus
  topic: keywords
subject: Literacy
  topic: keywords
subject: Enablement
  topic: keywords
subject: Communication
  topic: keywords
subject: Quality
  topic: keywords
subject: Control
  topic: keywords
creator: Catarina Carvalho dos Santos
creator: Albino Miguel Pereira
creator: Luiz Miguel Santiago
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-27
publication date: 2025-06-27
starting page: 208
ending page: 18
doi: 10.32385/rpmgf.v41i3.14016

VoluntariaMente: o impacto do papel social individual na melhoria da saúde mental
type: item
description: Introdução: As patologias de saúde mental estão entre os problemas de saúde mais comuns em todo o mundo, sendo uma causa importante de morbilidade e isolamento social. Este trabalho teve como objetivo implementar um projeto de intervenção com pessoas que sofrem de ansiedade e/ou depressão, com o intuito de melhorar os seus índices de depressão e ansiedade. Métodos: Pacientes de uma Unidade de Saúde Familiar portuguesa, medicados com ansiolíticos e/ou antidepressivos para tratar os seus transtornos de ansiedade e/ou depressão, foram selecionados e integrados num projeto de voluntariado que durou um ano. Os sintomas de ansiedade foram medidos pela Escala de Ansiedade de Hamilton e os índices de depressão foram quantificados pelo Questionário de Saúde do Paciente-9, antes e depois da intervenção. Resultados: Foram selecionados 33 participantes e 25 foram incluídos no projeto. A maioria era mulheres, com mais de 50 anos, tendo realizado uma média de 48 horas de voluntariado. Houve uma redução estatisticamente significativa nos níveis de ansiedade e/ou depressão após a intervenção, independentemente do número de horas de voluntariado realizado. Conclusões: Sugere-se que o trabalho voluntário qualificado e acompanhado pode ajudar a reduzir os índices de ansiedade e depressão.
subject: Practice
  topic: section
subject: Saúde mental
  topic: keywords
subject: Ansiedade
  topic: keywords
subject: Depressão
  topic: keywords
subject: Voluntariado
  topic: keywords
subject: Cuidados de saúde primários
  topic: keywords
creator: Patrícia Tuna
creator: Sofia Almeida
creator: Ana Sara Ferreira
creator: Francisco Santos Coelho
creator: Pedro Couto
creator: Bárbara Teves Reis
creator: Ana Gonçalves
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-09-05
publication date: 2025-09-05
starting page: 370
ending page: 6
doi: 10.32385/rpmgf.v41i4.14133

Migration of an inguinal hernia prosthesis: case report
type: item
description: Introduction: Inguinal hernia is a type of abdominal wall hernia and is the most common surgical condition in primary health care. Local infection and development of seroma or hematoma are common complications, unlike more severe complications such as mesh migration or perforation of adjacent organs. Case description: A 57-year-old male patient with a history of multiple abdominal wall hernia surgeries presented to the health center with pain in the left iliac region and increased flatulence, symptoms that arose after his last laparoscopic hernia repair. A colonoscopy revealed multiple diverticula and a metallic mesh obstructing the colon. A CT scan confirmed the presence of a foreign body and adjacent inflammation. He was referred to general surgery, where the presence of a foreign body in the sigmoid colon was diagnosed, due to probable migration of a hernia mesh, and surgery was scheduled. Due to worsening clinical conditions while awaiting surgery, the patient was admitted and treated for an infection related to the foreign body. After surgery and several cycles of antibiotic therapy, he suffered complications, including a postoperative infection, requiring reoperation. Comment: This case highlights the importance of recognizing hernia mesh migration as a complication of hernia repair, a rare but highly morbid phenomenon, underscoring the need for timely detection and referral. The initial contact with the family doctor was crucial in triggering the diagnosis and the close follow-up of the patient through in-person and telephone consultations, which contributed to managing the emotional response and restoring confidence in the healthcare provided.
subject: Case Reports
  topic: section
subject: Abdominal wall hernia
  topic: keywords
subject: Inguinal hernia prosthesis
  topic: keywords
subject: Migration
  topic: keywords
creator: Maria Mendes
creator: Andreia Pacheco
creator: Carlos Russo
creator: Maria João Martins
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-27
publication date: 2025-06-27
starting page: 252
ending page: 6
doi: 10.32385/rpmgf.v41i3.14167

The impostor phenomenon and the psychological distress in the general practice / family medicine doctors in Portugal
type: item
description: Objective: To evaluate the impostor phenomenon (IP) in general and family medicine (GP/FM) specialists, according to gender, and years of specialty experience and to ascertain its association with distress or psychological sufferance. Methods: Cross-sectional observational study on a sample of GP/FM specialists, applying a questionnaire in specific conversation social networks with the Clance Impostor Phenomenon Scale (CIPS) and the Patient Health Questionnaire 4 (PHQ-4) questionnaires. Results: In a sample of n=304, significant differences were found for distress by sex, worse in women (p<0.001) and number of years of specialty, with younger practitioners suffering more (50.2%), for professional practice up to five years (27.6%), and 11.1% above 16 years of professional practice (p=0.008). The FI significantly differed for the number of years of specialty practice, with the younger practitioners suffering more (p<0.001). Moderate or severe psychological distress was observed in 21.7% of the sample, with women significantly experiencing more moderate or severe distress, p<0.001. A weak and non-significant positive correlation was found between distress or psychological suffering and FI, r=0.066, p=0.249, in the absolute value of each scale. Discussion: IP was weakly related to psychological suffering but has a negative impact on the individual’s functional status, making it urgent that preventive and even therapeutic measures at both a personal and institutional level are taken. Conclusion: A frequency of 27.6% of GP/FM doctors experienced frequent or intense IP, not significantly different between genders, but significantly lower with increasing years of professional practice. Moderate or severe psychological distress was more common in females and younger GP/FM doctors. A weak non-significant correlation between IP and psychological distress was found.
subject: Original Research
  topic: section
subject: Impostor phenomenon
  topic: keywords
subject: Distress
  topic: keywords
subject: Family medicine
  topic: keywords
subject: General practice
  topic: keywords
subject: CIPS
  topic: keywords
subject: PHQ-4
  topic: keywords
creator: Inês Cerqueira de Oliveira
creator: José Augusto Simões
creator: Luiz Miguel Santiago
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-27
publication date: 2025-06-27
starting page: 243
ending page: 51
doi: 10.32385/rpmgf.v41i3.13972

Rapid antigenic diagnostic test: determinants of use, clinical orientation and economic impact in primary health care
type: item
description: Introduction: Acute tonsillitis is a common reason for seeking medical evaluation in primary health care (PHC) in pediatric age. Although the majority of cases have a viral etiology, 35% are caused by bacteria and, consequently, require antibiotic treatment. The use of rapid antigenic diagnostic tests (RADTs) aids in both diagnosis and the identification of the most common causal agent. Objectives: (1) Assessment of the importance of using RADT in the diagnostic and therapeutic guidance of patients; and (2) estimation of the costs of a large-scale use of RADT and whether this use could result in a reduction in the costs of treating these patients. Methods: An observational, retrospective, and descriptive study was conducted between January 2021 and May 2024 at the ULS of Entre Douro e Vouga units. The sample is made up of pediatric patients diagnosed with acute tonsillitis. The statistical analysis was carried out using SPSS. Results: Eight hundred and thirty-two episodes of acute tonsillitis were analyzed, most of them in FHU-B. In these, RADT was used in 66.1% of cases. The use of RADT contributed to significantly lower antibiotic prescriptions, as well as a reduced need for reevaluation consultations. The age of the clinician, the clinician’s gender, and the type of PHC unit were important factors in both the use of the test and antibiotic prescription. Economically, the implementation of RADT does not increase the cost of the medical procedure and results in a significant reduction in the total cost of the treatment. Conclusion: The use of RADT proves to be a crucial tool in diagnosing and identifying the etiological agent in patients with acute tonsillitis, thereby improving therapeutic guidance and reducing the costs associated with their treatment.
subject: Original Research
  topic: section
subject: Acute tonsillitis
  topic: keywords
subject: RADT
  topic: keywords
subject: Antibiotherapy
  topic: keywords
subject: Cost-effectiveness
  topic: keywords
creator: Bárbara Duarte Ferreira
creator: Carolina Pais Neto
creator: Cátia Almeida
creator: Susana Oliveira
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-11-03
publication date: 2025-11-03
starting page: 397
ending page: 405
doi: 10.32385/rpmgf.v41i5.14191

Bisalbuminaemia, a family trait: case report
type: item
description: Introduction: Human serum albumin is the most abundant serum protein in plasma and plays several essential roles. Among the various polymorphisms in its expression is bisalbuminaemia. This phenotype can be hereditary, a relatively rare genetic condition, or transient (secondary). Case description: We present a 4-year-old male child with food selectivity and no abnormalities on physical examination. An analytical assessment revealed iron deficiency anaemia and a protein electrophoresis pattern of bisalbuminaemia, with no other abnormalities. The innate form was presumed to be a genetic cause, and the mother was asked to undergo protein electrophoresis, which showed an identical pattern, corroborating this hypothesis. Iron supplementation was started, and a reassessment confirmed the ferropenic anaemia correction and the bisalbuminaemia pattern’s maintenance. Comment: Hereditary bisalbuminaemia has a low prevalence in the population, however recognising this pattern is particularly important in clinical practice, especially in the context of primary healthcare. Early identification of this benign variant allows the family doctor to guide the patient appropriately, clarifying the genetic and non-pathological nature of the condition and avoiding unnecessary interventions.
subject: Case Reports
  topic: section
subject: Blood protein electrophoresis
  topic: keywords
subject: Serum albumin
  topic: keywords
subject: Bisalbuminaemia
  topic: keywords
subject: Case report
  topic: keywords
creator: Marta Veloso
creator: Mariana Braga
creator: Mariana Mendes
creator: Marta Portugal
creator: Rebeca Hatherly
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-05-15
publication date: 2025-05-15
starting page: 158
ending page: 63
doi: 10.32385/rpmgf.v41i2.14134

The importance of the family approach in family medicine
type: item
description: Introduction: The family approach is a fundamental clinical tool in family medicine. The clinical case presented reinforces the relevance of its use whenever the biomedical model reveals insufficiencies. Case description: M., 44 years old, belonging to a reconstructed family, with a personal history of depressive disorder, had a new depressive episode in the postpartum period. M.’s past traumatic events were preponderant in the etiology and evolution of his current clinical condition. Discussion: Family assessment tools allow identifying factors related to or even at the origin of an individual's dysfunction and empowering users to solve their problems. The family approach should be an integral part of family medicine consultations.
subject: Case Reports
  topic: section
subject: Family approach
  topic: keywords
subject: Family
  topic: keywords
subject: Family medicine
  topic: keywords
creator: Miguel Bhatt Ambaram
creator: Nelson Encarnação Calado
rights: Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-27
publication date: 2025-06-27
starting page: 262
ending page: 7
doi: 10.32385/rpmgf.v41i3.14144