Portuguese Journal of Family Medicine and General Practice
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.
Associação Portuguesa de Medicina Geral e Familiar
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.
WONCA Working Party on Women and Family Medicine – Over two decades transforming gender equity in General Practice and Family Medicine worldwide
Copyright (c) 2026 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
Victor Ramos is a leading figure in General and Family Medicine in Portugal
In Portugal, Victor Ramos is an iconic figure in general and family medicine (GFM), known not only for his dedication as a family physician but also for his role in medical education, professional activism, and involvement in health policy. He is a unique individual who harmoniously combines human qualities—such as deep empathy—with outstanding intellectual and professional skills. His professional career runs parallel to the history of GFM and reflects a balance between a cultured, visionary spirit and a sensitive, caring personality that has always shaped his interpersonal relationships and clinical practice. He anticipated needs and opportunities within the health system and translated ideas into concrete projects, achieving tangible results such as the implementation of the primary health care (PHC) reform and the creation of Family Health Units (FHU). For these reasons, he is widely recognized for his ability to bring together a broad, strategic, and pragmatic vision, which has enabled him to influence significant changes in healthcare in Portugal.
Agradecimento a Revisores de 2025
A new future for General Practice and Family Medicine: a dream and a responsibility for all of us
Family medicine and Artificial Intelligence: a human touch
Luciana Couto, um legado de um sentido profundo de missão
O testemunho que aqui deixo, pensado como um “currículo de legado” da Professora Doutora Luciana Couto — minha colega e amiga — baseia-se, em primeiro lugar, no conhecimento direto que tenho da sua pessoa e da sua trajetória profissional, académica e associativa, nomeadamente no seio da Ordem dos Médicos. A este conhecimento pessoal acrescentei uma investigação complementar, de modo a construir um retrato mais completo, fiel e respeitoso de alguém cuja vida se entrelaça de forma exemplar com a ciência médica, o ensino, a investigação e o humanismo.
Silva Henriques – Family doctor and ideals
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.
Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice http://creativecommons.org/licenses/by-nc-nd/4.0
25th WONCA World Conference – Abstract Book
Ciência dos Fatores Humanos: colocando as pessoas no centro dos cuidados de saúde
Letter to the Editor about the article Physicians’ perception about defensive medicine in primary healthcare: cross-sectional study
When performance causes anxiety: case report on sexual dysfunction
Introduction: Sexuality is an important dimension throughout life. In the elderly, sexual engagement remains a significant contributor to health and well-being, correlating with their perception of a higher quality of life. Sexual dysfunction can be a cause of high concern and have repercussions on daily life. Case description: A 75-year-old male with several cardiovascular risk factors and polymedicated was diagnosed with erectile dysfunction and has been on phosphodiesterase 5 inhibitors for about three years. He sought consultation for sexual complaints causing significant distress, considering discontinuing his usual medication, which he believes may be the potential cause of this condition. Through a patient-centered approach and conducting a comprehensive and detailed history, a diagnosis of sexual performance anxiety was identified. By normalizing the discussion of issues related to sexuality and promoting shared decision-making, it was possible to effectively address the problem and resolve associated complaints. Thus, the patient's quality of life improved without the need to change chronic medication. Comment: The authors aim to illustrate the relevance of addressing sexuality during consultations, valuing patients’ sexual complaints, and integrating them into their overall health. The holistic, patient-centered approach, characteristic of family medicine, was fundamental in recognizing the psychosocial, relational, and cultural factors that contributed to the onset and maintenance of complaints.
Continuous quality improvement of pneumococcal vaccination in risk groups
Introduction: Pneumococcal disease is an important cause of morbimortality potentially preventable through vaccination. Although widely implemented in the pediatric population, pneumococcal vaccination remains underused in adults belonging to increased risk groups for invasive pneumococcal disease (IPD). Objectives: To assess and improve the pneumococcal vaccination profile in risk groups within a Portuguese family health unit (USF). Methods: Quasi-experimental, with pre- and post-intervention assessment, in a northern Portugal USF. The target population was defined by age ≥65 years or diagnosis coded by ICPC-2 corresponding to a risk group for IPD, in accordance with the respective clinical guidance standard. The first evaluation was carried out in July 2023, through analysis of the vaccination profile of a representative sample. The six-month intervention period included a clinical session aimed at the multidisciplinary team, consultation support material, a moment of self-reflection, and the application of opportunistic vaccination recommendation strategies. The second evaluation took place in May 2024. The quality criteria for the pneumococcal vaccination rate were defined as: insufficient if <15%, sufficient if 15-25%, good if 25-50%, very good if 50-75%, and excellent if >75%. Results: Initially, a pneumococcal vaccination rate of 24.6% (sufficient quality standard), variable between risk groups for IPD was found. In the second evaluation, a vaccination rate of 29.6% was achieved (good quality standard), 23.2% being prescribed and administered during the intervention period, with 100% adherence. Conclusion: Despite the improvement in the quality standard of vaccination, it will be necessary to extend the intervention period and reflect on the determinants of prescription and vaccination adherence related to the doctor and the patient, to promote a more expressive and sustained increase in pneumococcal vaccination in risk groups.
Factors influencing organized populational screening for colorectal cancer in the Lisbon and Tagus Valley Health Region: a six-year analysis of demographic and organizational influences
Introduction: Colorectal cancer (CRC) ranks third among malignant neoplasms in Portugal, emphasizing the importance of early detection. The initiation of a population-based CRC screening program (CRCSP) in the Lisbon and Tagus Valley Health Region (LTVHR) in 2017 prompted this study to assess and inform health policies. It aims to identify associations between screening participation outcomes, user geodemographics, and organizational features (2017-2022). Methods: This cross-sectional study analysed 87,223 users aged 50 to 74 undergoing CRCSP in LTVHR, in 3 rounds (2017-2018, 2019-2020, and 2021-2022). We compared screening uptake and test results across sex, age, health centre grouping, unit type, and family physician assignment using chi-square tests and adjusted relative frequency ratios (RFa) derived from a generalized linear model. Results: Screening participation differed by sex, with a 5.8% higher rate in women (RFa 1.058; CI1.047-1.068). Younger groups exhibited lower adherence, with those aged 50-54, 55-59, and 60-64 showing RFa of 0.826, 0.887, and 0.968, respectively. Family Health Units (FHU) and users with a Family Physician (FP) showed higher participation rates. There was a 37.7% higher RFa in the 1st-round screenings and a 31.4% lower RFa in the 2nd-round. Positivity rates varied among Health Centres Grouping (HCG), with no differences by health unit type or FP assignment. Most screened users belonged to specific HCG (63.6%), particularly HCG 1, indicating potential organizational influences.
Introduction: Familial amyloidotic polyneuropathy (FAP) or amyloidosis is an autosomal dominant disease caused mainly by a mutation in the transthyretin (TTR) gene, leading to the accumulation of amyloid deposits in various tissues and organs, such as the skin, heart, liver, and peripheral nerves. As most plasma TTR is produced by the liver, liver transplantation is the best therapeutic option. The acquired form of FAP consists of the presence of this same accumulation of amyloid deposits in patients who have undergone liver transplantation from FAP patients and is known as domino liver transplantation. Sensory polyneuropathy is the most common initial symptom, followed by dysautonomia and motor symptoms later in the course of the disease. Case description: A 70-year-old man with a history of liver transplantation in 2011 for hepatocarcinoma came to the primary health care center for an episode of syncope associated with bladder incontinence and headache, and was referred to the emergency department. On suspicion of epilepsy, he was discharged with antiepileptic medication, which he never started. Afterwards, he was referred multiple times for complaints of right lumbosciatalgia, refractory to analgesic medication, physiotherapy, and acupuncture. After extensive evaluations, he was diagnosed with acquired FAP through a salivary gland biopsy. Being only treated symptomatically, the disease progressed, impairing his autonomy and quality of life, and he ended up dying on the 17th of May 2024. Comment: In patients who have undergone sequential liver transplantation, the physician should inquire about the appearance of new clinical manifestations at each appointment, particularly urinary or gastrointestinal symptoms, sensory complaints, or changes in muscle strength. The fact that the initial symptoms were sensory, which are often underestimated by both the patient and the doctor, makes this disease a diagnostic challenge and often leads to a delay in diagnosis. We hope that in the future there will be more research into the treatment of this disease, to stop or slow down its progression, which otherwise becomes incapacitating and even fatal.
Para além da consulta de MGF: porque o futuro da saúde começa na comunidade
Evolution of psychotropic drug user profile in a Primary Care Unit over 20 years
Introduction: Portugal is the second country in Europe with the highest prevalence of psychiatric disorders, with anxiety and depression being the most common conditions. It is unsurprising that the consumption of psychotropic drugs has also been on the rise. The main objectives of this study were to assess the prevalence of psychotropic drug use, to describe and analyse the population that uses them, and to compare them with the population of the health unit in 2004. Methods: A descriptive, cross-sectional observational study was carried out on a randomised sample of adult patients registered at the Canelas Health Unit, through the administration of a questionnaire. Descriptive analysis of the sample was followed by a comparative assessment using the Chi-Square Test or Fisher’s Exact Test. Results: The prevalence of anxiolytic use was 19.95%, antidepressants 22.37%, and antipsychotics 3.23%. The use of anxiolytics and antidepressants was higher among females, older age groups, and predominantly among widowed individuals. Anxiolytic use was associated with families presenting a high degree of dysfunction, whereas antidepressant use was linked to low educational levels. Discussion: The study revealed a 50.50% reduction in the use of anxiolytics compared to 2004, accompanied by an increase in the consumption of antidepressants and antipsychotics. This shift reflects greater adherence to current clinical guidelines, which recommend alternatives to benzodiazepines – particularly antidepressants – especially in the treatment of insomnia and anxiety. Economic factors, such as changes in medication reimbursement policies, may also have influenced these trends. Conclusion: Despite limitations, such as the difficulty in linking prescriptions to specific diagnoses, the study reinforces the importance of understanding the profile of psychotropic drug users to promote more effective prescribing practices. There was a reversal in usage prevalence compared to 2004, with antidepressants surpassing anxiolytics and hypnotics, highlighting changes both in prescribing patterns and in patient profiles.
Myodesopsias as an alarm sign for ocular melanoma: case report
Ocular melanoma constitutes 5% of all cases of primary melanoma and is the most common primary intraocular malignancy in adults. Here is described the case of an 81-year-old patient who was presented to the family health unit with complaints of myodesopsia in the right eye that had been developing for eight days. She was referred by her family doctor to the ophthalmology emergency service, and the ophthalmological examination raised the suspicion of a carotid-cavernous fistula. The imaging study continued, and a nuclear magnetic resonance was performed, which detected “possible uveal melanoma”. Staging was carried out to exclude distant disease, and she underwent enucleation of the right eye with the introduction of an implant. Histological diagnosis confirmed the presence of ciliochoroidal melanoma. This is a successful case, and after two years of follow-up, the patient remains asymptomatic and clinically stable.
Comparative view between Realistic Medicine and Realistic Health in the Portuguese general practice/family medicine environment: an exploratory observational study
Introduction: Realistic Medicine (RM) and Realistic Health (RH) are two concepts related to physicians' approaches to patient care. Objectives: To assess the opinions of Portuguese general and family medicine (GP/FM) doctors regarding the criteria of RM and RH. Methods: Following ethical and authorship approvals, a validated specific questionnaire, its responding invitation in mailing lists in 2023 and 2024, with context variables sex, age, being a medical resident of specific training in MGF (MIFE-GP) or a specialist doctor (E-GP), and type of health unit of work (USF or UCSP) were observed and made. Informed consent, a single anonymous response, on a 1 to 5 points Likert scale, 5 (strongly agree). Total scores ranged from [10 to 50] for RH and [6 to 30] for RM. Descriptive and inferential non-parametric analyses were performed. Results: A n=130 convenience sample, 64.3% women, 74.6% working in the USF model, 28.5% under 34 years, and 46.9% between 35 and 54 years, and 15.4% being MIFE-GP, was studied. The RM score between MIFE-GP and E-GP, the latter scoring higher, was different, p=0.032. “Do you consider that Realistic Medicine is similar to Realistic Health?” was different for sex (p=0.037) and age group (p=0.039), with men and older respondents more likely to recognize the difference. A moderate positive correlation between RM and RH scores for E-GP, r=0.497, p<0.001, and a weak positive one for MIFE-GP, r=0.277, p=0.237, were found. Discussion/Conclusion: This unprecedented and exploratory study revealed a lack of conceptual clarity among respondents regarding RM and RH, particularly among MIFE-GP, about the broader RH.
Pré-Conferência WONCA 2025: um encontro que transforma
Luís Rebelo's legacy: family health and smoking cessation in general and family medicine
Unscheduled consultation in pediatric health
Introduction: The family doctor plays a significant role as the primary responder in cases of acute disease. Given the high demand for unscheduled consultations (UC) in pediatric age groups, it was considered pertinent to characterize UC in a Family Health Unit (FHU). UC were considered those without prior scheduling, intended for the observation of acute disease. Methods: The sample consisted of UC cases conducted within the pediatric population (<18 years old) in 2022 at the FHU. A retrospective, observational, and descriptive study was conducted, analyzing demographic variables, reasons for consultation, diagnosis, and therapeutic plans. The follow-up of these children at the Child and Youth Health Consultation (CSIJ) was also evaluated. Statistical analysis was performed using SPSS® v. 28. Results: Out of 1,224 consultations, which occurred at a median age of 6.2 years, 42.0% occurred before school age. Most children had regular follow-up in CYHC, with adolescents aged 14 years and above showing lower follow-up rates. Consultation distribution was not uniform throughout the year, with 39.4% occurring from October to December. Fever (40.6%), along with cough/runny nose (28.5%), were the primary reasons for consultation. The most frequent diagnostic group was respiratory pathology (46.5%), and in most consultations, the plan consisted of general and symptomatic measures (52.4%). Only 6.1% were referred to the hospital emergency service (ES), with 62.7% of these referrals considered appropriate. Conclusion: UC plays a fundamental role in managing acute disease in the pediatric population, significantly reducing the use of the ES. Most pathologies were respiratory infections, managed solely with symptomatic measures. There is a need to improve follow-up among adolescents and reinforce healthcare teams during the fall/winter seasons. Therefore, this study may serve as a starting point for improving UC response, with better planning and quality of care provided.
Addressing sexuality in consultations with older adults in primary health care
Introduction: Sexuality and the desire for intimacy are an integral part of human development and are present in all stages of life, contributing to physical and psychological balance. However, they are influenced by psychological, biological, and social factors. Despite the recent growing interest, sexuality among the elderly is still taboo, making it a crucial topic to be approached by the family doctor. Objectives: The goal of this investigation is to evaluate the approach of sexuality in the elderly by family doctors. Methods: Observational, cross-sectional, and descriptive study. A questionnaire was applied to family physicians. A descriptive and inferential statistical analysis was performed using the SPSS® program. Results: One hundred and twelve family physicians, residents, and specialists have participated. In the studied sample, sexuality is frequently discussed with the elderly only by 4.5% of the doctors, compared to the 19.6% seen within other age groups. There was a statistically significant difference in the approach to sexuality between residents and specialists being more frequently approached by specialists. Transversely, the sample refers difficulty of the elderly in approaching their sexuality. Biological alterations are the main reason for sexual inactivity (52.7%). Of the sample, 47.3% of the physicians believe that respect is the most valued sexuality component by their patients, and 68.8% consider that there are changes in the value of sexuality’s different components. Conclusion: No other similar study was found in Portugal. Therefore, the matter of this study and its results are evident. The present investigation highlights the deficient approach to sexuality in the elderly. This should motivate other larger studies and the training of clinicians to improve the clinical practice of family doctors around this subject.
Prevalência e preditores de doença renal diabética: um estudo transversal nos cuidados de saúde primários
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.
WONCA World Conference – Lisbon, September 2025
Gouty arthritis, gouty tophi: the reality of a non-compliant patient (case report)
Introduction: Gout is an inflammatory disease caused by the buildup of uric acid crystals in the joints and surrounding tissues. If untreated, gout can progress to a chronic form, leading to the formation of tophi and potentially severe joint damage, including ulceration. Case description: This case report presents a patient who developed a severe case of ulcerated gouty arthritis due to non-adherence to treatment. Comments: This patient’s non-adherence to both medical follow-up and medication therapy led to the worsening of their condition, with a negative personal impact, as well as an inadequate use of medical and pharmacological resources. Health education, effective communication between healthcare professionals and patients, and regular follow-up are essential to prevent complications and improve patients’ quality of life with gout.
Gender dysphoria: when no one is paying attention
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.
Cross-cultural adaptation and validation of the Social Needs: Patient Questionnaire to European spoken Portuguese
Objectives: To cross-culturally adapt and validate the Social Needs: Patient Questionnaire (SN-PQ) for European Portuguese for individuals 18 to 65 years old. Methods: Observational study, the questionnaire underwent cross-cultural adaptation following translation debriefing and back-translation to English, and its internal consistency, doubts, and criticism. The validation stage used a Google Forms version of the questionnaire distributed via social networks, with its score being calculated, and gender, the Socioeconomic Deprivation Index, and suffering from multimorbidity were used as context variables. The SN-PQ score was calculated as the sum of the eleven needs, higher score meaning more needs. Results: The correlation between SEDI and SN-PQ was moderately negative and significant, ρ=-0.415, p<0.001. Women more frequently showed concern about food and medical care expenses, p=0.027 and p=0.007, respectively. People with higher socio-economic stratum showed significantly less housing problems, p=0.001, more confidence in completing documents alone, p=0.010, and dealing with health and problems, p=0.010. For n=61 (48.8%) of this sample, there was at least one social need, transport to and from medical appointments being the most frequent one. No differences were found by gender, p=0.069, age group, p=0.122, or having multimorbidity, p=0.291. Discussion: This is the first Portuguese study to address these social needs of health. It is worth stressing the pertinence of further research for a deeper understanding of the relationship between a person’s social needs and health consequences. Conclusion: In this online sample, 48.8% reported at least one social need that should be addressed in Primary Care for better results and health consequences. A better socio-economic class meant fewer social needs.
Livro de Resumos 42º ENMGF 2025 - Troia