Browsing by Author "Heleno, Bruno"
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- Do smartphone applications and activity trackers increase physical activity in adults? Systematic review, meta-analysis and metaregressionPublication . Laranjo, Liliana; Ding, Ding; Heleno, Bruno; Kocaballi, Baki; Quiroz, Juan C; Tong, Huong Ly; Chahwan, Bahia; Neves, Ana Luisa; Gabarron, Elia; Dao, Kim Phuong; Rodrigues, David; Neves, Gisela Costa; Antunes, Maria Da Luz; Coiera, Enrico; Bates, David WObjective: To determine the effectiveness of physical activity interventions involving mobile applications (apps) or trackers with automated and continuous self-monitoring and feedback. Design: Systematic review and meta-analysis. Data sources: PubMed and seven additional databases, from 2007 to 2020. Study selection: Randomised controlled trials in adults (18-65 years old) without chronic illness, testing a mobile app or an activity tracker, with any comparison, where the main outcome was a physical activity measure. Independent screening was conducted. Data extraction and synthesis: We conducted a random-effects meta-analysis and all effect sizes were transformed into a standardized difference in means (SDM). We conducted exploratory metaregression with continuous and discrete moderators identified as statistically significant in subgroup analyses. Main outcome measures: Physical activity: daily step counts, min/week of moderate-to-vigorous physical activity, weekly days exercised, min/week of total physical activity, metabolic equivalents. Results: Thirty-five studies met inclusion criteria and 28 were included in the meta-analysis (n=7454 participants, 28% women). The meta-analysis showed a small-to-moderate positive effect on physical activity measures (SDM 0.350, 95% CI 0.236 to 0.465, I2=69%, T 2=0.051) corresponding to 1850 steps per day (95% CI 1247 to 2457). Interventions including text-messaging and personalization features were significantly more effective in subgroup analyses and metaregression. Conclusion: Interventions using apps or trackers seem to be effective in promoting physical activity. Longer studies are needed to assess the impact of different intervention components on long-term engagement and effectiveness.
- Factors associated with cervical cancer screening among migrant women in Europe: a systematic scoping review protocolPublication . Marques, Patrícia; Nunes, Mariana; Antunes, Maria Da Luz; Heleno, Bruno; Dias, SóniaCervical cancer is the 4th most common cancer in women in Europe. Cervical cancer screening (CCS) reduces its incidence and mortality, but its effectiveness relies on the quality of screening and women's participation. Migrant women show low participation in CCS, which might compromise an early diagnosis of the disease. Since migration rates are high in Europe, it is important to understand which barriers and facilitators influence participation in CCS among migrants to develop strategies to increase their participation. The main objective of this study is to analyze existing evidence about the factors associated with CCS participation among migrant women in Europe,
- Factors associated with cervical cancer screening participation among migrant women in Europe: a scoping reviewPublication . Marques, Patrícia; Nunes, Mariana; Antunes, Maria Da Luz; Heleno, Bruno; Dias, SóniaBackground: Cervical cancer screening has been effective in reducing the incidence and mortality of cervical cancer, leading European countries to implement screening programs. However, migrant women show lower screening participation compared to nationals. This scoping review aims to provide a synthesis of the growing evidence on factors associated with participation in cervical cancer screening among migrant women in Europe. Methods: Electronic peer-reviewed databases were searched in November 2019 for studies on factors related to the participation of migrants in cervical cancer screening conducted in EU/EFTA countries, using comprehensive search expressions. Retrieved articles were screened and those eligible were selected for data extraction. Quantitative and qualitative studies were included. Factors were classified as barriers and facilitators and were divided into further categories. Results: Twenty out of 96 articles were selected and analyzed. Factors associated with participation in cervical cancer screening were classified into categories related to sociodemographic, healthcare-system, psychological, migration, knowledge, language, and cultural factors. Lack of information, lack of female healthcare providers, poor language skills, and emotional responses to the test (especially fear, embarrassment, and discomfort) were the most reported barriers to cervical cancer screening. Encouragement from healthcare providers and information available in migrants’ languages were frequently stated as facilitators. Results on the role of sociodemographic factors, such as age, education, employment, and marital status, are the most conflicting, highlighting the complexity of the issue and the possibility of interactions between factors, resulting in different effects on cervical cancer screening participation among migrant women. Several identified barriers to screening are like those to accessing healthcare services in general. Conclusions: Efforts to increase migrant women’s participation in CCS must target barriers to access to healthcare services in general but also specific barriers, including cultural differences about sexuality and gender, past traumatic personal experiences, and the gender and competences of healthcare professionals performing CCS. Healthcare services should strengthen resources to meet migrants’ needs, including having CCS information translated and culturally adapted, as well as healthcare providers with skills to deal with cultural backgrounds. These findings can contribute to improving CCS programs among migrant women, reducing health disparities, and enhancing their overall health and well-being.
- Portuguese primary care physicians response rate in surveys: a systematic reviewPublication . Basílio, Nuno; Cardoso, Sara; Mendes-Nunes, José; Laranjo, Liliana; Antunes, Maria Da Luz; Heleno, BrunoIntroduction: Surveys are a useful tool in primary care. However, low response rates can introduce selection bias, impairing both external and internal validity. The aim of this study was to assess the average response rate in surveys with Portuguese general practitioners (GPs). Method: We searched the Medline, Web of Science, Scopus, Embase, PsychInfo, SciELO, IndexRMP, RCAAP, Revista Portuguesa de Medicina Geral e Familiar, Acta Médica Portuguesa and the proceedings of conferences of general practice from inception to December 2016. We included all postal, e-mail, telephone and personal surveys to primary care physicians without language restrictions. We did not assess the risk of bias of included studies since the main outcome was surveyed response rate. We performed planned subgroup analyses of the use of monetary incentives, the use of non-monetary incentives, survey delivery modes and prior contact with participants. Results: A total of 1,094 papers were identified and 37 studies were included in this review. The response rate in surveys done to Portuguese GPs was 56% (95CI 47-64%). There was substantial heterogeneity among included studies (I2=99%), but subgroup analysis did not explain this heterogeneity. Conclusion: Consistent with other published studies, the average response rate in surveys done with Portuguese GPs was 56%, with substantial variation among studies. Use of monetary incentives, one of the most effective strategies to increase response rates, was not present in any of the included studies.
- Primary care physicians’ decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative researchPublication . Silvério-Rodrigues, David; Sousa, Paulo Faria; Basílio, Nuno; Antunes, Ana; Antunes, Maria Da Luz; Santos, Maria Isabel; Heleno, BrunoIntroduction: Good patient outcomes correlate with the physicians' capacity for good clinical judgment. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians' perspectives, views or experiences on decision-making with patients with multimorbidity. Methods and analysis: This will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase, and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians' perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. The thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis.