Background Lifting The Burden (LTB) and European Headache Federation (EHF) have developed a set of headache service quality indicators, successfully tested in specialist headache centres. Their intended application includes all levels of care. Here we assess their implementation in primary care. Methods We included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients’ records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety. Results The principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 (“headache”) rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60 min in Germany). Nevertheless, most patients (> 85%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers. Conclusions The study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements. This study also demonstrated that patients’ satisfaction is not, on its own, a good indicator of service quality.
Suicide is the act of intentionally causing one's own death. It is often committed out of despair, the cause of which is attributed to a mental disorder, alcoholism, drug abuse or stress factors such as financial difficulties or troubles with interpersonal relationships. In the 20th century it is possible that more people have died from suicide than in the two great wars ocurred in the same century. The World Health Organization estimates that it is the 13th leading cause of death worldwide.This study aimed to describe the situation of different regions of central Portugal with regard to suicidal behavior in the general population, comparing different data from coastal and inland regions. The intention was also to compare these realities with nacional and european standards.The authors present a retrospective study of over 8000 forensic autopsies performed between 2006 and 2010 in the portuguese regions of Aveiro, Castelo Branco, Coimbra, Covilhã, Figueira da Foz, Leiria, Viseu and Tomar, of which around 15% were related to suicide. Several variables were characterized in order to establish the profile and circumstances of suicide in these regions.As the portuguese legislation predicts a forensic exam in cases of violent death, the continuous raise of the number of autopsies from suicides means that this trend shows an alarming increase. Data collected from forensic post mortem exams may prove essential to understand this phenomenon, which is a source of economical and social impoverishment.
Suicide is the act of intentionally causing the one's own death and it can be explored by different studies using different methodologies, one of which is the statistical analysis of suicide, recognized by World Health Organization as very useful in research to gain a better understanding of the phenomenon.Research data from statistical analysis collected from various countries shows that there are gender-by-culture differences in rates of suicide completion and it has been reported that biological, social and psychological factors affect suicidal behavior differently in men and women.Several variables were characterized by the authors not only to establish the gender differences in suicide completion in the central Portugal but also to compare this reality with nacional and european patterns.The authors present a retrospective study of forensic autopsies performed between 2006 and 2010 in the central portuguese regions of Aveiro, Castelo Branco, Coimbra, Covilhã, Figueira da Foz, Guarda, Leiria, Viseu and Tomar. Among 8148 forensic autopsies 15% (N=1248) were due to suicide and data collected from these forensic post mortem exams helped to establish the profile and circumstances of suicide in men and women.Health care professionals must consider gender differences in treating patients who are at risk for suicide, although this field clearly deserves more research attention to generate information that can guide clinical practice and prevention strategies.
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