Background Governments are being challenged to integrate at least part of dementia care into primary care. However, little is known about the current role of general practitioners (GPs) regarding dementia care, especially in countries that do not have dementia strategies in place. The aim of this study was to explore the experiences of GPs, persons with dementia and their family carers in Portuguese primary care settings, to better understand GPs’ contribution to dementia care. Methods A qualitative interview study of participants recruited from six practices in different social contexts within the Lisbon metropolitan area was carried out. Purposive sampling was used to recruit GPs, persons with dementia and carers. Interviews with GPs explored dementia care comprehensiveness, including satisfactory and challenging aspects. Interviews with patients and carers explored the experience of talking to GPs about cognitive impairments and related difficulties and the type of help received. Thematic analysis of interview transcripts was carried out using the framework approach. Results Five major themes were identified: GPs have a limited contribution to dementia care, the case of advanced dementia, doctor–patient relationships, doctor–carer relationships and management of chronic conditions other than dementia. Conclusion General practitioners seemed to contribute little to dementia care overall, particularly regarding symptom management. The exception was patients with advanced stages of dementia, given that specialists no longer followed them up. Remarkably, GPs seemed to be alone within primary care teams in providing dementia care. These findings strongly suggest that Portuguese primary care is not yet prepared to comply with policy expectations regarding the management of dementia.

Background: Portugal has a Dementia Strategy that endorses care coordination in the community, but the strategy is not implemented despite there being a network of multidisciplinary primary care clinics that could support it. Recent research into barriers to dementia management in primary care has focused essentially on general practitioners’ (GPs) factors and perspectives. A comprehensive triangulated view on the barriers to dementia management emphasising teamwork is missing. Aim: To explore the barriers to the implementation of the Portuguese Dementia Strategy by primary care teams, from the perspectives of service users and professionals. Methods: Purposive sampling was used to recruit 10 GPs, 8 practice nurses, 4 social workers, 8 people with dementia and 10 family carers from 6 practices in different social contexts within the Lisbon metropolitan area. The analytical framework combined codes derived from the transcripts with codes from the available literature. Themes focused on the access to professionals/community services, care coordination within healthcare teams, and between health and community services. Findings: Several system barriers were identified (undefined roles/coordination within teams, time constraints, insufficient signposting to community services) along with individual barriers (limited competence in dementia, unrecognised autonomy, limited views on social health and quality of life (QoL)), hindering users access to dementia services. Conclusion: Enhanced competence in dementia, and nurse-led systematic care of people with dementia and their carers, are necessary. They can be effective in improving the QoL in dementia, but only if associated with better community support.

Introduction: Brazil is currently living in a scenario of epidemiological transition in health. Simultaneous occurrence of diseases is common to those of developed and underdeveloped countries, thus, facing a major challenge in planning and managing efficient public health policies that cover ongoing transitions. The increase in life expectancy leads to an increase in the incidence of chronic-degenerative diseases such as cancer. The use of the Internet for lectures, courses, and questionnaires, due to agility, low cost, wide reach, and excellent use of responses has been demonstrated as an excellent tool for research and teaching. Objective: The aim of this study was to assess the importance and impact of conducting online training courses for primary health care professionals in the screening, identification, and management of breast diseases/ breast cancer. Methodology: This is all cross-sectional and descriptive, carried out through the selection of 80 physicians and 100 nurses from primary health care in the municipality of Foz do Iguaçu by virtual communication and link to attend the course with mastological content elaborated from the Mastology Treaty of the Brazilian Mastology Society. Online lecture was held by shared platform with later discussion and clarification, application of a virtual questionnaire on the perception of the importance of the lecture content in their daily activities, and assimilation of the content. The value of the answers to the questionnaire was determined according to the profession and time of graduation. Results: We observed a higher access among nursing professionals when compared with physicians, 46%×28%. The group of physicians, mean age of 39.7 years, ranging from 28 to 56 years, equally distributed between 3 and 5 years, 5 and 10 years, and more than 10 years were formed. Regarding nursing, the groups with mean age of 36.9 years, ranging from 23 to 57 years, predominantly professionals with more than 10 years were formed (60.9%). All participants found this study useful or very useful for their professional activities. We observed a performance higher than 75% in correct answers to the questions in 61% and 56% of medical professionals and nurses, respectively, and close to 80% with performance higher than 50% in both groups. Among themselves related to the lowest rate of correct answers were the exclusion of self-examination as a measure of prevention and the higher rate are the indications of breast ultrasound complementary to mammography. Conclusion: Online courses for primary care professionals can be considered a useful tool in the training process, with low cost, good results, and great acceptance.

Introduction: The measures of social isolation and campaigns to combat the COVID-19 pandemic released after March 2020 and the risk of severe respiratory disease in the population older than 65 years determined a decrease in the performance of preventive tests and demand to outpatient clinics, as well as the removal of professionals in risk groups reducing the supply of care. The delay in diagnosis and initiation of treatment is considered a problem in health systems worldwide, directly impacting mortality from the disease. In force since 2012, Lawn. 12732 of the Brazilian Department of Health establishes that the first cancer treatment for SUS (Brazilian Unified Health System) patients must begin within a maximum of 60 days from the signature of the pathological report that confirms malignant neoplasia. Objectives: To evaluate the effects of the pandemic in a mastology service at a tertiary hospital of the Unified Health System (SUS) from the measurement of the interval between diagnosis and initiation of treatment, first proposed oncological, surgical (CT) or systemic (TS) treatment and the justifications pointed out when the beginning of treatment occurred in a period of more than sixty days. Methods: Cross-sectional cohort study of patients diagnosed with breast cancer between March 2019 and January 2021, divided into two groups – prepandemic and pandemic from the evaluation of data in the hospital management system (Stratec) and comparison of information between the two groups. Results: In group 1, prepandemic, from March 2019 to March 2020, 82 patients admitted, mean of 6.3 patients per month, 62 started treatment before 60 days (59TC and 3TS) and 20 after (13TC and 7TS). In group 2, pandemic, from April 2020 to January 2021, 65 patients, mean of 7.2 patients per month, 51 started treatment before 60 days (37TC and 14TS) and 14 after (11TC and 3TS), 32.3 and 27.5%, respectively. Regarding the indication of initial treatment, surgical treatment predominated in both groups, however there was an increase in the indication of systemic treatment in group 2 (17/65 vs 10/82). Among the main justifications for delay in the beginning of treatment, we identified clinical conditions of the patients, the need for a plastic surgery team and unavailability of a vacancy in the operating room in the first group, and clinical conditions of the patients and indecision to accept the therapeutic proposal in the second group. Conclusions: The reception by the nursing team to the patients at the time of diagnosis guiding the performance of preoperative examinations and consultations, availability of the operating room exclusively for emergencies, cardiac or oncological surgeries and replacement of professionals when the absence was necessary were effective measures in the maintenance of care and quality of service.