Blood pressure (BP) is the force with which blood circulates through the blood vessels in the body. However, there are a number of factors — genetic and environmental — that can cause this pressure on the artery walls to excessively increase. This scenario corresponds to arterial hypertension (HTN).

According to several studies, it is estimated that 30-45% of the population of Europe suffers from hypertension and Portugal is no exception to these figures. Currently, 42.2% of the adult population in Portugal has high blood pressure. However, it is estimated that only 75% of these people are on medication and only 42% have effectively controlled their hypertension*.

It is precisely because of the fact that there is such a high percentage of patients whose hypertension is not controlled or corrected that hypertension is one of the main risk factors for the onset of cardiovascular disease.

Sources:

*Polonia J, Martins L, Pinto F, Nazare J. Prevalence, awareness, treatment and control of hypertension and salt intake in Portugal: changes over a decade. The PHYSA study. J Hypertens 2014;32:1211-21.

Dyslipidaemia is a term used for all quantitative or qualitative abnormalities in blood lipids (fats).

In 2015, the estimated prevalence of diabetes among the Portuguese population aged between 20 and 79 years (7.7 million individuals) was 13.3% which means that more than one million Portuguese people in this age group have diabetes. *
 

Sources:

*Observatório da Diabetes. Annual Report of Observatório Nacional da Diabetes [National Diabetes Observatory] – published 2016. Sociedade Portuguesa de Diabetologia [Portuguese Diabetes Association] [Online]. 2016 [cited 14 Apr 2021]; Available at: https://apdp.pt/publicacoes/relatorio-anual-do-observatorio-nacional-da-diabetes-2016/

Genitourinary Syndrome of Menopause (GSM), as the name suggests, often appears after menopause and is characterised by vaginal dryness, irritation, flaccidity of the mucous membrane, decreased libido, pain during sexual intercourse, and is associated with urge urinary incontinence.

The main cause is the decrease in female hormones – oestrogen. As oestrogen decreases, the walls of the vagina become thinner, drier, and less elastic, often causing a burning sensation. An imbalance of the vaginal flora may also occur, increasing the risk of vaginal and urinary infections.

Most women will experience a vaginal infection in their lifetime, which is usually characterised by discharge, itchiness, or odour.

The aetiological diagnosis requires an in-depth look at the patient's clinical history (including information on sexual practices and behaviour, menstrual cycles, hygiene habits, and medications), a gynaecological examination, and laboratory tests.

The three conditions most commonly associated with vaginal discharge are bacterial vaginosis, candidiasis, and trichomoniasis. The terms candidiasis and trichomoniasis were adopted due to the presence of inflammation.

The presence of objective signs of vulvar inflammation, in the absence of pathogenic germs identified in laboratory tests, suggests the possibility of mechanical, chemical, allergic, or other non-infectious vulvar irritation (e.g. dermatoses). The discharge can be caused by other physiological and pathological conditions, including cervicitis, atrophic vaginitis, and mucoid cervical ectropion. Psychosexual problems and depression may occur with recurrent episodes of vaginal discharge.

There is an inflammatory condition with long-lasting symptoms and intermittent flare-ups called aerobic vaginitis, which is also characterised by decreased lactobacilli and high pH, where gut-derived aerobic microflora such as Escherichia coli, group B streptococci, and Staphylococcus aureus prevail. There is as of yet no conclusive information on this condition.

Urinary incontinence (UI) is a condition that results from the inability to store and control urine outflow. It is characterised by involuntary urinary leakage that varies considerably in nature, from very slight and occasional leakages to more serious and regular ones. It is women who are most affected by UI. Currently, 33% of women and 16% of men over the age of 40 have symptoms of the disease, according to data from the Portuguese Urology Association.*

Urinary incontinence affects 20% of the Portuguese population over the age of 40, which means that 1 in 5 Portuguese people over the age of 40 suffer from the condition.*

Involuntary urine leakage is extremely common. However, it is a symptom that defines a public health problem and has a considerable social and economic impact. Even the smallest urine leakages have implications on quality of life, having physical, social, sexual, and psychological implications, and causing emotional repercussions.

Sources:

* Portuguese Urology Association and Portuguese Neurourology and Urogynecological Association . Urinary Incontinence. [Online] [cited 2021 Apr 9] Available from: https://www.apurologia.pt/incontinencia/incontinencia_2014/Dossier_Inc_Urinaria_2014.pdf.

The prostate is a small chestnut-shaped organ situated just below the bladder, which the urethra passes through. Only men have a prostate and its development is stimulated by testosterone, the male sex hormone.

BPH (Benign Prostatic Hyperplasia) is a disease characterised by an increase in the size of this organ. This is age-related and related to testosterone production.

Benign Prostatic Hyperplasia (BPH) is one of the most common pathological conditions in men over the age of 50 and its prevalence increases progressively with age.

Vitamin D deficiency is a global health problem affecting an estimated 1 billion children and adults worldwide and is recognised as a major public health issue.*

In Portugal, 66% of adults suffer from vitamin D insufficiency or deficiency **.

The main source of vitamin D is the sun. The body obtains vitamin D through skin exposure to sunlight (UVB radiation) and, to a lesser extent, through diet.**

The main cause of vitamin D deficiency is a lack of sun exposure, due to a decrease in outdoor living. Winter, old age, and obesity are important risk factors. **

Vitamin D deficiency and insufficiency pose a negative impact, particularly on musculoskeletal health. This vitamin is crucial in regulating bone metabolism and muscle development. It preserves and even increases bone density and muscle strength, especially in the elderly, preventing falls, fractures, and even more serious conditions, such as osteoporosis.

Sources:

*Duarte C, Carvalheiro H, Rodrigues AM, Dias SS, Marques A, Santiago T, et al. Prevalence of vitamin D deficiency and its predictors in the Portuguese population: a nationwide population-based study. Arch Osteoporos [Internet]. 2020 Mar. 15(1):36.

**DGS [Portuguese General Directorate of Health]. Ordinance No. 4/2019 of 14/08/2019

The term osteoporosis literally means “porous bone” and this is a condition that results from a reduction in the density and quality of our bones. A healthy bone under a microscope looks like a honeycomb. The honeycombs in a bone with osteoporosis, on the other hand, are expanded and much wider.

Please note that as the bones become more porous and fragile, the risk of fracture increases considerably. However, bone loss happens in a silent and progressive way and often there are no symptoms until the first fracture occurs. Sometimes the bones become so weak that they can break in a fall, or in the case of more serious osteoporosis, even after a simple sneeze.

The most common fractures associated with osteoporosis occur in the wrist, hip, and spine. Spinal fractures can have serious consequences such as loss of height, severe back pain, and deformities (including what is known as a hunchback). A hip fracture, on the other hand, often requires surgery and can result in loss of independence or even death.*

Osteoporosis is known for being a silent disease. It is often only diagnosed when the first fracture occurs following minor trauma (in particular to the vertebrae, hip, or wrist).

In any case, sudden, intense, and inexplicable back pain is one of the possible symptoms of the disease.

Also, changes in the shape of the body can be a clear sign of the condition. A person with osteoporosis often “loses height” (more than 2.5 cm), has a curved spine (also known as a hunchback), and has shoulders that slump forward.

As a consequence of this structural change, the ribs “lean” against the hip bones, the waist becomes wider, the abdomen more prominent, and the lower back flatter.

Since osteoporosis has no obvious symptoms, apart from fracturing when the bone is already significantly weakened, it is important for the doctor to assess the degree of bone mineral density, especially if the patient is in a risk group.

Bone densitometry (DEXA scan), a low-radiation X-ray examination, is the most important test for the diagnosis of osteoporosis because it measures bone density, which is directly related to bone mass. This is recommended for women over the age of 65 and for men over the age of 70, or for both sexes over the age of 50 if risk factors are present.

The test makes it possible to assess bone mineral density (BMD) of a given area and can be performed in different regions of the body, including the hips, spine, forearms, wrists, fingers, or heels.

When BMD is below a certain threshold (T-Score < -2.5) it is deemed that the person already has osteoporosis.

Besides being safe (low radiation) and painless, bone densitometry is a test that provides important information about bone health and is a useful tool that can prevent or avert any worsening symptoms of osteoporosis. Early diagnosis can make all the difference in terms of future well-being.

In order to avoid the consequences of osteoporosis—increased mortality following vertebral or hip fractures, chronic pain, loss of autonomy, deformities, and depression—the best thing is to prevent the condition by promoting a bone-healthy lifestyle at all stages in life.

Sources:

*International Osteoporosis Foundation (https://www.iofbonehealth.org/what-is-osteoporosis)

Acute pain refers to pain that has appeared recently and is likely to be of limited duration, usually as a symptom associated with a condition, acting as a warning sign of the disease that caused it. While it is useful in many circumstances, it is important that it is treated so that it does not perpetuate and eventually become chronic pain.

Chronic pain is persistent or recurrent pain, lasting three months or more, which often remains after the original injury has healed, or exists without any apparent injury.

In Portugal, 37% of the adult population suffers from chronic pain and this is associated with significant repercussions on a personal, family, and social level.*

Source:

*Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM. Epidemiology of chronic pain: A population-based nationwide study on its prevalence, characteristics and associated disability in Portugal. J Pain. 2012;13(8):773-83.