Search

Introduction and objectives: Severe asthma management during the coronavirus disease 2019 (COVID-19) pandemic is a challenge and will continue to be, at least in the next few months, as herd immunity is still a mirage. A lot has to be learned about how COVID-19 affects underlying diseases, and severe asthma is no exception. Methods: Narrative review of papers available until February 2021 in PubMed and Google Scholar, relating severe asthma and COVID-19. Four main research topics were reviewed: SARS-CoV-2 infection: immunology and respiratory pathology; interrelationship of severe asthma endotypes and COVID-19 disease mechanisms; severe asthma epidemiology and COVID-19; and biologics for severe asthma in the context of COVID-19. Results: COVID-19 disease mechanisms start with upper respiratory cell infection, and afterwards several immunological facets are activated, contributing to disease severity, namely cell-mediated immunity and antibody production. Although infrequent in the COVID-19 course some patients develop a cytokine storm that causes organ damage and may lead to acute respiratory distress syndrome or multiorgan failure. Regarding severe asthma endotypes, type2-high might have a protective role both in infection risk and disease course. There is conflicting data regarding the epidemiological relationship between COVID-19 among severe asthma patients, with some studies reporting increased risk of infection and disease course, whereas others the other way round. Biologics for severe asthma do not seem to increase the risk of infection and severe COVID-19, although further evidence is needed. Conclusions: Globally, in the era of COVID-19, major respiratory societies recommend continuing the biologic treatment, preferably in a self-home administration program. info:eu-repo/semantics/publishedVersion

Enquadramento: A violência no namoro é um problema grave, pelas consequências físicas e mentais, pelo impacto nos padrões de relacionamento amoroso futuro e enquanto problema de saúde pública. São objetivos identificar as variáveis sociodemográficas, académicas e afetivas que influenciam a violência no namoro. Tratase de um estudo quantitativo, descritivo-correlacional e transversal, com uma amostra constituída por 429 estudantes, com uma média de idade de 22.11 anos (dp=4.55). Para recolha de dados, utilizou-se o questionário que permitiu fazer a caracterização sociodemográfica, académica e afetiva. Foi ainda incluída a Escala de práticas e comportamentos de vitimização na relação de namoro de Dixe, Rodrigues, Freire, Rodrigues, Fernandes e Dias (2010). Apurou-se que 11.9% é vitima de violência na atual relação de namoro. Os estudantes do sexo masculino, do curso de humanidades e os que já reprovaram, manifestam práticas e comportamentos de vitimização mais frequentes, com diferenças estatisticamente significativas (p

A gravidez constitui um período de extrema importância enquanto momento de transição para a parentalidade. Decorrente das alterações biopsicossociais desta fase, torna-se pertinente analisar os fatores que promovem a literacia em saúde mental da grávida. São objetivos avaliar o grau de literacia em saúde mental positiva e analisar as variáveis promotoras da literacia em saúde mental, em grávidas. Trata-se de um estudo quantitativo, transversal, descritivo e correlacional, constituído por uma amostra de 222 grávidas, média de idade 30.45 anos (dp±4.64). O instrumento de colheita de dados foi um questionário, que permitiu caracterizar a amostra nas dimensões sociodemográfica e clínica. Foi ainda utilizada a escala de avaliação da literacia em saúde mental positiva de Chaves, Sequeira & Duarte (2018). Em termos de resultados constatou-se que as grávidas com companheiro, residentes em zona urbana, com ensino superior, ativas profissionalmente, com uma profissão intelectual, sem hábitos tabágicos, que classificam a sua alimentação como saudável/muito saudável, revelam mais literacia em saúde mental positiva. Verificou-se ainda que as grávidas cuja gravidez foi planeada, que recorreram a tratamentos de fertilidade, que a gravidez é vigiada por enfermeiro e médico, que cumprem a vigilância da gravidez, que frequentam curso de preparação para o parto e parentalidade, apresentam mais literacia em saúde mental positiva. Recomendam-se programas de intervenção, como por exemplo, a realização de rastreio de saúde mental na grávida.

Background: The increase in the prevalence of oncological diseases such as cervical cancer (CC) makes it a worldwide public health problem involving resources in the area of prevention. Objectives: To determine the influence of sociodemographic variables, gynecological and sexual context on health beliefs related to cervical cancer. Methodology: It is a quantitative, descriptive-correlational study. The data collection protocol was the questionnaire that allowed to characterize the sample in the gynecological, sexual and sociodemographic dimensions. We also use the Health Beliefs Scale, composed of four dimensions: vulnerability, severity, benefits and obstacles (Patrao and Leal, 2002). The sample is non-probabilistic for convenience, consisting of 946 participants. Results: Regarding the vulnerability dimension, significant statistical differences were found in the variables, having gynecological problems, frequency in the frequency of gynecological consultations, using contraceptive methods, existence of family members with CC. For the severity dimension, significant statistical differences were found for the variables, frequency of gynecological consultations and use of contraceptive methods. In the benefits dimension, statistical significance was found for age (adults) and using contraceptive methods. For the obstacles dimension, we found statistical significance for the frequency of frequency of gynecological consultations and the beginning of sexual activity. Conclusions: Understanding individual aspects involved in the prevention of CC is essential for individualized care, since these aspects are subjective in nature and require different actions.

The belief that people with mental illnessare unpredictable,violentand dangerousstill persistsin today’ssociety, with indiscriminate beliefs about mental and psychiatric illnesses that harm the quality of life of people who suffer from them. Objectives: To identify the socio-demographic variables that interfere in the beliefs, about mental illness, of the professionals of education, health and safety; to find out how the socio-professional variables interfere in the beliefs, about mental illness, of the professionals of education, health and safety. Methods: Quantitative, transversal and descriptive-correlational study. Data were collected from 136 educational agents, 62.5% of whom were teachers, 32.4% nurses and 5.1% public security agents, mostly female (70.6%), with an average age of 48.34 years (±7.49 years). A socio-demographic and socio-professional characterisation questionnaire and the Mental Illness Belief Inventory (Loureiro, Dias e Ferreira, 2009) were used as data collection tools. Results: Educational agents (education, health and safety professionals) present higher levels of beliefs regarding the recognition of the disease (M=4.69±0.64) and regarding mental illness as a medical condition (M=4.48±0.73), with lower average index in the cause of stigma and discrimination (M=2.21±0.68). The sociodemographic variables that interfered with mental health beliefs are gender, age and education; the socioprofessional variables that influenced mental health beliefs in education, health and safety professionals were the professional group and length of service; the predictor variables of incurability, recognition of illness, dangerousness and belief in mental illness as a medical condition are age, male gender, urban residents and length of service ≤20 years. Conclusions: The results of this study lead to infer the need to develop training actions and/or health education programs in order to provide communities with more mental health literacy, where the nurse has a prominent role as a promoter of mental health literacy, which will certainly contribute to the demystification of beliefs about mental illness and a better care of the person with mental pathology.

Background Allergic rhinitis (AR) and asthma are two common chronic diseases that often coexist. There is a need for a validated tool to evaluate HRQoL of Portuguese speakers with asthma and/or rhinitis patients in clinical practice. Objectives To adapt and validate RhinAsthma Patient Perspective (RAPP) in Portuguese. Methods The RAPP questionnaire was translated into Portuguese. Asthmatics with comorbidities and rhinitis attending the allergy department of Coimbra University Hospital were asked to complete the Portuguese translation of RAPP, in addition to the SF-12, ACT, and a Symptomatologic VAS twice, with a 4-week interval between visits. During Visit 2, a Global Rating Scale (GRS) was completed to assess any change in health status. Scale dimensions, internal consistency and convergent validity, reliability, discriminant ability and responsiveness to change, as well as Minimal Clinical Difference were assessed. Results Factor and confirmatory analysis confirm the unidimensional structure of the questionnaire. Internal consistency has been shown to be satisfactory (0.82 visit 1 and 0.86 at visit 2). The tool is able to discriminate between patients on the basis of asthma severity, asthma control level, and rhinitis severity; convergent validity showed a significant correlation with SF-2 Physical component (r = −0.46 and 0.42, p at Visits 1 and 2). An ICC of 0.97 and a CCC = 0.94 indicate that the tool is highly reliable. Responsiveness was shown in detecting a significant association with GRS changes (r = 0.41, p Conclusions The Portuguese version of RAPP has been demonstrated to have good measurement properties and sensitivity to health changes, which will provide a valid, reliable and standardized HRQoL measurement in patients with asthma and comorbid allergic rhinitis in clinical practice.

Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has spread worldwide and epidemiological studies suggest that type 2 severe asthma endotypes have a protective role in infection and disease course. Further evidence is needed about the effect of asthma biologic treatment. We aim to describe COVID-19 clinical presentation in our severe asthma patients undergoing biologic treatment. Methods: Data were collected from electronic medical records of patients with severe asthma under biologic treatment reported with SARS-CoV-2 infection, until Dec. 2020, in a tertiary severe asthma unit. Results: Out of a population of 87 patients under biologic asthma treatment, 4 have tested positive for SARS-CoV-2 infection (omalizumab n=2; mepolizumab n=1; benralizumab n=1). All of them were type-2 asthmatics. Three patients were diagnosed with SARS-CoV-2 infection after developing mild symptoms in the sequence of a close professional/personal contact, while one was diagnosed on a routine test. Two patients were managed entirely on an out-patient setting, while the other two presented to the emergency department for medical evaluation (one was discharged after assessment and symptomatic treatment, while the other one, who had SARS-CoV-2 pneumonia and respiratory insufficiency, had to be admitted for clinical surveillance). All of them are now recovered and asymptomatic. Conclusions: Only a minority of this population tested positive for COVID-19 and none of them developed serious disease, supporting the evidence that both severe type-2 asthma and its targeted treatment do not convey increased risk for disease. However, additional studies regarding long-term complications should also be performed.

Introdução: A automedicação é um importante problema de saúde pública e constitui um desafio em diversos países europeus, designadamente em Portugal. Os objetivos deste estudo foram estimar a prevalência de automedicação numa amostra de adultos portugueses da Região Centro e Norte de Portugal e identificar fatores sociodemográficos e de saúde associados à automedicação. Participantes e métodos: Estudo transversal analítico. A amostra ficou constituída 197 indivíduos da comunidade, região centro e norte de Portugal, com uma média de idades de 38,26±14,20 anos e maioritariamente do género feminino (65,0%). Os dados foram recolhidos através da aplicação de um questionário, composto por questões de caracterização sociodemográfica, de contexto de saúde e questões referentes à automedicação. Resultados: No total da amostra a prevalência de automedicação ao longo da vida foi de 74,1% e nos últimos 6 meses foi de 59,9%. A automedicação ao longo da vida associou-se significativamente com a área de residência urbana (p=0,018). A automedicação nos últimos 6 meses relacionou-se positivamente com a idade ≤25 anos (OR=3,69; IC95% 1,04-12,14) e negativamente com a área de residência (rural OR=0,36; IC95% 0,15-0,84). Conclusões: Observámos elevadas prevalências de automedicação ao longo da vida e nos últimos 6 meses na comunidade norte e centro de Portugal. A automedicação associou-se com variáveis sociodemográficas e de saúde. Os resultados do presente estudo criam evidência para o planeamento de intervenções no âmbito do controlo da automedicação na comunidade., Self-medication is an important public health issue and a challenge in several European countries, particularly in Portugal. The objectives of this study were to estimate the prevalence of self-medication in a sample of Portuguese adults in the Central and Northern Region of Portugal and to identify sociodemographic and health factors associated with self-medication. Participants and Methods: A cross-sectional analytical study was performed. The sample consisted of 197 individuals from the community, central and northern Portugal, with a mean age of 38.26 ± 14.20 years and mostly female (65.0%). The data collection was accomplished through the application of a questionnaire, composed of questions of sociodemographic characterization, health context and issues related to selfmedication. Results: In the total sample, the prevalence of self-medication throughout life was 74.1% and in the last 6 months it was 59.9%. Lifelong self-medication was significantly associated with urban residence (p = 0.018). Self-medication in the last 6 months was positively correlated with age ≤25 years (OR = 3.69, 95% CI 1.04-12.14) and negatively with the residential area (rural OR = 0.36, 95% CI, 0.15-0.84). Conclusions: We observed a high prevalence of self-medication throughout the life and in the last 6 months among the northern and central communities of Portugal. Self-medication was associated with sociodemographic and health variables. The results of the present study provide evidence for the planning of interventions in the control of selfmedication in the community.

Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support.Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use.Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app ≥30 days was used as the cut-off for higher app use.Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25–P75) 16–36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3–45] days, translated on a median use rate of 15 [3–38]%. Median inhaler adherence assessed through the app was 34 [4–73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6–83]% and 43 [3–73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen.Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.

Background Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients’ asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring ≥4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app.

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13&ndash, 17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p &lt, 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms, at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

Introduction and objectives We aimed to build a national consensus to optimize the use of oral corticosteroids (OCS) in severe asthma in Portugal. Material and methods A modified 3-round Delphi including 65 statements (topics on chronic systemic corticotherapy, therapeutic schemes, asthma safety and monitoring) was performed via online platform (October-November 2019). A five-point Likert-type scale was used (1-‘strongly disagree’; 5-‘strongly agree’). Consensus threshold was established as a percentage of agreement among participants ≥90% in the 1st round and ≥85% in the 2nd and 3rd rounds. The level of consensus achieved by the panel was discussed with the participants (face-to-face meeting). Results Forty-eight expert physicians in severe asthma (specialists in allergology and pulmonology) participated in the study. Almost half of the statements (28/65; 43.1%) obtained positive consensus by the end of round one. By the end of the exercise, 12 (18.5%) statements did not achieve consensus. Overall, 87% of physicians agree that further actions for OCS cumulative risk assessment in acute asthma exacerbations are needed. The vast majority (91.7%) demonstrated a favorable perception for using biological agents whenever patients are eligible. Most participants (95.8%) are more willing to accept some degree of lung function deterioration compared to other outcomes (worsening of symptoms, quality of life) when reducing OCS dose. Monitoring patients’ comorbidities was rated as imperative by all experts. Conclusions : These results can guide an update on asthma management in Portugal and should be supplemented by studies on therapy access, patients’ adherence, and costs. This work was supported by AstraZeneca. The funding source had no role in study design, data collection, analysis and interpretation, and in the writing or submitting decision of the article.

InspirerMundi app aims to transform adherence into a positive experience through gamification and social support, while allowing objective monitoring of inhaler adherence. We explored patients’ engagement with this app. Adolescents and adults with persistent asthma, followed in 24 Portuguese hospital outpatient clinics, were invited by their physicians to use the InspirerMundi app daily for 4 months and register medication and symptoms. To stimulate engagement, the app includes a gamification component (point and badge system with a storyline of a warrior evolving to an Inspirer-advanced player that can motivate warriors to improve adherence). During the study period, patients received 3 phone interviews for additional data collection and 6 text messages to promote app engagement. Usage rate (days with app uses/total days) during weeks that followed a contact (phone/message) were compared to weeks with no contacts. A total of 77 patients (27±13y) were recruited and 72 used the app a median[P25-P75] of 48[24-114] days (usage rate 60[32-83]%).Total use period was >30 days for 2/3 of patients and >90 days for 1/3. Sixty-four patients registered ≥1 medication; 66 patients answered a median of 14[4-35] symptom questionnaires; 63 received ≥1 badge; and 9 achieved Inspirers level. Text messages did not seem to influence usage rate (p=.386), while phone calls seemed to have a negative effect (p=.003). 16 (22%) users continued to use the app after the end of the study. The usage rate of InspirerMundi app was higher than usage reported for other health apps. These results might be related to the app engagement features and to the recommendation of use by a physician. Additional contacts do not seem to improve app usage rate.

The Portuguese Severe Asthma Registry (RAG) is a national web-based disease registry of adult and pediatric patients with severe asthma. Since its launch, plans for collaborative research were established. This study aims to describe the baseline characteristics of the patients included in RAG and the planned research activities. RAG collects real-life data patients with severe asthma followed at specialized care centres (Global Initiative for Asthma step 4/5). RAG’s data are collected at the time of routine medical appointments. A total of 68 patients were included by 22 physicians. The median age was 55 yrs (P25-P75, 48-63), two patients were The management of severe asthma is still an unmet need. Further characterization of patients, treatments and asthma phenotypes may improve disease-related knowledge and ultimately optimize care pathways.

Unsupervised methods may unveil the potential of the INSPIRERS studies to comprehend the heterogeneous characteristics of asthma. Therefore, we aimed to identify distinct classes of asthma among the participants, using latent class analysis (LCA), and to compare their characteristics across classes. We applied LCA to 308 adults (≥18 years) with persistent asthma (treated with daily inhaled medication) participants in the observational and prospective INSPIRERS studies, conducted in 26 secondary care outpatient clinics from Portugal and Spain. The classifying variables included asthma-related demographics, unscheduled healthcare use, Control of Allergic Rhinitis and Asthma Test (CARAT), and EuroQol 5 dimensions (EQ-5D) questionnaires. A three-class model was identified. Class 1 (21%) and Class 2 (26%) were characterized by highly symptomatic and uncontrolled asthma, with concomitant upper airways symptoms and reporting problems across all EQ-5D dimensions; they differed on high unscheduled healthcare use (Class 1) and early asthma onset (Class 2). Class 3 (53%): early asthma onset, controlled asthma with upper airways symptoms and without problems in EQ-5D dimensions. Compared to other classes, Class 1 had a higher proportion of subjects with FEV1 Three distinct and clinically meaningful unsupervised classes of asthma were identified among participants of the INSPIRERS studies, revealing the studies’ potential to support and enable patient-centered care and further research.

We assessed the feasibility of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). A 1-month multicentre observational study was conducted in 26 hospital outpatient clinics from Portugal and Spain. During medical visits (T0), 107 patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients presented the medication (inhaler, blister or other recipients) to an app image detection tool. Physicians reported patients’ asthma therapeutic plan at T0. At 1-month, patients were interviewed by phone and app satisfaction was assessed on a 1(low)-5(high) scale. A total of 99 patients (29±13 years) installed the app (93%) and 79 (74%) completed the 1-month interview. At least one medication was registered in the app by 77 patients (72%): 73 ≥1 inhaler and 42 at least another medication, e.g., pills, nasal spray. Almost 90% of patients registered in the app at least 50% of medications of the therapeutic plan, with 71% registering all prescribed inhalers and 52% all other prescribed medication. Median medication adherence was 75[25-90]% for inhalers and 82[50-94]% for other types. Most patients were satisfied with the features of medication adherence monitoring (70% scored ≥4), but less with the inhaler detection tool (53% ≥4). Half of the patients (53%) stated that the app had motivated them to better adhere to inhaled medication. InspirerMundi app was feasible to monitor medication adherence in patients with asthma. These results led to the redesign of the therapeutic plan registration and of the inhaler detection tool.

The interface between communication and health is built collectively, involving a myriad of interlocutors in determined social contexts, with the ultimate goal of making the communication and health rights established in the 1988 Federal Constitution effective. In order to promote this exchange, as well as training professionals from both areas, the School of Public Health of Minas Gerais (SP-MG) offers the postgraduate course in Communication and Health, in which the Theories of Communication discipline is highlighted, since it is essential to know the fundamentals of human communication and the dynamics of Social Communication, with emphasis on the theoretical-practical fild known as Communication and Health (CES). This article reports the experience of the course from the Theories of Communication subject, in order to situate it as essential knowledge not only for communicators, but also for health professionals.

Objective: We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. Design: Baseline data from two prospective multicentre observational studies. Setting: 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. Participants: 395 patients (≥13 years old) with persistent asthma. Measures: Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. Results: High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p

The paper version of CARAT (pCARAT) is valid to assess asthma control over a 4-week period. For follow-up purposes, assessment through mobile apps (aCARAT) or telephone (tCARAT) may be useful alternatives. We explored the psychometric properties of the aCARAT and tCARAT. Patients with asthma were recruited at secondary care outpatient clinics. During medical visits, patients filled in the pCARAT and were invited to complete the aCARAT in the following days using the app of project Inspirers (InspirerMundi). After 1 week, tCARAT was collected. Patients completing the 3 CARAT versions within 28 days were analysed. CARAT scores (0-worst, 30-best) were calculated. The internal consistency (Cronbach’s α), convergent validity (Spearman correlation-rs) and reliability (intraclass correlation coefficient-ICC, Bland-Altman analysis) were determined. 55 patients (21 male; median 19 [interquartile range 17-37]y) were included. The aCARAT was completed by 82% of patients within 1 week of pCARAT; and by 78% within 1 week of tCARAT. The median pCARAT score was 21[17-24], the aCARAT 21[18-26], and the tCARAT 23[21-26]. Internal consistency was good for all versions (α=.73-.77). pCARAT was more strongly correlated with aCARAT than with tCARAT. Reliability was better for aCARAT than for tCARAT (table 1). App and telephonic CARAT versions are valid and reliable, exhibiting comparable psychometric properties to the paper version. These new CARAT versions are promising alternatives for assessing control in patients with asthma.

The crucial role played by cervical cancer screening (CCS) in women’s health, originated a qualitative, cross-sectional, exploratory and descriptive study aiming to understand what cervical cancer screening and nursing interventions carried out during medical appointments really mean to women. The sample consisted of female users of a healthcare unit, among which 20 women who had missed their cervical cancer screening sessions were contacted and selected. The semi-structured interview was the instrument selected to collect data. Data analysis was carried out using content analysis techniques, with semantic categorization, and an inductive approach using version 11 of the NVivo program. Data analysis gave rise to a set of arguments that shed some light on why women choose not to attend CCS sessions and on which nursing interventions conducted in those CCS sessions are really meaningful to them.

Summary Background. Anaphylaxis is a potentially fatal medical emergency. The frequency of hospital admissions for anaphylaxis seems to be increasing in the recent decades. Objective. Characterize the patients admitted for anaphylaxis to the adult emergency department (ED) of a tertiary care hospital over a 10-year period, discriminating aetiologies, clinical features and therapy administered. Methods. Retrospective, descriptive and inferential study, evaluating age, sex, Manchester triage system, suspected allergen, site of allergen exposure, comorbidities, cofactors, clinical findings and symptoms, treatment and management. Patients admitted between January 2007 and December 2016 were included. Results. Forty-three patients were enrolled: 23 males, mean age 54.3 ± 16.2 years, n = 22 had history of allergic disease. Two patients were triaged as non-urgent. The most frequently suspected causes of anaphylaxis were: drugs (33%, n = 14), Hymenoptera venoms (23%, n = 10), foods (21%, n = 9) and iodinated contrast products (12%, n = 5). Adrenaline was used in 88% of the episodes (n = 38), 55% of which (n = 21) intramuscularly. Mortality was registered in one case. At discharge, adrenaline auto-injector was prescribed in 7% (n = 3) of the patients, and Allergy and Clinical Immunology consultation (ACIC) was requested in 65% of the episodes (n = 28). Statistically significant associations (p minor 0.05) were established: a, anaphylaxis to drugs associated with a low intramuscular adrenaline use and with frequent oxygen therapy; b, anaphylaxis to food associated with intramuscular adrenaline administration; c, anaphylaxis to Hymenoptera venom associated with male sex; and d, anaphylaxis to iodinated contrasts associated with referral to ACIC and with shock. All obese patients developed shock. Conclusions. Anaphylaxis is a life-threatening condition that requires early recognition. Although most patients received adrenaline, administration was not always performed by the recommended route and only a few patients were prescribed adrenaline auto-injector.

Objective: We evaluated the effect of weight loss (WL) on lung function (LF) in obese individuals who underwent bariatric surgery, and on asthma control, quality of life, LF, and controller medication in a sub-group of obese asthma (OA) patients. Materials and methods: Obese individuals who underwent bariatric surgery between July 2015 and July 2017 were included in this prospective longitudinal study. They were classified as OA or obese non-asthmatics (O-NA). LF was assessed preoperatively and 6–9 months postoperatively. In OA patients, asthma control, quality of life, and treatment step were evaluated. P

Background: IgE is a biomarker used for asthmatics selection for omalizumab(OMZ), but does not constitute a good response predictor to that therapy. Contrariwise, increased blood eosinophils(BE)counts relate to a good response. However, few studies assess its fluctuation during OMZ therapy. Aim: Analyze the effect of OMZ in BE and the correlation between eosinophils reduction and improvement in disease outcomes. Methods: Retrospective study of severe persistent allergic asthmatics treated with OMZ in a severe asthma outpatient clinic.BE counts at baseline and after 4, 8 and 12months of treatment were assessed. Results: 13 patients were included (44±19 years, 61.5% female). Chronic rhinitis (90.9%), anxiety (63.6%) and gastroesophageal reflux (54.5%) were the most noticed comorbidities. 68.3% were overweight (meanBMI=28±6kg/m2). At baseline FEV1 was 75±22%, number of exacerbations/year was 4±1 and mean BE was 520±277/μL. After 1year treatment there was a significant reduction in exacerbations (∆=-3±1, p=0.001) and improvement in CARAT (∆=7±4, p=0.003), and AQLQ (∆=-4±2, p=0.005). FEV1 increased in 270±218mL and RV decreased in 360±280mL. Mean BE decreased to 460±439/μL, 320±217/μL and 374±336/μL after 4, 8 and 12months, respectively. Nevertheless, we did not found any correlation with exacerbations reduction or improvement in asthma control, quality of life or lung function. Conclusions: In the studied population, a reduction in BE was evident, as well as a significant reduction in exacerbations, improvement in asthma control, quality of life and lung function.BE has been related with some treatable traits such as exacerbations and lung function, and the cutoff value of ≥400/μL related with greater risk.

With regards to home care, primary care nurses should carry out their activities and performance with an emphasis on health education. Considering patient satisfaction in the relationship aspect of helping and communication can contribute to improving nursing care. This cross-sectional, descriptive and analytical study, whose aim is to assess the degree of patient satisfaction in relation to nursing care provided at home, particularly in the dimensions of relationships, communication and health education. To conduct this research an intentional non-probabilistic sample, consisting of 44 dependent patients, belonging to the area of a health centre in the central region of Portugal, who receive nursing care at home was selected. The data collection instrument used was a form, consisting of two parts: the first part to characterise the sample with 10 questions, one of which is subdivided and the second part consisting of 16 Likert type scale questions to obtain the patients’ opinions. From our results we stress that our sample had a very aged population, mostly residing in urban areas. Satisfaction was evaluated in three dimensions: relationships, communication and health education. With regard to relationships, older males (age range 88-98 years), who are more highly dependent, married, uneducated and living in rural districts are more satisfied. Regarding communication, older males (88-98 years), with a greater degree of dependency, bachelors, educated and living in urban parishes are most satisfied. As for the health education dimension, younger men (68-78 years), who are less dependent, married, educated and living in urban environments are more satisfied. The main conclusions inferred are that, in the overall assessment of all of the dimensions, the classification is very good, and it is suggested that organizational investments are made and to equip health centres with human and material resources.

Female urinary incontinence is a common condition with a relevant impact in the quality of life. The treatment is now possible for a significant number of cases. The purpose of this study is identify the quality of life of women with urinary incontinence and analise the influence of vulnerability to stress and the impact of incontinence on quality of life. This is an exploratory and correlational study, with 200 participants suffering from incontinence who reported urine loss at least once a week in the previous 3 months. The data collection protocol was a questionnaire which allowed for the socio-demographic characterization of the sample. It included the scales of impact of urinary incontinence (UCIQ-SF), KHQ and vulnerability to stress (23 QVS). The average age is 58.42 years (sd = 11.52). The sample presents a moderate quality of life in all areas. Predictor factors of overall quality of life are urge urinary incontinence, the dramatization of existence and deprivation of affection and rejection concerning the vulnerability to stress. Given the results, it is important to alert the female population for the prevention of urinary incontinence, due to the negative impact on quality of life and as a limiting factor in the activities of daily living.

Objective To identify risk factors for urinary incontinence (UI) and assess the quality of life (QoL) of affected women. Methods A cross-sectional study was conducted of all women with UI who attended the urology and gynecology services of four hospitals in central Portugal between March and December 2012. Information was obtained from participants using questionnaires assessing sociodemographic, obstetric, gynecologic, and lifestyle variables. Results Among 505 participants, 351 (69.5%) had urgency UI, 107 (21.2%) stress UI, and 47 (9.3%) mixed UI. Stress UI was associated with smoking, alcohol consumption, constipation, gravidity, parity, and vaginal infections (P ≤ 0.02 for all). Urgency UI was associated with age above 50 years, employment, smoking, and sitting for 2 hours or less per day (P ≤ 0.02 for all). Mixed UI was associated with age 50 years or younger, smoking, sitting for 2 hours or less per day, and frequently carrying more than 3 kg in weight (P < 0.001 for all). A negative impact on QoL was reported by 501 (99.2%) women. Compared with younger participants, women older than 50 years presented with more sleep/energy disturbances and performance limitations (P ≤ 0.04 for both). Conclusion UI is associated with several risk factors and has a negative impact on QoL. Appropriate investigation regarding the factors associated with the types of UI should be performed to diminish its impact on QoL.

IntroductionEpidemiological studies have indicated that the greatest challenge of hypertension is treatment adherence. This condition should be the primary focus of health care, particularly in chronic diseases/hypertension. The objectives of this study were to assess the treatment adherence among adults with hypertension in a Family Health Unit and characterise hypertensive patients of a Family Health Unit in Viseu, Portugal.Research MethodsIn a cross-sectional study we assessed 106 patients (50.9% male), mean age 58.26 ± 11.60 years and followed them up in the hypertension medical appointment in primary health care. We collected data through a questionnaire answered at the hypertension medical appointment, with questions about sociodemographic variables, Measure Treatment Adherence (MTA) scale and issues related to healthy lifestyle practices.FindingsOn average the hypertensive patients had this disease for 8.68±9.8 years; higher among males (p

Introduction: Oral health education is an important issue that should be given to children and adolescents, allowing the acquisition of correct oral health behaviours. The objective of this study was to determine the prevalence and assess the quality of oral health behaviours among a sample of portuguese adolescents and verify their association with socio-demographic variables. Participants and methods: A cross-sectional study was designed with a sample of 447 adolescents aged 12 to 19 years old, attending a public school in Satao, Portugal. An interview was made questioning about socio-demographic factors and oral health behaviours to each adolescent in the classroom. Prevalence was expressed in proportions and crude odds ratio (OR) with 95% confidence intervals (CI) were used to measure the strength of association between oral health behaviours and socio-demographic factors. Results: The prevalence of toothbrushing (twice-a-day or more) was 90.6%. Five point eight percent of adolescents reported daily flossing, more frequent among female gender (female, OR=2.03 95% CI=1.35-3.05) and adolescents older than 15 years (>15years, OR=1.90 95% CI=1.24-2.92). Sixty-seven percent had at least one dental appointment in the previous twelve months. The prevalence of dental appointments was associated with socio-economic variables such as the father's professional situation (unemployed, OR=0.33 95% CI=0.17-0.65) and crowding index (>1,OR=0.495%CI=0.16-0.98). Conclusion: Considering the results of the present study, oral health community programs and primary preventive strategies, such as improvement of oral health education in schools should be considered in order to reduce the risk level of oral diseases and develop better oral health behaviours. (C) 2015 Published by Elsevier Ltd.

Aims and objectives To determine the prevalence of domestic violence (physical, psychological or sexual) during pregnancy and to characterise these women. Background Pregnant women are not immune to domestic violence and therefore may be subject to any form of physical, psychological or sexual violence by partners. Health professionals’ knowledge and awareness are important in the identification and intervention of pregnant women who experience domestic violence. Methods Quantitative, descriptive, correlational study, using a nonprobabilistic convenience sample consisting of a total of 852 postpartum women, of whom 370 were experiencing domestic violence according to the criteria adopted through the modified scale of prevalence, applied between February–June 2012 in two Portuguese public health institutions. Authorisation was given by the Ethics Committees/Administration Councils of both institutions involved and the National Committee of Data Protection. Results The prevalence of DV during pregnancy was 43·4% (physical violence – 21·9%; psychological violence – 43·2%; and sexual violence – 19·6%). These women had the following profile: immigrant (OR = 5·70; IC95% 3·32–9·78), non-Caucasian (OR = 6·27; IC95% 3·76–10·46), single/divorced/widowed (OR = 2·28; IC95% 1·70–3·05), academic qualifications up to year 9 (OR = 4·94; IC95% 3·31–7·37); between 10–12 years of schooling (OR = 2·36; IC95% 1·70–3·29); unemployed (OR = 2·01; IC95% 1·50–2·69); and with a monthly income

Post-partum is expected to be a time of joy. However, this is not always the case, as it can be a time marked by moments of sadness, fatigue and discouragement. This study intended to obtain the best scientific evidence to understand whether breastfeeding has a preventive effect on postpartum depression. For this, an integrative review of the literature was made on the relationship between breastfeeding and postpartum depression through the databases: EBSCO host, LILACS, PubMed, SciELO, institutional repositories and Google Scholar. Most studies identify breastfeeding as being preventive of postpartum depression, highlighting its importance for the puerperium’s mental health and consequently reducing the chances of developing postpartum depression. An informed and supported woman about breastfeeding will be able to feel confident in her new role. A constant investment by the health team, initiated during the couple’s planning process for pregnancy, is essential, and is maintained throughout pregnancy, delivery and postpartum.

Objective To characterise sleep-wake patterns and their influence on academic performance for a sample of Portuguese adolescents. Research design Cross-sectional, analytical-explanatory, correlational epidemiological research. The protocol includes the composite morningness questionnaire (Barton et al, 1985 adapted by Silva et al, 1985), the Epworth Sleepiness Scale (Murray, 1991), chronic fatigue scale (Smith et al, 1995), the Pittsburgh Sleep Quality Index (Buysse, 1988), Educational Achievement (Fermin, 2005), personal and academic data. Participants 2094 students (55.3% girls; 16–23 years old; M = 16.82 ± 1.25) attending secondary school in central Portugal. Living in urban areas, living with their parents and about 57.1% are in a family with reasonable economic resources. Results Adolescents’ sleep patterns reveal that they sleep on average between 8–9 hours a night, do not use medication to sleep, with sleep latency within the normal range, with good sleep efficiency, without daytime dysfunction and with undisturbed sleep, predominantly intermediate chronotype. Minor drowsiness, increased sleep efficiency, improved subjective sleep satisfaction, less sleep disturbance, less daytime dysfunction, not consuming hypnotic medications, associated with better academic performance. Morningness/eveningness, sleep efficiency, daytime dysfunction and sleep latency emerge as predictors of academic performance. The chronotype interacts to predict the quality of sleep enhancing it as a mediator of school performance. Conclusions Sleep and associated individual characteristics should be considered in the diagnosis and intervention process in secondary education.

Objective: To review the main papers published on the main available tests to obtain objective values of nasal patency and to demonstrate aspects of their use in medical practice. Methodology: We performed a non-systematic review of the MEDLINE and LILACS databases, and the most relevant articles were selected. Results: Objective evaluations are important in epidemiological studies and in monitoring of patients with nasal obstruction. There is a wide variety of objective tests of nasal function; among them acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow (PNIF) are currently the most used tests. Conclusion: The choice of the method to evaluate nasal function depends on the conditions of each health service. PNIF has been highlighted as a simple and reliable alternative that provides easy-to-interpret results, and is thus an attractive method for clinical practice.

Background: The promotion of breastfeeding is affirmed as a public health strategy with health benefits for the mother and child. Objectives: To analyse the relation between the prevalence of breastfeeding and the mothers’ perception on the nurses’ interventions in the promotion of breastfeeding. Methodology: A quantitative, cross-sectional, descriptive and correlational study with a sample of 1102 women from mainland Portugal, with a mean age of 32 years (sd± 5.87). The data collection method was a questionnaire which enabled the sociodemographic characterization, to characterize the baby at birth, the pregnancy and breastfeeding. It also includes the Nurses’ Interventions to Promote Breastfeeding Scale (Coutinho et al, 2016). Results: As for the prevalence of breastfeeding and its relationship with the interventions of nurses promoting breastfeeding, there are no statistically significant differences in breastfeeding at six months. In contrast, breastfeeding at 24 months presented statistically significant differences (p = 0.000) in the group of women who breastfed at 24 months who perceived the nurses’ interventions as being very adequate and in the group of women who do not breastfeed at 24 months and viewed the interventions as not adequate. Conclusion: Nurses’ interventions are more valued by women who breastfeed for a longer period, so breastfeeding should be promoted early, leading to greater awareness of its importance by women / families. In this sense, it is recommended that nurses adjust their interventions according to each woman.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in EJCoP, 2(2) (year) 139 - 144, http://dx.doi.orghttp://dx.doi.org/10.5964/ejcop.v2i2.31.The duplicate article has therefore been withdrawn.

The family APGAR scale was developed by Smilkstein, Ashworth, and Montano (1982). The satisfaction assessment of the elderly with chronic illness regarding family is essential. This study aims to describe the socio-demographic and clinical profile of elderly people with chronic illness and correlate with perceived family support. This is a cross-sectional, analytical study of 294 elderly people (51.4% female), patients at the Health Centre in the district of Viseu - Portugal, diagnosed with chronic illness (77.9% cardiovascular); Mean age was 72.22 ± 6.13, 70.7% were married and 52% had 4 years of schooling; Data was gathered using a questionnaire and the Family APGAR (Adaptation, Partnership, Growth, Affection and Resolve). In relation to family functionality, 18.7% perceive families as highly functional, 26.9% mildly dysfunctional and 54.4% severely dysfunction. There is a statistically significant relationship between the family APGAR and the presence of chronic illness ( p < 0.001). We found no statistical significance between the family APGAR and gender ( p = 0.26), age ( p = 0.26), marital status ( p = 0.32) and educational level ( p = 0.28). Economic, political and social changes in our society has an impact on the family and the support they provide which is manifested among vulnerable groups, as is the case of an elderly person with chronic illness. Thus, we propose specialised psychological support for this age group which is more vulnerable and without the needed support from within the family.

Introduction. Infection by the bacterium Helicobacter pylori (H. pylori) is transmissible and is considered a public health issue which affects people of all ages. The objective of this study was to identify factors (lifestyles, dietary factors, and hygiene conditions) related to the prevalence of H. pylori infection. Methods. We carried out an observational cross-sectional study with a community sample of adults from the municipalities of Viseu and Sátão, Portugal. The final sample resulted in 166 adults. The data were collected through a self-administered questionnaire with questions regarding sociodemographic aspects and lifestyles. H. pylori infection was identified using the 13C-urea breath test. Results. No association was found between the prevalence of H. pylori infection and the use of tobacco, alcohol, or coffee or dietary factors. The prevalence of H. pylori infection was higher in adults who reported higher consumption of fried food and lower consumption of vegetables and fruit. H. pylori infection was significant for the variables of lower frequency of handwashing before going to the bathroom (p=0.02) and well water consumption (p=0.05). Conclusion. A significant association was found for H. pylori infection with the lower frequency of handwashing before going to the bathroom and the consumption of well water.

Background: Asthma is a heterogeneous disease with different severity degrees and several modifiable risk factors that might place the patient at risk for exacerbations. Their adequate management is crucial to achieve disease control. When indicated, the referral to expert advice should be considered. Aim: Analyze the characteristics of exacerbated asthmatics, namely their risk factors for adverse outcomes, disease severity and strategies for follow-up. Methods: Retrospective study of asthmatic patients admitted for acute exacerbations in a Pneumology ward of a central university hospital during 2014. GINA 2015 criteria were used to assess disease control. Results: Most of the 83 admissions were due to infectious exacerbations, with a peak during the winter months, and 67.2% of those had no influenza or pneumococcal vaccination. Median age was 56 years (IR=35), mostly female (72.3%). Comorbidities like overweight (68.6%) and smoking history with COPD overlap (25%) were most noticed. At least one risk factor was present in 89.2% and a significant number (18.1%) had no medical management or chronic medication. From the 24.1% of patients managed in primary care, two thirds were on Step 3 or 4 GINA treatment and had at least one criteria for expert referral. Only a small percentage had a written action plan. Conclusions: The most noticed comorbidities are modifiable with directed strategies (obesity, smoking habits, vaccination). Several important steps of assessment and management of asthmatic patients suggested by international guidelines were not fulfilled so we conclude that there is a need to raise awareness to a more precise evaluation of asthmatics in order to achieve a better disease control and avoid severe exacerbations.

Pain is considered the 5th vital sign and its measurement/assessment and records are required and must be systematic. Ineffective pain management involves complications in clinical status of patients, longer hospitalization times and higher costs with health. In the surgical patient with impaired cognition, hetero measurements should be made, based on behavioural and physiological indicators. We used to determine the efficacy and efficiency of the Observer Scale, the Abbey Pain Scale and Pain Assessment in Advanced Dementia (PAINAD). Our study is an applied, non-experimental, quantitative, descriptive and analytical research. The data collection instrument consisted of patients’ sociodemographic and clinical data, the Observer Scale, the Abbey Pain Scale (Rodrigues, 2013) and PAINAD (Batalha et al., 2012). We assessed pain at an early phase and 45 minutes after an intervention for its relief. The sample is non-probabilistic for convenience, consisting of 76 surgical patients with impaired cognition, admitted to the surgery services of a central hospital, aged between 38 and 96 years. There was a positive correlation between the results of the three scales, most evident in the initial evaluation. Pain intensity in the same patient is higher when assessed with PAINAD (OM = 2.16) and lower when assessed with the Observer Scale (OM = 1.78). The most effective and efficient scale is PAINAD. Due to the small sample size, we suggest confirmatory studies so that the results can be generalized.

Cultural practices linked to maternity require profound knowledge and respect for each woman and for what they consider as making sense in their experience of becoming a mother. However, the same senses are not always shared by the participants, justifying the need for intercultural mediation. The aim of this study was to understand the intercultural mediation in nursing care in obstetrics. It is a qualitative study, using the semi-structured interview to 15 obstetric nurses and analysis of the content supported by NVivo 10. Emerging categories were: meaning attributed to the intercultural mediation, principles of intercultural mediation; functions of informal intercultural mediator nurses, and reasons for intercultural mediation in obstetrics. We conclude that although in their clinical practice in obstetrics, nurses sometimes exercise informal intercultural mediator functions; they need training in intercultural mediation, which is evident from the opinions of the participants.

Bronchodilator response may be influenced by airway flow limitation, age and genetics. Evidence has shown that this response increases with higher levels of airway obstruction and is altered with age and presence of specific genetic polymorphisms of the β2 adrenergic receptors.Correlate the airway flow limitation (FEV1, FVC, IC, RV) with the bronchodilation response, to β-adrenergics (salbutamol (s)) and to anticholinergics (ipratropium bromide (b)), in a group of elderly people with diagnosed asthma.We submitted a group of twelve aged individuals (>65Y), with diagnosed asthma, to a basal ventilatory lung function evaluation, followed by a bronchodilation test, in two consecutive days (in one day using s, in the other using b). They were submitted to a functional ventilatory evaluation followed by a bronchodilator test (one day with s, other day with b). The individuals were in a stable period, without anti-asthmatic medication in the previous 24 hours. Plethismography and spirometry followed ATS/ERS 2005 criteria. Statistic analysis used SPSS for Windows. Correlations were established using the Pearson coefficient (r value).The bronchodilation response after b correlated best, with basal ventilatory evaluated parameters, than bronchodilation response after. - The FEV1 response increased as lower were the basal IC/TLC values, only after b; - The FVC response was increased as lower were the basal IC/TLC values and as higher were basal RV/TLC values, only after b; - The IC/TLC response increased as lower were basal IC/TLC values, only after b; - For both b and s, the RV/TLC responses increased as lower were basal VR/TLC values.The found correlations point out the relation of increased airway flow limitation and better bronchodilation response to b, which assumed importance to the responses related with the RV basal variation. The responses to s didn't show such a grade of dependence. That might be explained by the probable concurrence of other variables for the grade of bronchodilation response to the β-adrenergics. The existence of genetic polymorphisms of ADRB2 gene, already described in the literature, show an increasing in bronchodilation response of Arg/Arg homozygotes when β-adrenergic therapeutic is replaced for the anticholinergic one.

Background: The prevalence of asthma and its association with chronic rhinosinusitis (CRS) have not been widely studied in population-based epidemiological surveys. Methods: The Global Allergy and ...

To cite this article: Tomassen P, Newson RB, Hoffmans R, Lotvall J, Cardell LO, Gunnbjornsdottir M, Thilsing T, Matricardi P, Kramer U, Makowska JS, Brozek G, Gjomarkaj M, Howarth P, Loureiro C, Toskala E, Fokkens W, Bachert C, Burney P, Jarvis D. Reliability of EP3OS symptom criteria and nasal endoscopy in the assessment of chronic rhinosinusitis – a GA2LEN study. Allergy 2011; 66: 556–561. Abstract Background: The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic, endoscopic, and radiologic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies, the definition is based on symptoms only. We aimed to assess the reliability and validity of a symptom-based definition of CRS using data from the GA2LEN European survey. Methods: On two separate occasions, 1700 subjects from 11 centers provided information on symptoms of CRS, allergic rhinitis, and asthma. CRS was defined by the epidemiological EP3OS symptom criteria. The difference in prevalence of CRS between two study points, the standardized absolute repeatability, and the chance-corrected repeatability (kappa) were determined. In two centers, 342 participants underwent nasal endoscopy. The association of symptom-based CRS with endoscopy and self-reported doctor-diagnosed CRS was assessed. Results: There was a decrease in prevalence of CRS between the two study phases, and this was consistent across all centers (−3.0%, 95% CI: −5.0 to −1.0%, I2 = 0). There was fair to moderate agreement between the two occasions (kappa = 39.6). Symptom-based CRS was significantly associated with positive endoscopy in nonallergic subjects, and with self-reported doctor-diagnosed CRS in all subjects, irrespective of the presence of allergic rhinitis. Conclusion: Our findings suggest that a symptom-based definition of CRS, according to the epidemiological part of the EP3OS criteria, has a moderate reliability over time, is stable between study centers, is not influenced by the presence of allergic rhinitis, and is suitable for the assessment of geographic variation in prevalence of CRS.

Uma gravidez sem consumo de tabaco traduz-se em mais saúde para a mãe e para a criança. A vigilância de gravidez assegura a identificação atempada de fatores de risco e a possibilidade de uma assistência pré-natal precoce que previna complicações. O enfermeiro assume-se como um profissional de charneira na promoção de saúde e prevenção de complicações no acompanhamento da mulher/casal ao longo da gravidez e na consciencialização da importância de adoção de estilos de vida saudáveis. Objetivo: Identificar os determinantes do consumo de tabaco e vigilância da gravidez. Metodologia: Trata-se de um estudo quantitativo, transversal, descritivo e correlacional, com uma amostra de 3232 mulheres que foram mães. O estudo foi realizado em 32 maternidades/hospitais com maternidade, de Norte a Sul de Portugal, no serviço de obstetrícia/internamento de puérperas, entre os anos de 2010 e 2012. O instrumento de colheita de dados foi o questionário que permitiu a caracterização sociodemográfica da amostra com uma idade média das mulheres de 28,75 anos (dp=±5,463 anos), 78,2% de nacionalidade portuguesa e 21,8% estrangeiras. Foram assegurados os procedimentos éticos, e o estudo teve a autorização da Comissão Nacional de Proteção de Dados para além dos pareceres favoráveis das Comissões de ética das instituições envolvidas. Os dados foram tratados com o programa SPSS (Statistical Package for the Social Sciences) versão 24 para Windows.Resultados: A mulher que vive com companheiro, e que não planeou a gravidez tem maior probabilidade de vigilância adequada de gravidez e não consumir tabaco durante a gravidez. Por outro lado, o local de residência em meio rural, mulher com formação profissional superior ou formação técnica, que não exerce uma profissão, que teve problemas de saúde durante a gravidez e que não efetuou preparação para o parto apresenta menor probabilidade de não vigiar a gravidez e consumir tabaco. Conclusão: A vigilância adequada de gravidez assegura a identificação atempada de fatores de risco como o consumo de tabaco e a possibilidade de uma sensibilização atempada da mulher/casal para uma gravidez sem tabaco e para a prevenção de complicações.

There is a 10â36% rate of obstructive sleep apnoea syndrome (OSAS) associated with rapid eye movement (REM) in the OSAS population. Prior studies have suggested an increased prevalence of psychiatric disorders and an effect of gender and age on these patients.Our aim was to study the clinical and polysomnograph (PSG) characteristics of our patients with REM-related sleep disordered breathing (REM SDB).Inclusion criteria was the identification of REM SDB detected by PSG defined as apnea-hypopnea index (AHI) in REM sleep â¥Â 5 h, AHI in non-REM sleep (NREM) â¤Â 15 h and REM/NREM AHI â¥Â 2.Several Sleep Disorders Questionnaire (SDQ) version 1.02 parameters were analysed.The study comprised 19 patients with a mean age of 54.0 (SD ± 13.97), a mean BMI of 29.01 (SD ± 4.10) and a 0.58 female / male ratio. The mean Epworth Sleepiness Scale score was 12.74 (SD ± 4.86). Mean AHI was 9.16/h (SD 4.09); mean AHI in REM sleep 37.08/h (SD 25.87) and mean REM-AHI/NREM-AHI 8.86 (SD 8.63).The anxiety disorder rate was 33.3%; 44.4% in females, 16.7% in males.The average deep sleep was 20.7% (SD 10.42) and REM sleep 15.45% (SD 9.96), with a sleep efficiency of 85.3 (SD 8.70).No significant statistical correlation was found between the REM/NREM AHI index and anxiety symptoms, daytime sleepiness and sleep quality (REM and deep sleep percentages).These patients differ from the general OSAS population: on average, they are not obese, there are a greater number of females affected and they do not present a very significant diurnal hypersomnia. Reduced deep sleep and increased REM sleep were also present versus general population data, and sleep efficiency was just below the normal limit.Anxiety disorders were more prevalent in this group than described for the general population (3%) and OSAS patients. Resumo: A síndroma de apneia obstrutiva do sono (SAOS) associada ao sono REM tem uma incidência de 10â36% na população com SAOS. Estudos anteriores têm sugerido, nestes doentes, um aumento de prevalência de distúrbios psiquiátricos, bem como um efeito da idade e do género.Propusemo-nos, por isso, estudar as características clínicas e polissonográficas de doentes com o referido diagnóstico.Os critérios de inclusão foram a identificação de SAOS em REM, por polissonografia (PSG), definida como IAH em REM â¥Â 5/h, IAH em sono não REM (NREM) â¤Â 15/h, IAH REM/NREM â¥Â 2. Foram ainda analisados alguns parâmetros do sleep disorders questionnaire (SDQ) versão 1.02, nomeadamente os relacionados com ansiedade ou depressão. Foram estudados 19 doentes com média de idades de 54,0 anos (SD 13,97) e média de IMC de 29,01 (SD Dev 4,10). A razão entre género feminino/masculino foi de 0,58. O valor médio da escala de Epworth foi de 12,74 (SD 4,86). Em relação à gravidade da SAOS, a média do IAH foi de 9,16/h (SD 4,09) e a do IAH em REM de 37,08/h (SD 25,87). Para a relação IAH-REM/IAH-NREM obtivemos a média de 8,86 (SD 8,63).A prevalência do distúrbio de ansiedade foi de 33,3% (44,4% no sexo feminino e 16,7% no sexo masculino). Na população estudada, o tempo de sono profundo foi de 20,7% (SD 10,42) e de sono REM de 15,45% (SD 9,96), com uma eficiência de sono de 85,3% (SD 8,70).Não se verificou qualquer correlação estatisticamente significativa entre o índice de IAH REM/NREM e a sintomatologia ansiosa, a sonolência diurna e a qualidade do sono (percentagem de sono profundo e de sono REM). Concluímos que a subpopulação estudada apresenta características que divergem das descritas para a população com SAOS; em média, não são doentes obesos, as mulheres são mais afectadas, a sintomatologia não é tão exuberante, nomeadamente a hipersonia diurna. Observa-se, também, uma redução do sono profundo e um aumento do sono REM neste grupo de doentes versus a população geral, estando a eficiência do sono no limite inferior da normalidade.Ainda o distúrbio de ansiedade apresenta maior prevalência em relação à descrita para a população geral (3%) e em relação à descrita para a população com SAOS. Key-words: REM related sleep disorder breathing, anxiety, females, Palavra-chave: Distúrbio respiratório do sono relacionado com REM, ansiedade, sexo feminino

BACKGROUND: There is evidence that selenium levels are relatively low in Europe and may be falling. Low levels of selenium or low activity of some of the enzymes dependent on selenium have been associated with asthma. METHODS: The GA(2)LEN network has organized a multicentre case-control study in Europe to assess the relation of plasma selenium to asthma. The network compared 569 cases in 14 European centres with a diagnosis of asthma and reporting asthma symptoms in the last 12 months with 576 controls from the same centres with no diagnosis of asthma and no asthmatic symptoms in the last 12 months. RESULTS: All cases and controls were selected from the same population defined by age and place of residence. Mean plasma selenium concentrations among the controls ranged from 116.3 microg/l in Palermo to 67.7 microg/l in Vienna and 56.1 microg/l among the children in Oslo. Random effects meta-analysis of the results from the centres showed no overall association between asthma and plasma selenium [odds ratio (OR)/10 microg/l increase in plasma selenium: 1.04; 95% confidence interval (CI): 0.89-1.21] though there was a significantly protective effect in Lodz (OR: 0.48; 95% CI: 0.29-0.78) and a marginally significant adverse effect in Amsterdam (OR: 1.68; 95% CI: 0.98-2.90) and Ghent (OR: 1.35; 95% CI: 1.03-1.77). CONCLUSION: This study does not support a role for selenium in protection against asthma, but effect modification and confounding cannot be ruled out.