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Background People with COPD have been reported to bear a distinct airway microbiota from healthy individuals based on bronchoalveolar lavage (BAL) and sputum samples. Unfortunately, the collection of these samples involves relatively invasive procedures and is resource-demanding, limiting its regular use. Non-invasive samples from the upper airways could constitute an interesting alternative, but its relationship with COPD is still underexplored. We examined the merits of saliva to identify the typical profile of COPD oral bacteria and test its association with the disease. Methods Outpatients with COPD and age-sex matched healthy controls were recruited and characterised based on clinical parameters and 16S rRNA profiling of oral bacteria. A clustering analysis based on patients’ oral bacteria beta-diversity and logistic regressions were performed to evaluate the association between oral bacteria composition and COPD. Results 128 individuals participated (70 patients and 58 controls). Differential abundance analyses showed differences in patients comparable to the ones previously observed in samples from the lower respiratory tract, i.e., an increase in Proteobacteria (particularly Haemophilus) and loss of microbiota diversity. An unsupervised clustering analysis separated patients in two groups based on microbiota composition differing significantly in the frequency of patients hospitalized due to severe acute exacerbation of COPD (AECOPD) and in the frequency of GOLD D patients. Furthermore, a low frequency of Prevotella was associated with a significantly higher risk of recent severe AECOPD and of being GOLD D. Conclusion Salivary bacteria showed an association with COPD, particularly with severe exacerbations, supporting the use of this non-invasive specimen for future studies of heterogeneous respiratory diseases like COPD.

Introdução: A disponibilidade de ecrãs tem sido associada a efeitos negativos. Pretendemos caracterizar e comparar o “tempo de ecrã” em crianças e adolescentes da área de Vila Nova de Gaia, com e sem psicopatologia. Material e Métodos: Estudo observacional, com amostra de conveniência e aplicação de questionários entre 1 de outubro de 2018 e 31 de junho de 2019 a crianças e adolescentes seguidos em Cuidados Saúdes Primários e em consulta de Psiquiatria da Infância e Adolescência. Resultados: Amostra de 223 participantes, 184 com psicopatologia (82,5%) e 39 sem (17,5%). A maioria apresentava “tempo de ecrã” superior ao recomendado (71,4%), com superioridade naqueles com psicopatologia (p=0,006). Verificámos o mesmo relativamente à utilização de dispositivos ao adormecer ou background TV (p=0,024 e 0,008, respetivamente). A covisualização foi mais frequente nos participantes sem psicopatologia (p=0,045). O “tempo de ecrã” superior ao recomendado, background TV e covisualização mantiveram‑se significativos após regressão logística (p=0,029, p=0,024 e p=0,013, e OR = 3,741 [IC 1,148‑12,194]; OR=3,494 [IC 1,175‑10,392] e OR = 0,249 [IC 0,083‑0,750] respetivamente). Discussão: Os resultados coadunam com o que éapontado na literatura sobre uma possível associação entre “tempo de ecrã” e psicopatologia. Será importante avaliar o efeito de causalidade desta associação. Conclusão: O “tempo de ecrã” éexcessivo e mais frequente nos participantes com psicopatologia. A uniformização de recomendações e adaptação à realidade portuguesa são de relevância crescente na atualidade.

Bronchoalveolar lavage (BAL) and sputum samples are commony used to provide valuable information on airway microbiota of COPD but they are too invasive to be routinely collected. An interesting alternative would be the use of non-invasive samples from the upper airways but its validation is still lacking. Here, we have explored the merits of saliva to identify the typical profile of COPD microbiota. 70 patients with COPD (60 male, 68±9y, BMI 25.5±3.5, FEV1pp 48±16, GOLD A-12, B-32, C-5, D-21) and 50 healthy matched controls (42 male, 67±8y, BMI 27.6±3.8, FEV1pp 103±17) were characterised based on sociodemographic, anthropometric, clinical parameters and 16S rRNA profiling of their salivary microbiota. Microbiota composition was significantly different between healthy individuals and patients with COPD and could also descriminate moderate from severe patients. Healthy individuals were enriched in Alloprevotella and Prevotella, both Bacteroidetes’ genera, whereas moderate patients were enriched in Granullicatella and Lachnoanaerobaculum (Firmicutes) and severe patients were significantly enriched in Haemophilus (Proteobacteria) (Fig1.A). Furthermore, patients showed a significantly less diverse microbiota than healthy individuals (MW-U, p=0.001) (Fig1.B). Our results corroborate the findings reported previously using BAL and sputum samples encouraging further exploration of salivary microbiota as a potential disease biomarker. published

Chronic obstructive pulmonary disease (COPD) is influenced by environmental factors, such as indoor/outdoor contaminants. However, patients’ views on environmental exposure are little-known and this is an often-neglected topic in psychoeducational sessions in pulmonary rehabilitation (PR). We explored the views of patients with COPD about indoor/outdoor environment and its influence on their health and the impact of an environmental educational session within PR, on their daily living. Focus groups were conducted before and after community-based PR. An educational session was designed and included in PR after the first focus group. Data were analysed with thematic analysis. Four focus groups were conducted with 31 patients with COPD (71±8y; 74%male; FEV1 48±17pp; 45% GOLD2; 58% GOLDB). Prior to PR, 3 themes emerged: 1) “just seeing the tip of the iceberg” since some awareness existed but a feeling of probably not knowing the real impact was shared; 2) “feeling resigned” where patients acknowledged having poor strategies to avoid contaminants and felt there was little they could do; and 3) “willingness to learn” as they reported the need for an educational session to improve their knowledge on environmental exposures. After PR, 2 themes were found: 1) “gratefulness” where patients shared that the session was helpful for themselves and significant others; and 2) “personal change”, where patients expressed how their behaviour changed towards more health-enhancing strategies to deal with contaminants. Environmental education within PR is valued by patients and leads to specific behaviour changes to deal with contaminants’ exposure. Further attention to this topic is warranted. published

Objectivos: Caracterizar as referenciações efectuadas pelos Cuidados de Saúde Primários (CSP) à consulta da Unidade de Psiquiatria da Infância e da Adolescência (UPIA) do Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E); avaliar a comunicação entre os dois níveis de cuidados. Tipo de Estudo: Observacional descritivo transversal. Local: UPIA do Serviço de Psiquiatria e Saúde Mental do CHVNG/E. População: A amostra incluiu todas as referenciações dirigidas à referida unidade provenientes dos CSP, via ALERT P1®, durante os anos de 2010 e 2011. Métodos: Procedeu-se à análise descritiva das variáveis género, idade, motivo de referenciação, prioridade da referenciação, prioridade atribuída pelo triador, motivo de recusa/devolução do pedido, tempo de espera, comparência do utente e qualidade da carta de referenciação. Resultados: A análise incluiu 980 referenciações (61,5% do género masculino). A faixa etária entre os 6-10 anos foi a mais referenciada (41,4%). O motivo mais referenciado foi “Sinais/sintomas do comportamento da criança” (31,9%). De todos os pedidos, 16,9% foram considerados urgentes pelo médico de família. Destes, 11,6% foram considerados prioritários pelo triador. De todas as referenciações, 11,3% foram recusadas/devolvidas, maioritariamente devido a informação insuficiente (36,1%). Cerca de 90% das referenciações consideradas prioritárias foram agendadas num prazo = 60 dias e quase 100% das restantes referenciações foram marcadas num prazo = 150 dias. Das 853 primeiras consultas marcadas, 10,5% das crianças faltaram à consulta e não pediram remarcação da mesma. Cerca de 20% das referenciações foram consideradas de boa qualidade e cerca de 14% de má qualidade. Conclusões: Os resultados sugerem que a articulação e a comunicação entre o médico de família e o psiquiatra da infância e da adolescência são eficazes, embora alguns aspectos possam ser melhorados, nomeadamente a adequação das prioridades atribuídas e a qualidade da informação dos pedidos de consulta. Objectives: To characterize the referrals from Primary Health Care (PHC) to the child and adolescent psychiatry consultation unit of the Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E) and to evaluate the communication between these two levels of care. Study design: Cross-sectional. Setting: Child and Adolescent Psychiatry Unit of Psychiatry and Mental Health Service of CHVNG/E. Population: Our sample included all referrals from primary care to the referral unit, using ALERT P1®, in 2010 and 2011. Methods: Descriptive analyses were performed regarding gender, age, reason for referral, priority of the referral, priority given by the psychiatrist, reason for refusal or return of referral, waiting time, patient attendance, and quality of the referral letter. Results: Our analysis was based in 980 referrals (61.5% male). Patients aged 6-10 years were the most commonly referred (41.4%). The most frequent reason for referral was ‘signs and symptoms of child behaviour’ (31.9%). Of all referrals, 16.9% were considered urgent by the family doctor. Of these, 11.6% were considered as urgent by the psychiatrist. Of all referrals, 11.3% were refused or returned, mainly because of insufficient information (36.1%). About 90% of the referrals considered as priorities were scheduled within = 60 days and almost 100% of the remaining referrals were scheduled within = 150 days. Of the 853 scheduled first consultations, 10.5% of the children missed the consultation and did not ask for another appointment. About 20% of the referral letters were considered of good quality and about 14% were considered of poor quality. Conclusions: Our results suggest that communication between family doctors and child and adolescent psychiatrists is effective. Some aspects need improvement, particularly the definition of urgency and the quality of information in the referral letters.