Estará a sub-utilização dos beta-bloqueantes associada a aumento de mortalidade em doentes com Doença Pulmonar Obstrutiva Crónica que desenvolveram Enfarte Agudo do Miocárdio?

Introdução As doenças cardiovasculares são muito comuns entre os doentes que sofrem de doença pulmonar obstrutiva crónica. A caracterização da relação entre doença pulmonar obstrutiva crónica e enfarte agudo do miocárdio ainda não está claramente descrita, sendo importante fazer uma análise de várias vertentes, comportamental, sócio-demográfica, comorbilidades associadas e abordagem farmacológica. Desta forma, é pertinente analisar e conhecer a relação entre as referidas patologias, para que possa haver uma melhor abordagem na gestão das mesmas. Objectivos Perceber de que forma a sub-prescrição de beta-bloqueantes, em doentes com doença pulmonar obstrutiva crónica que desenvolveram enfarte agudo do miocárdio, está relacionada com o aumento de mortalidade nestes doentes. Ficando em aberto a possibilidade de, com este trabalho, se encontrarem áreas de investigação que ajudem na decisão clínica mais adequada. Metodologia Revisão bibliográfica com base em artigos científicos actuais. Resultados Doentes com doença pulmonar obstrutiva crónica recebem com menos frequência beta-bloqueantes, após enfarte agudo do miocárdio, comparativamente com aqueles sem esta patologia. A maioria dos estudos defende que o uso de beta-bloqueantes diminui a mortalidade após enfarte, todavia estes resultados não são unânimes. Não foi encontrada nenhuma evidência entre o uso de beta-bloqueantes e prejuízo da função respiratória. Registou-se uma preferência pelo uso de beta-bloqueantes cardio-selectivos em detrimento dos não selectivos. Conclusão Vários estudos apontam para melhores outcomes resultantes da administração de beta-bloqueantes, contudo estes resultados não são globais. Doentes com doença pulmonar obstrutiva crónica, aos quais foram prescritos beta-bloqueantes, encontram-se melhor clinicamente, isto pode implicar que os beta-bloqueantes podem não conferir os mesmos benefícios em adultos idosos que os observados em adultos jovens. A ponderação da administração deste grupo farmacológico deve ser feita caso a caso, dando sempre preferência ao uso de beta-bloqueantes cardio-selectivos.Introduction Cardiovascular diseases are very common among patients suffering from chronic obstructive pulmonary disease. The characterization of the relationship between chronic obstructive pulmonary disease and acute myocardial infarction is not clearly described, it is important to make an analysis of various aspects, behavioral, socio-demographic, associated comorbidities and pharmacological approach. Thus, it is relevant to analyze and know the relationship between those conditions, in order to do a better approach in their management. Objectives Understand how the sub-prescription beta-blocker, in patients with chronic obstructive pulmonary disease who developed an acute myocardial infarction, is related to increased mortality in these patients. Opening up the possibility to find research areas that help the most appropriate clinical decision. Methodology Literature review based on current scientific articles. Results Patients with chronic obstructive pulmonary disease are less likely to receive beta-blockers after acute myocardial infarction compared to those without this condition. Most studies argue that the use of beta-blockers decreases mortality after stroke, however these results are not unanimous. No evidence was found between the use of beta-blockers and impairment of respiratory function. There was a preference for the use of cardio-selective beta-blockers over non-selective beta-blockers. Conclusion Several studies lead to better outcomes resulting from the administration of beta blockers, however these results are not global. Patients with chronic obstructive pulmonary disease who have been prescribed with beta blockers are clinically better, this may imply that beta-blockers may not confer the same benefits in older adults as seen in young adults. The deliberation of the administration of this pharmacological group should be made on a case-by-case basis, giving preference to the use of cardio-selective beta blockers

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self‐report and physician assessment

Background Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. Methods This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0–100). Results A total of 193 patients (72% female; median [P25–P75] age 28 [19–41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0–71]%; 1 month: 18 [0–48]%) than patient self-report (80 [60–95]) and physician assessment (82 [51–94]) (p 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). Conclusions Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.info:eu-repo/semantics/publishedVersio

Morphological and Postural changes in the foot during pregnancy and puerperium : a longitudinal study

The aim of this study is to observe the morphological and postural changes to the foot that take place during pregnancy and the puerperium. Method: In this descriptive, observational, longitudinal study, we analysed 23 pregnant women, with particular attention to morphological and postural aspects of the foot, at three time points during and after pregnancy: in weeks 9-13 of gestation, weeks 32-35 of gestation and weeks 4-6 after delivery. The parameters considered were changes in foot length, the Foot Posture Index (FPI) and the Hernández Corvo Index, which were analysed using a pedigraph and taking into account the Body Mass Index (BMI). The same procedure was conducted in each review. Results: The statistical analyses obtained for each foot did not differ significantly between the three measurement times. A pronator-type footprint was most frequently observed during the third trimester of pregnancy; it was predominantly neutral during the postpartum period. Statistically significant differences between the measurement times were obtained in the right foot for cavus vs. neutral foot type (between the first and third trimesters and also between the first trimester and the puerperium) (in both cases, p < 0.0001). Conclusions: Foot length increases in the third trimester and returns to normal in the puerperium. According to FPI findings, the third trimester of pregnancy is characterised by pronation, while the posture returns to neutrality during the postpartum period. During pregnancy, the plantar arch flattens, and this persists during the puerperium. The incidence of cavus foot increases significantly in the third trimester and in the puerperium

Definição de estratégias de segurança no circuito do medicamento pediátrico

Dissertação de Mestrado Integrado em Engenharia Biomédica (Área de especialização em Engenharia Clínica)A preocupação com a segurança do cliente e o aumento da exigência deste, aliados à procura da melhoria contínua e posição na vanguarda da qualidade por parte das entidades de saúde, leva a que estas invistam na prevenção e no estudo prévio das necessidades daqueles que as visitam. Desta forma, as equipas responsáveis pela melhoria contínua da qualidade e gestão do risco das organizações prestadoras de cuidados de saúde compostas por profissionais que, auxiliados por sistemas de notificação, são capazes de intervir sobre os fatores de risco mais frequentes da unidade, priorizá-los e tratá-los de acordo com o nível de risco definido. Os erros e eventos adversos relacionados com o medicamento representam uma parcela considerável dos episódios reportados. Estes podem ser potencialmente mais graves em populações sensíveis como a pediátrica, idosa ou em situação crítica, pelo que devem consequentemente apresentar um maior número de estratégias de segurança. O objetivo do presente trabalho prendeu-se, então, em identificar e propor ações de melhoria nas possíveis lacunas no circuito do medicamento pediátrico desde a sua requisição à monitorização do seu efeito terapêutico e potenciais reações adversas, indo paralelamente ao encontro das necessidades e metas apontadas pela Joint Commission International durante o processo de acreditação do Hospital da Luz Lisboa. Foram propostas sugestões de melhoria em quase todas as fases do circuito do medicamento pediátrico, desde campanhas de sensibilização fomentando a aproximação direta com a população e o envolvimento do cliente, a implementação de novos procedimentos durante as fases de preparação e dispensa de terapêutica e outras soluções com implicação na estrutura organizacional do serviço. Todas estas propostas foram estudadas com o apoio da direção dos Serviços Farmacêuticos e todas as suas áreas e vertentes, internamento pediátrico e neonatal e Gabinete de Gestão de Risco do Hospital da Luz Lisboa. Considera-se que o trabalho foi realizado com grande sucesso com três medidas implementadas, uma em fase de implementação e cinco em análise.The concern with the client's safety and the increase of his demands, allied to the search of the constant progress and the position as the front line of quality by the health entities, leads them to a consequent investment in prevention and the previous study of the necessities of those who visit them. This way, the teams responsible for the continuous quality's improvement and risk management of the health care organizations are composed by professionals which, aided by notification systems, are capable of interfering on the unit's most frequent risk factors, prioritize them and treat them according to the level of the risk defined. Drug related errors and adverse events associated to it represent a considerable portion of reported episodes. These may be potentially more serious in susceptible populations such as the pediatrics, elderly or in critical situation, and consequently must present a greater number of security strategies. The objective of the current work was to identify and propose actions aiming to overcome possible gaps in the pediatrics drug circuit starting with its request and ending with the monitoring of its therapeutic effect and potential adverse reactions, going parallel to the meeting of the needs and goals pointed out by the Joint Commission International during the Hospital da Luz's accreditation process. Suggestions for improvement have been proposed in almost all phases of the pediatrics drug circuit, from campaigns to increase the awareness of the population, the proximity to the population and the client involvement, as well as the implementation of new procedures during the preparation and dispensation phases of therapy and other solutions with implications in the organizational structure of the service. All of these proposals were studied with the support of the Pharmaceutical Services and all its areas and aspects, pediatrics and neonatal internment and the Risk Management Office of the Hospital da Luz Lisboa. It is considered that the work was carried out with great success with three implemented measures, one in phase of implementation and five under analysis

Resistir para/com a infância continuar a existir: Transcrição de 21 lives sobre infâncias e Educação Infantil na pandemia de Covid-19

Starting from the emergence of considering children and childhoods in the proposals aimed at early childhood education in this scenario of a non-face-to-face education in the context of the pandemic, in this publication of the section Other languages of the Zero-a-Seis magazine, we gather transcripts of speeches extracted from livestream videos broadcast on Youtube from April to july 2020. The livestreams were located based on a previous survey performed by researcher Natalia Francisca Cardia dos Santos, published in the special edition "Covid-19: Educação em tempos de pandemia" of the Olhar de professor magazine and selected using as criteria the fact that they deal with themes related to early childhood education in times of Covid-19 from the perspective of the defense of both children and childhoods, with a contribution to childhood pedagogy and childhood sociology. Considering that it is essential to enable an intersectional view of the social and political context that permeates education and educational policies, we have also included in our selection some live stream videos in which we approach themes such as racism in early childhood education, gender relations, and the relationship between feminism and public education policies for early childhood education, broadcast until August of the same year. We live in an unprecedented time in which important topics like these are being discussed, studied and reflected upon together through computer screens and shared on social media which, although present themselves as a legitimate mobilization strategy, imply the risk that we lose the preciousness of these exchanges and analyses in the midst of the time and logic of digital speed. When we launched the challenge of dividing into other languages, together with the 49 researchers (women and men) who have accepted the invitation to join us, we gathered dialogues from various places in Brazil, with records transcribed by the authors themselves, faithful to what was said in that moment, except for some necessary changes made in some words to make it  possible to understand what was said, cuts from longer excerpts and/or examples making the writing/reading structure more objective and compact, yet preserving the content, which remains with the irality marks and the space-time contextuality of when they were transmitted live, and organized by date of transmission. In this manner, we give rise to the fact that the transcribed speeches themselves account for locating the events in this chronological delimitation, functioning as a kind of retrospective of what was materiality to live streams that add so many looks and points of view on this theme, we have composed a documentary collection in multiple axes, and from here on we continue with the hopes that the union of forces of the spoken and written word will be a powerful and relevant instrument for those who risk, at this or another time, dreaming and living education in favor of a more citizen life for all people, resisting and daring along with the childhood to continue to exist in times of Covid-19 and whatever outcomes from that period.Partindo da emergência de considerarmos as crianças e suas infâncias nas propostas voltadas à Educação Infantil, nesse cenário de educação não presencial no contexto da pandemia, nesta publicação da seção ‘Outras linguagens’, da revista Zero a Seis, reunimos transcrições de falas extraídas de vídeos ao vivo (lives) transmitidos pelo Youtube no período de abril a julho de 2020. As lives foram localizadas a partir de uma pesquisa prévia realizada pela pesquisadora Natalia Francisca Cardia dos Santos, publicada na edição especial “Covid-19: Educação em tempos de pandemia”, da Revista Olhar de professor, e selecionadas usando como critério tratarem de temáticas relacionadas à Educação Infantil em tempos de Covid-19, sob a ótica da defesa das crianças e das infâncias, com aporte na Pedagogia da infância e na Sociologia da infância. Avaliando ser essencial possibilitar uma visão interseccional da conjuntura social e política que permeia a educação e as políticas educacionais, incluímos também em nossa seleção algumas lives em que foram abordados temas como racismo na Educação Infantil, relações de gênero e a relação entre feminismo e políticas públicas de educação para a Educação Infantil, transmitidas até o mês de agosto do mesmo ano.  Vivemos um tempo sem precedentes, em que temas importantes como estes estão sendo discutidos, estudados e refletidos conjuntamente por meio de telas de computador e compartilhadas em mídias sociais, que, embora se apresentem como uma estratégia legítima de mobilização, implicam risco de que percamos a preciosidade dessas trocas e análises em meio ao tempo e à lógica da velocidade digital. Ao nos lançarmos ao desafio de mergulhar em outras  linguagens, juntamente com as(os) quarenta e nove pesquisadoras(es) que aceitaram o convite de se juntarem a nós,  reunimos diálogos de vários lugares do Brasil,  com registros transcritos pelas(os) próprias(os) autoras(es), fiéis do que foi dito naquele momento, salvo algumas alterações efetuadas em palavras necessárias para possibilitar a compreensão do que foi explicitado e   cortes de trechos mais longos, e/ou exemplos tornando a estrutura da escrita/leitura mais objetiva e compacta, mas preservando o conteúdo, que permanecem com as marcas de oralidade e da contextualidade espaço-temporal de quando foram transmitidos ao vivo, e organizados por data da transmissão.  Deste modo, ensejamos que as próprias falas transcritas deem conta de localizar os acontecimentos nessa delimitação cronológica, funcionando como uma espécie de retrospectiva do que foi discutido acerca de Educação Infantil no mencionado recorte de tempo. Temos certeza de que, ao conferirmos materialidade às lives, que somam tantos olhares e pontos de vista  dessa temática, compusemos um acervo documental em múltiplos eixos, e daqui seguimos com a esperança de que a união da força da palavra dita à palavra escrita seja instrumento potente e relevante para quem arrisque, neste ou em outro tempo, sonhar e viver a educação em prol de uma vida mais cidadã para todas as pessoas,  resistindo e ousando com a infância, para continuar a existir em tempos de Covid-19 e no que vier a partir  desse período. “Queremos um mundo onde sejamos socialmente iguais, humanamente diferentes e totalmente livres” (Rosa de Luxemburgo

Symptoms of anxiety and depression in patients with persistent asthma : a cross-sectional analysis of the INSPIRERS studies

ObjectivesAnxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms.MethodsThis is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6 +/- 16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score &gt;= 8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built.ResultsAccording to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression.ConclusionAt least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies

Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma : Secondary Analysis of Observational Studies

Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were &lt;= 40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score&gt;70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use