BODE index versus GOLD classification for explaining anxious and depressive symptoms in patients with COPD – a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Anxiety and depression are common and treatable risk factors for re-hospitalisation and death in patients with COPD. The degree of lung function impairment does not sufficiently explain anxiety and depression. The BODE index allows a functional classification of COPD beyond FEV₁. The aim of this cross-sectional study was (1) to test whether the BODE index is superior to the GOLD classification for explaining anxious and depressive symptoms; and (2) to assess which components of the BODE index are associated with these psychological aspects of COPD.</p> <p>Methods</p> <p>COPD was classified according to the GOLD stages based on FEV_1%predictedin 122 stable patients with COPD. An additional four stage classification was constructed based on the quartiles of the BODE index. The hospital anxiety and depression scale was used to assess anxious and depressive symptoms.</p> <p>Results</p> <p>The overall prevalence of anxious and depressive symptoms was 49% and 52%, respectively. The prevalence of anxious symptoms increased with increasing BODE stages but not with increasing GOLD stages. The prevalence of depressive symptoms increased with both increasing GOLD and BODE stages. The BODE index was superior to FEV_1%predictedfor explaining anxious and depressive symptoms. Anxious symptoms were explained by dyspnoea. Depressive symptoms were explained by both dyspnoea and reduced exercise capacity.</p> <p>Conclusion</p> <p>The BODE index is superior to the GOLD classification for explaining anxious and depressive symptoms in COPD patients. These psychological consequences of the disease may play a role in future classification systems of COPD.</p

Capacidade Funcional: estudo prospectivo em idosos residentes em uma instituição de longa permanência

The Short Physical Performance Balance - SPPB has been largely used in researches related to the effects of aging, as a practical and efficient instrument to estimate the physical conditions and screening of elderly people with future disability risk. The SPPB estimates the performance of lower limbs in three aspects: muscle strength, gait and balance, all recognized as fundamental to achieve good quality of life, being accepted as universal indicators to value the health conditions of the elderly. PURPOSE: Analyze the SPPB effectiveness to detect functional capacity changes among institutionalized elderly patients and how it is influenced by cognitive, clinical and global functional variables. METHODS: a prospective study, involving 30 residents of a philanthropic long-term care facility in São Paulo (17 women and 13 men), with ages above 60 years old (43% older than 80 years old) and an average of seven years of residence. After 18 months, these old people were reevaluated and data were compared. RESULTS: Considering the evaluated elderly who had good performance (17%), all of them showed up loss of strength during the research. It was observed that there was an improvement of 16% and 1%, respectively, in the balance and in gait, respectively. There was one or more falls in 47% of them. Comparing the Katz's Index of Independency in the Daily Living, the SPPB was more sensitive to the functional decline, indicating 39%, as compared to the 14% of the loss indentified by Katz. CONCLUSIONS: the data confirm the previous studies, which indicate the functional capacity decline of institutionalized elderly and for the SPPB applicability in the routine of functional attendance of this population.A Short Physical Performance Balance - SPPB vem sendo utilizada largamente em pesquisas sobre o envelhecimento, como instrumento prático e eficaz na avaliação do desempenho físico e rastreamento de idosos com riscos futuros de incapacidades. Ela avalia o desempenho de membros inferiores em três aspectos: força muscular, marcha e equilíbrio, reconhecidos como componentes fundamentais para a qualidade de vida, sendo aceitos como indicadores universais do estado de saúde em idosos. OBJETIVO: Analisar a eficácia da SPPB em detectar alterações na capacidade funcional do idoso institucionalizado e como esta é influenciada pelas variáveis cognitivas, clínicas e funcionais globais. METODOLOGIA: estudo prospectivo do qual participaram 30 residentes de uma instituição de longa permanência, filantrópica, em São Paulo (17 mulheres e 13 homens), com idades acima de 60 anos ou mais (43% maiores de 80 anos) e média de sete anos de residência. Após 18 meses, estes idosos foram reavaliados e os dados, comparados. RESULTADOS: Dos idosos avaliados que obtiveram bom desempenho (17%), todos apresentaram perda de força ao longo do seguimento. Quanto ao equilíbrio e marcha, notou-se melhora de 16% e 1%, respectivamente. Apresentaram uma ou mais quedas, 47% dos sujeitos. Quando comparada com o Índex de Independência nas Atividades de Vida Diária de Katz, a SPPB se mostrou mais sensível em relação ao declínio funcional, apontando 39% em comparação aos 14% de perda identificada pelo Katz. CONCLUSÃO: os dados corroboram estudos anteriores, que apontam para o declínio da capacidade funcional de idosos institucionalizados e para a aplicabilidade da SPPB na rotina de acompanhamento funcional dessa população.Universidade Federal de São Paulo (UNIFESP) Curso de Especialização em Reabilitação GerontológicaLar Escola São Francisco Centro de Reabilitação Setor de Reabilitação GerontológicaUniversidade de São Paulo Faculdade de Medicina Hospital das ClínicasUNIFESP, Curso de Especialização em Reabilitação GerontológicaSciEL

A systematic review evaluating the psychometric properties of measures of social inclusion

Introduction: Improving social inclusion opportunities for population health has been identified as a priority area for international policy. There is a need to comprehensively examine and evaluate the quality of psychometric properties of measures of social inclusion that are used to guide social policy and outcomes. Objective: To conduct a systematic review of the literature on all current measures of social inclusion for any population group, to evaluate the quality of the psychometric properties of identified measures, and to evaluate if they capture the construct of social inclusion. Methods: A systematic search was performed using five electronic databases: CINAHL, PsycINFO, Embase, ERIC and Pubmed and grey literature were sourced to identify measures of social inclusion. The psychometric properties of the social inclusion measures were evaluated against the COSMIN taxonomy of measurement properties using pre-set psychometric criteria. Results: Of the 109 measures identified, twenty-five measures, involving twenty-five studies and one manual met the inclusion criteria. The overall quality of the reviewed measures was variable, with the Social and Community Opportunities Profile-Short, Social Connectedness Scale and the Social Inclusion Scale demonstrating the strongest evidence for sound psychometric quality. The most common domain included in the measures was connectedness (21), followed by participation (19); the domain of citizenship was covered by the least number of measures (10). No single instrument measured all aspects within the three domains of social inclusion. Of the measures with sound psychometric evidence, the Social and Community Opportunities Profile-Short captured the construct of social inclusion best. Conclusions: The overall quality of the psychometric properties demonstrate that the current suite of available instruments for the measurement of social inclusion are promising but need further refinement. There is a need for a universal working definition of social inclusion as an overarching construct for ongoing research in the area of the psychometric properties of social inclusion instruments