Misuse of inhalers devices in clinical practice

Misuse of inhalers devices in clinical practiceIn COPD, therapeutic success depends on a correct inhalation technique, and the choice of inhaler devices (ID) can be as determinant as the drug itself. We present the preliminary results of an ongoing prospective cross-sectional study aimed to assess the patient’s inhaler technique in COPD patients, diagnosed according to GOLD guidelines. We defined a check-list with five steps for each ID, for a correct inhalation technique, as well as essential steps and critical errors, and patient were asked to demonstrate their inhaler technique. A statistics analysis was then performed. We studied 203 COPD outpatients over 40 years-old (median 67,16 years), performing a total of 336 inhalations (30,4% incorrect). Ten types of IDs were examined, and misuse access according to priming/loading and inhalation procedures. Misuse ranged from 27,6% for soft-mist inhaler to 50,0% for pMDI, and in DPIs group from 0% for Aeroliser® to 48,3% for Handihaler®. Preference reasons for an inhaler were the ease of use (39,8%), their characteristics (25,2%) and seem more practical to use (25,2%). No significant relationship was found between correct use and patient preference (p=.236). There was also no significant relationship between the correct use and the number of inhalers used per patient (p=.531). Despite technological advances, inhalers mishandling remains an important clinical issue. A good inhalation technique depends on the type of ID. Poor coordination and inhalation failure remain cause of pMDI misuse. Soft-mist inhaler is the type of ID with the low rates of incorrect use. Misuse was not associated with multiple inhalers use nor to patient’ preference.info:eu-repo/semantics/publishedVersio

Estudo comparativo entre a corrida em esteira e a corrida aquática em duas profundidades diferentes

Deep water running has increased in popularity as a mode of exercise. Biomechanical studies on deep water running are important because they would explain whether the techniques used during deep and shallow water running can really be considered mechanically similar to that of running on land. Thus, the purpose of this study was to compare the spatio-temporal variables and body positions of deep water, shallow water and treadmill running techniques. Three males and three females experienced in deep water running volunteered to this study. A bidimensional approach was performed using video analysis. Sagital plane images were recorded with an underwater view of the water running techniques. Two velocities were tested: self-selected and maximal. The discussion made concerns the changes in the running pattern that were considered as effects of the mechanical characteristics of the water environment and of the absent of ground contact during deep water runningEste estudo objetiva analisar comparativamente a corrida terrestre em esteira com a corrida aquática realizada em piscina rasa e em piscina funda, a fim de descrever semelhanças e diferenças no padrão de movimento em função das demandas ambientais impostas. Foram identificadas variáveis espaço-temporais e angulares fundamentais à descrição do correr nas três situações, partindo-se de uma padroniza ção do esforço percebido. Seis voluntários, três mulheres e três homens, idade média de 28 ± 5,8 anos, ativos em um programa extensivo de corrida aquática em piscina funda participaram do estudo, após consentirem com os procedimentos experimentais. Foi utilizado o método da cinemetria em uma abordagem bidimensional, com avaliação das amplitudes de movimento no plano sagital, para a quantificação das projeções dos ângulos formados entre os segmentos coxa e perna, perna e pé e entre o tronco e a horizontal, além das durações das fases de apoio e balanço, cadência (ciclos por minuto) e as amplitudes de passo. As formas de corrida foram avaliadas em duas velocidades: auto-selecionada e máxima. Os resultados foram discutidos com base nas diferenças e semelhanças entre as formas de corrida que poderiam ser atribuídas às demandas mecânicas do meio líquido, bem como à falta de apoio fixo. Avaliou-se que algumas características observadas poderiam responder por alterações nas funções dos segmentos durante a propulsão no meio aquático, com prováveis efeitos na atividade fásica da musculatura envolvida

Vitamina C para aumento da imunidade: efeitos benéficos e efeitos adversos

Introduction: Vitamin C has been used by the population for a long time. Due to all these already known benefits, the intake of vitamin C has become a daily habit for many people during the new coronavirus pandemic. Objective: To describe the benefits of consuming vitamin C and its adverse effects when ingested in excessive doses and without adequate pharmaceutical guidance. Methodology: this is a Literature Review with a qualitative and descriptive approach. The bibliographic search was carried out on academic sites, Pubmed, Scielo and international journals. All articles used in the construction of this work will have a maximum of 05 years of publication, works published during the years 2018 to 2022. Results: The search for vitamin C aims to prevent diseases and fight various types of infections, in addition to acting in the absorption of iron, reduce the level of triglycerides and cholesterol, in addition to strengthening the immune system. Conclusion: the consumption of vitamin C should be done in a rational way and with correct dosages, under the guidance of the pharmacist, guiding as to possible adverse effects and their importance for the immune system.Tema: Vitamina C para aumento da imunidade: efeitos benéficos e efeitos adversos. Problema: quais os benefícios e os efeitos adversos que o consumo da vitamina C em excesso ou sem orientação médica, pode proporcionar para a saúde da população? Hipótese: o uso da vitamina C tem sido usado para aumento da imunidade, todavia é notórios os efeitos benéficos e adversos. Assim a atuação farmacêutica é imprescindível para o uso desse produto. Objetivos: Descrever os benefícios do consumo da vitamina C e seus efeitos adversos, quando ingeridos em doses excessivas e sem orientação farmacêutica adequada. Justificativa: uma vez que conhecer todos os benefícios da vitamina C poderá auxiliar no seu uso correto para prevenção ou tratamento de doenças. Além disso, contribuirá evitando seu consumo sem necessidade, o que muitas vezes é frequente.  Metodologia: trata-se de uma Revisão de Literatura com uma abordagem qualitativa e descritiva. Será feito buscas de bibliografias em sites acadêmicos, Pubmed, Scielo e revistas internacionais. Todos os artigos usados na construção deste trabalho, terá no máximo 05 anos de publicação, trabalhos publicados durante os anos de 2018 a 2022.  Resultados. A busca pela vitamina C visa prevenir doenças e combater vários tipos de infecções, além de atuar na absorção do ferro, reduzir o nível de triglicerídeos e de colesterol, além de fortalecer o sistema imunológico

Cross-cultural adaptation and psychometric evaluation of the Portuguese version of the family resilience questionnaire – short form (FaRE-SF-P) in women with breast cancer

Funding Information: The authors would like to acknowledge clinicians from the Breast and Neuropsychiatry Units of the Champalimaud Clinical Centre (Champalimaud Foundation), for assistance in patient recruitment and assessment, and the BOUNCE and FAITH Consortium members for their contributions to this study. Funding Information: RL is supported by the 2018 Scientific Employment Stimulus from Fundação para a Ciência e Tecnologia, Portugal (CEECIND/04157/2018). DF, BC, BS, and AO-M were supported by the BOUNCE project (grant agreement number 777167), and DS and AO-M are supported by the FAITH project (grant agreement number 875358), both funded by the European Union’s Horizon 2020 research and innovation programme. AO-M is supported by grants FCT-PTDC/MEC-PSQ/30302/2017-IC&DT-LISBOA-01-0145-FEDER, and FCT-PTDC/MED-NEU/31331/2017, both funded by FCT/MCTES and the former co-funded by FEDER, under the Partnership Agreement Lisboa 2020 – Programa Operacional Regional de Lisboa. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Publisher Copyright: Copyright © 2023 Almeida, Rodrigues da Silva, Frasquilho, Costa, Sousa, Mourinho Baptista, Grácio, Lemos and Oliveira-Maia.Background: A diagnosis of cancer, and the resulting treatment process, can be perceived as a life-threatening event, affecting not only patients but also their social network and, more specifically, their relatives. While the ability to cope and adjust to difficult health situations may be challenging, family resilience may optimize a positive adaptation to adversity and contribute to enhance the patient’s quality of life. The Family Resilience Questionnaire (FaRE) is a self-report measure of family resilience that assesses this construct systematically. We aimed to validate the Portuguese version of a short form of the FaRE (FaRE-SF-P) in a sample of women with breast cancer. Methods: 147 women recently diagnosed with early breast cancer were recruited at the Champalimaud Clinical Centre in Lisbon. Participants completed psychometric assessment including the Portuguese version of the FaRE-SF-P, composed by two subscales of the original version – the FaRE Perceived Family Coping (FaRE-PFC) and the FaRE Communication and Cohesion (FaRE-CC). Confirmatory factor analysis (CFA) was performed to assess the factor structure of the FaRE-SF-P. Construct validity was assessed using the Hospital Anxiety and Depression Scale (HADS) for divergent validity, and the Modified Medical Outcomes Study Social Support Survey (mMOS-SS) as well as the social functioning subscale from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) for convergent validity. Results: The CFA results confirmed a correlated two-factor structure model consistent with the Perceived Family Coping and the Communication and Cohesion subscales. Internal consistency reliability indicated good values both for Perceived Family Coping and Communication and Cohesion subscales. The results for construct validity showed acceptable convergent and divergent validity. Discussion: The FaRE-SF-P showed good psychometric properties demonstrating to be a valid and reliable family resilience measure to use in Portuguese women diagnosed with breast cancer. Since FaRE-SF-P is a short instrument it may be a useful screening tool in an oncological clinical practice routine.publishersversionpublishe

Cross-cultural adaptation and psychometric evaluation of the Portuguese version of the family resilience questionnaire – short form (FaRE-SF-P) in women with breast cancer

Background: A diagnosis of cancer, and the resulting treatment process, can be perceived as a life-threatening event, affecting not only patients but also their social network and, more specifically, their relatives. While the ability to cope and adjust to difficult health situations may be challenging, family resilience may optimize a positive adaptation to adversity and contribute to enhance the patient’s quality of life. The Family Resilience Questionnaire (FaRE) is a self-report measure of family resilience that assesses this construct systematically. We aimed to validate the Portuguese version of a short form of the FaRE (FaRE-SF-P) in a sample of women with breast cancer. Methods: 147 women recently diagnosed with early breast cancer were recruited at the Champalimaud Clinical Centre in Lisbon. Participants completed psychometric assessment including the Portuguese version of the FaRE-SF-P, composed by two subscales of the original version – the FaRE Perceived Family Coping (FaRE-PFC) and the FaRE Communication and Cohesion (FaRE-CC). Confirmatory factor analysis (CFA) was performed to assess the factor structure of the FaRE-SF-P. Construct validity was assessed using the Hospital Anxiety and Depression Scale (HADS) for divergent validity, and the Modified Medical Outcomes Study Social Support Survey (mMOSSS) as well as the social functioning subscale from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) for convergent validity. Results: The CFA results confirmed a correlated two-factor structure model consistent with the Perceived Family Coping and the Communication and Cohesion subscales. Internal consistency reliability indicated good values both for Perceived Family Coping and Communication and Cohesion subscales. The results for construct validity showed acceptable convergent and divergent validity. Discussion: The FaRE-SF-P showed good psychometric properties demonstrating to be a valid and reliable family resilience measure to use in Portuguese women diagnosed with breast cancer. Since FaRE-SF-P is a short instrument it may be a useful screening tool in an oncological clinical practice routineinfo:eu-repo/semantics/publishedVersio

a cross-sectional population-based study

Funding Information: We thank Prof. Carla Nunes (NOVA National School of Public Health – Universidade NOVA de Lisboa) for the valuable insights and discussions in the conceptualization of this project. We thank the EpiDoc Unit and EpiReumaPt team for conceptualizing, planning, and implementing the main research project. We also acknowledge the support of CHRC (UIDP/04923/2020), granted by national funds through Fundação Ciência e Tecnologia, IP. Funding Information: This study received funding from an independent research grant (ID: 64165707) by Pfizer, and the first author received a grant from Fundação Ciência e Tecnologia, IP under the PhD grant SFRH/BD/148420/2019. The funders were not involved in study design; collection, analysis, or interpretation of data; or writing this article or the decision to submit it for publication. Publisher Copyright: © 2023, The Author(s).Background: Pain due to knee and / or hip osteoarthritis (HKOA) is the most common symptom for seeking healthcare. Pain interferes on daily activities, social and occupational participation in people with HKOA. The goal of this study is to estimate the prevalence of unmanageable pain levels (UPL) among people with HKOA), characterize this population and identify factors associated with UPL, and compare therapeutic strategies used by people with UPL versus manageable pain levels (MPL). Methods: We analysed data from the EpiReumaPt study (n = 10,661), that included a representative sample of the Portuguese population. Among these, 1081 participants had a validated diagnosis of HKOA by a rheumatologist. Sociodemographic, lifestyle and health-related data were collected in a structured interview. Pain intensity (NPRS) data were collected in a medical appointment. Painmedication (last month), physiotherapy and surgery were considered as therapies for pain management. UPL was defined as a mean pain intensity in the previous week of ≥5 points on 11-point numeric pain rating scale. The factors associated with UPL were analyzed with logistic regression (p < 0.05, 95%CI). The effect of unmanageable pain levels was assessed by the HOOS/KOOS activities of daily living and quality of life subscales. Symptoms of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Analysis was completed with linear and logistic regression. All analysis were weighted. Results: The estimated prevalence of UPL among people with HKOA was 68.8%. UPL was associated with being female (odds ratio (OR) = 2.36, p < 0.001), being overweight (OR = 1.84, p = 0.035) or obese (OR = 2.26, p = 0.006), and having multimorbidity (OR = 2.08, p = 0.002). People with UPL reported worse performance in activities of daily living and lower quality of life (β = − 21.28, p < 0.001 and β = − 21.19, p < 0.001, respectively) than people with MPL. People with UPL consumed more NSAIDs (22.0%, p = 0.003), opioids (4.8%, p = 0.008), paracetamol (2.7%, p = 0.033), and overall analgesics (7.3%, p = 0.013) than people with MPL. A higher proportion of people with UPL underwent physiotherapy (17.5%, p = 0.002) than people with MPL. Conclusion: Two-thirds of people with HKOA in Portugal have poor management of their pain levels. Clinical and lifestyle factors, that are highly presented in individuals with HKOA, are associated with unmanageable pain. Our results highlighting the need for further research and implementation of effective interventions to improve pain, function and quality of life in people with HKOA.publishersversionpublishe

Food and Nutrition Surveillance System markers predict diet quality

OBJECTIVE: To investigate the performance of food consumption markers of the Food and Nutrition Surveillance System (Sisvan) in assessing the overall dietary quality. METHODS: The study was carried out based on the reproduction of responses to markers in 24-hour recall data from 46,164 individuals aged ≥ 10 years, from the 2017–2018 Household Budget Survey (POF). Seven Sisvan markers were evaluated, and two scores were calculated for each participant, based on the sum of the number of healthy food markers (beans, fruits, and vegetables, ranging from 0 to 3) and unhealthy (hamburgers/sausages, sweetened beverages, instant noodles/salt snacks/crackers, stuffed cookies/sweets/candies, ranging from 0 to 4) consumed. Linear regression analyses were used to assess the association between scores and diet quality indicators (ultra-processed foods, dietary diversity, and levels of saturated and trans fat, added sugar, sodium, potassium, and fiber in the diet). RESULTS: The score of healthy eating markers increased significantly with increasing dietary diversity and potassium and fiber contents in the diet, while the opposite trend was observed for the densities of added sugar, sodium, saturated and trans fat (p &lt; 0.001). The score of unhealthy eating markers increased significantly with the increase in the consumption of ultra-processed foods and densities of added sugar, saturated and trans fat levels in the diet, while an inverse trend was observed for potassium and fiber (p &lt; 0.001). The joint analysis of the combination of the two marker scores showed that individuals with better performance (3 in the healthy food score, and 0 in the unhealthy food score) have a lower number of inadequacies in nutrient consumption. CONCLUSION: Sisvan food consumption markers, quickly and easily applied and already incorporated into the Brazilian public health system, have good potential to reflect the overall dietary quality.OBJETIVO: Investigar o desempenho dos marcadores do consumo alimentar do Sistema de Vigilância Alimentar e Nutricional (Sisvan) na avaliação da qualidade global da alimentação. MÉTODOS: O estudo foi realizado a partir da reprodução de respostas aos marcadores em dados de recordatórios de 24 horas, de 46.164 indivíduos com idade menor ou igual a 10 anos, da Pesquisa de Orçamentos Familiares 2017–2018. Foram avaliados sete marcadores do Sisvan e calculados dois escores para cada participante, a partir do somatório do número de marcadores de alimentação saudável (feijão, frutas, verduras/legumes, variando de 0 a 3) e não saudável (hambúrguer/embutidos, bebidas adoçadas, macarrão instantâneo/salgadinhos/biscoitos salgados, biscoito recheado/doces/guloseimas, variando de 0 a 4) consumidos. Análises de regressão linear foram usadas para avaliar a associação entre os escores e indicadores de qualidade da alimentação (participação de alimentos ultraprocessados, diversidade e teores de gordura saturada, trans, açúcar de adição, sódio, potássio e fibra da dieta). RESULTADOS: o escore de marcadores de alimentação saudável aumentou de forma significativa com o aumento da diversidade e dos teores de potássio e fibra da dieta, enquanto tendência oposta foi observada para as densidades de açúcar de adição, sódio, gordura saturada e trans (p &lt; 0,001). Observou-se que o escore de marcadores de alimentação não saudável aumentou de forma significativa com o aumento da participação de alimentos ultraprocessados e dos teores de açúcar de adição, gordura saturada e trans da dieta, enquanto tendência inversa é observada para potássio e fibra (p &lt; 0,001). A análise conjunta da combinação dos dois escores de marcadores mostrou que indivíduos com melhor desempenho (3 no escore de alimentos saudáveis, e 0 no de alimentos não saudáveis) possuem menor número de inadequações no consumo de nutrientes. CONCLUSÃO: Os marcadores do consumo alimentar do Sisvan, aplicados de forma rápida e prática e já incorporados no sistema público de saúde brasileiro, possuem bom potencial para refletir a qualidade global da alimentação

Prevalence of schistosomiasis mansoni in indigenous Maxakali villages, Minas Gerais, Brazil

Intestinal parasitic infections are a common health problem among Amerindian populations and schistosomiasis represents one of the most prevalent diseases in Maxakali people. The Kato-Katz is the diagnostic method recommended by WHO for epidemiological studies; however, one of the technique’s limitations is the failure to detect parasites in individuals with low parasite load. The aim of this study was to establish the prevalence of Schistosoma mansoni in indigenous Maxakali villages, evaluating the TF-Test® performance for diagnosis compared to the Kato-Katz technique. Stool samples from 545 individuals were processed by the TF-Test® (1 sample) and Kato-Katz (1 slide). The positivity rate for S. mansoni by Kato-Katz was 45.7%. The rate by the TF-Test® was 33.2%, and 51.9% by the combined parasitological techniques. The amplitude of parasite load was 24 to 4,056 eggs per gram of feces (epg), with a geometric mean of 139 epg. The co-positivity, co-negativity, and accuracy values by TF-Test® in relation to Kato-Katz were 59.0%, 88.5%, and 75.0%, respectively. The agreement between these techniques was moderate (k=0.486) as determined by the kappa index. Thus, the results of this study demonstrated that the performance of Kato-Katz was superior (

Florística e estrutura do componente arbóreo e análise ambiental de um fragmento de Floresta Ombrófila Mista Alto-Montana no município de Painel, SC

http://dx.doi.org/10.5902/198050988449The highland Araucaria Forest is a little-studied forest formation, occurring in altitudes above 1,000 m. The objectives of this study were to understand the structural and floristic patterns of the tree component of a remaining of this forest in the southern plateau region of Santa Catarina State and to determine the environmental variables that influence these patterns. The tree component survey and the environmental data collection were conducted in 50 plots of 200 m2. Within these plots, all living trees with circumference at breast height (CBH) ³ 15,7 cm were measured (CBH and height) and identified. In each plot, environmental variables related to soils physical and chemical traits, topography and canopy cover were collected. Phytosociological parameters and the diameter structure (whole tree community and tree populations with the importance value above 5%) were calculated. The floristic-structural similarities among plots were analyzed by NMDS (Nonmetric Multidimensional Scaling) and vectors of environmental variables (p &lt;0.05) were plotted a posteriori. A total of 50 tree species were identified, distributed in 33 genera and 20 families. The species with the highest VI were Araucaria angustifolia (Bertol.) Kuntze (17.32%), Myrceugenia euosma (O. Berg) D. Legrand (15.24%) and Acca sellowiana (O. Berg) Burret (7.84% ). The diameter structure of the whole community and of the study populations (except Dicksonia sellowiana Hook.) showed a distribution close to the "inverted J". The NMDS analysis showed a higher percentage of clay in the plots with the highest density of Acca sellowiana and lowest percentage in the plots with high density of Dicksonia sellowiana, Inga lentiscifolia Benth. and Ocotea pulchella Mart. Plots with higher declivity had a higher density of Drimys brasiliensis Miers and those of lower declivity, higher elevation and greater canopy closure, had a higher occurrence of Drimys angustifolia Miers, Prunus myrtifolia (L.) Urb, Calyptranthes concinna DC. and Myrceugenia oxysepala (Burret) D. Legrand &amp; Kausel.http://dx.doi.org/10.5902/198050988449A Floresta Ombrófila Mista Alto-Montana é uma formação pouco estudada que ocorre em altitudes acima de 1.000 m. Os objetivos deste estudo foram conhecer os padrões florísticos e estruturais do componente arbóreo de um fragmento desta floresta na região do Planalto Sul Catarinense e determinar as variáveis ambientais que influenciam esses padrões. O levantamento da composição florística e estrutural e a coleta das variáveis ambientais foram conduzidos em 50 parcelas de 200 m2. Nelas, todos os indivíduos arbóreos com CAP (circunferência medida a altura do peito) ≥ 15,7 cm foram medidos (CAP e altura) e identificados. Foram coletadas, em cada parcela, variáveis ambientais relacionadas às características químicas e físicas dos solos, topográficas e de cobertura do dossel. Foram calculados os parâmetros fitossociológicos e a estrutura diamétrica da comunidade e das populações com valor de importância (VI) acima de 5 %. A similaridade florístico-estrutural entre as parcelas foi analisada pela NMDS (Nonmetric Multidimensional Scaling) e os vetores das variáveis ambientais significativas (p &lt; 0,05) foram plotados a posteriori. Foram identificadas 50 espécies arbóreas distribuídas em 33 gêneros e 20 famílias botânicas. As espécies com maior VI foram: Araucaria angustifolia (Bertol.) Kuntze (17,32 %), Myrceugenia euosma (O.Berg) D.Legrand (15,24 %) e Acca sellowiana (O.Berg) Burret (7,84 %). A estrutura diamétrica de toda a comunidade e das populações estudadas (exceto Dicksonia sellowiana Hook.) teve distribuição próxima ao “J invertido”. A análise NMDS demonstrou maior porcentagem de argila nas parcelas com maior densidade de Araucaria angustifolia e menor porcentagem, nas parcelas com maior densidade de Dicksonia sellowiana, Inga lentiscifolia Benth. e Ocotea pulchella Mart. As parcelas de maior declividade tiveram maior densidade de Drimys brasiliensis Miers e aquelas de menor declividade, maior cota e maior cobertura do dossel, tiveram maior ocorrência de Drimys angustifolia Miers, Prunus myrtifolia (L.) Urb., Calyptranthes concinna DC. e Myrceugenia oxysepala (Burret) D.Legrand &amp; Kausel