The Ideal Profile of the Telemedicine User– Experience From Portugal

Over the last few years, all over the world, telemedicine has been gaining momentum, and became more accepted by both health workers and patients as an essential tool in medicine. There have been a considerable number of studies whose results show the benefits of telemedicine programmes, not only in cost reduction and decreasing the number of exacerbations and hospital admissions, but also in improving health outcomes, with the patients having a better understanding of their illness and how they can manage it. This study is based on a tele monitoring programme being carried out in the village of Sabugueiro in Portugal. This village is one the first “Smart mountain villages” in the world, and besides having the concept of Internet of Things” applied to its infrastructure, it also has a tele-monitoring component, where blood pressure, blood glucose levels and weight of part of the population are monitored, in both healthy and unhealthy individuals. Abnormal changes of these parameters are very prevalent in our society, being responsible for a great deal of the national health system expenditure and being an important risk factor for cardiovascular events, the number one cause of death in Portugal. Therefore, their correct management is of vital importance in order to reduce costs, morbidity and mortality related to these events. However, this programmes results fell short of what was desired, with low compliance by the patients, who did not make the recommended number of measurements. The main goal of this study was to understand what can improve the compliance of a telemonitoring patient, what they find the most difficult to cope with, and when this kind of programme is useful

Association of statin therapy with blood pressure control in hypertensive hypercholesterolemic outpatients in clinical practice

Background: Some clinical evidence revealed that statins, apart from lowering cholesterol levels, also have an antihypertensive effect. Our aim was to evaluate the existence of a possible association of statin therapy with blood pressure (BP) control in clinical practice. Materials and Methods: Patients attending a hypertension/ dyslipidemia clinic were prospectively evaluated. Those patients with a diagnosis of stage 1 hypertension and hypercholesterolemia who consented to participate were included in the study, either in the statin group (when taking a statin) or in the control group (when not taking a statin). Exclusion criteria included dementia, pregnancy, or breastfeeding, and history or evidence of stage 2 hypertension. Detailed clinical information was prospectively obtained from medical records. A total of 110 hypertensive patients were assigned to the study (82 in the statin group and 28 in the control group). Results: Although there were no signifcant differences (P > 0.05) in both groups concerning gender, body mass index, antihypertensive pharmacotherapy, and serum levels of high-density lipoprotein cholesterol and triglycerides, a higher BP control was observed in the statin group (P = 0.002). Signifcantly lower systolic BP (−6.7 mmHg, P = 0.020) and diastolic BP (−6.4 mmHg, P = 0.002) levels were reported in the statin group. Serum levels of low-density lipoprotein were also signifcantly lower in the statin group (P < 0.001). Conclusions: This observational study detected an association of statin therapy with BP control in hypertensive hypercholesterolemic patients in clinical practice. These fndings raise the possibility that statin therapy may be useful for BP control in the studied population.We thank the FCT (Fundação para a Ciência e a Tecnologia) for supporting the fellowship grant (no. SFRH/BD/36756/2007) attributed to Manuel Morgad

Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: Review and meta-analysis

A literature review and meta–analysis showed that pharmacist interventions can significantly improve medication adherence, SBP, DBP, and BP control in patients with essential hypertension. Interventions were complex and multifaceted and included medication management in all analyzed studies.Purpose. Pharmacist interventions to enhance blood pressure (BP) control and adherence to antihypertensive therapy in adults with essential hypertension were reviewed. Methods. A literature search was conducted to identify relevant articles describing pharmacist interventions intended to improve adherence to antihypertensive medications. Studies were included if they described a pharmacist intervention to improve medication adherence and analyzed adherence to therapy and BP control as outcomes. A fixed-effects model was used to combine data from randomized controlled trials. Results. A total of 15 studies were identified, testing 16 different interventions and containing data on 3280 enrolled patients. Although 87.5% of the interventions resulted in significant improvements in treatment outcomes, only 43.8% of the interventions were associated with significant increases in medication adherence. All interventions that increased antihypertensive medication adherence also significantly reduced BP. Almost all the interventions that were effective in increasing adherence to medication were complex, including combinations of different strategies. Meta-analysis of 2619 patients in 8 studies found that pharmacist interventions significantly reduced systolic blood pressure (SBP) (p < 0.001) and diastolic blood pressure (DBP) (p = 0.002) and that the meta-analytic differences in SBP and DBP changes from baseline to endpoint in intervention and control groups were –4.9 ± 0.9 mm Hg (p < 0.001) and –2.6 ± 0.9 mm Hg (p < 0.001), respectively. Conclusion. A literature review and meta-analysis showed that pharmacist interventions can significantly improve medication adherence, SBP, DBP, and BP control in patients with essential hypertension. Interventions were complex and multifaceted and included medication management in all analyzed studies.Supported by fellowship grant SFRH/BD/36756/2007 from the Fundação para a Ciência e a Tecnologia

A neurophysiological signature of dynamic emotion recognition associated with social communication skills and cortical gamma-aminobutyric acid levels in children

IntroductionEmotion recognition is a core feature of social perception. In particular, perception of dynamic facial emotional expressions is a major feature of the third visual pathway. However, the classical N170 visual evoked signal does not provide a pure correlate of such processing. Indeed, independent component analysis has demonstrated that the N170 component is already active at the time of the P100, and is therefore distorted by early components. Here we implemented, a dynamic face emotional paradigm to isolate a more pure face expression selective N170. We searched for a neural correlate of perception of dynamic facial emotional expressions, by starting with a face baseline from which a facial expression evolved. This allowed for a specific facial expression contrast signal which we aimed to relate with social communication abilities and cortical gamma-aminobutyric acid (GABA) levels.MethodsWe recorded event-related potentials (ERPs) and Magnetic Resonance (MRS) measures in 35 typically developing (TD) children, (10–16 years) sex-matched, during emotion recognition of an avatar morphing/unmorphing from neutral to happy/sad expressions. This task allowed for the elimination of the contribution low-level visual components, in particular the P100, by morphing baseline isoluminant neutral faces into specific expressions, isolating dynamic emotion recognition. Therefore, it was possible to isolate a dynamic face sensitive N170 devoid of interactions with earlier components.ResultsWe found delayed N170 and P300, with a hysteresis type of dependence on stimulus trajectory (morphing/unmorphing), with hemispheric lateralization. The delayed N170 is generated by an extrastriate source, which can be related to the third visual pathway specialized in biological motion processing. GABA levels in visual cortex were related with N170 amplitude and latency and predictive of worse social communication performance (SCQ scores). N170 latencies reflected delayed processing speed of emotional expressions and related to worse social communication scores.DiscussionIn sum, we found a specific N170 electrophysiological signature of dynamic face processing related to social communication abilities and cortical GABA levels. These findings have potential clinical significance supporting the hypothesis of a spectrum of social communication abilities and the identification of a specific face-expression sensitive N170 which can potentially be used in the development of diagnostic and intervention tools

An fMRI paradigm based on Williams inhibition test to study the neural substrates of attention and inhibitory control

The purpose of this study is to present an fMRI paradigm, based on the Williams inhibition test (WIT), to study attentional and inhibitory control and their neuroanatomical substrates. We present an index of the validity of the proposed paradigm and test whether the experimental task discriminates the behavioral performances of healthy participants from those of individuals with acquired brain injury. Stroop and Simon tests present similarities with WIT, but this latter is more demanding. We analyze the BOLD signal in 10 healthy participants performing the WIT. The dorsolateral prefrontal cortex, the inferior prefrontal cortex, the anterior cingulate cortex, and the posterior cingulate cortex were defined for specified region of interest analysis. We additionally compare behavioral data (hits, errors, reaction times) of the healthy participants with those of eight acquired brain injury patients. Data were analyzed with GLM-based random effects and Mann-Whitney tests. Results show the involvement of the defined regions and indicate that the WIT is sensitive to brain lesions. This WIT-based block design paradigm can be used as a research methodology for behavioral and neuroimaging studies of the attentional and inhibitory components of executive functions.info:eu-repo/semantics/publishedVersio

Identificação de Problemas e Propostas para Melhoria

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Key Learning Outcomes for Clinical Pharmacology and Therapeutics Education in Europe: A Modified Delphi Study.

Harmonizing clinical pharmacology and therapeutics (CPT) education in Europe is necessary to ensure that the prescribing competency of future doctors is of a uniform high standard. As there are currently no uniform requirements, our aim was to achieve consensus on key learning outcomes for undergraduate CPT education in Europe. We used a modified Delphi method consisting of three questionnaire rounds and a panel meeting. A total of 129 experts from 27 European countries were asked to rate 307 learning outcomes. In all, 92 experts (71%) completed all three questionnaire rounds, and 33 experts (26%) attended the meeting. 232 learning outcomes from the original list, 15 newly suggested and 5 rephrased outcomes were included. These 252 learning outcomes should be included in undergraduate CPT curricula to ensure that European graduates are able to prescribe safely and effectively. We provide a blueprint of a European core curriculum describing when and how the learning outcomes might be acquired

O papel da sincronização da actividade neuronal no tálamo e córtex visual de mamíferos.

Os neurofisiologistas da visão tentam identificar os mecanismos celulares e de sistema que estão subjacentes à percepção visual. Esta é reconhecida como um processo construtivo, em que o mundo físico externo é organizado em representações de objectos. O nosso sistema visual tende a integrar os sinais provenientes da retina em superfícies e finalmente em objectos perceptuais. Isto significa que o mesmo estímulo físico pode, em situações ambíguas, originar representações alternativas e distintas do mundo visual, de acordo com diferentes critérios de organização perceptual implementados ao nível neuronal. O nosso trabalho veio mostrar que oscilações sincrónicas ocorrem simultaneamente em diversos níveis do sistema visual de uma forma que reflecte propriedades globais do estímulo visual. Identificámos mecanismos distintos de sincronização a nível cortical e subcortical, correlacionados com diferentes atributos do estímulo visual. Demonstrámos subsequentemente que a actividade de células isoladas ou grupos de células no córtex visual do gato pode modificar-se em função das possíveis interpretações perceptuais e de acordo com leis psicofísicas que regem a visão natural. Representações neuronais distintas parecem assim evoluir dinamicamente através de uma estratégia de sincronização e dessincronização. Um objecto seria assim representado por uma população neuronal sincronizada e a sua cisão em dois ocasionaria a emergência de duas populações dessincronizadas entre si. Efectuámos por fim estudos de imagiologia funcional em humanos (Ressonância Magnética Funcional) que mostraram que diferentes padrões de actividade cortical emergem consoante o tipo de interpretação perceptual, mesmo quando o estímulo visual permanece físicamente constante. A variação da dinâmica de activação cerebral para estímulos ambíguos, que induzem alternâncias perceptuais na presença de um padrão de estimulação constante na retina, mostra que o córtex cria representações dinâmicas da cena visual, muito para além de uma mera recriação fiel mas passiva do mundo exterior

How positive emotional content overrules perceptual history effects: Hysteresis in emotion recognition

The human visual system is constantly processing multiple and often conflicting sensory cues to make perceptual decisions. Given the nonlinear nature of emotion recognition, this often leads to different percepts of the same physical facial expression. Moreover, the state of the emotion recognition system might depend on the trajectory of temporal context, potentially leading to a phenomenon known as perceptual hysteresis. Here, we aimed to explore temporal context-related mechanisms underlying perceptual hysteresis during emotion recognition. We hypothesized that dependence on recent perceptual experience might reveal important clues about the role of short-term memory on the perception of emotional stimuli. Behavioral data were acquired using reality-based, changing emotion expressions morphed from a source to a target emotion with different valences, always passing through a neutral expression. Participants identified the onset and offset of what they perceived as the neutral expression interval. Our results showed that current perception of emotional expression is affected by recent temporal context, thus revealing perceptual hysteresis. We also found a relation between recent perceptual history effects and stimulus emotional Content: The positive valence of the stimulus emotional content appeared to abolish perceptual history effects, whereas negatively loaded stimuli induced clear short-term memory effects and positive hysteresis. Our findings show direct competition between recent perceptual experience and stimulus emotional content during decision making, which affects the formation of current percepts in emotion recognition

Transcranial Direct Current Stimulation as an Approach to Mitigate Neurodevelopmental Disorders Affecting Excitation/Inhibition Balance: Focus on Autism Spectrum Disorder, Schizophrenia, and Attention Deficit/Hyperactivity Disorder

Transcranial direct current stimulation (tDCS) has been proposed as a promising therapy for rehabilitation of neurodevelopmental disorders. In this review, we discuss studies on the impact of tDCS as a therapy for autism, schizophrenia, and attention deficit/hyperactivity disorder, as well as the tDCS&rsquo; mechanism of action, and propose future paths of research to optimize tDCS treatment protocols. The mechanism underlying tDCS effects is the modulation of excitatory and/or inhibitory activity, making it a valuable tool for restoring the excitation/inhibition (E/I) balance which is disrupted in many neurodevelopmental disorders. Clinical studies have shown that tDCS therapy is well-tolerated by patients and seems to ameliorate behavior and cognitive functions. Alterations in early development of neuronal circuits lead to disruptions in brain activity in neurodevelopmental disorders. An increasing amount of research into the effects of tDCS on neuronal activity has provided a foundation for its use as a therapy for behavior and cognitive characteristics of neurodevelopmental disorders. Clinical studies show that tDCS appears to ameliorate behavioral and cognitive outcomes of patients with autism, schizophrenia, and attention deficit/hyperactivity disorder. More research is needed to understand the mechanisms of action of tDCS and to optimize treatment protocols