Abstract B62: Intratumoral genetic heterogeneity in rectal cancer and response to neoadjuvant chemoradiotherapy

Response to neoadjuvant chemoradiotherapy (nCRT) varies substantially among patients with locally advanced rectal cancer, but key determinants of treatment response are not fully understood. Intratumoral genetic heterogeneity (ITGH) is a common feature of solid tumors and has been proposed to drive disease progression and treatment response. Others and we have recently demonstrated that primary nontreated rectal tumors exhibit significant ITGH, but the effect of nCRT in shaping the clonal architecture of rectal cancer has not yet been addressed. In the present work, we further expanded the analysis of ITGH in rectal cancer by analyzing whole-exome sequencing (WES) and clinical data from 79 primary nontreated rectal cancers obtained from The Cancer Genome Atlas. We show that primary rectal tumors exhibit a remarkable variability in the degree of ITH. We also analyzed the effect of nCRT on ITGH and monitored tumor cell subpopulation dynamics after treatment through WES of paired tumor samples collected at diagnosis (pretreatment) and at surgery following nCRT (post-treatment) from seven patients. We show that treatment exposure does not introduce novel somatic mutations or significantly alter tissue genetic heterogeneity. Instead, nCRT acts as a potent selective pressure, shaping the mutational landscape of rectal tumors and allowing the selection and expansion of tumor cell subpopulations, which are more prone to resist nCRT. Our results shed light on the highly heterogeneous and dynamic mutational landscape of rectal tumors and indicate that ITGH may directly affect response to nCRT.

Citation Format: Cibele Masotti, Fabiana Bettoni, Bruna R. Correa, Angelita Habr-Gama, Joaquim Gama-Rodrigues, Maria Viana, Bruna B. Vailati, Guilherme P. Sao Juliao, Laura M. Fernandez, Pedro A. F. Galante, Rodrigo O. Perez, Anamaria A. Camargo. Intratumoral genetic heterogeneity in rectal cancer and response to neoadjuvant chemoradiotherapy [abstract]. In: Proceedings of the AACR International Conference held in cooperation with the Latin American Cooperative Oncology Group (LACOG) on Translational Cancer Medicine; May 4-6, 2017; São Paulo, Brazil. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(1_Suppl):Abstract nr B62.

Workplace exposure and release of ultrafine particles during atmospheric plasma spraying in the ceramic industry

Atmospheric plasma spraying (APS) is a frequently used technique to produce enhanced-property coatings for different materials in the ceramic industry. This work aimed to characterise and quantify the impact of APS on workplace exposure to airborne particles, with a focus on ultrafine particles (UFPs, <100nm) and nanoparticles (<50nm). Particle number, mass concentrations, alveolar lung deposited surface area concentration, and size distributions, in the range 10nm-20μm were simultaneously monitored at the emission source, in the potential worker breathing zone, and in outdoor air. Different input materials (known as feedstock) were tested: (a) micron-sized powders, and (b) suspensions containing submicron- or nano-sized particles. Results evidenced significantly high UFP concentrations (up to 3.3×10⁶/cm³) inside the spraying chamber, which impacted exposure concentrations in the worker area outside the spraying chamber (up to 8.3×10⁵/cm³). Environmental release of UFPs was also detected (3.9×10⁵/cm³, outside the exhaust tube). Engineered nanoparticle (ENP) release to workplace air was also evidenced by TEM microscopy. UFP emissions were detected during the application of both micron-sized powder and suspensions containing submicron- or nano-sized particles, thus suggesting that emissions were process- (and not material-) dependent. An effective risk prevention protocol was implemented, which resulted in a reduction of UFP exposure in the worker area. These findings demonstrate the potential risk of occupational exposure to UFPs during atmospheric plasma spraying, and raise the need for further research on UFP formation mechanisms in high-energy industrial processes.

[Ecchymosis as the presenting manifestation of Wilson disease: A case report]

INTRODUCTION

The presence of a psychiatric disorder during the course of an organic disease is a common cause of delayed diagnosis.

CASE REPORT

We report a 16-year-old girl who was admitted with thrombocytopenia and had a two-year history of neuropsychiatric disorder which was attributed to a difficult family situation. Neurological examination showed a frontal lobe disorder and extrapyramidal manifestations. The thrombocytopenia was attributed to liver cirrhosis. These neurological and hepatic injuries were consistent with a metabolic disease, most likely Wilson disease. This was supported by the presence of a corneal Kayser-Fleischer ring and a decreased ceruloplasmin concentration. An urgent liver transplantation was required due to worsening neurological symptoms.

CONCLUSION

Wilson disease is a rare genetic disease caused by copper toxicity. It is characterized by combined hepatic and neurologic damage to varying degrees and can develop at any age. Urgent treatment is required, but the diagnosis may be delayed by prevailing psychiatric symptoms.

Process-generated nanoparticles from ceramic tile sintering: Emissions, exposure and environmental release

The ceramic industry is an industrial sector in need of significant process changes, which may benefit from innovative technologies such as laser sintering of ceramic tiles. Such innovations result in a considerable research gap within exposure assessment studies for process-generated ultrafine and nanoparticles. This study addresses this issue aiming to characterise particle formation, release mechanisms and their impact on personal exposure during a tile sintering activity in an industrial-scale pilot plant, as a follow-up of a previous study in a laboratory-scale plant. In addition, possible particle transformations in the exhaust system, the potential for particle release to the outdoor environment, and the effectiveness of the filtration system were also assessed. For this purpose, a tiered measurement strategy was conducted. The main findings evidence that nanoparticle emission patterns were strongly linked to temperature and tile chemical composition, and mainly independent of the laser treatment. Also, new particle formation (from gaseous precursors) events were detected, with nanoparticles <30nm in diameter being formed during the thermal treatment. In addition, ultrafine and nano-sized airborne particles were generated and emitted into workplace air during sintering process on a statistically significant level. These results evidence the risk of occupational exposure to ultrafine and nanoparticles during tile sintering activity since workers would be exposed to concentrations above the nano reference value (NRV; 4×10(4)cm(-3)), with 8-hour time weighted average concentrations in the range of 1.4×10(5)cm(-3) and 5.3×10(5)cm(-3). A potential risk for nanoparticle and ultrafine particle release to the environment was also identified, despite the fact that the efficiency of the filtration system was successfully tested and evidenced a >87% efficiency in particle number concentrations removal.

Variability of the characteristics of a migraine attack within patients

Background

Migraine attacks may present different features in different patients and also within the same patient. The percentage of patients reporting stereotyped attacks and those reporting attacks with different phenotypes has not been the object of specific investigations.

Objective

The objective of this article is to evaluate the percentage of migraine patients reporting the same characteristics, in terms of phenotype and response to symptomatic medications on three consecutive migraine attacks.

Methods

Thirty patients with migraine without aura prospectively recorded the features of three consecutive attacks in a headache diary. Characteristics recorded were: pain intensity, presence of nausea, vomiting, photophobia, phonophophia, osmophobia, allodynia, cranial autonomic symptoms (at least one), and premonitory symptoms. Patients were allowed to take frovatriptan as symptomatic medication, whose efficacy was evaluated as the two hours pain-free status.

Results

None of the patients presented identical characteristics on the three studied attacks. This was still the case if we reduced the number of variables evaluated from 11 to seven of the eight core features indicated by the ICHD. Considering just six variables: unilaterality and quality of pain, presence/absence of nausea, vomiting, photophobia and phonophobia, only two patients (6%) had identical features on three consecutive attacks. With respect to the response to frovatriptan, 39% of patients had the same response, either positive (i.e. pain free after two hours) or negative (i.e. not pain free after two hours) on three consecutive attacks.

Conclusion

Migraine attacks show a high variability not just among patients, but also within the same patient. Our data indicate that stereotypy of attacks is uncommon, and reinforces the underlying logic of the current operational classification system.

Psychological factors associated with failure of detoxification treatment in chronic headache associated with medication overuse

Aim

The aim of this study was to evaluate the psychological factors associated with a negative outcome following detoxification in a 2-month follow-up in medication-overuse headache.

Methods

All consecutive patients entering the detoxification program were analysed in a prospective, non-randomised fashion. Psychiatric conditions and personality characteristics were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I) and the Minnesota Multiphasic Personality Inventory (MMPI)-2. χ2 tests, one-way analyses of variance, and odds ratios (ORs) were used.

Results

A total of 248 patients completed the follow-up: 156 stopped overuse and their headaches reverted to an episodic pattern (Group A); 23 kept overusing without any benefit on headache frequency (Group B); and 51 stopped overuse without any benefit on headache frequency (Group C). The prognostic factors for the outcome of Group B were higher scores on the correction (OR 1.128; p = 0.036), depression (OR 1.071; p = 0.05), hysteria (OR 1.106; p = 0.023), and overcontrolled hostility (OR 1.182; p = 0.04) MMPI-2 scales, whereas those for Group C were psychiatric comorbidities (OR 1.502; p = 0.021) and higher scores on the hysteria scale (OR 1.125; p = 0.004).

Conclusions

The outcome of detoxification is influenced by psychological factors that should be considered when considering treatment strategies.

Spatiotemporally resolved black carbon concentration, schoolchildren's exposure and dose in Barcelona

At city level, personal monitoring is the best way to assess people's exposure. However, it is usually estimated from a few monitoring stations. Our aim was to determine the exposure to black carbon (BC) and BC dose for 45 schoolchildren with portable microaethalometers and to evaluate the relationship between personal monitoring and fixed stations at schools (indoor and outdoor) and in an urban background (UB) site. Personal BC concentra-tions were 20% higher than in fixed stations at schools. Linear mixed-effect models showed low R(2) between personal measurements and fixed stations at schools (R(2)  ≤ 0.28), increasing to R(2)  ≥ 0.70 if considering only periods when children were at schools. For the UB station, the respective R(2) were 0.18 and 0.45, indicating the importance of the distance to the monitoring station when assessing exposure. During the warm season, the fixed stations agreed better with personal measurements than during the cold one. Children spent 6% of their time on commuting but received 20% of their daily BC dose, due to co-occurrence with road traffic rush hours and the close proximity to the source. Children received 37% of their daily-integrated BC dose at school. Indoor environments (classroom and home) were responsible for the 56% BC dose.

Industrial sources of primary and secondary organic aerosols in two urban environments in Spain

In urban areas, primary and secondary organic aerosols are typically considered to originate from vehicular traffic emissions. However, industrial emissions within or in the vicinity of urban areas may also be significant contributors to carbonaceous aerosol concentrations. This hypothesis was tested and validated in two urban areas in Spain. The observed unusual dominance of organic carbon (OC) over elemental carbon (EC), the analysis of the variability of OC, EC and OC/EC and their correlation with transport patterns suggested the presence of OC sources associated with industrial activities. A methodology based on chemical speciation of particulate matter (PM) followed by the application of receptor modelling techniques allowed for the identification of the specific industrial sources of OC, which were linked to primary OC emissions from a grain drying plant (cereal) and to secondary OC formation from paper production activities (paper mills), as well as from urban sources and biogenic emissions. This work presents an integrated approach to identifying and characterizing of industrial sources of carbonaceous aerosols in urban areas, aiming to improve the scarce body of literature currently available on this topic.

Environmental and health benefits from designating the Marmara Sea and the Turkish Straits as an emission control area (ECA)

Ship emissions degrade air quality and affect human health, and are increasingly becoming a matter of concern. Sulfur emission control areas (ECA), specific coastal regions where only low-sulfur fuels may be consumed by ocean-going ships, have proven to be useful tools to reduce ship-sourced air pollution along the North American, Canadian, and European North and Baltic Sea coastlines. The present work assesses the environmental and health benefits which would derive from designating an ECA in the Marmara Sea and the Turkish Straits (50 000 ships/year; 23 million inhabitants). Results show evidence that implementing an ECA would be technically viable and that it would reduce ship-sourced PM10 and PM2.5 ambient concentrations in Istanbul by 67%, and SO2 by 90%. The reduction of the air pollution burden on health was quantified as 210 hospital admissions from exposure to PM10, 290 hospital admissions from exposure to SO2, and up to 30 premature deaths annually due to ECA emission controls. Consequently, the designation of an ECA in the Marmara Sea and the Turkish Straits is evaluated as a positive, technically viable and real-world measure to reduce air pollution from ships in Turkey.

Outdoor and indoor UFP in primary schools across Barcelona

Indoor and outdoor measurements of real-time ultrafine particles (UFP; N10-700 in this study) number concentration and average diameter were collected twice at 39 primary schools located in Barcelona (Spain), with classrooms naturally ventilated under warm weather conditions. Simultaneous outdoor N concentration measurements at schools under different traffic exposures showed the important role of this source, with higher levels by 40% on average at schools near heavy traffic, highlighting thus the increased exposure of children due to urban planning decisions. A well-defined spatial pattern of outdoor UFP levels was observed. Midday increases in outdoor N levels mainly attributed to nucleation processes have been recorded both at high and low temperatures in several of the outdoor school sites (increasing levels by 15%-70%). The variation of these increases also followed a characteristic spatial pattern, pointing at schools' location as a key variable in terms of UFP load owing to the important contribution of traffic emissions. Indoor N concentrations were to some extent explained by outdoor N concentrations during school hours, together with average temperatures, related with natural ventilation. Outdoor midday increases were generally mimicked by indoor N concentrations, especially under warm temperatures. At specific cases, indoor concentrations during midday were 30%-40% higher than outdoor. The time scale of these observations evidenced the possible role of: a) secondary particle formation enhanced by indoor precursors or conditions, maybe related with surface chemistry reactions mediated by O3, and/or b) UFP from cooking activities. Significant indoor N increases were detected after school hours, probably associated with cleaning activities, resulting in indoor N concentrations up to 3 times higher than those in outdoor. A wide variability of indoor/outdoor ratios of N concentrations and mean UFP sizes was detected among schools and measurement periods, which seems to be partly associated with climatic conditions and O3 levels, although further research is required.

Sources of indoor and outdoor PM2.5 concentrations in primary schools

Children spend a third of their day in the classroom, where air pollution levels may differ substantially from those outdoors due to specific indoor sources. Air pollution exposure assessments based on atmospheric particle mass measured outdoors may therefore have little to do with the daily PM dose received by school children. This study aims to investigate outdoor and indoor sources of PM2.5 measured at 39 primary schools in Barcelona during 2012. On average 47% of indoor PM2.5 measured concentrations was found to be generated indoors due to continuous resuspension of soil particles (13%) and a mixed source (34%) comprising organic (skin flakes, clothes fibers, possible condensation of VOCs) and Ca-rich particles (from chalk and building deterioration). Emissions from seven outdoor sources penetrated easily indoors being responsible for the remaining 53% of measured PM2.5 indoors. Unpaved playgrounds were found to increase mineral contributions in classrooms by 5-6 μg/m(3) on average with respect to schools with paved playgrounds. Weekday traffic contributions varied considerably across Barcelona within ranges of 1-14 μg/m(3) outdoor and 1-10 μg/m(3) indoor. Indoors, traffic contributions were significantly higher (more than twofold) for classrooms with windows oriented directly to the street, rather than to the interior of the block or to playgrounds. This highlights the importance of urban planning in order to reduce children's exposure to traffic emissions.

2001-2012 trends on air quality in Spain

This study aims at interpreting the 2001-2012 trends of major air pollutants in Spain, with a major focus on evaluating their relationship with those of the national emission inventories (NEI) and policy actions. Marked downward concentration trends were evidenced for PM10, PM2.5 and CO. Concentrations of NO2 and NOx also declined but in a lesser proportion at rural and traffic sites. At rural sites O3 has been kept constant, whereas it clearly increased at urban and industrial sites. Comparison of the air quality trends and major inflection points with those from NEIs, the National Energy Consumption and the calendar of the implementation of major policy actions allowed us to clearly identify major benefits of European directives on power generation and industrial sources (such as the Large Combustion Plants and the Integrated Pollution Prevention and Control Directives). This, together with a sharp 2007-2008 decrease of coal consumption has probably caused the marked parallel decline of SO2, NOx and for PM2.5 concentrations. Also the effect of the EURO 4 and 5 vehicle emission standards on decreasing emissions of PM and CO from vehicles is noticeable. The smooth decline in NO2-NOx levels is mostly attributed to the low efficiency of EURO 4 and 5 standards in reducing real life urban driving NO2 emissions. The low NOx decrease together with the complexity of the reactions of O3 formation is responsible for the constant O3 concentrations, or even the urban increase. The financial crisis has also contributed to the decrease of the ambient concentration of pollutants; however this caused a major reduction of the primary energy consumption from 2008 to 2009, and not from 2007 to 2008 when ambient air PM and SO2 sharply decreased. The meteorological influence was characterized by a 2008-2012 period favorable to the dispersion of pollutants when compared to the 2001-2007.

Child exposure to indoor and outdoor air pollutants in schools in Barcelona, Spain

Proximity to road traffic involves higher health risks because of atmospheric pollutants. In addition to outdoor air, indoor air quality contributes to overall exposure. In the framework of the BREATHE study, indoor and outdoor air pollution was assessed in 39 schools in Barcelona. The study quantifies indoor and outdoor air quality during school hours of the BREATHE schools. High levels of fine particles (PM2.5), nitrogen dioxide (NO2), equivalent black carbon (EBC), ultrafine particle (UFP) number concentration and road traffic related trace metals were detected in school playgrounds and indoor environments. PM2.5 almost doubled (factor of 1.7) the usual urban background (UB) levels reported for Barcelona owing to high school-sourced PM2.5 contributions: [1] an indoor-generated source characterised mainly by organic carbon (OC) from organic textile fibres, cooking and other organic emissions, and by calcium and strontium (chalk dust) and; [2] mineral elements from sand-filled playgrounds, detected both indoors and outdoors. The levels of mineral elements are unusually high in PM2.5 because of the breakdown of mineral particles during playground activities. Moreover, anthropogenic PM components (such as OC and arsenic) are dry/wet deposited in this mineral matter. Therefore, PM2.5 cannot be considered a good tracer of traffic emissions in schools despite being influenced by them. On the other hand, outdoor NO2, EBC, UFP, and antimony appear to be good indicators of traffic emissions. The concentrations of NO2 are 1.2 times higher at schools than UB, suggesting the proximity of some schools to road traffic. Indoor levels of these traffic-sourced pollutants are very similar to those detected outdoors, indicating easy penetration of atmospheric pollutants. Spatial variation shows higher levels of EBC, NO2, UFP and, partially, PM2.5 in schools in the centre than in the outskirts of Barcelona, highlighting the influence of traffic emissions. Mean child exposure to pollutants in schools in Barcelona attains intermediate levels between UB and traffic stations.

Functional polymorphisms in COMT and SLC6A4 genes influence the prognosis of patients with medication overuse headache after withdrawal therapy

BACKGROUND AND PURPOSE

It is currently unknown if common genetic variants influence the prognosis of patients with medication overuse headache (MOH). Here the role of two common single nucleotide polymorphisms in the COMT gene (rs4680 and rs6269), as well as the STin2 variable number tandem repeat (VNTR) polymorphism in the SLC6A4 gene, were evaluated as predictors for long-term outcomes of MOH patients after withdrawal therapy.

METHODS

Genotyping was conducted by polymerase chain reaction (PCR), PCR restriction fragment length polymorphism analysis or real-time PCR allelic discrimination assay on genomic DNA extracted from peripheral blood. Gene variants association was evaluated by logistic regression analysis adjusted for clinical confounding factors, and the threshold of statistical significance for multiple testing was set at P < 0.012.

RESULTS

Sixty-five MOH patients with unsuccessful detoxification and 83 MOH patients with effective drug withdrawal therapy were available for the analysis. rs4680G allele carriers or the COMT rs6269G-rs4680G haplotype were found to be associated with a lower risk of relapse within the first year after successful detoxification therapy, in comparison with homozygous rs4680A allele carriers [odds ratio (OR) 0.17, 95% confidence interval (CI) 0.05-0.61, P = 0.007] or with the COMT rs6269A-rs4680A haplotype (OR 0.19, 95% CI 0.06-0.54, P = 0.003), respectively. In addition, carriers of the STin2 VNTR short allele were found at higher odds for the composite poor outcome including unsuccessful withdrawal therapy and relapse within 12 months of follow-up after successful detoxification (OR 2.81, 95%CI 1.26-6.25, P = 0.009).

CONCLUSIONS

Our results indicate that genotyping for COMT rs4680 and SLC6A4 STin2 VNTR could be useful for the identification of MOH patients at higher risk of poor prognosis after drug withdrawal.

Natural sources of atmospheric aerosols influencing air quality across Europe

Atmospheric aerosols are emitted by natural and anthropogenic sources. Contributions from natural sources to ambient aerosols vary widely with time (inter-annual and seasonal variability) and as a function of the distance to source regions. This work aims to identify the main natural sources of atmospheric aerosols affecting air quality across Europe. The origin, frequency, magnitude, and spatial and temporal variability of natural events were assessed for the years 2008 and 2009. The main natural sources of atmospheric aerosols identified were African dust, sea spray and wildfires. Primary biological particles were not included in the present work. Volcanic eruptions did not affect air quality significantly in Europe during the study period. The impact of natural episodes on air quality was significant in Southern and Western Europe (Cyprus, Spain, France, UK, Greece, Malta, Italy and Portugal), where they contributed to surpass the PM10 daily and annual limit values. In Central and Northern Europe (Germany, Austria and Latvia) the impact of these events was lower, as it resulted in the exceedance of PM daily but not annual limit values. Contributions from natural sources to mean annual PM10 levels in 2008 and 2009 ranged between 1 and 2 μg/m(3) in Italy, France and Portugal, between 1 and 4 μg/m(3) in Spain (10 μg/m(3) when including the Canary Islands), 5 μg/m(3) in UK, between 3 and 8 μg/m(3) in Greece, and reached up to 13 μg/m(3) in Cyprus. The evaluation of the number of monitoring stations per country reporting natural exceedances of the daily limit value (DLV) is suggested as a potential tool for air quality monitoring networks to detect outliers in the assessment of natural contributions. It is strongly suggested that a reference methodology for the identification and quantification of African dust contributions should be adopted across Europe.

Investigation on Detergent Tablet Stability: from Raw Materials to Tablet Properties

The aim of this study is to investigate the functional characteristics (mechanical strength, disintegration and dissolution) of effervescent detergent tablets with chlorine provider under various storage conditions. The contribution of surfactant to the tablet stability was studied by comparing tablets without and with surfactant. After one year of storage in polypropylene tubes, the properties were modified for both formulas but the way to reach the end-point was different. In order to precise the influence of relative humidity, the tablets were exposed to controlled humidity levels, after a preliminary drying stage: with the surfactant, stability was better at lower humidity but for higher relative humidity, tablet properties were affected to a larger extent, compared to the formula without surfactant. Raman spectroscopy pointed out modifications of effervescent couple with humidity indicating i) a beginning of effervescence in the tablets and ii) the limiting effect of the surfactant on this phenomenon.

Health effects from Sahara dust episodes in Europe: literature review and research gaps

The adverse consequences of particulate matter (PM) on human health have been well documented. Recently, special attention has been given to mineral dust particles, which may be a serious health threat. The main global source of atmospheric mineral dust is the Sahara desert, which produces about half of the annual mineral dust. Sahara dust transport can lead to PM levels that substantially exceed the established limit values. A review was undertaken using the ISI web of knowledge database with the objective to identify all studies presenting results on the potential health impact from Sahara dust particles. The review of the literature shows that the association of fine particles, PM₂.₅, with total or cause-specific daily mortality is not significant during Saharan dust intrusions. However, regarding coarser fractions PM₁₀ and PM₂.₅₋₁₀ an explicit answer cannot be given. Some of the published studies state that they increase mortality during Sahara dust days while other studies find no association between mortality and PM₁₀ or PM₂.₅₋₁₀. The main conclusion of this review is that health impact of Saharan dust outbreaks needs to be further explored. Considering the diverse outcomes for PM₁₀ and PM₂.₅₋₁₀, future studies should focus on the chemical characterization and potential toxicity of coarse particles transported from Sahara desert mixed or not with anthropogenic pollutants. The results of this review may be considered to establish the objectives and strategies of a new European directive on ambient air quality. An implication for public policy in Europe is that to protect public health, anthropogenic sources of particulate pollution need to be more rigorously controlled in areas highly impacted by the Sahara dust.

Assessing feasibility and acceptability of home-care based rehabilitation from the perspective of stroke patients and their informal caregivers

Purpose

To report on stroke patients and their informal caregivers’ perceptions and experiences regarding feasibility and acceptability of home-care based rehabilitation, in the context of the implementation of an EHSD procedure.

Theory

EHSD procedures are considered promising alternatives to conventional care in stroke rehabilitation, as they seem to be able to reduce costs with illness and to accrue important benefits to patients and their informal caregivers. The literature in this area provides some guidelines of how to organize and assess this type of intervention, regarding the impact on patient’s functionality and related costs. Less investigated are the perspectives of patients and their informal caregivers, namely, their perceptions and experiences regarding feasibility and acceptability of home-care based rehabilitation.

Methods

Data were collected using focus group discussion. We conducted two focus groups with key-informants, selected patients and caregivers, chosen due to the diversity and deepness of their cases, aiming at improving both evidence-based knowledge and theoretical framework. A group of three researchers with specific roles joined each focus group, namely a moderator, a recorder and a coordinator. During the sessions, participants were encouraged to speak until all views were expressed. The data were recorded, transcribed and analyzed. The content analysis was performed with NVivo 9 which allowed us to identify the main themes of each topic under discussion.

Results and conclusions

Home-care based rehabilitation seems to be feasible and acceptable for patients and their caregivers. Our results point out the advantages of home-care over traditional models. Moreover, patients and their caregivers identified aspects that can be improved in home-based services.