Childbirth hospitalizations in Bipolar disorder patients: a nationwide study protocol

Introduction

Bipolar disorder (BD) is usually diagnosed in adulthood, around childbearing age. Research has shown that BD has deleterious effects on pregnant women and birth outcomes. However, few nationwide studies using administrative data have approached this at-risk population focusing specifically on childbirth.

Objectives

This study aims to characterize hospitalizations of women with BD in the peripartum period regarding sociodemographic and clinical variables and to investigate the impact BD has on hospitalization outcomes.

Methods

An observational retrospective study will be performed using an administrative database that comprises routinely collected hospitalization data from all mainland Portuguese public hospitals. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes will be used to identify all women’s admissions for childbirth purposes (V27.X) and codes 296.XX (except 296.2X, 296.3X, 296.9X) will be used to ascertain BD. Episodes will be assigned to one of two mutually exclusive groups (with vs without BD). Multivariate methods will be used to compare both groups concerning key variables and outcomes. This work will comply with the RECORD statement recommendations.

Results

Descriptive and analytical statistics will be conducted in order to describe and characterize this group of patients. Results will be presented as crude and adjusted odds ratio quantifying the risk associated with BD in pregnancy, childbirth and hospitalization outcomes. Findings will be disseminated via publication in peer-reviewed journals.

Conclusions

With this nationwide analysis, we expect to contribute to a better understanding of the demographic and clinical profile of pregnant women with BD and to encourage timely medical and psychological interventions during gestation and childbirth.

Disclosure

No significant relationships.

[Digital home-based multidisciplinary cardiac rehabilitation: How to counteract physical inactivity during the COVID-19 pandemic]

Introduction and Objectives

Center-based cardiac rehabilitation (CR) programs have been forced to close due to COVID-19. Alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be considered. The aim of this study was to assess physical activity (PA) levels after completing a home-based digital CR program.

Methods

A total of 116 cardiovascular disease (CVD) patients (62.6±8.9 years, 95 male) who had been attending a face-to-face CR program were recruited and assessed (baseline and at three months) on the following parameters: PA, sedentary behavior, adherence, cardiovascular and non-cardiovascular symptoms, feelings toward the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted of a multidisciplinary digital CR program, including regular patient assessment, and exercise, educational and psychological group sessions.

Results

Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out rate). A favorable main effect of time was an increase in moderate to vigorous PA and a decrease in sedentary time at three months. Almost half of the participants completed at least one online exercise training session per week and attended at least one of the online educational sessions. No major adverse events were reported and only one minor event occurred.

Conclusion

During the pandemic, levels of moderate to vigorous PA improved after three months of home-based CR in CVD patients with previous experience in a face-to-face CR model. Diversified CR programs with a greater variety of content tailored to individual preferences are needed to meet the motivational and clinical requirements of CVD patients.

POS0013 MUSCULOSKELETAL MANIFESTATIONS IN PATIENTS WITH ENDOCRINE DISEASES IN TERTIARY SERVICE

Background:

Musculoskeletal diseases represent about 50 to 70% of the frequency of chronic diseases according to previous studies (SOUZA, OLIVEIRA, 2015). Chronic pain is often associated with these diseases and is an important cause of care in the health service. Thus, medical professionals are required to adequately manage their patients. Despite the lack of knowledge of some, endocrine diseases are basic diseases linked to musculoskeletal manifestations.

Thus, secondary arthropathies of the non-rheumatologic origin or osteoarticular complaints that simulate or show rheumatic diseases can be seen in patients with endocrine diseases during their evolution or in the initial phase along with other systemic symptoms.

Based on this concept, the musculoskeletal manifestations presented by patients with endocrine disorders in tertiary health service were monitored and evaluated.

Objectives:

The objective of this study is to characterize the musculoskeletal manifestations in patients with endocrine diseases: type 1 and type 2 diabetes mellitus; hypothyroidism; hyperthyroidism and pituitary diseases and to clinically classify the patients based on physical and imaging findings.

Methods:

A cross-sectional and descriptive study, where clinical screening was performed at the endocrinology outpatient clinic, in which patients with musculoskeletal complaints were identified. These patients were referred for evaluation with a rheumatologist with clinical, laboratory and imaging investigation for the diagnosis of rheumatic disease. A questionnaire with epidemiological and clinical data was applied.

Results:

In this study, 325 patients with endocrine diseases were interviewed, 53 ± 16.4 years old, 258 (80%) were female and 64 (20%) males. Of the interviewed patients, 236 (72.8%) reported musculoskeletal pain, being that 196 (75.9%) of the women and 33% of the men indicated this type of symptom. Regarding endocrine diseases, the most frequent was Diabetes Mellitus type 2 with 158 patients (48.6%), and 75% of these people have chronic musculoskeletal pain, most 5 to 7 times a week, showing an intrinsic character of this disease with pain complaints from a large part of this population. It was also identified the prevalence of 25% of Hypothyroidism, 12% of Diabetes type 1, 9% of Hyperthyroidism and less expressive amounts of other endocrine diseases such as Acromegaly (2.1%), Gigantism (0.3%) and similar. About 63% of those who have pain are not followed up in the service of rheumatology, 42% of these have already indicated these pains to their endocrinologist, however they have not had their complaint properly flagged. Of these patients, 94 (29%) use Antihypertensives and 25% Oral Antidiabetics. The most notable diagnoses in rheumatology are: Rheumatoid Arthritis (29%); Osteoarthritis (27%); Osteoporosis and Fibromyalgia both with 20.6% of diagnoses and Psoriatic Arthritis and GOUT with 6%. The main regions that are subject to pain are the Hands (52%); Knees (40%); Spine and feet with 30% each.

Conclusion:

Although there is a demand of more confirmatory studies, our preliminary results showed the mutuality between endocrine diseases and musculoskeletal manifestations and, therefore, that rheumatological findings are increasingly frequent in this population. The high prevalence of these symptoms secondary to endocrine diseases raises serious questions in order to improve the quality of life of these patients, and also to increase the number of researches in this field, because the pathophysiological mechanisms of this association are not well elucidated and, from this, expand this information to professionals who may not be aware of this relationship.

References:

[1]SOUZA, Cesario da Silva; OLIVEIRA, Anamaria Siriani. Prevalência de encaminhamentos às doenças musculoesqueléticas segundo a classificação estatística internacional de doenças (CID-10): reflexões para formação do fisioterapeuta na área de musculoesquelética. Fisioterapia e Pesquisa v. 22, n. 1, p. 48–53, 2015.

Disclosure of Interests:

None declared.

Ultrathin Monolithic Zirconia Veneers: Reality or Future? Report of a Clinical Case and One-year Follow-up

Yttria-stabilized polycrystalline zirconia ceramics have greatly advanced over the past few years. High-translucent zirconia is a newly introduced ceramic that affords high strength and esthetics and that has significantly increased the clinical indications of monolithic zirconia restorations. Thus, the purpose of this case report was to evaluate the performance of ultrathin monolithic zirconia veneers adhesively luted to enamel surfaces after minimally invasive preparations; in addition, we aimed at presenting a clinical protocol for zirconia surface treatment in order to promote bonding effectiveness to resin cement. This type of restoration presented very acceptable esthetic results and decreased the risk of fracturing the veneer during try-in and clinical use. The results were still satisfactory after one-year follow-up. However, randomized, prospective, controlled clinical trials are required to determine the long-term clinical durability of this treatment.