Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies

OBJECTIVES

Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms.

METHODS

This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built.

RESULTS

According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression.

CONCLUSION

At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.

Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies

Background

Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities.

Objective

This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage.

Methods

A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R.

Results

A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83).

Conclusions

A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.

[Correction to the article "The Role of Adipose Tissue and Macrophages in Chronic Inflammation Associated with Obesity - Clinical Implications", published on Acta Med Port 2008; 21: 489-496]

On page 489, on the authorship list, where it reads: Renata RAMALHO, Cristina GUIMARÃES It should read: Sofia SANTARENO, Joao CERQUEIRA, Joao PORTUGUÊS, Joana CRUZ, Renata RAMALHO, Cristina GUIMARÃESOn page 489, on the right-side column where it reads: R.R., C.G.: Serviço e Laboratório de Imunologia. Faculdade de Medicina da Universidade do Porto. Porto It should read: S.S., J.C., J.P., J.C.: Faculdade de Medicina da Universidade do Porto. PortoR.R., C.G.: Serviço e Laboratório de Imunologia. Faculdade de Medicina da Universidade do Porto. PortoOn the headers of pages number 490, 491, 492, 493, 494 and 495, where it reads: Renata RAMALHO et al, Papel do tecido adiposo e dos macrófagos no estado de inflamação..., Acta Med Port. 2008; 21(5):489-496 It should read Sofia SANTARENO et al, Papel do tecido adiposo e dos macrófagos no estado de inflamação..., Acta Med Port. 2008; 21(5):489-496Article published with errors:https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1635

Portuguese consensus document for the management of alpha-1-antitrypsin deficiency

Alpha-1-antitrypsin deficiency (AATD) is a genetic autosomal codominant disorder caused by mutations in SERPINA1 gene. It is one of the most prevalent genetic disorders, although it remains underdiagnosed. Whereas at international level there are several areas of consensus on this disorder, in Portugal, inter-hospital heterogeneity in clinical practice and resources available have been adding difficulties in reaching a diagnosis and in making therapeutic decisions in this group of patients. This raised a need to draft a document expressing a national consensus for AATD. To this end, a group of experts in this field was created within the Portuguese Pulmonology Society - Study group on AATD, in order to elaborate the current manuscript. The authors reviewed the existing literature and provide here general guidance and extensive recommendations for the diagnosis and management of AATD that can be adopted by Portuguese clinicians from different areas of Medicine. This article is part of a supplement entitled "Portuguese consensus document for the management of alpha-1-antitrypsin deficiency" which is sponsored by Sociedade Portuguesa de Pneumologia.

Impacto econômico da doença de Alzheimer no Brasil: é possível melhorar a assistência e reduzir custos?

O objetivo deste estudo foi discutir dados relativos aos custos da Doença de Alzheimer (DA) e as iniciativas assistenciais para reduzir custos e auxiliar a família e os cuidadores no manejo com a doença. O fator de maior custo para as pessoas com DA leve foi o do tempo do cuidador não remunerado, enquanto que para aqueles com a doença em estágio avançado foi o dos cuidados relativos à institucionalização. Frente a esse panorama a literatura propõe a adoção de modelos de atenção que maximizem a independência funcional do idoso e a manutenção de suas habilidades, como a implantação do Centro Dia para Idosos e de programas de reabilitação e amparo ao idoso e família. Esses modelos de atenção precisam ser discutidos, estruturados e implantados na realidade brasileira.

Epworth Sleepiness Scale in obstructive sleep apnea syndrome--an underestimated subjective scale

Excessive daytime sleepiness is a major symptom in obstructive sleep apnea syndrome (OSAS) and can be evaluated using both subjective and objective methods. The Epworth Sleepiness Scale (ESS) is a simple and validated questionnaire for assessing subjective daytime sleepiness in the context of sleep disorders. Although its subjective character may limit the accurate expression of daytime sleepiness, the clinical benefit of sequential ESS is clear and demonstrates how ESS scores evolve in individual patients and how these scores may relate to various parameters. In this context we compared the severity of daytime sleepiness reported at baseline visit with severity of baseline sleepiness assessed, retrospectively, after treatment with automatic positive airway pressure (APAP). We conducted a prospective study that included 66 patients evaluated in a sleep clinic diagnosed with OSAS. The diagnosis was confirmed by in-laboratory or portable sleep studies. Their mean age was 53.3 years and the majority were men (88%, n=58). The ESS was answered during the first interview (baseline daytime sleepiness). During follow-up visits, after APAP treatment, the patient was asked to assess baseline sleepiness, retrospectively, as well as post-treatment sleepiness. The mean baseline ESS score was 11.8, mean retrospective baseline ESS 15.4, with a mean difference of 3.55 (p<0.001 t-Test) and post-treatment ESS 7.3. There was no significant correlation between the difference in ESS score (baseline - retrospective baseline) with the average daily (hours) use of APAP, the apnea-hypopnea index (AHI), the minimal recorded SatO(2), disease duration, body mass index (BMI) and age. Our findings confirm that the severity of subjective sleepiness reported before treatment with positive airway pressure is often underestimated by patients with OSAS.

Prognostic value of unrelated atypical serum immunofixation patterns during multiple myeloma therapy

Autologous stem cell transplantation (ASCT) is the gold standard therapy for suitable multiple myeloma (MM) patients after induction with high dose therapy. To date, the evidence of a reliable marker of prognosis in these cases remains scarce. Our aim was to evaluate appearance of unrelated atypical serum immunofixation patterns (ASIPs) as a marker of prognosis in MM patients submitted to ASCT. We retrospectively analysed data from 65 patients. Interestingly, we observed that presence of ASIPs was associated with longer progression-free survival and longer overall survival. Our results suggested that presence of ASIPs could be a novel marker of good prognosis in MM patients submitted to ASCT.

DHM simulation in virtual environments: a case-study on control room design

This paper will present the workflow developed for the application of serious games in the design of complex cooperative work settings. The project was based on ergonomic studies and development of a control room among participative design process. Our main concerns were the 3D human virtual representation acquired from 3D scanning, human interaction, workspace layout and equipment designed considering ergonomics standards. Using Unity3D platform to design the virtual environment, the virtual human model can be controlled by users on dynamic scenario in order to evaluate the new work settings and simulate work activities. The results obtained showed that this virtual technology can drastically change the design process by improving the level of interaction between final users and, managers and human factors team.

DHM and serious games: a case-study oil and gas laboratories

The aim in this paper is to present a research on the application of serious games for the design of laboratories in the oil and gas industries. The focus is in human virtual representation acquired from 3D scanning, human interaction, workspace layout and equipment designed considering ergonomics standards. The laboratory studies were simulated in Unity3D platform, which allows the users to control the DHM1 on the dynamic virtual scenario, in order to simulate work activities. This methodology can change the design process by improving the level of interaction between final users, managers and human factor teams. That helps to better visualize future work settings and improve the level of participation between all stakeholders.

[Pneumonia associated with health care versus community acquired pneumonia: different entities, distinct approaches]

Healthcare-associated pneumonia (HCAP) is now identified as a unique entity that differs from community-acquired pneumonia (CAP), and in many ways is similar to nosocomial pneumonia (NP). Patients with the diagnosis of CAP and HCAP admitted to our Pneumology Unit during one year were retrospectively analysed. The objective was to compare the characteristics and the approach of these two entities. 197 patients were included, 144 with CAP and 53 with HCAP. Sex, age, comorbilities, Pneumonia Severity Index (PSI) score, radiological involvement, bacteriology, treatment and outcomes were analysed in the 2 groups. Compared to CAP, HCAP was associated with more severe disease, a higher mortality rate and greater length of hospitalization. HCAP differed from CAP mainly in bacteriology and outcomes.

[The role of adipose tissue and macrophages in chronic inflammation associated with obesity: clinical implications]

In the last decades, life style modifications particularly those related to food patterns and food choices, gave risen to a worldwide pandemic disease with no precedent in Human History: obesity. Energy storing and free fatty acids production were the only adipose tissue functions. However, it has been well established other adipose tissue functions like low grade pro-inflammatory molecules production (cytokines, adipokines and chemotactic factors) evolved in obese inflammatory condition. In this inflammatory state, adipocytes active role is inflammatory mediators (adipokines) production and and cell to cell interaction with resident macrophages. Adipose tissue low vascularization is even lower in the obese; so, hypoxia can be a critical factor in inflammatory obese state manifestation. Adipose tissue cytokines production and pre-adipocyte conversion into macrophage results in adipose tissue and macrophages interactions. One of the mononuclear phagocytic system components, macrophage, has an important role in obese-related inflammatory state. These cells have been found to be increased in number and shape proportional to Body Mass Index, rising to up to 60% of total adipose tissue components. The macrophages proportional accumulation could lead to an increase in pro-inflammatory molecules expression and contribute to the inflammatory state in a significant way. The reversion of the low grade inflammation and the reduction of risk factors in obese individuals seem to occur when a reduction in Body Mass Index is achieved and loss of adipose tissue is observed. We performed a critical review of last five years literature in order to better describe the impact of adipose tissue and macrophages interactions in low grade chronic inflammatory condition in the obese and their role in comorbidities pathogenesis.

Partition coefficients of beta-blockers in bile salt/lecithin micelles as a tool to assess the role of mixed micelles in gastrointestinal absorption

The objective of this study was to develop non-invasive spectroscopic methods to quantify the partition coefficients of two beta-blockers, atenolol and nadolol, in aqueous solutions of bile salt micelles and to assess the effect of lecithin on the partition coefficients of amphiphilic drugs in mixed bile salt/lecithin micelles, which were used as a simple model for the naturally occurring mixed micelles in the gastrointestinal tract. The partition coefficients (Kp) at 25.0 +/- 0.1degreesC and at 0.1 M NaCl ionic strength were determined by spectrofluorimetry and by derivative spectrophotometry, by fitting equations that relate molar extinction coefficients and relative fluorescence intensities to the partition constant Kp. Drug partition was controlled by the: (i) drug properties, with the more soluble drug in water (atenolol) exhibiting smaller values of Kp, and with both drugs interacting more extensively in the protonated form; and by (ii) the bile salt monomers, with the dihydroxylic salts producing larger values of Kp for the beta-blockers, and with glycine conjugation of the bile acid increasing the values of Kp for the beta-blockers. Addition of lecithin to bile salt micelles decreases the values of Kp of the beta-blockers. Mixed micelles incorporate hydrophobic compounds due to their large size and the fluidity of their core, but amphiphilic drugs, for which the interactions are predominantly polar/electrostatic, are poorly incorporated in mixed micelles of bile salts/lecithin.

Study of partition of nitrazepam in bile salt micelles and the role of lecithin

The effect of trihydroxy (sodium cholate and sodium glycocholate) and dihydroxy (sodium deoxycholate and sodium glycodeoxycholate) bile salt micelles on the spectrophotometric properties and on the solubility of nitrazepam in aqueous solution, at 25.0 degrees C and at ionic strength 0.1 M in sodium chloride, has been assessed. From the results obtained it was possible to calculate the partition coefficients (Kp) of nitrazepam between aqueous and micellar phases. The partition coefficients of nitrazepam have also been determined in mixed micelles of cholate or deoxycholate with lecithin (egg yolk phosphatidylcholine), which were used as a model of the gastrointestinal tract. Drug partition was found to depend on the bile acid (number of hydroxyl groups and conjugation with glycine), and our data indicate further that addition of lecithin to bile salt micelles decreases the values of the partition coefficients in the mixed micelles at physiological pH.

Paracrine neuroprotective effect of nitric oxide in the developing retina

The retina of newborn rats consists of the ganglion cell layer (GCL), the inner plexiform layer (IPL), the inner nuclear layer (INL) containing amacrine cells and the neuroblastic layer (NBL). In retinal explants, the GCL enters cell death after sectioning of the optic nerve, whereas there is almost no cell death in the NBL. When protein synthesis is inhibited with anisomycin, cell death is blocked in the GCL and induced in the NBL. We tested the roles of nitric oxide (NO) on cell death in the retina in vitro. Either L-arginine, the substrate for NO synthase or the NO donor S:-nitroso-acetylpenicillamine (SNAP) blocked cell death induced by anisomycin in the NBL, but had no effect in the GCL. Sepiapterin, a precursor of the nitric oxide synthase (NOS)-cofactor tetrahydrobiopterin also had a protective effect against anisomycin. The use of 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one, an inhibitor of soluble form of guanylyl cyclase, showed that anti-apoptotic effect of SNAP is partially mediated by cGMP generated by activation of guanylyl cyclase. NADPH-diaphorase histochemistry stained cells only in the GCL and INL. Thus, the degenerative effect of anisomycin is observed within the NBL, whereas the localization of NOS is restricted to the GCL and INL. The protective effect of both the NO substrate and cofactor upon cell death induced by anisomycin in the NBL, indicates that NO produced by amacrine and ganglion cells is a paracrine modulator of cell death within the retinal tissue.

Phenolic acids and derivatives: studies on the relationship among structure, radical scavenging activity, and physicochemical parameters

The antiradical activity of caffeic acid (1), dihydrocaffeic acid (5), and their corresponding n-alkyl esters was evaluated by using the 2,2-diphenyl-1-picrylhydrazyl radical (DPPH(*)) method. Dihydrocaffeic acid (5) was the most potent compound, having an antiradical effect higher than that of (+/-)-alpha-tocopherol, whereas caffeic acid (1) was less efficient. Esterification of the carboxyl group of dihydrocaffeic acid (5) had a dramatic effect on its antiradical potency, but similar effects were not observed for caffeic acid (1) derivatives. The n-alkyl esters of both phenolic series had similar potencies, and their antiradical activities were independent of the alkyl chain length. Dose-dependent scavenger effects were found in both series. Acid-base properties of the compounds, evaluated by using potentiometry and spectrophotometry, showed that the catechol moiety had pK(a2) and pK(a3) values of 9. 24-9.02 and 11.38-10.99 in the dihydrocaffeic series and 8.48-8.24 and 11.38-11.07 in the caffeic series, respectively. Antiradical activity and pK(a) values of the compounds were not related.

Fluorimetric and solubility studies of nadolol and atenolol in SDS micelles

The effect of sodium dodecyl sulfate (SDS) micelles on the spectrofluorimetric intensities and on the solubility of two beta-blockers (atenolol and nadolol) were studied at 25.0 +/- 0.1 degrees C and I = 0.1 M NaCl. From the dependence of these physical properties on SDS concentration it was possible to calculate the binding constants drug-micelle, and it was found that both techniques yield similar results for the binding constants, and that are in agreement with those calculated from the effect of micelles on the apparent acidity constants of the beta-blockers.

Acid/base properties of beta-blockers and benzodiazepines in sodium dodecyl sulfate micelles. A spectrophotometric and potentiometric study

The effect of sodium dodecyl sulfate (SDS) micelles on the acid-base properties of two family of pharmaceutical drugs (beta-blockers and benzodiazepines) at 25 degrees C and I = 0.1 M NaCl have been studied. The characterization of the several solution equilibria for the system drug/SDS micelle solution was performed by potentiometry and spectrophotometry, below and above the critical micelle concentration (cmc). Two widely used models have been applied to quantify the effect of micelles on the pKa of the drugs, and the results obtained point to different interactions of each family of drugs with the micelles.

[Beds for general hospital assistance in the Paraiba Valley, Brazil, 1974]

Com o objetivo de estabelecer relações entre recursos do Sistema Saúde - leitos - e os pacientes internados, foram estudadas as saídas ocorridas em leitos de assistência hospitalar geral do Vale do Paraíba (Brasil), em 1974. Os resultados permitiram relacionar determinadas variáveis - sexo, idade, procedência do paciente, tipo de tratamento a que foi submetido, fonte financiadora de sua assistência e média de permanência. A análise abrangeu as relações entre as variável entre si e cada uma delas com a média de permanência, proporcionando dados de valia para o planejamento, visto fornecerem além do valor quantitativo, caracterização sobre a necessidade de leitos de uma região.