Cláudia Ribeiro

Geriatric oncology: comparing health related quality of life in head and neck cancer patients.

BackgroundPopulation ageing is increasing the number of people annually diagnosed with cancer worldwide, once most types of tumours are age-dependent. High-quality healthcare in geriatric oncology requires a multimodal approach and should take into account stratified patient outcomes based on factors other than chronological age in order to develop interventions able to optimize oncology care.This study aims to evaluate the Health Related Quality of Life in head and neck cancer patients and compare the scores in geriatric and younger patients.MethodsTwo hundred and eighty nine head and neck cancer patients from the Oncology Portuguese Institute participated in the Health Related Quality of Life assessment. Two patient groups were considered: the geriatric (≥ 65 years old, n = 115) and the younger (45-60 years old, n= 174). The EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires were used.ResultsHead and neck cancer patients were mostly males, 77.4% within geriatric group and 91.4% among younger patients group.The most frequent tumour locations were similar in both groups: larynx, oral cavity and oropharynx - base of the tongue.At the time of diagnosis, most of younger male patients were at disease stage III/IV (55.9%) whereas the majority of younger female patients were at disease stage I/II (83.4%). The geriatric patient distribution was found to be similar in any of the four disease stages and no gender differences were observed.We found that age (geriatrics scored generally worse), gender (females scored generally worse), and tumour site (larynx tumours denounce more significant problems between age groups) clearly influences Health Related Quality of Life perceptions.ConclusionsGeriatric oncology assessments signalize age-independent indicators that might guide oncologic geriatric care optimization. Decision-making in geriatric oncology must be based on tumour characteristics and chronological age but also on performance status evaluation, co-morbidity, and patient reported outcomes assessment.

Patient reported outcomes in head and neck cancer: selecting instruments for quality of life integration in clinical protocols

BackgroundHealth Related Quality of Life has been used in medical research for more than twenty years, being progressively accepted during the last decade as an important patient reported outcome. Considering the multidimensional approach involved in Health Related Quality of Life assessment, instrument applicability and cultural adaptation must be tested for each population. In order to select the most appropriate instrument for Head and Neck cancer patients, two major Health Related Quality of Life specific questionnaires for Head and Neck cancer patients were compared. Conceptual differences, psychometric characteristics, scores, reliability, construct validity and sensitivity to symptomatology, tumour location, tumour size were analyzed.Methods102 consecutive Head and Neck cancer patients completed two different Health Related Quality of Life questionnaires: EORTC QLQ-C30 and its specific head and neck module QLQ-H&N35 and the Functional Assessment of Cancer Therapy Scales (FACT-H&N). Patients completed the questionnaires, immediately before consultation as a part of the routine evaluation.ResultsA greater variability was always found in the EORTC QLC-C30 questionnaires scores for all comparable domains. Both instruments revealed a good internal consistency and demonstrated to be good tools to distinguish symptomatic patients. The EORTC questionnaires still demonstrated sensitivity to distinguish T3 and T4 staging. Conceptual differences and the psychometric characteristics are discussed. Our results suggest that these two instruments assess different aspects of Health Related Quality of Life - the questionnaires should be used separately and chosen according to the study objectives and methodology.ConclusionsThis study emphases the importance in selecting the appropriate tool as a critical success factor in implementing routine Health Related Quality of Life assessment in clinical practice. This decision assumes particularly importance when utilization of results in real time and integration into clinical protocols are considered.

Ultrasonography as an Evaluation Tool in a Randomized Controlled Trial Assessing Balneotherapy Effects in Rheumatoid Arthritis

Objective: To evaluate the usefulness of ultrasonography as an evaluation tool in a Randomized Controlled Trial assessing Balneotherapy effects in Rheumatoid Arthritis. Methods: A prospective controlled clinical trial, not blinded, randomly assigned of patients with rheumatoid arthritis accordingly to the American College of Rheumatology criteria. The Balneotherapy group received Balneotherapy’s throughout 21 days in S. Jorge Spa. The main outcome was hand/wrist ultrasonography measured at the same moments in the two groups, and McNemar’s tests were used to compare changes in ecographics signals, with a 5% statistical significance level. Secondary outcomes were taken at same time for HAQ-DI and DAS28. A moderated regression analysis, complemented with the Johnson-Neyman (J-N) technique was used to perform the statistical analysis. Results: In thermal group there was a statistically significant result (p < 0.05) regarding the evolution of synovitis only at left hand/wrist according to ultrasonography signals, between baseline and day 21, end of thermal treatment, and after 3 months. Curiously, the same statistical findings were found in the control group, but at right side. No difference was found in DAS28 at the end of Balneotherapy but almost reach significance at month 3. HAQ-DI at end of treatment and 3rd month follow-up was significantly improved in the Balneotherapy. Conclusions: Pain and diminished function are hallmarks of RA patients, so any complementary contribution with no or mild side effects, as Balneotherapy, is welcome to enhance quality of life. In this study ultrasonography could detect improvement in synovitis in both RA patients groups, Balneotherapy translating both the possible effect of treatment and the natural history of RA. Both joints were the more affected at enrolment and the Balneotherapy had a slightly higher DAS28. Quality of life had a sustainable improvement with Balneotherapy. Ultrasonography is an objective, inexpensive modality to measure the response of RA small joint synovitis to Balneotherapy, provided that it is realized by a medical doctor with specific formation.

Determinants of gingival recessions in Portuguese adults

Objectives: The objective of this study consisted in determining the prevalence of gingival recession and potential risk factors associated in a sample of patients that had a dental appointment in the University Clinic of the Portuguese Catholic University in Viseu, Portugal. Methods: We conducted an epidemiological observational cross-sectional study where a sample of 101 patients was assessed. The participants were subjected to a questionnaire and an intra-oral clinical examination was made in order to assess gingival recessions. Results: The prevalence of recession was 85.1%. The presence of habits and a high plaque index are associated with the onset of recessions and its severity. The aesthetic condition was influenced only in 14.0% of the cases and just 17.4% of the patients with gingival recession had tooth hipersensibility. There is a stronger association between the development of recessions and using a brushing technique based mostly on horizontal movements and brushes with harder bristles. Conclusion: Although further studies need to be applied in a more representative sample, we conclude that the majority of the analyzed sample has already suitable oral health behaviors, however, some need to be modified as the understanding of the need to change certain habits to prevent development of recessions.

DETERMINANTS OF GINGIVAL RECESSIONS IN PORTUGUESE ADULTS

Acidified and non acidified samples of wastewaters from the Etoudi’s slaughterhouse (Yaounde, Cameroon) were analyzed before and after having been exposed to an electric discharge in a cold plasma reactor at different exposure times. Analyses reveal that untreated and non acidified wastewaters (pH = 7.8) contain 230.4 mgL-1 of phosphate (PO4 3-) and 479.6 mgL-1 of nitrate (NO3 -) ions. Exposure of these wastewaters to the gliding discharge (“glidarc”) operated in humid air induces PO4 3- and NO3 - concentrations abatement by 41.55% for phosphates and 86.24% for nitrates within 20 min of exposure for a gas flow rate of 800 Lh-1,which confirms the efficiency of the glidarc treatment in humid air in case of waste treatments. On the other hand, exposure of acidified wastewaters (pH = 2.2) to the glidarc in the same conditions showed that PO4 3- andNO3 - concentrations increase with exposure time; this result is in conformity with oxidation phenomena induced by the glidarc and previously presented by several authors. From these results the efficiency of the “glidarc” technique in degrading phosphates and nitrates in basic medium was proven.

Calidad de vida relacionada con la salud de pacientes crónicos con enfermedades del sistema inmune: estudio piloto

A qualidade de vida relacionada com a saude (QVRS) e sobrevivencia sao dois desfechos importantes nas doencas cronicas. Este estudo objetivou comparar a QVRS de pacientes com diferentes patologias cronicas do sistema imune e com os dados normativos da populacao Portuguesa. Foram seleccionados 103 pacientes para a amostra por conveniencia, para completar o SF-32v2. As pontuacoes mais baixas foram encontradas entre as medidas para a saude geral (41,0), vitalidade (47,5), dor (51,0) e saude mental (56,4); as mulheres, exceto na funcao fisica, e os doentes com doencas autoimunes obtiveram piores escores em todas as dimensoes, quando comparados com os dados normativos. Os escores mais altos foram obtidos nas dimensoes: funcao fisica (69,1), funcionamento social (66,9) e funcao emocional (64,9). Viver com doencas cronicas imunologicas apresenta impacto sobre a QVRS e a versao Portuguesa do SF-36v2 fornece dados validos e confiaveis na mensuracao da QdV destes doentes.Health related quality of life (HRQL) and survival are two important outcome measures in chronic diseases. This study aimed to compared HRQL in patients with different chronic diseases of immune system and normative data from the general Portuguese Population. It was selected 103 out-patients, by convenience, to complete SF-36v2. The lowest scores were found among measures for general health (41.0), vitality (47.5), bodily pain (51.0), mental health (56.4); women, except for role-physical, and patients with auto-immune diseases have had the worse scores on all assessed dimension of subjective health, when compared with normative data. Highest scores were obtained in the following scales: physical functioning (69.1), social functioning (66.9), role-emotional (64.9). Living with chronic immune disease have impact on HRQL and it can be expected that the Portuguese version of SF-36v2 provide valid and reliable HRQL data.

Qualidade de vida relacionada com a saúde de doentes crónicos com patologias do sistema imune: estudo piloto

A qualidade de vida relacionada com a saude (QVRS) e sobrevivencia sao dois desfechos importantes nas doencas cronicas. Este estudo objetivou comparar a QVRS de pacientes com diferentes patologias cronicas do sistema imune e com os dados normativos da populacao Portuguesa. Foram seleccionados 103 pacientes para a amostra por conveniencia, para completar o SF-32v2. As pontuacoes mais baixas foram encontradas entre as medidas para a saude geral (41,0), vitalidade (47,5), dor (51,0) e saude mental (56,4); as mulheres, exceto na funcao fisica, e os doentes com doencas autoimunes obtiveram piores escores em todas as dimensoes, quando comparados com os dados normativos. Os escores mais altos foram obtidos nas dimensoes: funcao fisica (69,1), funcionamento social (66,9) e funcao emocional (64,9). Viver com doencas cronicas imunologicas apresenta impacto sobre a QVRS e a versao Portuguesa do SF-36v2 fornece dados validos e confiaveis na mensuracao da QdV destes doentes.Health related quality of life (HRQL) and survival are two important outcome measures in chronic diseases. This study aimed to compared HRQL in patients with different chronic diseases of immune system and normative data from the general Portuguese Population. It was selected 103 out-patients, by convenience, to complete SF-36v2. The lowest scores were found among measures for general health (41.0), vitality (47.5), bodily pain (51.0), mental health (56.4); women, except for role-physical, and patients with auto-immune diseases have had the worse scores on all assessed dimension of subjective health, when compared with normative data. Highest scores were obtained in the following scales: physical functioning (69.1), social functioning (66.9), role-emotional (64.9). Living with chronic immune disease have impact on HRQL and it can be expected that the Portuguese version of SF-36v2 provide valid and reliable HRQL data.

Health related quality of life of chronic patients with immune system diseases: a pilot study

A qualidade de vida relacionada com a saude (QVRS) e sobrevivencia sao dois desfechos importantes nas doencas cronicas. Este estudo objetivou comparar a QVRS de pacientes com diferentes patologias cronicas do sistema imune e com os dados normativos da populacao Portuguesa. Foram seleccionados 103 pacientes para a amostra por conveniencia, para completar o SF-32v2. As pontuacoes mais baixas foram encontradas entre as medidas para a saude geral (41,0), vitalidade (47,5), dor (51,0) e saude mental (56,4); as mulheres, exceto na funcao fisica, e os doentes com doencas autoimunes obtiveram piores escores em todas as dimensoes, quando comparados com os dados normativos. Os escores mais altos foram obtidos nas dimensoes: funcao fisica (69,1), funcionamento social (66,9) e funcao emocional (64,9). Viver com doencas cronicas imunologicas apresenta impacto sobre a QVRS e a versao Portuguesa do SF-36v2 fornece dados validos e confiaveis na mensuracao da QdV destes doentes.Health related quality of life (HRQL) and survival are two important outcome measures in chronic diseases. This study aimed to compared HRQL in patients with different chronic diseases of immune system and normative data from the general Portuguese Population. It was selected 103 out-patients, by convenience, to complete SF-36v2. The lowest scores were found among measures for general health (41.0), vitality (47.5), bodily pain (51.0), mental health (56.4); women, except for role-physical, and patients with auto-immune diseases have had the worse scores on all assessed dimension of subjective health, when compared with normative data. Highest scores were obtained in the following scales: physical functioning (69.1), social functioning (66.9), role-emotional (64.9). Living with chronic immune disease have impact on HRQL and it can be expected that the Portuguese version of SF-36v2 provide valid and reliable HRQL data.