Lia Fernandes

Validation of a questionnaire (CARAT10) to assess rhinitis and asthma in patients with asthma

To cite this article: Fonseca JA, Nogueira‐Silva L, Morais‐Almeida M, Azevedo L, Sa‐Sousa A, Branco‐Ferreira M, Fernandes L, Bousquet J. Validation of a questionnaire (CARAT10) to assess rhinitis and asthma in patients with asthma. Allergy 2010; 65: 1042–1048.

Delirium in elderly people: a review

The present review aims to highlight this intricate syndrome, regarding diagnosis, pathophysiology, etiology, prevention, and management in elderly people. The diagnosis of delirium is based on clinical observations, cognitive assessment, physical, and neurological examination. Clinically, delirium occurs in hyperactive, hypoactive, or mixed forms, based on psychomotor behavior. As an acute confusional state, it is characterized by a rapid onset of symptoms, fluctuating course and an altered level of consciousness, global disturbance of cognition or perceptual abnormalities, and evidence of a physical cause. Although pathophysiological mechanisms of delirium remain unclear, current evidence suggests that disruption of neurotransmission, inflammation, or acute stress responses might all contribute to the development of this ailment. It usually occurs as a result of a complex interaction of multiple risk factors, such as cognitive impairment/dementia and current medical or surgical disorder. Despite all of the above, delirium is frequently under-recognized and often misdiagnosed by health professionals. In particular, this happens due to its fluctuating nature, its overlap with dementia and the scarcity of routine formal cognitive assessment in general hospitals. It is also associated with multiple adverse outcomes that have been well documented, such as increased hospital stay, function/cognitive decline, institutionalization and mortality. In this context, the early identification of delirium is essential. Timely and optimal management of people with delirium should be performed with identification of any possible underlying causes, dealing with a suitable care environment and improving education of health professionals. All these can be important factors, which contribute to a decrease in adverse outcomes associated with delirium.

Association of anxiety with asthma: subjective and objective outcome measures.

Background The relationship between anxiety and asthma is currently being intensively studied. Objective The authors examined anxiety that influences and is influenced by this complex disease. Method The authors conducted a cross-sectional study of adults with asthma at a hospital outpatient department, excluding known psychiatric patients. A sample of 195 patients, mostly middle-aged women with moderate/severe asthma, underwent pulmonary function and airway-inflammation tests and were given anxiety rating questionnaires. Results A high level of anxiety was present in 70% of the patients. Anxiety was associated with worse subjective asthma outcomes and increased use of medication/healthcare services, but with decreased airway inflammation, and was not associated with lung function. Conclusion Anxiety seems to influence patients’ perception/awareness of asthma symptoms.

Asthma patients are willing to use mobile and web technologies to support self‐management

Practical problems and patients or doctors low compliance has been hampering a wider use of self-management in asthma. Mobile or web technologies for supporting selfmanagement may improve patient–doctor communication and patient self-efficacy (1, 2). Furthermore, recent evidence suggests that interactive Internet-based asthma monitoring improves asthma control (3). However, patients may not be willing to use a web asthma diary for more than short periods, possibly because it does not fit into their everyday lives (4). The use of mobile phones has been suggested to overcome this problem (4, 5), but, to our knowledge, no data are available on the willingness of patients to use mobile phones, and very few data have been reported on their willingness to use the web for asthma self-management (6). In the framework of a running randomized controlled trial on psycho-educational interventions in asthma, 74 adults with moderate to severe asthma were randomly allocated to fill a symptoms diary for 1 month. Of these, 37 dropped-out of the trial and the remaining 47 (63%) completed a self-administered questionnaire about asthma monitoring. These two groups did not differ significantly regarding age, education, socio-economic status, and asthma severity. Approximately one-third was younger than 31 years and half was older than 40 years; 84% were female; nearly 70% had low socio-economic background (class IV and V) and 44% had 5 or fewer years of formal education. FEV1 predicted % was below 80% in 53%, while 64% were treated with high-dose inhaled steroids. During the previous year, 56% had at least one exacerbation requiring oral steroids and one in five was admitted to a hospital because of their asthma. Only 28% had ever self-monitored asthma before entering the study. However, none of the patients referred unwillingness to monitor their asthma in the future, and 56% of them were strongly in favor to its use; furthermore, one-third of patients were happy to monitor their symptoms daily, whereas another third preferred to do it less than once a week. Also, one in five considered it was easy to forget to register symptoms in the paper diary, and all patients considered it to help them better understand their disease. The proportions of referred willingness to use mobile or web technologies to support self-management are described in Table 1. There were no significant associations between willingness to use mobile or web technologies and patient’s sex, age, education level, socio-economic status, tobacco usage, other chronic diseases, and duration and severity of asthma. Caution is needed in the generalization of these results as the patients who were studied were mostly middle-aged women with low education, and low socio-economic background, who had moderate to severe asthma followed at secondary care. Nevertheless, a large majority of patients seem willing and ready to use communication technologies such as mobile phones and the Web to help them manage their asthma. Are the doctors and the health administrators also ready to test the effectiveness of this AL LERGY 2 0 0 6 : 6 1 : 3 8 9 – 3 9 5 • COPYR IGHT a 2006 BLACKWELL MUNKSGAARD • ALL R IGHTS RESERVED • CONTRIBUT IONS TO THIS SECT ION WILL NOT UNDERGO PEER REVIEW, BUT WILL BE REV IEWED BY THE ASSOCIATE EDITORS •

Portuguese version of the Tilburg Frailty Indicator: Transcultural adaptation and psychometric validation.

To present the translation and validation process of the Portuguese version of the Tilburg Frailty Indicator (TFI).

Determinants of frailty: the added value of assessing medication

This study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (±7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (0–4 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8, 25.3, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of daily-consumed drugs was independently associated with physical frailty, and the consumption of medication for the cardiovascular system and for the blood and blood-forming organs explained part of the variance of total and physical frailty. The adverse effects of polymedication and its direct link with the level of comorbidities could explain the independent contribution of the amount of prescribed drugs to frailty prediction. On the other hand, findings in regard to medication type provide further evidence of the association of frailty with cardiovascular risk. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains highlight the relevance of the integral model of frailty. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty.

Suicidal ideation, depression and quality of life in the elderly: study in a gerontopsychiatric consultation

The global increase in elderly population all over the world, especially in Portugal, justifies the importance of mental health study in this age group. The aim of this study was to characterize the elderly patients in Gerontopsychiatry Consultation of Centro Hospitalar São João in Porto, related to socio-demographic aspects, physical and global disabilities, depression, suicidal ideation and quality of life, and to explore the association between suicidal ideation, depression, and quality of life and global and functional disability. In this cross-sectional study, 155 patients were recruited consecutively, with a final sample of 75 subjects (59 women and 16 men) without cognitive deficits and a mean age of 72.8 (SD = 6.04). Concerning the depression level measured with the Geriatric Depression Scale (Barreto et al., 2008) it was found that 66.7% presented severe depression and suicidal ideation (M = 41.96, SD = 36.38), a value considered with a potential risk of suicide using the Suicidal Ideation Questionnaire (Ferreira & Castela, 1999). The elderly also perceived their quality of life as low, revealing global disability assessed with the EasyCare- Elderly Assessment (Sousa & Figueiredo, 2000a). A significant positive correlation was also found between depression and suicidal ideation (rs =.71, p < .001), as well as quality of life (rs = .50, p < .001), and suicidal ideation with quality of life (rs = .40, p < .001). The data obtained in this study corroborate the results found in other studies.

The needs of older people with mental health problems: a particular focus on dementia patients and their carers.

The problems and needs of older people are often associated with mental illness, characterized by a set of clinical manifestations, which constitute important domains for investigation and clinical practice. This paper presents the results of a pilot study whose main purpose was to identify met and unmet needs and to analyze the relationship between those needs, psychopathology and functionality in older people with mental health problems. A sample of 75 patients aged 65 or over, of both sexes, diagnosed with mental illness using ICD-9. The main diagnoses were depression (36%) and dementia (29.3%). Most patients had cognitive impairment (MMSE, 52%; CDT, 66.7%), depression (GDS, 61.3%), anxiety (ZAS, 81.3%), and moderate dependence (BI, 49.3% and LI, 77.3%). The main unmet needs found were daytime activities (40%), social benefits (13.3%), company (10.7%), psychological distress (9.3%), and continence (8%). The majority of these unmet needs occur with dementia patients. The majority of the carers of these patients had global needs (met and unmet) in terms of psychological distress. Findings also reveal that a low level of functionality is associated with dementia diagnoses. The association analyses suggest that dementia is an important determinant of the functional status and needs.

Bipolar disorder: clinical perspectives and implications with cognitive dysfunction and dementia.

Introduction. Cognitive dysfunction as a core feature in the course of bipolar affective disorder (BPD) is a current subject of debate and represents an important source of psychosocial and functional burden. Objectives. To stand out the connection and clinical implications between cognitive dysfunction, dementia, and BPD. Methods. A nonsystematic review of all English language PubMed articles published between 1995 and 2011 using the terms “bipolar disorder,” “cognitive dysfunction,” and “dementia”. Discussion. As a manifestation of an affective trait or stage, both in the acute phases and in remission, the domains affected include attention, executive function, and verbal memory. The likely evolution or overlap with the behavioural symptoms of an organic dementia allows it to be considered as a dementia specific to BPD. This is named by some authors, as BPD type VI, but others consider it a form of frontotemporal dementia. It is still not known if this process is neurodevelopmental or neurodegenerative in nature, or both simultaneously. The assessment should consider the iatrogenic effects of medication, the affective symptoms, and a neurocognitive evaluation. Conclusion. More specific neuropsychological tests and functional imaging studies are needed and will assume an important role in the near future for diagnosis and treatment.

Frailty as a predictor of short-term adverse outcomes.

The objectives of this study were to compare how different frailty measures (Frailty Phenotype/FP, Groningen Frailty Indicator/GFI and Tilburg Frailty Indicator/TFI) predict short-term adverse outcomes. Secondarily, adopting a multidimensional approach to frailty (integral conceptual model–TFI), this study aims to compare how physical, psychological and social frailty predict the outcomes. A longitudinal study was carried out with 95 community-dwelling elderly. Participants were assessed at baseline for frailty, determinants of frailty, and adverse outcomes (healthcare utilization, quality of life, disability in basic and instrumental activities of daily living/ADL and IADL). Ten months later the outcomes were assessed again. Frailty was associated with specific healthcare utilization indicators: the FP with a greater utilization of informal care; GFI with an increased contact with healthcare professionals; and TFI with a higher amount of contacts with a general practitioner. After controlling for the effect of life-course determinants, comorbidity and adverse outcome at baseline, GFI predicted IADL disability and TFI predicted quality of life. The effect of the FP on the outcomes was not significant, when compared with the other measures. However, when comparing TFI’s domains, the physical domain was the most significant predictor of the outcomes, even explaining part of the variance of ADL disability. Frailty at baseline was associated with adverse outcomes at follow-up. However, the relationship of each frailty measure (FP, GFI and TFI) with the outcomes was different. In spite of the role of psychological frailty, TFI’s physical domain was the determinant factor for predicting disability and most of the quality of life.