Pedro Sá-Couto

Prevalence and impact of urinary incontinence among female athletes.

To assess the prevalence of urinary incontinence (UI) in a group of female athletes and to explore its impact on their lives.

Assessment and topographic characterization of locoregional recurrences in head and neck tumours.

PurposeTo evaluate the differences between three methods of classification of recurrences in patients with head and neck tumours treated with Radiation Therapy (RT).Materials and methods367 patients with head and neck tumours were included in the study. Tumour recurrences were delineated in the CT images taken during patient follow-up and deformable registration was used to transfer this volume into the planning CT. The methods used to classify recurrences were: method CTV quantified the intersection volume between the recurrence and the Clinical Target Volume (CTV); method TV quantified the intersection between the Treated Volume and the recurrence (for method CTV and TV, recurrences were classified in-field if more than 95% of their volume were inside the volume of interest, marginal if the intersection was between 20-95% and outfield otherwise); and method COM was based on the position of the Centre Of Mass of the recurrence. A dose assessment in the recurrence volume was also made.ResultsThe 2-year Kaplan-Meier locoregional recurrence incidence was 10%. Tumour recurrences occurred in 22 patients in a mean time of 16.5 ± 9.4 months resulting in 28 recurrence volumes. The percentage of in-field recurrences for methods CTV, TV and COM was 7%, 43% and 50%, respectively. Agreement between the three methods in characterizing individually in-field and marginal recurrences was found only in six cases. Methods CTV and COM agreed in 14. The percentage of outfield recurrences was 29% using all methods. For local recurrences (in-field or marginal to gross disease) the average difference between the prescribed dose and D98% in the recurrence volume was -5.2 ± 3.5% (range: -10.1%-0.9%).ConclusionsThe classification of in-field and marginal recurrences is very dependent on the method used to characterize recurrences. Using methods TV and COM the largest percentage of tumour recurrences occurred in-field in tissues irradiated with high doses.

Self-Reported Disability: Association With Lower Extremity Performance and Other Determinants in Older Adults Attending Primary Care

Background Measurement of function usually involves the use of both performance-based and self-report instruments. However, the relationship between both types of measures is not yet completely understood, in particular for older adults attending primary care. Objective The main objective of the study was to investigate the association between the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Short Physical Performance Battery (SPPB) for older adults at primary care. A secondary objective was to determine the influence of sociodemographic and health-related variables on this relationship. Design This was a cross-sectional study. Methods A total of 504 participants aged 60 years and older from 18 different primary care centers underwent a one-session assessment including: sociodemographic variables, comorbidities, performance, self-reported disability, pain, depressive symptoms, and physical activity. Performance was assessed using the SPPB, and self-reported disability was assessed using the WHODAS 2.0. Results The correlation between WHODAS 2.0 and SPPB scores was strong (r=.65). Regression analysis showed that the SPPB total score explained 41.7% of the variance in WHODAS 2.0 scores (adjusted R2=41.6%). A second model including the SPPB subtests (balance, gait, and sit-to-stand), depressive symptoms, number of pain sites, pain intensity, and level of physical activity explained 61.7% of the variance in WHODAS 2.0 scores (adjusted R2=60.4%). No model improvement was found when considering the 6 WHODAS 2.0 individual domains. Limitations The cross-sectional nature of the study does not allow inferences on causal relationships. Conclusions This studys findings confirm that self-report and performance-based measures relate to different aspects of functioning. Further study is needed to determine if primary care interventions targeting lower extremity performance and depressive symptoms improve self-reported disability.

A Model for Educational Simulation of Hemodynamic Transitions at Birth

Birth is characterized by swift and complex transitions in hemodynamic and respiratory variables. Unrecognized pathologies or incidents may quickly become fatal or cause permanent damage. This article introduces an essential component of an acute perinatal care simulator, namely a model for educational simulation of normal hemodynamic transitions seen during and shortly after birth. We explicitly formulate educational objectives and adapt a preexisting model for the simulation of neonatal cardiovascular physiology to include essential aspects of fetal hemodynamics. From the scientific literature, we obtain model parameters that characterize these aspects quantitatively. The fetal model is controlled by a time- and event-based script of changes occurring at birth, such as onset of breathing and cord clamping, and the transitory phase up to 24 h after birth. Comparison of simulation results with published target data confirms that realistic simulated hemodynamic vital signs are achieved.

Women's experiences of low back pain during pregnancy

OBJECTIVES This study investigated the self-reported prevalence and impact of low back pain (LBP) during pregnancy in primiparous and multiparous women, and their treatment-seeking rationales and experiences, including their use of physiotherapy. METHODS A sample of 105 post-partum women was recruited. All participants answered a questionnaire; women who experienced LBP during pregnancy (n=71) continue in the study and later they were also interviewed. Content analysis, descriptive and inferential statistics were used to analyse the data. RESULTS Reports of LBP were common (n=71; 67.6%) and slightly more frequent in primiparous (n=40; 56.3%) than multiparous (n=31; 43.7%) women. Multiparous women with LBP were significantly older (p< 0.001) and reported more sleep disturbances (p=0.026) than primiparous women with LBP. LBP prevented women performing their daily activities (n=41; 57.7%) and worsened with the advance of pregnancy (n=55; 77.5%), yet 93.0% (n=66) of these women received no treatment. CONCLUSION LBP is a prevalent and important clinical condition affecting the daily life of many pregnant women. Nevertheless, few women seek any treatment and physiotherapy is rarely considered. Given the significant impact on quality of life, health professionals need to be proactive in asking women about LBP.

Assessment of comatose patients: a Portuguese instrument based on the Coma Recovery Scale – Revised and using nursing standard terminology

AIMS To translate and adapt the Coma Recovery Scale - Revised to Portuguese using the ICNP® (International Classification of Nursing Practice) terminology and to determine if it can be administered reliably across examiners. BACKGROUND Assessment tools for the person in a coma can contribute to the planning, implementation and evaluation of care. It also strengthens the autonomy and responsibility of nurses, contributing to the safety, quality and satisfaction of those who deliver and receive care. This allows the sharing of information amongst healthcare professionals and supports decision-making within a multidisciplinary team. METHODS A convenience sample of 20 patients admitted to an intensive care unit constituted the study participants. The data were collected during 2009. The instrument was administered by the same two raters in all the patients on two consecutive days. The total and subscale score agreement was then examined, using inter-rater and test-retest analyses. The intercorrelation dependencies between the subscales were also analysed. RESULTS The results of the analyses suggest that the instrument can be used reliably, even when there are some patient fluctuations. The correlation of the subscale scores was high and better than the results presented for the original Coma Recovery Scale - Revised, indicating that this scale is a homogeneous measure of neurobehavioural function. CONCLUSION The new instrument can be administered reliably by trained examiners and produces a high degree of reproducibility in scores between raters over repeated assessments. We believe that assessment tools that can assess the communication ability of patients will be relevant to evaluating the continuity of care, and promote the effectiveness of care.

Cluster analysis in phenotyping a Portuguese population

BACKGROUND Unbiased cluster analysis using clinical parameters has identified asthma phenotypes. Adding inflammatory biomarkers to this analysis provided a better insight into the disease mechanisms. This approach has not yet been applied to asthmatic Portuguese patients. AIM To identify phenotypes of asthma using cluster analysis in a Portuguese asthmatic population treated in secondary medical care. METHODS Consecutive patients with asthma were recruited from the outpatient clinic. Patients were optimally treated according to GINA guidelines and enrolled in the study. Procedures were performed according to a standard evaluation of asthma. Phenotypes were identified by cluster analysis using Wards clustering method. RESULTS Of the 72 patients enrolled, 57 had full data and were included for cluster analysis. Distribution was set in 5 clusters described as follows: cluster (C) 1, early onset mild allergic asthma; C2, moderate allergic asthma, with long evolution, female prevalence and mixed inflammation; C3, allergic brittle asthma in young females with early disease onset and no evidence of inflammation; C4, severe asthma in obese females with late disease onset, highly symptomatic despite low Th2 inflammation; C5, severe asthma with chronic airflow obstruction, late disease onset and eosinophilic inflammation. CONCLUSIONS In our study population, the identified clusters were mainly coincident with other larger-scale cluster analysis. Variables such as age at disease onset, obesity, lung function, FeNO (Th2 biomarker) and disease severity were important for cluster distinction.

Identification of Seniors at Risk (ISAR) in the emergency room: A prospective study

INTRODUCTION The Identification of Seniors at Risk (ISAR) is one of the most frequently utilized risk screening tools in emergency departments (ED). The goal of this study was to evaluate the predictive validity of the ISAR screening tool for adverse outcomes in an ED. METHODS This was a prospective single-center observational study in a Portuguese urban university hospital ED, and included 402 older adults (OA). After triage, baseline sociodemographic and clinic data were collected by the researcher and the ISAR was administered. Baseline ISAR, adverse outcomes (ED revisits and hospital admission) at 30 (early) and 180 (late) days were evaluated. RESULTS ISAR screening showed that 308 (76.62%) OAs were at risk (cutoff≥2). High-risk patients were more like to be older, take more medication, have urgent or very urgent ED visits and have longer ED lengths of stay. The high-risk group were more likely to demonstrate both early (OR=2.43, 95% CI 1.35-4.35, p<0.01) and late returns to the ED (AO=1.70, 95% CI 1.04-2.79, p<0.05). The ISAR did not predict any significant variable for hospital admission in 30 or 180days. DISCUSSION The ISAR predicted returns to EDs at 30 and 180days for OAs at risk, but was unable to predict early or late hospital readmission.

Pain, pain intensity and pain disability in high school students are differently associated with physical activity, screening hours and sleep

BackgroundStudies exploring the association between physical activity, screen time and sleep and pain usually focus on a limited number of painful body sites. Nevertheless, pain at different body sites is likely to be of different nature. Therefore, this study aims to explore and compare the association between time spent in self-reported physical activity, in screen based activities and sleeping and i) pain presence in the last 7-days for 9 different body sites; ii) pain intensity at 9 different body sites and iii) global disability.MethodsNine hundred sixty nine students completed a questionnaire on pain, time spent in moderate and vigorous physical activity, screen based time watching TV/DVD, playing, using mobile phones and computers and sleeping hours. Univariate and multivariate associations between pain presence, pain intensity and disability and physical activity, screen based time and sleeping hours were investigated.ResultsPain presence: sleeping remained in the multivariable model for the neck, mid back, wrists, knees and ankles/feet (OR 1.17 to 2.11); moderate physical activity remained in the multivariate model for the neck, shoulders, wrists, hips and ankles/feet (OR 1.06 to 1.08); vigorous physical activity remained in the multivariate model for mid back, knees and ankles/feet (OR 1.05 to 1.09) and screen time remained in the multivariate model for the low back (OR = 2.34. Pain intensity: screen time and moderate physical activity remained in the multivariable model for pain intensity at the neck, mid back, low back, shoulder, knees and ankles/feet (Rp2 0.02 to 0.04) and at the wrists (Rp2 = 0.04), respectively. Disability showed no association with sleeping, screen time or physical activity.ConclusionsThis study suggests both similarities and differences in the patterns of association between time spent in physical activity, sleeping and in screen based activities and pain presence at 8 different body sites. In addition, they also suggest that the factors associated with the presence of pain, pain intensity and pain associated disability are different.

Validation of the Professional Issues Scales with Portuguese Nurses

The Professional Issues (PI) scales were designed to measure potential barriers that nurses perceive as obstacles to providing quality care to hospitalized older adults. This study involved validation of the PI scales among 1,068 Portuguese nurses and evaluated the influence of hospital and nurse characteristics on the perception of PI related to nursing care. A six-factor solution was obtained (i.e., staff/family/patient disagreement, perceived legal vulnerability, burden of upsetting behaviors, staff disagreement, perceived upsetting behaviors, use of geriatric services), with Cronbachs alpha coefficients ranging from 0.857 to 0.716. These factors were significantly associated with the following variables: sex, hospital type, hospital location, unit type, perceived institutional support for geriatric-specific education, perceived staff knowledge, and the burden of caring for older adults. The PI scales are reliable and valid for assessing the geriatric-related PI of nurses working in Portuguese hospitals and are useful for developing, planning, and implementing geriatric programs.