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- Adult asthma scores—development and validation of multivariable scores to identify asthma in surveysPublication . Sá-Sousa, Ana; Pereira, Ana Margarida; Almeida, Rute; Araújo, Luís; Couto, Mariana; Jacinto, Tiago; Freitas, Alberto; Bousquet, Jean; Fonseca, João A.One of the questions in epidemiology is the identification of adult asthma in studies. To develop and validate multivariable scores for adult asthma identification in epidemiological studies and to explore cutoffs to rule in/rule out asthma, compared with asthma diagnosed by a physician after clinical examination and diagnostic tests, blinded to the self-administered questions. We analyzed data (n = 711 adults) from a nationwide population-based study. The predictors were self-administered questions identified in a literature review (the Adult Asthma Epidemiological Score [A2 score]) and from the Global Allergy and Asthma Network of Excellence (GA2LEN) questionnaire (the GA2LEN Asthma Epidemiological Score [GA2LEN score]). Scores were developed using exploratory factor analysis. Internal consistency, discriminative power, and diagnostic accuracy were assessed. The A2 score comprises 8 questions (including “Did a physician confirm you had asthma?”) and the GA2LEN score comprises 6 questions (including “Have you ever had asthma?”). Both had high Cronbach α (0.89 and 0.85, respectively, for the A2 score and the GA2LEN score) and good area under the receiver-operating characteristic curve (90.4% and 89.0%). The scoring is the sum of positive answers. Asthma is present (rule in) for scores of 4 or more (specificity, 99.2%; PPV, 93.3% and 91.7%; accuracy, 89.4% and 87.4%, respectively, for the A2 score and the GA2LEN score). Asthma is excluded (rule out) for A2 scores of 0 to 1 and a GA2LEN score of 0 (sensitivity, 93.1%; NPV, 98.2% and 98.0%; accuracy 89.4% and 82.8%, respectively, for the A2 score and the GA2LEN score). These practical scores can be used to rule in/rule out asthma in epidemiological studies and clinical screening/triage settings. They may help physicians in primary care or other specialties to screen patients with asthma using a simple score with a high level of discrimination and to identify the best candidates to be referred for a diagnostic workup. Moreover, their use may contribute to reducing the inconsistencies of operational definitions of asthma across studies and surveys.
- A relação dos Sintomas do Trato Urinário Baixo com os achados Urodinâmicos na Doença de ParkinsonPublication . Rodrigues, Ana Catarina; Lopes, Ana; Jacinto, TiagoA Doença de Parkinson (PD) é uma doença neurodegenerativa que se manifesta através de distúrbios motores e autonómicos, sendo a disfunção da bexiga um dos mais frequentes. A disfunção da bexiga leva ao surgimento de sintomas do Trato Urinário Baixo (LUTS), sendo a prevalência de LUTS em pacientes com PD de 27-63%. A etiologia dos LUTS nesta patologia não está totalmente esclarecida, porém pensa-se que a redução de recetores dopaminérgicos leva a que os gânglios da base deixem de inibir o reflexo miccional, originando o surgimento de contrações involuntárias do detrusor. Relacionar os LUTS e os achados urodinâmicos apresentados por indivíduos com PD, seguidos na consulta externa de Urologia no Centro Hospital Universitário do Porto (CHUP). Estudar a influência do sexo, da idade e duração da doença nos LUTS e nos achados Urodinâmicos apresentados pelos indivíduos. Este estudo realizado com recurso à análise dos dados de 23 indivíduos com PD, obtidos após a realização do estudo Urodinâmico (EUD) no Serviço de Urologia do CHUP, presentes na base de dados do serviço. A disfunção urinária demonstrou afetar principalmente a fase de armazenamento, sendo o LUTS mais frequente a urgência urinária e o achado urodinâmico mais comum a diminuição da acomodação vesical. O sexo e a idade não demonstraram influência sobre os parâmetros estudados. O estudo permitiu reparar na importância da realização do EUD em indivíduos com PD, uma vez que possibilita a caracterização da disfunção urinária e consequentemente a aplicação de uma terapia adequada.
- Allergen sensitization associates with worse lung function parametersPublication . Gonçalves, I.; Pereira, A. M.; Jacinto, Tiago; Amaral, Rita; Fonseca, J. de Almeida Lopes daTo assess the association between the number of allergen sensitizations and lung function variables in individuals with airway symptoms. Methods. Retrospective study with all individuals who performed lung function and skin-prick tests at CUF-Porto (01/2011-06/2016). Six allergen groups were considered. % predicted Pre-Bronchodilator test (BD) and % change after BD were analysed for spirometry and plethysmography parameters. Results. A total of 1293 individuals were included, 54% (n = 698) adults and 69% (n = 891) with sensitization to ≥ 1 allergen group. % FEV1 was significantly higher and % change in FEV1 significantly lower in non-sensitized individuals. % sRaw was higher in polysensitized (vs non-sensitized). Conclusions. The presence of allergen sensitizations was significantly associated with worse key lung function parameters.
- The treatment of acute bronchiolitis: past, present and futurePublication . Petrarca, Laura; Jacinto, Tiago; Nenna, RaffaellaLower respiratory tract infections are a common cause of hospitalisation in infants. It is estimated that infants younger than 12 months with bronchiolitis account for 18% of all paediatric admission, representing a great burden to industrialised healthcare systems each winter. Bronchiolitis is defined as the first respiratory tract infection in infants younger than 12 months. Clinically, it can be manifested by cough, tachypnoea, apnoea, increased respiratory effort, fever, nasal congestion and rhinorrhoea. On chest auscultation, the key feature is diffuse bilateral inspiratory crackles. The most common virus detected in children with bronchiolitis is respiratory syncytial virus (RSV)
- What physical education teachers know about asthma: impact of a training coursePublication . Couto, M; Marques, J; Silva, D; Paiva, M; Jacinto, Tiago; Câmara, RGiven the current prevalence of asthma in developed countries, there are likely to be at least 2 or 3 asthmatic children in most classes. However, few teachers have received training on how to manage the disease. A previous study in Portugal showed teacher knowledge of asthma to be deficient.
- Measurement of respiratory function with a mobile application: comparison with a conventional spirometer and evaluation of usabilityPublication . Pinheiro, Catarina; Viana, Paulo; Amaral, Rita; Jacinto, TiagoMobile apps can improve home measurements of pulmonary function via built-in phone sensors, (e.g. microphone). This could promote greater access to health interventions for patients with respiratory diseases, reducing the need of face-to-face visits..
- Influência do consumo adicional de sal na qualidade do sonoPublication . Gomes, Maria Luísa; Freitas, Mónica; Jacinto, TiagoO sono é um estado neurológico complexo controlado pelo relógio circadiano, homeostase sono-vigília e comportamento voluntário, cuja função principal é proporcionar descanso e restaurar os níveis de energia do corpo. Evidências mostram que o sono influencia as escolhas alimentares, contudo pouco se sabe sobre o impacto da dieta e dos nutrientes no sono. Relativamente ao sal, este encontra-se associado à maior dificuldade na manutenção do sono e a sua maior ingestão está relacionada com os sintomas associados à má qualidade do sono. Avaliar se o consumo adicional de sal ao jantar tem influência na qualidade do sono. Os participantes realizaram um estudo experimental longitudinal dividido em duas fases: de controlo em que consumiram a quantidade de sal habitual e de intervenção em que consumiram ao jantar uma quantidade de sal adicional, correspondente a 0,05g/kg do peso corporal. No último dia de cada fase, foi aplicado o índice de qualidade do sono de Pittsburgh na versão portuguesa (PSQI-PT) para avaliação da qualidade do sono. Foi constatada uma diferença estatisticamente significativa na pontuação total do PSQI-PT (p=0.039) entre as duas fases, contudo não foram obtidas diferenças estatisticamente significativas nas variáveis correspondentes às suas questões individuais. Verificou-se uma diminuição na qualidade do sono na amostra deste estudo após a ingestão da quantidade adicional de sal, contudo não é possível deduzir estes dados para a população no geral, uma vez que a dimensão da amostra é pequena e tem limitações, vieses e fatores externos associados.
- Identification of asthma phenotypes in the US general population: A latent class analysis approachPublication . Amaral, Rita; Pereira, Ana M; Jacinto, Tiago; Malinovsch, A; Janson, C; Alving, K; Fonseca, J. A.Combining clinical and physiological data from adults with asthma by means of unsupervised classification methods could provide a better taxonomy among the general asthma population. Therefore, we aimed to identify distinct phenotypes using latent class analysis (LCA), in adults with current asthma from the general population.
- Does lung microbiome play a causal or casual role in asthma?Publication . Di Cicco, Maria; Pistello, Mauro; Jacinto, Tiago; Ragazzo, Vincenzo; Piras, Martina; Freer, Giulia; Pifferi, Massimo; Peroni, DiegoAsthma is the most common chronic disease in childhood. The pathogenesis of asthma is multifactorial and is thought to include environmental factors interacting with genetics during pregnancy and in the first years of life. In the last decades, a possible role of gut microbiota in allergic disease pathogenesis has been demonstrated. Next generation sequencing techniques have allowed the identification of a distinct microbiome in the healthy lungs. The lung microbiome is characterized by the prevalence of bacteria belonging to the phylum Bacteroidetes (mostly Prevotella and Veilonella spp) in healthy subjects and to the phylum Proteobacteria in asthmatics (mostly Haemophilus, Moraxella, and Neisseria spp). In asthma, as well as in other diseases, the lung microbiome composition changes due to a disruption of the delicate balance between immigration and elimination of bacteria. The lung microbiome can interact with the immune system, thus influencing inflammation. Early infections with viruses, such as respiratory syncytial virus, may alter lung microbiome composition favoring the emergence of Proteobacteria, a phylum which is also linked to severity of asthma and bronchial hyperreactivity. Lastly, antibiotics may alter the gut and lung microbiota and potentially disturb the relationship between microbiota and host. Therefore, antibiotics should be prescribed with increasing awareness of their potential harmful effect on the microbiota in young children with and without asthma. The potential effects of probiotics and prebiotics on lung microbiome are unknown.
- Where do we stand with asthma phenotypes derived from data-driven methods? A systematic reviewPublication . Amaral, Rita; Jacinto, Tiago; Sousa-Pinto, Bernardo; Fonseca, JoãoAsthma phenotypes can be refined using methods without a priori assumptions (data-driven). We aimed to describe asthma phenotypes derived with data-driven methods, using variables easily measurable in a clinical setting, and to summarize their consistency.