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- Prevalence and risk factors for food allergy in older people: protocol for a systematic reviewPublication . Dias, Inês Laia; Lozoya-Ibáñez, Carlos; Skypala, Isabel; Gama, Jorge; Nurmatov, Ulugbek; Lourenço, Olga; Barata, Luis TabordaStudies suggest that the prevalence of food allergy may be increasing worldwide. Results regarding the prevalence and features of adverse food reactions older people have, however, scarcely been analysed in the literature. Thus, the objective of the present systematic review will be to describe the prevalence of food allergy in older individuals, its risk factors, clinical features, as well as the most frequently and commonly involved foods.
- Inhaler training and asthma knowledge are associated with a higher proportion of patients with correct inhaler technique in young but not in elderly asthmatic patientsPublication . Ferreira, Eduardo Freitas; Pascoal, Adriana dos Santos; Silva, Patrícia; Lourenço, Olga; Valente, Maria La Salete; Valente, Maria de Jesus; Loureiro, Marli; Gama, Jorge; Fonseca, Joao A; Taborda Barata, LuisObjective: Incorrect inhaler usage is frequent, particularly in elderly asthmatic patients. This study aimed at comparing inhaler technique errors and their determinants, as well inhaler technique self-perception versus real performance, between elderly and non-elderly asthmatics. Methods: Cross-sectional assessment of 92 elderly and 100 non-elderly asthmatics followed at specialty clinics. A standardized questionnaire was applied and inhaler technique demonstration was requested. Errors were assessed using checklists based on manufacturers’ instructions and inhaler technique was graded as correct, acceptable or incorrect. Chi-Square Test and Fischer’s Exact Test were used for comparative analysis of nominal variables. A p value equal to or less than 0.05 was considered statistically significant. Results: Inhaler technique was correct in a minority of elderly and young patients, without significant differences between study groups. Only 11.1% of the elderly who classified their inhaler as easy and 12.7% who stated their technique was correct had no errors. Previous regular inhaler training was associated with better actual performance in young but not in elderly patients. Conclusion: Our study showed that in spite of regular follow up at specialized outpatient clinics, inhaler devices are associated with a high frequency of errors in elderly and non-elderly asthmatics. In addition, most patients tend to overestimate their technique as correct. Finally, previous, frequent training was associated with a significantly higher percentage of patients showing correct or acceptable technique but only in non-elderly asthmatics, which suggests that elderly asthmatics may need specifically tailored inhaler education programs.
- Ventilação Não Invasiva: Experiência de um Serviço de Medicina InternaPublication . Costa, José Coutinho; Machado, João Neiva; Costa, Joana; Fortuna, Jorge; Gama, Jorge; Rodrigues, CidáliaIntrodução: A ventilação não invasiva (VNI) é uma forma de suporte ventilatório não invasivo, com benefícios comprovados em diversas patologias. O objetivo foi avaliar as indicações da VNI em doentes com insuficiência respiratória e identificar fatores preditivos da resposta à VNI. Material e Métodos: Análise retrospetiva dos processos clínicos de doentes submetidos a VNI, internados no Serviço de Medicina, entre Janeiro e Dezembro de 2014. Resultados: Incluídos 54 doentes, com idade média de 82,2 anos (± 8,4). Quarenta e quatro doentes apresentavam patologias que são consideradas indicações, com níveis de evidência estabelecida, para utilização de VNI: 33 (75,0%) tinham insuficiência cardíaca descompensada, cinco (11,4%) exacerbação aguda da doença pulmonar obstrutiva crónica, quatro (9,1%) síndrome de obesidade-hipoventilação e dois (4,5%) pneumonia no imunocomprometido. A taxa de falência foi 20,5%. Nos restantes doentes, a VNI foi utilizada na pneumonia no imunocompetente, choque séptico e intoxicação por benzodiazepinas. A taxa de falência foi 70,0%. Verificou-se uma melhoria estatisticamente significativa nos parâmetros gasométricos duas horas após a VNI nos doentes com patologia com níveis de evidência estabelecida para VNI e nos doentes em que não houve falência desta modalidade ventilatória. Conclusão: Na nossa amostra a taxa falência da VNI foi bastante inferior nos doentes que cumpriam as indicações formais para a VNI. Assim, apesar da crescente utilização da VNI, a seleção criteriosa dos doentes constitui uma etapa essencial para o seu sucesso. O melhor preditor do sucesso da VNI foi a boa resposta após 1 a 2 horas de terapêutica.
- Prevalence of asthma, allergic rhinitis and eczema in 6–7-year-old schoolchildren from Luanda, AngolaPublication . Arrais, Margarete; Lulua, Ofélia M.; Quifica, Francisca G.S.; Pinto, José Rosado; Gama, Jorge; Barata, Luis TabordaBackground: Epidemiological data have shown that the prevalence of asthma, rhinoconjunctivitis and eczema in children is still increasing, namely in Africa. However, there are no epidemiological studies on asthma or allergic diseases in Angolan children. Objective: To study the prevalence of asthma and other allergic diseases in Angolan children. Methods: Descriptive, observational, cross-sectional study, using the ISAAC study methodology, in the province of Luanda, Angola in 6-7-yearold children. Forty-six (8.3%) public schools were randomly selected. Data were analysed using the SPSS Statistics version 24.0 software. Results: A total of 3080 children were studied. Results showed that the prevalence of asthma (wheezing in the previous 12 months) was 15.8%, that of rhinitis (sneezing, runny or blocked nose in the previous 12 months) was 19% and that of eczema (itchy skin lesions in the previous 12 months) was 22%, without differences between sexes. Rhinitis was associated with a higher number of episodes of wheezing episodes, disturbed sleep and night cough, in children with asthma. Rhinitis, eczema, Split-type air conditioning system, antibiotic intake in the child's first year of life, frequent intake (more than once per month) of paracetamol and active maternal smoking were associated with a higher risk of having asthma, whereas electrical cooking was associated with a protective effect. Conclusion: Asthma and allergic diseases are highly prevalent in children from Luanda. A strategy for preventive and control measures should be implemented.
- Prevalence of asthma and allergies in 13–14-year-old adolescents from Luanda, AngolaPublication . Arrais, Margarete; Lulua, O.; Quifica, F.; Pinto, J. Rosado; Gama, Jorge; Barata, Luis TabordaSETTING: The few epidemiological studies on asthma and allergic diseases performed in Africa have shown that the prevalence of these diseases is high or increasing. No such studies have been performed in Angola. OBJECTIVE : To determine the prevalence of asthma and other allergic diseases in Angolan adolescents. DESIGN: This was a descriptive, observational, crosssectional study in the province of Luanda, Angola, using the International Study of Asthma and Allergies in Childhood study methodology in adolescents aged 13 and 14 years. Twenty-three (12%) public schools were randomly selected. Data were analysed using the Statistical Package for the Social Sciences version 22.0 software. RESULTS : A total of 3128 adolescents were included. The prevalence of asthma (wheezing in the previous 12 months) was 13.4%. The prevalence of rhinitis (sneezing, runny or blocked nose in the previous 12 months) was 27% and that of eczema (itchy skin lesions in the previous 12 months) was 20%; both were more prevalent in girls. Rhinitis was associated with a greater number of episodes of night cough in adolescents with asthma. Rhinitis and eczema, a split-type air conditioning system, and frequent intake (more than once per month) of paracetamol were associated with a higher risk of having asthma. CONCLUSION: Asthma and related allergic diseases are a public health problem in adolescents from Luanda. Preventive and control measures should be implemented.
- β2-adrenergic agonists and doping: Where do we stand?Publication . Lourenço, Olga; Cardoso, Ana Carolina Coelho; Mónico, Beatriz; Gama, Jorge M R; Neiva, H.P.; Marinho, DanielHostrup et al1 kindly commented on our previous paper related to the enhancement of physical performance by β2-agonists.2 First, we would like to thank the authors for their review and acknowledge that our title and conclusions may have been misleading because, in fact, they only refer to endurance/aerobic-dominated performances [...]
- Tobacco smoke as a risk factor for allergic sensitization in adultsPublication . Mónico, Beatriz; Gama, Jorge; Pastorinho, M. Ramiro; Lourenço, OlgaAllergic sensitization to aeroallergens is a common phenomenon and a crucial step in the development of allergic diseases. Nonetheless, the influence of tobacco smoke exposure on the development of allergic sensitization in adults is quite complex and not totally understood. [...]
- Validation of NoSAS (Neck, Obesity, Snoring, Age, Sex) score as a screening tool for obstructive sleep apnea: Analysis in a sleep clinicPublication . Coutinho Costa, J.; Rebelo-Marques, A.; Machado, João Neiva; Gama, Jorge; Santos, C.; Teixeira, F.; Moita, J.Screening methods have become increasingly important due to the growing number of patients suspected of having obstructive sleep apnea (OSA) being referred to sleep clinics. The Lausanne NoSAS (Neck circumference, Obesity, Snoring, Age, Sex) score test is a simple, efficient, and easily employed tool enabling identification of individuals at risk for the disease. The score ranges from 0 to 17 and the patient has a high probability of OSA if they have a NoSAS score of 8 or higher.
- Sulfite concentration and the occurrence of headache in young adults: a prospective studyPublication . Silva, Miguel; Gama, Jorge; Pinto, Nuno; Pivi, Glaucia; Brancal, Hugo Gonçalo Monteiro Silva Aguiar; Carvalho, Lurdes; Loureiro, Virgilio; Patto, Maria Da Assunção VazBackground/objectives: Sulfites are additives commonly used in food and wine industries that are associated to adverse clinical effects such as headaches. The objective of this study is to investigate the possible association between sulfite concentration in wine and the occurrence of headaches in young adults. Subjects/methods: Eighty volunteers, aged between 18 and 25 years, were evaluated. Sub-groups (with or without previous headaches related with wine) were created and volunteers were submitted to two wine tests (minimum and maximum sulfite concentration accordingly to weight). A questionnaire was handed out after the test regarding the presence or not of headaches, their main characteristics, as well as other symptoms associated. Results: Subjects that refer a previous headache history upon wine ingestion presented a risk 2266 greater of developing headaches after wine ingestion with a greater sulfite concentration. Those that refer constant headaches related to wine ingestion previous to the test present a risk of 6232 times more of developing headaches compared to those who refer sporadic headaches related to wine consumption. Conclusions: In our group of subjects, sulfite concentration in wine is related to the risk of developing headaches in individuals who are susceptible to wine induced headaches.
- Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or Chronic Obstructive Pulmonary Disease: A Meta-AnalysisPublication . Maricoto, Tiago; Monteiro, Luís; Gama, Jorge; Sousa, Jaime Correia de; Barata, Luis TabordaOBJECTIVES: To evaluate the effect of inhaler education programs on clinical outcomes and exacerbation rates in older adults with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Older adults with asthma or COPD, either in primary or secondary health care and pharmacy setting. MEASUREMENTS: We searched the Medline, Embase, and Central databases according to the main eligibility criteria for inclusion: systematic reviews, meta-analysis, clinical trials and quasi-experimental studies; participants aged 65 and older; education on inhaler technique and reporting of disease control and exacerbation rates. We used the Grading of Recommendations, Assessment, Development and Evaluations scale for quality assessment and used a random-effect model with Mantel–Haenszel adjustment to perform a meta-analysis. RESULTS: We included 8 studies (4 randomized, 4 quasiexperimental) with a total of 1,812 participants. The most frequent type of intervention was physical demonstration of inhaler technique, training with placebo devices. Five studies showed significant reduction in exacerbation rates (pooled risk ratio=0.71, 95% confidence interval=0.59–0.86; p < .001), although effect on disease control and quality of life showed high discrepancy in the reported results, and all randomized studies revealed uncertainty in their risk of bias assessment. CONCLUSION: All interventions seemed to improve inhaler performance and clinically relevant outcomes, but a placebo device could be the most effective. There is evidence that interventions reduce exacerbation risk in older adults, although to an overall moderate degree.