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INTRODUCTION: Supported accommodations (SAs) are key components of community mental health care, but little is known about residents' care pathways. This study analysed the care pathways of residents of SAs, and factors associated with their age of entry and length of stay. METHODS: A random sample of SAs' residents in Portugal was interviewed and a questionnaire was specifically developed to assess their care pathways. Associations between sociodemographic and clinical characteristics, age of entry and length of stay, were analysed using hierarchical regression. RESULTS: Overall, 213 residents of 43 different SAs participated. Their mean age was 55 years. Most were male, single, pensioners and had early-onset psychotic disorders. On average, they integrated the current SA at around 50 years old and had a 4.5 year length of stay. Most participants had been in another SA before (35.0% in more supported, 33.8% in less supported and 6.3% in similarly supported SAs). CONCLUSIONS: Findings suggest that residents spend several years in the residential pathway, with a significant proportion moving to more supported SAs. This calls for increasing the number of SAs with different typologies and developing coordinated community supports.
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The subjective experience of coercion may have a more significant impact on clinical outcomes than formal coercive measures. This study aimed to investigate the subjective experience of coercion among patients on admission in Portuguese psychiatric departments by assessing their perceived coercion, procedural justice, and negative pressures during admission. The study also investigated whether this subjective experience of coercion changed with time during admission, and the predictors of this change. Validated instruments, including the McArthur Admission Experience Survey (AES) and the Client Assessment of Treatment Scale, were used to collect information from 208 adults admitted to five public psychiatric inpatient departments in rural and urban regions of Portugal. About a third (32.24%, n = 49) of the sample had a legal involuntary admission status, while more than a third of them perceived their admission to be involuntary (40.13%, n = 61). The subjective experience of coercion was significantly higher among people who perceived their admission to be involuntary compared to people who perceived their admission to be voluntary (Median = 10, IQR = 5.5 vs. Median = 3, IQR = 6; p < 0.001). Satisfaction with their care was significantly inversely correlated with the subjective experience of coercion (p < 0.01). The changes in the subjective experience of coercion at the second assessment were predicted by the perceived admission status rather than the legal admission status, and the initial procedural justice (p < 0.05). The study findings highlight the importance of improving procedural justice in psychiatric admissions, regardless of the legal status of admission.
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The aim of this article is to study mental health conditions among survivors of severe physical intimate partner violence (IPV) and their utilisation of mental health services. This study is an integrated part of the World Mental Health Survey Initiative-Portugal, for which data was collected from a nationally representative adult sample using well-validated scales. Logistic regression models were used in the analysis. The most common statistically significant mental health conditions among IPV survivors were suicide ideation, PTSD, major depressive episode, and generalised anxiety disorder. More than one in three survivors developed PTSD. Suicide ideation was likely to occur after first experiencing IPV. Almost a half of survivors received specialised mental health treatment; in most cases, delivered by a psychiatrist. Over 60 % addressed their mental health issues consulting general physicians or other healthcare professionals. Those who experienced family violence in childhood had greater odds of also experiencing IPV; survivors of IPV with this experience were more likely to receive mental health treatment. The need to promote greater awareness and competencies of not only mental health professionals but also of general physicians and other healthcare professionals to provide support more effectively to survivors of any type of IPV deserves to be emphasised.
Assuntos
Transtorno Depressivo Maior , Violência por Parceiro Íntimo , Serviços de Saúde Mental , Adulto , Humanos , Saúde Mental , Portugal/epidemiologia , Violência por Parceiro Íntimo/psicologia , Inquéritos Epidemiológicos , Sobreviventes/psicologia , Organização Mundial da SaúdeRESUMO
BACKGROUND: Lithuania has one of the highest averages in the European Union when it comes to psychological and/or economic intimate partner violence (PE-IPV). IPV survivors are several times more likely to have mental health conditions than those without IPV experiences. The aim of this article is to study the prevalence, characteristics and attitudes of PE-IPV survivors in Lithuania, and the predictors of them accessing mental health services. METHODS: A cross-sectional study based on a national survey representative of the adult population. The survey was implemented by a third-party independent market research company employing an online survey panel. Logistic regression models were used in the analysis. RESULTS: Almost 50% of women in Lithuania experience PE-IPV. Females are significantly more likely to experience it than males. The vast majority of women find PE-IPV unacceptable; however, only one-third of survivors seek any type of help. Only one-tenth approach mental health services, with divorcees being at higher odds of doing so. CONCLUSIONS: Further research is needed to explore predictors and contextual factors of why IPV survivors seek mental healthcare, or not. Policy implications include the need to eliminate IPV and mental health stigma; develop accessible mental health services and effective treatment approaches.
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Violência por Parceiro Íntimo , Serviços de Saúde Mental , Sobreviventes , Humanos , Lituânia/epidemiologia , Feminino , Adulto , Estudos Transversais , Violência por Parceiro Íntimo/psicologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Prevalência , Pessoa de Meia-Idade , Sobreviventes/psicologia , Sobreviventes/estatística & dados numéricos , Adulto Jovem , Adolescente , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Inquéritos e Questionários , IdosoRESUMO
Cultural factors play a significant role in shaping the perception of coercion during psychiatric admissions. The present study aimed to assess the psychometric properties of the Portuguese Admission Experience Survey(P-AES). The study employed a cross-sectional approach in five psychiatric departments in three regions of Portugal. A total of 208 patients participated in the survey. Reliability was assessed through internal consistency and test-retest procedures. Internal validity was analyzed using a two-parameter logistic item response model, exploring three models, including a bifactor model. Convergent validity was determined by correlating AES scores with the Coercion Ladder (CL), Client Assessment of Satisfaction (CAT), and Global Assessment of Functioning (GAF) scale. Discriminatory power was assessed by comparing scores between patients with voluntary and involuntary admission status. The P-AES demonstrated satisfactory internal consistency and test-retest reliability. The bifactor model exhibited superior fit compared to the one-factor and three-factor models. Correlations between P-AES and CL, as well as CAT scores, indicated good convergent validity. Additionally, P-AES scores were notably higher in patients with compulsory psychiatric hospital admission compared to those admitted voluntarily, confirming its discriminatory power. The bifactor model suggests that all three domains of the AES should be used to measure the subjective experience of coercion.
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Acute pancreatitis (AP) is an increasingly frequent disease in which inflammation plays a crucial role. Fifty patients hospitalized with AP were included and peripheral blood samples were analyzed for B and T cell subpopulations at the time of hospitalization and 48 h after diagnosis. The Bedside Index of Severity in Acute Pancreatitis (BISAP) and length of hospital stay were also recorded. A healthy control (HC) group of 15 outpatients was included. AP patients showed higher neutrophil/lymphocyte (N/L) ratios and higher percentages of B cells than the HC group. The total B cell percentages were higher in patients with moderate/severe AP than in patients with mild AP. The percentages of B cells as well as the percentages of the CD27-IgD- B cell subset decreased from admission to 48 h after admission. The patients with higher BISAP scores showed lower percentages of peripheral lymphocytes but higher percentages of CD27-IgD- B cells. Higher BISAP scores, N/L ratios, and peripheral blood B cell levels emerged as predictors of hospital stay length in AP patients. Our findings underscore the importance of early markers for disease severity. Additionally, the N/L ratio along with the BISAP score and circulating B cell levels form a robust predictive model for hospital stay duration of AP patients.
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Background: Patients with chronic kidney disease (CKD) present a higher risk of cardiovascular (CV) morbidity and mortality compared with the general population. While there are several well-established traditional CV risk factors, few studies have addressed novel potential risk factors such as α-Klotho, asymmetric dimethylarginine (ADMA) and lean mass. Methods: This was an observational, prospective, single-center, cohort study that included prevalent hemodialysis (online hemodiafiltration) adult patients. By univariate logistic regression models, univariate and multivariate Cox proportional hazards models, and Kaplan-Meier analysis, we evaluated the association between the levels of α-Klotho, ADMA and lean mass, with the risk of peripheral vascular disease (PVD), CV events and all-cause mortality in these patients. Results: A total of 200 HD patients was included. We found that increased levels of log-α-Klotho were significantly associated with decreased odds of both PVD [odds ratio (OR) 0.521, 95% confidence interval (CI) 0.270-0.954, P = .034] and CV events (OR 0.415, 95% CI 0.203-0.790, P = .01), whereas increased levels of log-ADMA were only significantly associated with increased odds of PVD (OR 13.482, 95% CI 5.055-41.606, P < .001). We also found that the levels of log-α-Klotho (HR 0.357, 95% CI 0.140-0.906, P < .05) and lean mass (HR 0.187, 95% CI 0.042-0.829, P < .05), but not log-ADMA, were significantly associated with the risk of all-cause mortality, even after adjusting for possible confounding variables. Conclusions: Novel long-term clinical associations were generated that support α-Klotho and lean mass as novel CV risk factors in hemodialysis patients.
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Peritoneal membrane status, clinical data and aging-related molecules were investigated as predictors of long-term peritoneal dialysis (PD) outcomes. A 5-year prospective study was conducted with the following endpoints: (a) PD failure and time until PD failure, (b) major cardiovascular event (MACE) and time until MACE. A total of 58 incident patients with peritoneal biopsy at study baseline were included. Peritoneal membrane histomorphology and aging-related indicators were assessed before the start of PD and investigated as predictors of study endpoints. Fibrosis of the peritoneal membrane was associated with MACE occurrence and earlier MACE, but not with the patient or membrane survival. Serum α-Klotho bellow 742 pg/mL was related to the submesothelial thickness of the peritoneal membrane. This cutoff stratified the patients according to the risk of MACE and time until MACE. Uremic levels of galectin-3 were associated with PD failure and time until PD failure. This work unveils peritoneal membrane fibrosis as a window to the vulnerability of the cardiovascular system, whose mechanisms and links to biological aging need to be better investigated. Galectin-3 and α-Klotho are putative tools to tailor patient management in this home-based renal replacement therapy.
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Fragilidade , Falência Renal Crônica , Diálise Peritoneal , Fibrose Peritoneal , Humanos , Estudos Prospectivos , Galectina 3 , Fibrose Peritoneal/patologia , Envelhecimento , Falência Renal Crônica/terapiaRESUMO
OBJECTIVE: The purpose of this investigation is to compare the functional effect of the different surgical techniques used for addressing each section of the nose. METHODS: Prospective study of 57 consecutive rhinoplasty patients. Patients were evaluated with peak nasal inspiratory flow (PNIF), Nasal Obstruction Symptom Evaluation (NOSE), and Visual Analog Scale (VAS) for nasal obstruction before and 1 year after rhinoplasty. Additionally, esthetic evaluation of the nose was obtained with Rhinoplasty Outcomes Evaluation (ROE). According to the surgical technique used to address each portion of the nose, groups of patients were created and the functional improvement of these groups was compared. RESULTS: Using the TukeyHSD multiple pairwise-comparison test, the estimated difference of the increase of PNIF between using spreader grafts and using spreader flaps was 94.9 (95% CI 24.3, 165.5, P = .004) between spreader grafts and neither grafts or flaps was 79.2 (95% CI 5.8, 152.6, P = .03), between spreader grafts and bilateral spreader flaps plus a unilateral spreader graft was 90.2 (95% CI 22.1, 158.2, P = .005). In all other portions of the nose, no significant difference was found in the functional improvement between different surgical techniques. CONCLUSIONS: Spreader grafts increase PNIF more significantly than other surgical techniques used for dorsal mid-vault reconstruction. Spreader grafts should be preferred over other techniques whenever an improvement of nasal airflow is required. No significant differences were found between the functional effect of alternative techniques used in other sections of the nose. Additional cohort studies will be necessary to further confirm data from this investigation.
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Obstrução Nasal , Rinoplastia , Humanos , Rinoplastia/métodos , Obstrução Nasal/cirurgia , Estudos Prospectivos , Nariz/cirurgia , Retalhos Cirúrgicos , Septo Nasal/cirurgiaRESUMO
OBJECTIVES: Our objective was to investigate changes in specific generic health-related quality-of-life (HRQoL) domains achieved by rhinoplasty, to investigate whether modifications of somatic-, psychologic-, and social-related HRQoL domains are different in patients with functional or aesthetic motivation for rhinoplasty, and to investigate if HRQoL changes are related to a functional or an aesthetic nasal improvement. STUDY DESIGN: This was a prospective study with 1 year of follow-up. METHODS: Fifty-four consecutive Caucasian patients submitted to rhinoplasty were evaluated with 36-item Short Form Health Survey (SF-36) and EuroQuality-of-Life 5 Domain (EQ-5D) questionnaires. To correlate changes in generic HRQoL with functional and aesthetic modifications achieved by rhinoplasty, evaluation of patients also included assessment of Peak Nasal Inspiratory Flow and Nasal Obstruction Symptom Evaluation, Visual Analogue Scale for nasal airway obstruction (NAO), and Rhinoplasty Outcome Evaluation scores.Modifications in each generic HRQoL health-domain were analyzed to investigate the possible relation with motivation for surgery and with functional or aesthetic improvement. RESULTS: There was a significant improvement in EQ-5D (p < 0.001), EQ-5D VAS (p = 0.002) and in the SF-36 domains of general health (p < 0.001), energy (p < 0.001), physical functioning (p < 0.001), physical limitation (p = 0.005), pain (p = 0.003), and well-being (p = 0.018). Improvement was significant in groups of patients with NAO or in whom a septoplasty was performed and was associated with patient-reported functional improvement. There was a significant improvement in health change (p < 0.001), verified in all groups of patients. CONCLUSIONS: This prospective study with long-term results demonstrates that rhinoplasty significantly improves most domains of generic HRQoL. This improvement is associated with patient-reported functional improvement. Emotional limitation and social functioning are not significantly changed by rhinoplasty. LEVEL OF EVIDENCE: IV.
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Obstrução Nasal , Rinoplastia , Humanos , Rinoplastia/métodos , Estudos Prospectivos , Resultado do Tratamento , Obstrução Nasal/cirurgia , Estética Dentária , Inquéritos e Questionários , Qualidade de VidaRESUMO
BACKGROUND: To understand if supported accommodations (SA) are promoting the recovery of people with serious mental disorders, quality of life (QoL) is an important outcome. This study aimed to analyse the association between QoL and experiences of care in general and to identify specific experiences of care that are associated with QoL in users of SA. METHODS: A random sample of users of 42 SA was interviewed to obtain standardized measures of QoL and personal experiences of care. The sample was also characterized according to sociodemographic and clinical aspects. Linear regressions models analysed the association between QoL and experiences of care, adjusting for potential confounders. Results include estimated regression coefficients, corresponding 95% confidence intervals and p-values. RESULTS: The number of users interviewed was 272. The median QoL was 4.9 (2.3-6.8) out of 7. Although 84.9% of users were satisfied with the care received, only 16.2% felt involved in their treatment. Feeling safe (ß = .73; 95% CI [0.22-1.24], p = .006) and having privacy (ß = .42; 95% CI [0.09-0.75], p = .014) influenced QoL. Involvement in care (ß = .44; 95% CI [0.13-0.74], p = .006), safety and privacy (ß = .72; 95% CI [0.44-0.99], p = 8.38e-07) and user-professional relationship (ß = .42; 95% CI [0.14-0.69], p = .003) were also associated with QoL. CONCLUSIONS: Feeling safe, having privacy, feeling involved in care and having good user-professional relationships influence the QoL of users. These findings have implications from the political and economic level to the organizational and individual levels.
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Transtornos Mentais , Qualidade de Vida , Humanos , Emoções , Satisfação Pessoal , Transtornos Mentais/terapiaRESUMO
The COVID-19 pandemic put pressure on health systems, affecting populations' use of health services, especially those experiencing increased difficulties in healthcare access, as some migrant groups. This study aimed to investigate access and use of health services during the COVID-19 pandemic among migrants in Portugal. A mixed-methods approach was used. A community-based cross-sectional survey was conducted involving migrant communities residing in the Lisbon Metropolitan Area. Analyses of a subsample of participants (n = 929) examined factors associated with perceived worsening of access to health services during the pandemic. Semi-structured interviews with 14 migrants were conducted and thematically analyzed to further understand experiences and difficulties in health services' use. Around 44% of surveyed participants reported worsening of access to health services since the pandemic, more frequently women, those with lower income, and those who perceived being at moderate or high risk for COVID-19 infection. Digital change in services and lack of formal and informal support during lockdowns were highlighted by interviewers as main barriers in access to healthcare for migrants. The pandemic renewed concerns about inequalities in healthcare access among migrants. It is key that in following years health systems are able to address the potential accumulated burden of disease.
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COVID-19 , Migrantes , Humanos , Feminino , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Controle de Doenças Transmissíveis , Serviços de Saúde , Acessibilidade aos Serviços de SaúdeRESUMO
Social anxiety disorder (SAD) is one of the most underrecognized and undertreated common mental disorders. This study aimed to describe its epidemiology and to understand the association between childhood adversities and SAD in the context of Portugal's collectivist culture. Data about SAD, childhood adversities, socio-demographic variables were collected from a nationally representative sample using well-validated scales employed for the World Mental Health Survey. Logistic and linear regression models were carried out to explore the association between childhood adversities and SAD prevalence and age of onset. The estimated lifetime prevalence of SAD was 4.68% and the 12-month prevalence was 3.14%. The mean age of onset was 13.6 ± 8.79. People with a college education had 3.42 higher odds of having SAD compared to people with no education or a primary school education. Most childhood adversities significantly increased the odds of a lifetime prevalence of SAD. Parental Maladjustment increased the odds of SAD when gender, age, and education were adjusted. The study findings show a relatively high prevalence of SAD in Portugal and confirms that females, younger people, students, and single people are more likely to have SAD. The study highlights the need to address experiences of parental maladjustment in interventions for people with SAD in Portugal.
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Fobia Social , Criança , Feminino , Inquéritos Epidemiológicos , Humanos , Fobia Social/epidemiologia , Portugal/epidemiologia , Inquéritos e Questionários , Organização Mundial da SaúdeRESUMO
Increasing evidence on the effects of the COVID-19 pandemic suggests that its social and health impacts are being disproportionately shouldered by socioeconomically disadvantaged populations, including migrants. Knowledge of how these populations are experiencing the COVID-19 crisis is scarce. We examined the effects of the pandemic on the perceived individual financial situation and health condition of migrants in Lisbon, Portugal, and described the most affected subgroups. A cross-sectional survey was conducted with a diverse community-based sample of 1126 migrants. A worsening of their financial situation since the pandemic was reported by 55.6% of the participants and a worsening of their health condition by 19.9%. A worsened financial situation was most often reported by those ≥45 years old and with a lower income (Assuntos
COVID-19
, Migrantes
, Estudos Transversais
, Feminino
, Humanos
, Pessoa de Meia-Idade
, Pandemias
, Portugal/epidemiologia
, SARS-CoV-2
, Fatores Socioeconômicos
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BACKGROUND: The treatment gap for mental disorders remains a challenge worldwide. Identifying reasons for nontreatment may contribute to reducing this gap. AIMS: To evaluate sociodemographic and clinical factors associated with use and barriers to treatment in Portugal. METHOD: Data from the 2009 National Mental Health Survey were used. Participants reported 12-month treatment and reasons for nontreatment. Logistic regression models analysed the association between sociodemographic (education; employment; income; marital status) and clinical variables (mental disorder diagnosis; disability) with treatment and type of barriers (low perceived need; structural; attitudinal). RESULTS: The majority of participants with a mental disorder was not treated. Treatment was more common among participants with mood disorders (OR = 4.19; 95% CI: 2.72-6.46), and disability (OR = 2.43; 95% CI: 1.33-4.46), and less common among single participants (OR = 0.38; 95% CI: 0.20-0.70) and those with basic/secondary education (OR = 0.42; 95% CI: 0.24-0.73). Attitudinal barriers were more likely among participants with none/primary (OR = 2.90; 95% CI: 1.42-5.90) and basic/secondary education (OR = 1.70; 95% CI: 1.01-2.85), and less likely among those with substance use disorders (OR = 0.27; 95% CI: 0.10-0.70). Low perceived need was higher among single people (OR = 1.77; 95% CI: 1.01-3.08), and lower among those with anxiety (OR = 0.50; 95% CI: 0.28-0.90) and mood disorders (OR = 0.16; 95% CI: 0.09-0.30). Unemployed participants had higher odds of reporting structural barriers (OR = 3.76; 95% CI: 1.29-10.92). CONCLUSIONS: This study identifies factors associated with nontreatment, providing useful evidence to develop policies and effective interventions.
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Transtornos Mentais , Serviços de Saúde Mental , Inquéritos Epidemiológicos , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Portugal , Inquéritos e QuestionáriosRESUMO
Background: Rhinoplasty modifies the nasal pyramid, thereby also modifying the nasal airway. Objectives: To correlate the sensation of nasal breathing, as measured by patient-reported outcome measures, and nasal airflow, as assessed by peak nasal inspiratory flow (PNIF), with nasal airway dimensions, as measured on computed tomography (CT) images. Methods: Fifty Caucasian patients were studied through visual analogue scale (VAS), nasal obstruction symptom evaluation (NOSE) and PNIF. Measurements of the nasal airway were made on CT images: minimal distance between septum and inferior and middle turbinates, nasal valve angle, and nasal valve area. Results: There was a significant association between PNIF and nasal valve area, between VAS and the narrower nasal valve angle and between NOSE and minimal distance between septum and middle turbinate of the narrower side. Conclusions: This study suggests that the dimensions of the nasal valve and of the middle nasal airway have a substantial impact on nasal breathing capacity. It also highlights the importance of unilateral nasal airway obstruction to nasal breathing.
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Neoadjuvant chemotherapy (NACT) is common in breast cancer (BC) treatment, though more than half of the patients lack an effective response. Therefore, new predictive biomarkers and alternative therapies are crucial. Previously, we proposed HLA-DR-expressing cytotoxic T lymphocytes (CTLs) as a potential biomarker of the response to NACT. To validate this observation and further investigate these cells, 202 BC patients were enrolled. Flow cytometry analyses were performed in 61 biopsies and 41 blood samples pre-NACT and 100 non-NACT tumor samples. All the patients were followed up for 34 months. Blood-isolated immune cells were cultured with BC cell lines in a 3D system. We confirmed that HLA-DR level in CTLs is a highly sensitive, specific, and independent biomarker to predict response to NACT and developed a predictive probability model. This biomarker was also associated with progression-free survival, regardless of the treatment. The clinical observations are substantiated by the anti-tumor properties of HLA-DR-expressing CTLs. Intriguingly, HLA-DR level in CTLs can be modulated ex vivo, boosting their capacity to kill tumor cells synergistically with doxorubicin. Thus, HLA-DR expression in CTLs is a validated tool to select patients that will actually benefit from NACT, and its stimulation might be a novel therapeutic approach for BC.
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BACKGROUND: Identifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012. METHODS: Data from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors. RESULTS: An increment of involuntary hospitalizations was associated with male gender [exp([Formula: see text]) = 1.31; 95%CI 1.06-1.62, p < 0.05], having secondary and higher education [exp([Formula: see text]) = 1.45; 95%CI 1.05-2.01, p < 0.05, and exp([Formula: see text]) = 1.89; 95%CI 1.38-2.60, p < 0.001, respectively], a psychiatric diagnosis of psychosis [exp([Formula: see text]) = 2.02; 95%CI 1.59-2.59, p < 0.001], and being admitted in 2007 and in 2012 [exp([Formula: see text]) = 1.61; 95%CI 1.21-2.16, p < 0.01, and exp([Formula: see text]) = 1.73; 95%CI 1.31-2.32, p < 0.001, respectively]. A decrease in involuntary hospitalizations was associated with being married/cohabitating [exp([Formula: see text]) = 0.74; 95%CI 0.56-0.99, p < 0.05], having experienced a suicide attempt [exp([Formula: see text]) = 0.26; 95%CI 0.15-0.42, p < 0.001], and belonging to the catchment area of three of the psychiatric services evaluated [exp([Formula: see text]) = 0.65; 95%CI 0.49-0.86, p < 0.01, exp([Formula: see text]) = 0.67; 95%CI 0.49-0.90, p < 0.01, and exp([Formula: see text]) = 0.67; 95%CI 0.46-0.96, p < 0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively]. CONCLUSIONS: The findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with several sociodemographic, clinical, and contextual factors. This information may help identify high-risk patients and inform the development of better-targeted preventive interventions to reduce these hospitalizations.
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BACKGROUND: Evidence has shown that the sensation of nasal breathing is related to variations in nasal mucosa temperature produced by airflow. An appropriate nasal airflow is necessary for changing mucosal temperature. Therefore, the correlation between objective measurements of nasal airflow and patient-reported evaluation of nasal breathing should be dependent on the level of nasal airflow. OBJECTIVES: To find if the correlation between patient-reported assessment of nasal breathing and objective measurement of nasal airflow is dependent on the severity of symptoms of nasal obstruction or on the level of nasal airflow. METHODS: The airway of 79 patients was evaluated using NOSE score and peak nasal inspiratory flow (PNIF). Three subgroups were created based on NOSE and three subgroups were created based on PNIF level to find if correlation was dependent on nasal symptoms or airflow. RESULTS: The mean value of PNIF for the 79 patients was 92.6 L/min (SD 28.1 L/min). The mean NOSE score was 48.4 (SD 24.4). The correlation between PNIF and NOSE was statistically significant (P = .03), but with a weak association between the two variables (r = -.248). Evaluation of correlation based on symptoms demonstrated a weak or very weak association in each subgroup (r = -.250, r = -.007, r = -.104). Evaluation of correlation based on nasal airflow demonstrated a very weak association for the subgroups with middle-level and high PNIF values (r = -.190, r = -.014), but a moderate association for the subgroup with low PNIF values (r = -.404). CONCLUSIONS: This study demonstrated a weak correlation between NOSE scores and PNIF values in patients non-selected according to symptoms of nasal obstruction or to airflow. It demonstrated that patients with symptoms of nasal obstruction have different levels of nasal airflow and that low nasal airflow prevents the sensation of good nasal breathing. Therefore, patients with symptoms of nasal obstruction may require improving nasal airflow to improve nasal breathing sensation.
Assuntos
Obstrução Nasal/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Adolescente , Adulto , Idoso , Resistência das Vias Respiratórias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/fisiopatologia , Testes de Função Respiratória , Estudos Retrospectivos , Rinoplastia , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Improving the shape and contour of the nasal tip is a major goal in rhinoplasty. Extreme bulbosity and parenthesis deformity of the nasal tip are both frequently encountered. However, the underlying anatomical features that cause this kind of tip deformity are still not fully understood. OBJECTIVES: To evaluate the relation between the shape of the nasal tip and the anatomical position, orientation and shape of the lateral crura of the lower lateral cartilages and to estimate the incidence of cephalic malposition of lateral crura in Caucasian noses. MATERIALS AND METHODS: Nineteen Caucasian cadaver noses were studied, and the alar cartilages were measured and evaluated using a standardized method. RESULTS: Fourteen of the total 38 lateral crura evaluated had cephalic malposition (long axis angle with the midline equal to or less than 30°). Of the nasal tips classified as having parenthesis deformity, 84.6% had cephalic malposition of lateral crura and 46.2% had convex lateral crura. Vertical orientation of the short axis of the lateral crura was no more common in noses with parenthesis deformity of the nasal tip than in other kinds of nasal tip. CONCLUSIONS: The incidence of cephalic malposition of the lateral crura in this series of Caucasian noses was 36.8%. There was a statistically significant association between parenthesis deformity of the nasal tip and cephalic malposition of the lateral crura, as well as with convex shape of the lateral crura. No statistically significant association was found between the sagittal angle of the lateral crura and the type of nasal tip. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .