Clinical, Economic, and Humanistic Impact of Short-Bowel Syndrome/Chronic Intestinal Failure in Portugal (PARENTERAL Study).

Introduction: This study aimed to assess the clinical, economic, and humanistic impact of short-bowel syndrome/chronic intestinal failure (SBS/CIF) in Portugal. Methods: This is a retrospective multicenter cohort chart review study, with a cross-sectional component for quality-of-life (QoL) evaluation. Inclusion criteria comprised patients with SBS/CIF, aged ≥1 year, with stable parenteral nutrition (PN). Data collection included patient chart review over a 12-month period and patient/caregiver self-report and SF-36/PedsQL™ questionnaires. Main endpoints comprised clinical and PN characterization, healthcare resource use (HRU), direct costs, and patient QoL. Results: Thirty-one patients were included (11 adults and 20 children). Patients' mean age (standard deviation [SD]) was 57.9 (14.3) years in adults and 7.5 (5.0) years in children, with a mean time since diagnosis of 10.2 (5.9) and 6.6 (4.2) years, respectively. PN was administered for a mean of 5.2 and 6.6 days/week in adults and children, respectively; home PN occurred in 81.8% of adults and 90.0% of children for a mean of 9.6 and 10.8 months/year, respectively. The mean annual number of hospitalizations was 1.9 and 2.0 which lasted for a mean of 34.0 and 29.4 days in adults and children, respectively. Twenty-one and forty hospitalization episodes were reported in adults and children, respectively, of which 71.4% and 85.0% were due to catheter-related complications. Mean annual direct costs per patient amounted to 47,857.53 EUR in adults and 74,734.50 EUR in children, with PN and hospitalizations as the main cost-drivers. QoL assessment showed a clinically significant impaired physical component in adults and a notable deterioration in the school functioning domain in children. Conclusion: In Portugal, SBS/CIF patient management is characterized by a substantial therapeutic burden and HRU, translating into high direct costs and a substantial impairment of the adults' physical function and children's school functioning.

Introdução: Este estudo teve como objetivo avaliar o impacto clínico, económico e social da síndrome do intestino curto/falência intestinal crónica (SIC/FIC) em Portugal. Métodos: Estudo de coorte retrospectivo e multicêntrico de revisão dos processos clínicos incluindo uma componente transversal para avaliação da qualidade de vida (QV). Os critérios de elegibilidade incluíram doentes com SIC/FIC, idade ≥1 ano, em nutrição parenteral (NP) e clinicamente estáveis. A recolha de dados incluiu a revisão dos processos clínicos ao longo de um período de 12 meses e a aplicação de questionários auto-administrados a doentes e cuidadores e de questionários de QV (SF-36/PedsQL™). Os indicadores principais foram a caracterização clínica e da NP, a utilização de recursos de saúde, custos diretos e QV dos doentes. Resultados: Foram incluídos 31 doentes (11 adultos e 20 crianças). A idade média (desvio padrão: DP) foi de 57.9 (14.3) anos nos adultos e de 7.5 (5.0) nas crianças com um tempo médio desde o diagnóstico de 10.2 (5.9) e 6.6 (4.2) anos, respetivamente. A NP foi administrada durante uma média de 5.2 e 6.6 dias por semana, em adultos e crianças respetivamente, em 81.8% e 90.0% dos adultos/crianças foi feita em casa durante uma média de 9.6 ou 10.8 meses por ano, respetivamente. O número médio anual de hospitalizações foi de 1.9 (1.6) e 2.0 (1.5) com uma duração média de 34.0 (47.4) e 29.4 (32.3) dias, em adultos e crianças, respetivamente. Foram reportados 21 e 40 episódios de hospitalização em adultos/crianças, dos quais 71.4% e 85.0% foram devido a complicações relacionadas ao uso de cateter. Os custos diretos anuais médios por doente ascenderam a 47,857.53 EUR nos adultos e a 74,734.50 EUR nas crianças, sendo que os maiores responsáveis foram a NP e as hospitalizações. A avaliação da QV mostrou um comprometimento clinicamente significativo da componente física nos adultos e uma deterioração relevante da dimensão escolar nas crianças. Conclusões: A gestão dos doentes com SIC/FIC em Portugal é caracterizada por uma sobrecarga substancial a nível terapêutico e de utilização de recursos de saúde, o que se traduz em elevados custos diretos e comprometimento substancial da componente física nos adultos e do desempenho escolar nas crianças.

Consensus document on chronic coronary syndrome assessment and risk stratification in Portugal: A position paper statement from the [Portuguese Society of Cardiology's] Working Groups on Nuclear Cardiology, Magnetic Resonance and Cardiac Computed Tomography, Echocardiography, and Exercise Physiology and Cardiac Rehabilitation. / Documento de Consenso sobre Estratificação de Risco Cardiovascular e estudo da doença coronária em Portugal: a posição dos Grupos de Estudo de Cardiologia Nuclear, Ressonância Magnética e Tomografia Computorizada Cardíaca, de Ecocardiografia e de Fisiopatologia do Esforço e Reabilitação Cardíaca.

Despite constant medical evolution, the reimbursement policy of Portuguese National Health Service (NHS) for the study and risk stratification of coronary heart disease has remained unchanged for several decades. Lack of adjustment to contemporary clinical practice has long been evident. However, the recent publication of the European Guidelines for diagnosis and treatment of chronic coronary syndromes further highlighted this gap and the urgent need for a change. Prompted by these Guidelines, the Working Group on Nuclear Cardiology, Cardiac Magnetic Resonance and Cardiac CT, the Working Group on Echocardiography and the Working Group on Stress Pathophysiology and Cardiac Rehabilitation of the Portuguese Society of Cardiology, began a process of joint reflection on the current limitations and how these recommendations could be applied in Portugal. To this end, the authors suggest that the new imaging methods (stress echocardiogram, cardiac computed tomography and cardiac magnetic resonance), should be added to exercise treadmill stress test and myocardial perfusion scintigraphy in the available exam portfolio within the Portuguese NHS. This change would allow full adoption of European guidelines and a better use of tests, according to clinical context, availability and local specificities. The adoption of clinical guidance standards, based on these assumptions, would translate into a qualitative improvement in the management of these patients and would promote an effective use of the available resources, with potential health and financial gains.

Fractal Brownian Motion Assessment of the Center of Pressure Excursion During Impulse Phase on Standard Vertical Jump.

This study presents and applies fractal Brownian motion assessment of the center of pressure (COP) excursion during feet ground contact on standard vertical jump impulse phase with long and short countermovement (CM) in relation with lower limb muscle stretch-shortening cycle (SSC) comparing it with no CM and SSC. Fifty-four tests were performed by a group of six healthy male students of sports and physical education degree without previous injury, specific training, or fitness ability. Three repetitions were performed by each subject of a squat jump (SJ) without CM and SSC, countermovement jump (CMJ) with long CM and SSC, as well as drop jump (DJ) with short CM and SSC after depth jump from a 40 cm step. During trial tests ground reaction force and force moments were acquired with force platform and impulse phases were segmented for COP coordinates computation. Fractal Brownian motion analysis of COP excursion during impulse phases conduced to detection of differences between critical time and displacement as well as short and long-term diffusion coefficient (Ds, Dl) and Hurst index scale exponent (Hs, Hl), with Ds, Dl presenting statistical significative correlations -0.491, -0.559 and Hs, Hl non statistical significative correlations 0.266 and -0.424 with MVJ height (ht) at 5% significance for explaining underlying mechanisms on CM and SSC at MVJ.Clinical Relevance- This work contributes with new method for the study expansion of the center of pressure excursion and stability during feet ground contact from orthostatic standing position to the impulse phase during standard maximum vertical jump as the most adequate method for assessment of lower limb muscle stretch-shortening cycle.

A synthesis of European seahorse taxonomy, population structure, and habitat use as a basis for assessment, monitoring and conservation.

Accurate taxonomy, population demography, and habitat descriptors inform species threat assessments and the design of effective conservation measures. Here we combine published studies with new genetic, morphological and habitat data that were collected from seahorse populations located along the European and North African coastlines to help inform management decisions for European seahorses. This study confirms the presence of only two native seahorse species (Hippocampus guttulatus and H. hippocampus) across Europe, with sporadic occurrence of non-native seahorse species in European waters. For the two native species, our findings demonstrate that highly variable morphological characteristics, such as size and presence or number of cirri, are unreliable for distinguishing species. Both species exhibit sex dimorphism with females being significantly larger. Across its range, H. guttulatus were larger and found at higher densities in cooler waters, and individuals in the Black Sea were significantly smaller than in other populations. H. hippocampus were significantly larger in Senegal. Hippocampus guttulatus tends to have higher density populations than H. hippocampus when they occur sympatrically. Although these species are often associated with seagrass beds, data show both species inhabit a wide variety of shallow habitats and use a mixture of holdfasts. We suggest an international mosaic of protected areas focused on multiple habitat types as the first step to successful assessment, monitoring and conservation management of these Data Deficient species.

Consistency of surface electromyography assessment at lower limb selected muscles during vertical countermovement.

Given the difficulty of invasive methods to assess muscle action during natural human movement, surface electromyography (sEMG) has been increasingly used to capture muscle activity in relation to kinesiological analysis of specific tasks. Isolated isometric, concentric and eccentric forms of muscle action have been receiving the most attention for research purposes. Nevertheless natural muscle action frequently involves the use of a preceding eccentric muscle action as a form of potentiation of immediate muscle concentric action, in what is designated as muscle stretch-shortening cycle (SSC). The most frequently applied protocols for the evaluation of SSC on vertical jumps are by virtue of their reproducibility and control of experimental conditions, squat jump (SJ) without countermovement (CM), countermovement jump (CMJ) with long CM and drop jump (DJ) with short CM. The methods used to extract information and relationship of the captured signals also present a high diversity, with the question about the consistency of the methods and obtained results. The objective of this study is to evaluate the consistency of the analysis and results by applying different EMGs signal analysis techniques related to strategic muscle groups of the lower limbs at different countermovement evaluated in vertical jumps. Raw sEMG signals of 5 lower limb muscles of 6 subjects during SJ, CMJ and DJ were rectified, filtered and obtained their envelope, and then correlated (CR) for detection of synergistic, agonist and antagonist activity, applied principal component analysis (PCA) for the detection of uncorrelated components explaining maximum variability and normalized cross-correlation (CCRN) for detection of maximum correlations and time lag. CR of EMG envelopes presented higher coactivities (CoA) in DJ relative to SJ and these CoA superior to CMJ with greater synergy in DJ relative to SJ and CMJ that present several loop cycles corresponding to time lag of activity. CCRN of the EMG envelopes presented also higher CoA in DJ when compared to SJ and both higher CoA to CMJ. PCA allowed to detect a principal component (PC) explaining 92.2% of the variability of EMG in DJ, 90.6% in SJ and 78.7% in CMJ, the second PC responsible for the explanation of 4.9% variability in DJ, 6.7% in SJ and 15.3% in CMJ.

Low-cost wearable data acquisition for stroke rehabilitation: a proof-of-concept study on accelerometry for functional task assessment.

BACKGROUND: An increasingly aging society and consequently rising number of patients with poststroke-related neurological dysfunctions are forcing the rehabilitation field to adapt to ever-growing demands. Although clinical reasoning within rehabilitation is dependent on patient movement performance analysis, current strategies for monitoring rehabilitation progress are based on subjective time-consuming assessment scales, not often applied. Therefore, a need exists for efficient nonsubjective monitoring methods. Wearable monitoring devices are rapidly becoming a recognized option in rehabilitation for quantitative measures. Developments in sensors, embedded technology, and smart textile are driving rehabilitation to adopt an objective, seamless, efficient, and cost-effective delivery system. This study aims to assist physiotherapists' clinical reasoning process through the incorporation of accelerometers as part of an electronic data acquisition system. METHODS: A simple, low-cost, wearable device for poststroke rehabilitation progress monitoring was developed based on commercially available inertial sensors. Accelerometry data acquisition was performed for 4 first-time poststroke patients during a reach-press-return task. RESULTS: Preliminary studies revealed acceleration profiles of stroke patients through which it is possible to quantitatively assess the functional movement, identify compensatory strategies, and help define proper movement. CONCLUSION: An inertial data acquisition system was designed and developed as a low-cost option for monitoring rehabilitation. The device seeks to ease the data-gathering process by physiotherapists to complement current practices with accelerometry profiles and aid the development of quantifiable methodologies and protocols.