Effects of ActiGraph's filter, epoch length and non-wearing time algorithm on step counts in people with COPD.

The influence of the ActiGraph® processing criteria on estimating step counts in chronic obstructive pulmonary disease (COPD) remains uncertain. This study aimed to assess the influence of filters, epoch lengths and non-wearing time (NWT) algorithms on steps/day in people with COPD. ActiGraph GT3X+ was worn on the waist for seven days. Steps were detected using different filters (normal and low-frequency extension [LFE]), epoch lengths (15s and 60s), and NWT algorithms (Choi and Troiano). Linear mixed-effects model was applied to assess the effects of filter, epoch length, NWT algorithm on steps/day. Lin's concordance correlation and Bland-Altman were used to measure agreement. A total of 136 people with COPD (107 male; 69 ± 8 years; FEV1 51 ± 17% predicted) were included. Significant differences were found between filters (p < 0.001), but not between epoch lengths or NWT algorithms. The LFE increased, on average, approximately 7500 steps/day compared to the normal filter (p < 0.001). Agreement was poor (<0.3) and proportional bias was significant when comparing steps/day computed with different filters, regardless of the epoch length and NWT algorithm. Filter choice but not epoch lengths or NWT algorithms seem to impact measurement of steps/day. Future studies are needed to recommend the most accurate technique for measuring steps/day in people with COPD.

Sobrecarga e ansiedade em familiares de utentes instuticionalizados em ERPI ­ região de Bragança / Overload and anxiety in family members of users institutionalised in ERPI - Bragança region

O envelhecimento e as doenças crónicas são, na sua maioria, pela dependência que causam, a principal razão da institucionalização. Os cuidadores, experienciam um desgaste acentuado ao cuidar um familiar com elevado grau de dependência e a sobrecarga, física e mental, faz-se sentir na sua maioria. São poucos os estudos na área dos familiares de Utentes Institucionalizados. De uma forma geral, a avaliação das varáveis em causa ­ sobrecarga e ansiedade - está direcionada para os cuidadores formais e informais no domicílio ou em contexto de internamento temporário. Pretende- se, com este estudo, caracterizar e avaliar a sobrecarga e a ansiedade em familiares de Utentes Institucionalizados, correlacionando-os com os dados sócio-demográficos. Trata-se de um estudo quantitativo, observacional, analítico e transversal. Para a colheita de dados foram utilizados os seguintes instrumentos: Questionário Sociodemográfico, a Escala de Sobrecarga do Cuidador de Zarit (Sequeira, 2010); a Escala de Ansiedade e Depressão clínica ­ HADS (Pais-Ribeiro, 2007); e Escala de Avaliação da Sobrecarga para familiares de pessoas institucionalizadas em estruturas residenciais para idosos de Fukahori - (CBS-FNH) (Obanos-Martell, et al, 2016). A amostra deste estudo é constituída por 138 familiares de pessoas institucionalizadas em Estruturas Residenciais para Idosos do concelho de Bragança. Destacamos que os inquiridos são maioritariamente do sexo feminino (71%), com idades compreendidas entre 50 e 59 anos (54%). Temos familiares casados ou em união de facto a prevalecer (76,1%). As habilitações literárias que predominam na amostra em estudo são o ensino secundário (39%) e o ensino superior (36%), encontrando-se cerca de 67% a laborar em termos profissionais. Relativamente ao grau de parentesco com a pessoa institucionalizada a maioria dos inquiridos é filho(a) (67%), seguindo-se o conjugue (12%). No que diz respeito à sobrecarga - utilizando a escala de Sobrecarga de Zarit - observou-se que mais de metade dos inquiridos não apresentam sobrecarga (54%). No entanto, com base na escala da sobrecarga direcionada a familiares de Fukahori, apurou- se que a sobrecarga se faz sentir, de forma acentuada, em duas dimensões, a "culpa" e "luto e perdas antecipados". Relativamente à ansiedade percebemos que 46% dos familiares não apresentam ansiedade. Isto revela que é a nível da sobrecarga que os familiares necessitam de maior atenção por parte das estruturas residenciais. Na integração e ao longo da estadia na residência, o papel dos intervenientes, deve ser dotar os familiares com estratégias de coping para os ajudar na adaptação a estes sentimentos, apaziguando-os.

Aging and chronic diseases are, for the most part, the main reason for institutionalization due to the dependence they cause. Caregivers experience severe exhaustion when caring for a family member with a high degree of dependence and the physical and mental overload is felt in the majority of cases. There are few studies in the area of family members of Institutionalized Users. In general, the assessment of the variables in question - overload and anxiety - is aimed at formal and informal caregivers at home or in the context of temporary hospitalization. The aim of this study is to characterize and evaluate the burden and anxiety in family members of Institutionalized Users, correlating them with socio-demographic data. This is a quantitative, observational, analytical and cross-sectional study. The following instruments were used to collect data: Sociodemographic Questionnaire, the Zarit Caregiver Burden Scale (Sequeira, 2010); the Clinical Anxiety and Depression Scale ­ HADS (Pais-Ribeiro, 2007); and Burden Assessment Scale for family members of people institutionalized in residential facilities for the elderly in Fukahori - (CBS-FNH) (Obanos-Martell, et al, 2016). The sample of this study consists of 138 family members of people institutionalized in Residential Structures for the Elderly in the municipality of Bragança. We highlight that the respondents are mostly female (71%), aged between 50 and 59 years old (54%). We have family members who are married or in a civil union prevailing (76.1%). The educational qualifications that predominate in the sample under study are secondary education (39%) and higher education (36%), with around 67% working professionally. Regarding the degree of kinship with the institutionalized person, the majority of respondents are children (67%), followed by their spouse (12%). With regard to overload - using the Zarit Overload scale - it was observed that more than half of respondents do not have overload (54%). However, based on the scale of the burden directed at Fukahori's family members, it was found that the burden is felt, in a pronounced way, in two dimensions, "guilt" and "anticipated grief and losses". Regarding anxiety, we noticed that 46% of family members do not have anxiety. This reveals that it is at the level of overload that family members need greater attention from residential structures. During integration and throughout the stay at the residence, the role of those involved should be to provide family members with coping strategies to help them adapt to these feelings, appeasing them.

Effect of Data Reduction Techniques on Daily Moderate to Vigorous Physical Activity Collected with ActiGraph® in People with COPD.

ActiGraph® is a valid, frequently used, accelerometer to quantify moderate to vigorous physical activities (MVPA) in people with COPD. The impact of ActiGraph processing techniques on this population is unknown. This study aimed to explore the effect of data reduction techniques on MVPA in people with COPD. MVPA/day, through ActiGraph GT3X+, was estimated using: Troiano, Freedson 98 and FreedsonVM3 cutoffs, 15-s and 60-s epochs, and normal and low-frequency extension (LFE) filters. Cutoff, epoch, and filter effects were explored with Aligned Rank Transform-ANOVA. Lin's concordance correlation coefficients and Bland-Altman plots were used to evaluate agreement and bias between different techniques. The analysis included 136 people with COPD (79% male; 68 ± 8 years; FEV1 51 ± 17% predicted). MVPA/day differed according to cutoff, filter, and epoch selection (p-value < 0.001). FreedsonVM3 cutoff, 15-s epochs, and LFE yielded the highest MVPA (45 min/day, 68% of physically active participants). Troiano cutoff, 60-s epochs, and normal filter yielded the lowest MVPA (8 min/day, 20% of physically active participants). Only comparisons between Troiano and Freedson98 cutoffs presented an almost perfect agreement. ActiGraph data reduction techniques affected MVPA/day estimates and their interpretation at the individual and group level. Studies using different processing criteria should not be compared in people with COPD. Future studies with a gold standard are required to ascertain which processing technique produces the most accurate MVPA estimates in COPD. Meanwhile, future trials employing the ActiGraph GT3X+ may consider estimating MVPA based on Freedson VM3 cutofffs, 60-s epochs, and normal filter.

Interpersonal Values of Patients Participating in Phase II-III Clinical Trials: Implications for Clinical Trial Representativeness.

BACKGROUND: An individual's personal values strongly influence their immediate and long-term decisions. Psychological heterogeneity in clinical trial populations contributes to selection bias and may affect treatment outcomes and inevitably trial results. OBJECTIVES: The objective of this study was to characterize for the first time the main interpersonal values of patients who participated in Phase II and III clinical trials. METHODS: This multicenter observational study included 200 participants from 4 different hospitals who participated in a Phase II or III clinical trial. Patients from different therapeutic areas were included in this study. The patients' interpersonal values were studied using the Survey of Interpersonal Values (SIV). The SIV scale is grouped into six subscales that assess specific personal values: (1) support, the need to be treated with kindness and to receive encouragement from other people; (2) conformity, the extent to which one does what is acceptable and considered socially correct; (3) recognition, the need to be highly regarded and admired, to be considered important and recognized by others; (4) independence, the extent to which individuals feel free to make their own decisions; (5) benevolence, the capacity to understand and show generosity towards the less fortunate; and (6) leadership, the value ascribed to coordinating the work of others, being selected for a leadership position, and being in a position to tell others what to do. The results obtained from the patient population were classified using the following categories: "very high" (P95-P99), "high" (P70-90), "medium" (P35-65) low" (P10-30), or "very low" (P1-5), and subsequently compared with those of the Portuguese normative population. RESULTS: Compared with the normative population, regardless of the patient's underlying disease, the percentile frequency distributions were significantly higher for the independence (p < 0.001) and benevolence (p < 0.001) subscales, and significantly lower for the leadership (p < 0.001) and recognition (p < 0.001) subscales in the patient population. Patient distribution according to underlying disease differed significantly relative differences in distribution relative to the normative population for the majority of subscales. Non-alcoholic steatohepatitis (NASH), heart failure, myocardial infarction, lung cancer, and rheumatoid arthritis patients were those for which the greatest differences were observed across diseases, while stroke, multiple sclerosis, and HIV patients showed the least differences relative to the normative population. CONCLUSIONS: This novel analysis of the interpersonal values of patients that participate in Phase II and III clinical trials revealed that the patients' interpersonal values largely differed from those of the Portuguese normative population. Better understanding the implications of these findings for clinical trial representativeness and outcomes is of crucial importance.

Machine learning model for classification of predominantly allergic and non-allergic asthma among preschool children with asthma hospitalization.

OBJECTIVE: Asthma is the most frequent chronic airway illness in preschool children and is difficult to diagnose due to the disease's heterogeneity. This study aimed to investigate different machine learning models and suggested the most effective one to classify two forms of asthma in preschool children (predominantly allergic asthma and non-allergic asthma) using a minimum number of features. METHODS: After pre-processing, 127 patients (70 with non-allergic asthma and 57 with predominantly allergic asthma) were chosen for final analysis from the Frankfurt dataset, which had asthma-related information on 205 patients. The Random Forest algorithm and Chi-square were used to select the key features from a total of 63 features. Six machine learning models: random forest, extreme gradient boosting, support vector machines, adaptive boosting, extra tree classifier, and logistic regression were then trained and tested using 10-fold stratified cross-validation. RESULTS: Among all features, age, weight, C-reactive protein, eosinophilic granulocytes, oxygen saturation, pre-medication inhaled corticosteroid + long-acting beta2-agonist (PM-ICS + LABA), PM-other (other pre-medication), H-Pulmicort/celestamine (Pulmicort/celestamine during hospitalization), and H-azithromycin (azithromycin during hospitalization) were found to be highly important. The support vector machine approach with a linear kernel was able to diffrentiate between predominantly allergic asthma and non-allergic asthma with higher accuracy (77.8%), precision (0.81), with a true positive rate of 0.73 and a true negative rate of 0.81, a F1 score of 0.81, and a ROC-AUC score of 0.79. Logistic regression was found to be the second-best classifier with an overall accuracy of 76.2%. CONCLUSION: Predominantly allergic and non-allergic asthma can be classified using machine learning approaches based on nine features.Supplemental data for this article is available online at at www.tandfonline.com/ijas .

Demystification of artificial intelligence for respiratory clinicians managing patients with obstructive lung diseases.

INTRODUCTION: Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of morbidity and mortality worldwide. Despite all available diagnostics and treatments, these conditions pose a significant individual, economic and social burden. Artificial intelligence (AI) promises to support clinical decision-making processes by optimizing diagnosis and treatment strategies of these heterogeneous and complex chronic respiratory diseases. Its capabilities extend to predicting exacerbation risk, disease progression and mortality, providing healthcare professionals with valuable insights for more effective care. Nevertheless, the knowledge gap between respiratory clinicians and data scientists remains a major constraint for wide application of AI and may hinder future progress. This narrative review aims to bridge this gap and encourage AI deployment by explaining its methodology and added value in asthma and COPD diagnosis and treatment. AREAS COVERED: This review offers an overview of the fundamental concepts of AI and machine learning, outlines the key steps in building a model, provides examples of their applicability in asthma and COPD care, and discusses barriers to their implementation. EXPERT OPINION: Machine learning can advance our understanding of asthma and COPD, enabling personalized therapy and better outcomes. Further research and validation are needed to ensure the development of clinically meaningful and generalizable models.

Cut-off of the one-minute sit-to-stand test to detect functional impairment in people with chronic obstructive pulmonary disease.

INTRODUCTION: The 6-minute walking test (6MWT) is a widely used measure to assess functional status of people with chronic obstructive pulmonary disease (COPD). However, it requires a long hallway and might be time-consuming. Other simple measures might be useful as a first screening tool. We explored the predictive ability of the 1-minute sit-to-stand test (1-min STS) in discriminating people with COPD with or without functional impairment. METHODS: A receiver operating characteristics (ROC) curve analysis was performed. We determined a threshold for the 1-min STS to identify functional impairment based on different cut-offs of the 6MWT (300, 350, 400 and 450 m). RESULTS: A total of 135 people with COPD were included. Except for the <450 m cut-off of the 6MWT, all other cut-offs identified 19.5 repetitions as the optimal cut-off point for the 1-min STS. All AUCs showed excellent discrimination (AUCs = 0.812-0.901). The best AUC (<300 m cut-off) had an outstanding discrimination (0.901; 95%CI: 0.84-0.96; other AUCs 0.812-0.836) between people with or without functional impairment, with 86% specificity and 83% sensitivity. CONCLUSION: A cut-off of 19.5 repetitions in the 1-min STS discriminates accurately people with COPD with a functional impairment. Future studies may validate our treatable trait candidate in other samples and investigate its utility in predicting other meaningful outcomes.

What happened to hip fragility fractures during COVID-19 pandemic?

PURPOSE: COVID-19 changed the dynamics of all healthcare system, leading to the restructuring of inpatient teams as well as the emergency department. Scheduled surgeries were suspended, operating rooms were closed, and anesthesiologists redistributed among the various intensive care units. At the Centro Hospitalar do Baixo Vouga the number of patients admitted to the emergency department decreased to approximately 8.000 during the period of lockdown which ranged from 18th March to 1st June 2020. The aim of this study was to compare the number of patients presenting with hip fractures during the first wave of the COVID-19 pandemic with the equivalent period in 2019 and to analyze postoperative outcomes. METHODS: An observational retrospective study was conducted in two different periods. Patients over the age of 50 years admitted with hip fracture were included for analysis. The data was collected from the hospital database. A general descriptive analysis was performed. RESULTS: There was an overall reduction in the number of admissions due to hip fractures in Period 2020 compared with homologous Period in 2019 (68 patients and 94 patients, respectively). No statistically significant differences could be found regarding age, gender, ASA grade and pre-admission residence among patients admitted during these both periods. Nursing home patients in Period 2020 had a longer hospital stay (p=0.03), independently of the functional status (p=0.07). There were no statistically significant differences in the time it took the patient to go to the emergency department after the fall, place where the fracture had occurred, waiting time to perform the surgery, type of treatment performed, post-surgical complications and mortality. There was no relationship between mortality and the time it took the patient to access the emergency department (p=0,487), or mortality and the mean length of stay in the hospital (p=0,151). All the patients admitted to the emergency department in Period 2020 were negative to PCR test for SARS-CoV-2. CONCLUSION: The measures taken by the hospital during the pandemic had no impact in the healthcare provided to the admitted patients. This should be taken into account in order to optimize the efficiency of the health care system in future outbreaks.

O ajustamento de crianças com doença crônica / The adjustment of children with chronic illness / El ajuste de los niños con enfermedades crónicas

Este trabalho procura averiguar o impacte das doenças crônicas no ajustamento psicológico das crianças, tendo em conta diferentes tipos de doenças, suas características e a percepção dos pais. A amostra é constituída por 176 crianças, dos 3 aos 10 anos, distribuídas por quatro grupos: crianças com asma, com câncer, com patologia uronefrológica e sem doença. A recolha de dados ocorreu nas salas de espera de dois hospitais portugueses. Os instrumentos utilizados foram a escala de observação do brincar (POS), itens do revised illness perception questionnaire (IPQ-R) e o questionário de capacidades e de dificuldades (SDQ). A análise dos resultados permitiu perceber que não existe uma relação linear entre o ajustamento psicológico e a presença de uma doença crônica, e que a avaliação do ajustamento da criança pela observação direta do brincar nem sempre é coincidente com a perspectiva dos pais acerca desse ajustamento.

This study focus on the impact of chronic disease over the children’s psychological adjustment, based on the different types of diseases, their characteristics and parents’ perception. The sample is composed of 176 children, aged between 3 and 10 years, distributed in four groups: children with asthma, cancer, uro-nephrological pathology and free from any disease. The data were collected in the waiting rooms of two Portuguese hospitals. The Play Observation Scale (POS), items from the Revised Illness Perception Questionnaire (IPQ-R) and the Strengths and Difficulties Questionnaire (SDQ) were the tools applied in the study. The analysis of the results revealed that a linear relationship between the psychological adjustment of children and the presence of a chronic disease does not exist. In addition, the evaluation of the child’s adjustment through the direct observation of ludic activities does not always match the parents’ perspective regarding that adjustment.

Este trabajo trata de determinar el impacto de las enfermedades crónicas en el ajuste psicológico de los niños, teniendo en cuenta los diferentes tipos de enfermedades, sus características y la percepción de los padres acerca de ellos. La muestra se compone de 176 niños, de 3 a 10 años, divididos en cuatro grupos: los niños con asma, cáncer, patologías uronefrológicas y sin enfermedad. La recolección de datos ocurrió en las salas de espera de dos hospitales portugueses. Los instrumentos utilizados fueron la Play Observation Scale (POS), lo Revised Illness Perception Questionnaire (IPQ-R) y lo Strengths and Difficulties Questionnaire (SDQ). Los resultados nos permiten percibir que existe una relación lineal entre el ajuste psicológico y la presencia de una enfermedad crónica y que la evaluación de la adaptación de los niños a través de la observación directa del juego no siempre es coincidente con la visión de los padres sobre este ajuste.

Avaliação de um programa de promoção da saúde mental com crianças institucionalizadas / Evaluation of a program of mental health promotion with institutionalized children / Evaluación de un Programa de Promoción de Salud Mental en los niños institucionalizados

Este estudo pretende avaliar a eficácia de um programa de promoção da saúde mental com a duração de dois anos: "Chapéu de Chuva". A amostra é constituída por 45 crianças residentes em instituições de acolhimento, com idades compreendidas entre 6 e 12 anos (Mdn = 9). Os instrumentos utilizados para a avaliação dos resultados entre os momentos pré e pós-teste incluem o Kidscreen 27 e o "Sede de Viver". Foram encontradas melhorias estatisticamente significativas ao nível do bem-estar psicológico bem como ao nível da capacidade de tomada de decisão, assertividade e resistência à pressão de pares. Tendo em conta as melhorias encontradas em dimensões fundamentais ao nível da saúde mental e os elevados níveis de satisfação e envolvimento por parte do público-alvo, reflete-se acerca da importância de dar continuidade a intervenções dessa natureza junto dessa população vulnerável

The aim of this study is to assess the effectiveness of a 2 year project - Chapéu de Chuva - promoting mental health. The study sample is composed of 45 children resident in institutional care, between the ages of 6 and 12 years (Mdn = 9). The instruments used to evaluate results between pre-and post-test moments include the Kidscreen 27 and the "Sede de Viver". Statistically significant improvements were found in terms of psychological wellbeing, as well as in the decision making capacity, assertiveness and resistance to peer pressure. The improvements found in fundamental aspects of mental health and the high levels of satisfaction and involvement in the target group, leads one to reflect on the importance of giving continuity to interventions of this nature with this vulnerable population group

Este estudio tiene como objetivo evaluar la eficacia de un programa de promoción de la salud mental, con una duración de dos años - "Chapéu de Chuva". La muestra estuvo formada por 45 niños que viven en instituciones de acogida, con edades comprendidas entre 6 y 12 años (Mdn = 9). Los instrumentos utilizados para la evaluación de los resultados entre el pre y post-test incluyen Kidscreen 27 y "Sede de Viver". Se encontraron mejorías estadísticamente significativas en términos de bienestar psicológico, así como en el nivel de la capacidad de toma de decisiones, asertividad, y resistencia a la presión. Teniendo en cuenta las mejoras que se encontraron en las dimensiones fundamentales de la salud mental y los altos niveles de satisfacción y compromiso por parte del público destinatario, se reflexiona sobre la importancia de dar continuidad a intervenciones de esta naturaleza con esta población vulnerable

Avaliação de um programa de promoção da saúde mental com crianças institucionalizadas / Evaluation of a program of mental health promotion with institutionalized children / Evaluación de un Programa de Promoción de Salud Mental en los niños institucionalizados

Este estudo pretende avaliar a eficácia de um programa de promoção da saúde mental com a duração de dois anos: "Chapéu de Chuva". A amostra é constituída por 45 crianças residentes em instituições de acolhimento, com idades compreendidas entre 6 e 12 anos (Mdn = 9). Os instrumentos utilizados para a avaliação dos resultados entre os momentos pré e pós-teste incluem o Kidscreen 27 e o "Sede de Viver". Foram encontradas melhorias estatisticamente significativas ao nível do bem-estar psicológico bem como ao nível da capacidade de tomada de decisão, assertividade e resistência à pressão de pares. Tendo em conta as melhorias encontradas em dimensões fundamentais ao nível da saúde mental e os elevados níveis de satisfação e envolvimento por parte do público-alvo, reflete-se acerca da importância de dar continuidade a intervenções dessa natureza junto dessa população vulnerável

The aim of this study is to assess the effectiveness of a 2 year project - Chapéu de Chuva - promoting mental health. The study sample is composed of 45 children resident in institutional care, between the ages of 6 and 12 years (Mdn = 9). The instruments used to evaluate results between pre-and post-test moments include the Kidscreen 27 and the "Sede de Viver". Statistically significant improvements were found in terms of psychological wellbeing, as well as in the decision making capacity, assertiveness and resistance to peer pressure. The improvements found in fundamental aspects of mental health and the high levels of satisfaction and involvement in the target group, leads one to reflect on the importance of giving continuity to interventions of this nature with this vulnerable population group

Este estudio tiene como objetivo evaluar la eficacia de un programa de promoción de la salud mental, con una duración de dos años - "Chapéu de Chuva". La muestra estuvo formada por 45 niños que viven en instituciones de acogida, con edades comprendidas entre 6 y 12 años (Mdn = 9). Los instrumentos utilizados para la evaluación de los resultados entre el pre y post-test incluyen Kidscreen 27 y "Sede de Viver". Se encontraron mejorías estadísticamente significativas en términos de bienestar psicológico, así como en el nivel de la capacidad de toma de decisiones, asertividad, y resistencia a la presión. Teniendo en cuenta las mejoras que se encontraron en las dimensiones fundamentales de la salud mental y los altos niveles de satisfacción y compromiso por parte del público destinatario, se reflexiona sobre la importancia de dar continuidad a intervenciones de esta naturaleza con esta población vulnerable