Our study aimed to assess the frequency of hospitalizations related to feeding problems in patients with advanced dementia in an Internal Medicine Department, assess healthcare professionals’ attitudes, and compare outcomes between patients with and without enteral tube feeding. We conducted a retrospective cohort study among patients aged ≥65 years with advanced dementia admitted to Internal Medicine Department of Coimbra's Healthcare Integrated Delivery System and found that both feeding-related complications and development of infections are common in the terminal stages of dementia, as 17.4 Dementia is a chronic disease characterized by progressive and mostly irreversible cognitive and functional decline. Advanced dementia is linked to high mortality and morbidity, with over 85
BACKGROUND:Oral and ocular medications are frequently used in the treatment of allergic rhinitis (AR). As part of the update of the Allergic Rhinitis and its Impact on Asthma (ARIA)-EAACI guidelines, this manuscript presents the ARIA-EAACI 2024-2025 recommendations for oral and ocular treatments. METHODS:The ARIA-EAACI 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgements and recommendations, including systematic reviews, mHealth and pharmacovigilance data as well as a survey on costs. RESULTS:Eight guideline questions concerning oral treatments for AR and three questions concerning ocular treatments were addressed. These questions led to the recommendations. Overall, these questions concern the choice between different classes of medication. They also discuss the role of oral antihistamines (OAH), leukotriene receptor antagonists (LTRA), ocular antihistamines (OcAH) and ocular mast cell stabilisers. Four questions had not been previously evaluated in ARIA guidelines, while, for the other four, there was a change in the strength or directionality of the recommendations. Overall, these guidelines recommend using intranasal corticosteroids over OAH and using OAH over LTRA. Moreover, they suggest using OAH over OcAH and suggest being against adding LTRA to OAH. Finally, considerations for choosing between different individual OAHs are presented. CONCLUSION:This ARIA-EAACI 2024-2025 article supports patients, their caregivers and healthcare professionals in choosing oral and ocular treatments for AR. Decisions on treatment should consider the clinical variability of the disease, patients' values and the affordability of medications.
INTRODUCTION:Multiple Sclerosis (MS) is the leading cause of non-traumatic disability in young adults, burdening patients, caregivers, and healthcare systems. In Portugal, annual direct healthcare costs for MS are estimated between €12,303 and €16,451, with total costs reaching €34,400 per patient. This study aims to characterize MS patients in Coimbra, focusing on demographic, clinical, and economic aspects to assess the disease's socioeconomic impact. METHODS:A cost-of-illness study with cross-sectional and retrospective components was conducted between 2021 and 2022 at the single referral center for MS in Coimbra. Patients completed a survey assessing sociodemographic, clinical, and economic data. Descriptive and comparative non-parametric analyses stratified by MS severity (mild EDSS 0-3.5, moderate 4-6.5, severe above 6.5) were performed. RESULTS:Among 163 patients (69.9 % female, mean age 48), 87.1 % had relapsing-remitting MS. Higher education was common (69.3 %), 45.4 % were married. Employment declined with disease severity; 9.4 % of mild EDSS patients were unemployed, while severe EDSS patients were retired. Average annual direct healthcare costs were €12,406, increasing with severity (€12,267 in mild MS to €16,020 in severe MS). Disease-modifying therapies accounted for most direct costs, although these declined in advanced stages, with hospitalization costs rising. Total costs per patient were €14,954 (mild MS), €28,289 (moderate MS), and €35,557 (severe MS), with relapses adding €3277 annually. CONCLUSION:This study underscores the substantial economic burden of MS, particularly as disease severity progresses. Rising hospitalization and relapse costs highlight the need for cost-effective strategies and policies reducing MS-related socioeconomic impacts. Effective management could help mitigate these costs while improving outcomes.
BACKGROUND:Allergic rhinitis displays a relevant impact on quality of life. Medications used in the treatment of rhinitis have been assessed on their impact on rhinoconjunctivitis-related quality of life, but not on generic health-related quality of life metrics, such as utilities or EQ-5D visual analogue scale (VAS) levels. This study aimed to compare different medication classes and individual medications on utilities and EQ-5D VAS levels using data from a mobile app. METHODS:We conducted an observational study using direct patient data from the MASK-air mobile application, collected between May 2015 and December 2024. We compared rhinitis medication classes and individual medications on health utilities (computed from the EQ-5D-5L questionnaire) and the EQ-5D VAS. To account for confounding, we employed inverse probability treatment weighting based on propensity scores, adjusting for demographics, baseline symptom control, and asthma status. RESULTS:The study analysed 69,973 observations with EQ-5D VAS data and 842 observations with utility data. At the medication class level, fixed combinations of intranasal antihistamines and corticosteroids were associated with improvements in EQ-5D VAS (mean difference = 1.900; 95% CI = 1.316-2.484) and utilities (mean difference = 0.022; 95% CI = -0.015 to 0.059) compared with oral antihistamines (OAH). Intranasal antihistamines were associated with lower EQ-5D VAS and utility scores than other intranasal treatments. For individual medications, mometasone was associated with a lower EQ-5D VAS than budesonide and fluticasone furoate, while fexofenadine and levocetirizine tended to be associated with lower VAS values than other OAH. CONCLUSION:Fixed combinations of intranasal antihistamines and corticosteroids were associated with better quality-of-life than oral antihistamines and intranasal antihistamines. These findings could support future cost-effectiveness analyses.
OBJECTIVES:Previous studies in endometriosis have linked the experience and impact of pain to psychological distress and sexual dysfunction. However, little is known about how these factors interact over time or how underlying cognitive-emotional processes contribute to their complex interconnections. DESIGN:This study followed a Longitudinal Network Approach and explored the interconnections over time between pain (intensity and impact), psychopathological symptoms, sexual distress, and cognitive-emotional processes (cognitive fusion and difficulties in emotion regulation) in adult women with endometriosis. METHODS:Data was collected in a sample composed of N = 210 Portuguese cisgender women with endometriosis in a three-wave online assessment spanning 12 months. RESULTS:Using multilevel vector autoregressive network analysis, results showed significant temporal pathways in which pain intensity and pain impact predicted future increases in cognitive fusion, depression, and somatization, indicating a directional cascading effect of physical symptoms on psychological processes. Higher sexual distress over time was associated with decreases in cognitive fusion. Results also found strong positive associations among pain, anxiety, depression, and somatization at each time point, as well as between-subjects asymmetrical relationships, with anxiety and somatization more strongly predicting sexual distress than the reverse. CONCLUSIONS:Overall, these findings highlight the importance of targeting transdiagnostic cognitive-emotional processes in interventions to improve pain, mental health, and sexual outcomes in women with endometriosis.
