Never-smokers with NSCLC present distinct demographic and clinical characteristics. The characteristics of tumor also differ between never-smokers and ever-smokers, which may suggest different carcinogenic pathways.

This paper presents a study which aims to validate a scale for assessing the impact of Web 2.0 in education. From a structural perspective, we evaluate the influence of various factors (Training, Attitude and Use of Web 2.0) on the Impact of Web 2.0 in education with a sample of 403 students from different degrees of the University of Huelva, applying a Likert scale constructed for this purpose. To analyse the psychometric properties of the scale, we conducted a Chronbach’s Alpha reliability test and factor analysis. To validate the theoretical construct, we conducted an analysis according to structural equation modelling, which enabled us to confirm the influence of training, attitude and use on the Impact of Web 2.0, and to observe how the factors interrelate and influence each other. We conclude that the existence of a training plan is not enough in itself and that, rather, it is the approach taken to Web 2.0 and the use made of it that has more influence on its educational impact.

A ventilação não-invasiva melhora a venti-lação alveolar por criar um gradiente de pres-são transpulmonar sem a necessidade de uma via aérea artificial. Recentemente, Girou E et al. 1 publicaram uma pesquisa observacional, retrospectiva do tipo coorte avaliando 479 pacientes com doença pulmonar obstrutiva crônica (DPOC) ou edema agudo de pulmão (EAP) submetidos à ventilação mecânica con-vencional ou não-invasiva (VNI), durante um período de oito anos, em que se realizou concomitantemente o treinamento e se ela-boraram recomendações para facilitar a utili-zação da VNI. As principais variáveis estudadas foram a incidência de infecção adquirida na UTI e a taxa de mortalidade. Como resulta-dos, observou-se um aumento significativo da utilização da VNI com diminuição da freqüên-cia de pneumonia intrahospitalar de 20% em 1994 para 8% em 2001 (p = 0.04) e do risco de óbito (OR 0.37; IC 95%: 0.18-0.78). Comentário O benefício associado com a utilização da VNI resulta primariamente da redução do uso da ventilação pulmonar mecânica com intubação intratraqueal 2. Os sistemas invasivos como catéteres intravasculares e tubos intratraqueais são fatores de risco para infecção intra-hospita-lar 3. Nos pacientes submetidos à VNI a invasividade relacionada aos cuidados dos paci-entes é menor 4. Portanto, este estudo é interes-sante para nós clínicos, que tentamos passar para a prática clínica os resultados das pesquisas sobre VNI, entretanto, as evidências estão restritas a alguns tipos de pacientes adultos, principalmente com DPOC e EAP, não podendo ser extrapolados os dados existentes até o momento para pacientes na faixa etária pediátrica. WERTHER BRUNOW DE CARVALHO MARCELO CUNIO MACHADO FONSECA Referências 1. Girou E, Brun-Buisson C, Taille S, Lemaire F, Bochard L. Secular trends in nosocomial infections and mortality associated with noninvasive ventilation in patients with exacerbation of COPD and pulmonary edema. JAMA 2003; 290:2985-91. 2. Brochard L. Noninvasive ventilation for acute respiratory failure. JAMA 2002; 288:932-5. NO NO NO NO NO CLIMATÉRIO CLIMATÉRIO CLIMATÉRIO CLIMATÉRIO CLIMATÉRIO Estudo americano publicado em 2001 mostrou que a osteoporose provoca perda óssea mandibular, doença periodontal e per-das dentárias em mulheres após a menopau-sa; ademais, observou que a terapia hormonal com estrogênio protege não só contra a perda óssea sistêmica, mas também contra a perda dentária. Concluiu que cabe ao profis-sional de saúde atentar para qualquer altera-ção no osso alveolar e/ou na mobilidade dental em mulheres após a menopausa e que, na presença destes sintomas bucais deve sempre se suspeitar de osteopenia/ osteoporose e encaminhar a mulher para avaliação médica direcionada 1. Comentário Investigação recém-concluída em São Paulo envolvendo 94 participantes avaliou a saúde bucal de mulheres no climatério em um ambulatório especializado. Os resultados odontológicos obtidos mostraram-se surpre-endentes; de fato, a doença periodontal foi constatada em 83% dos sítios analisados e a perda média de dentes foi de 11, de ...

The aim of this study was to develop and validate the professional translation and cultural adaptation of the Portuguese Severe Respiratory Insufficiency (SRI) Questionnaire. The sample was composed of 93 patients (50 male patients, 53.8%) with a mean age of 66.3 years. The most frequent diagnostic groups were chronic obstructive pulmonary disease, obesity hypoventilation syndrome and restrictive chest wall disorders. The patients were asked to fill in both the SRI and SF-36 questionnaires. Factor analysis of the SRI questionnaire was performed leading to an explained variance of 73%, and resulted in 13 components. When analyzing the reliability, we obtained values for Cronbach's alpha above 0.70 for most subscales with the reliability of the summary scale being even higher (0.84). This professional translation and cultural adaptation of the Portuguese SRI Questionnaire has good psychometric properties which are similar, not only to the original, but also to other translations. These characteristics make this questionnaire applicable to the Portuguese population receiving home mechanical ventilation for severe respiratory insufficiency.

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Purpose Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is becoming increasingly widespread. The aim of this study was to provide an accurate description of the current practices and clinical characteristics of COPD patients on HMV in Portugal. Methods The study was designed as a cross-sectional, multicenter real-life study of COPD patients established on HMV for at least 30 days. Data related to clinical characteristics, adaptation and ventilatory settings were collected. Results The study included 569 COPD patients on HMV from 15 centers. The majority were male, with a median age of 72 years and a high prevalence of obesity (43.2%) and sleep apnea (45.8%). A high treatment compliance was observed (median 8h/day), 48.7% with inspiratory positive airway pressure ≥20 cmH 2 O and oronasal masks were the preferred interface (91.7%). There was an equal distribution of patients starting HMV during chronic stable condition and following an exacerbation. Patients in stable condition were initiated in the outpatient setting in 92.3%. Despite the differences in criteria and setting of adaptation and a slightly lower BMI in patients starting HMV following an exacerbation, we found no significant differences regarding age, gender, ventilation pressures, time on HMV, usage, severity of airflow obstruction or current arterial blood gas analysis (ABGs) in relation to patients adapted in stable condition. Conclusion Patients were highly compliant with the therapy. In agreement with most recent studies and recommendations, there seems to be a move towards higher ventilation pressures, increased use of oronasal masks and an intent to obtain normocapnia. This study shows that chronic hypercapnic and post exacerbation patients do not differ significantly regarding patient characteristics, physiological parameters or ventilatory settings with one exception: chronic hypercapnic patients are more often obese and, subsequently, more frequently present OSA.

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Background: The 8th edition of the tumor, node and metastasis (TNM) classification of lung cancer will be enacted in January 2017. The aim of this study was to analyze the survival differences among the three new categories of metastatic disease: intrathoracic metastasis (M1a), single extrathoracic metastasis (M1b) and multiple extrathoracic metastases (M1c) in our cohort of patients with non-small cell lung cancer (NSCLC).Methods: This is a retrospective single-center study including NSCLC patients with metastatic disease at diagnosis. Patients were divided into three groups (M1a, M1b, M1c). Overall survival (OS) within and between these subgroups was calculated using the Kaplan-Meier method.