| 1. |
- Menditto, Enrica, et al.
(författare)
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Adherence to treatment in allergic rhinitis using mobile technology : The MASK Study
- 2019
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Ingår i: Clinical and Experimental Allergy. - : WILEY. - 0954-7894 .- 1365-2222. ; 49:4, s. 442-460
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mobile technology may help to better understand the adherence to treatment. MASK-rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient-centred ICT system. A mobile phone app (the Allergy Diary) central to MASK is available in 22 countries. Objectives: To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App. Methods: An observational cross-sectional study was carried out on all users who filled in the Allergy Diary from 1 January 2016 to 1 August 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio (MPR) and the Proportion of days covered (PDC) approach. Results: A total of 12143 users were registered. A total of 6949 users reported at least one VAS data recording. Among them, 1887 users reported >= 7 VAS data. About 1195 subjects were included in the analysis of adherence. One hundred and thirty-six (11.28%) users were adherent (MPR >= 70% and PDC <= 1.25), 51 (4.23%) were partly adherent (MPR >= 70% and PDC = 1.50) and 176 (14.60%) were switchers. On the other hand, 832 (69.05%) users were non-adherent to medications (MPR <70%). Of those, the largest group was non-adherent to medications and the time interval was increased in 442 (36.68%) users. Conclusion and clinical relevance: Adherence to treatment is low. The relative efficacy of continuous vs on-demand treatment for allergic rhinitis symptoms is still a matter of debate. This study shows an approach for measuring retrospective adherence based on a mobile app. This also represents a novel approach for analysing medication-taking behaviour in a real-world setting.
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| 2. |
- Bousquet, Jean, et al.
(författare)
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Allergic Rhinitis and its Impact on Asthma (ARIA) Phase 4 (2018) : Change management in allergic rhinitis and asthma multimorbidity using mobile technology
- 2019
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Ingår i: Journal of Allergy and Clinical Immunology. - : Elsevier. - 0091-6749 .- 1097-6825. ; 143:3, s. 864-879
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Tidskriftsartikel (refereegranskat)abstract
- Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional.
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| 3. |
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| 4. |
- Sousa-Pinto, Bernardo, et al.
(författare)
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Comparison of rhinitis treatments using MASK-air® data and considering the minimal important difference
- 2022
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Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : John Wiley & Sons. - 0105-4538 .- 1398-9995. ; 77:10, s. 3002-3014
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Tidskriftsartikel (refereegranskat)abstract
- Background: Different treatments exist for allergic rhinitis (AR), including pharmacotherapy and allergen immunotherapy (AIT), but they have not been compared using direct patient data (i.e., “real-world data”). We aimed to compare AR pharmacological treatments on (i) daily symptoms, (ii) frequency of use in co-medication, (iii) visual analogue scales (VASs) on allergy symptom control considering the minimal important difference (MID) and (iv) the effect of AIT.Methods: We assessed the MASK-air® app data (May 2015–December 2020) by users self-reporting AR (16–90 years). We compared eight AR medication schemes on reported VAS of allergy symptoms, clustering data by the patient and controlling for confounding factors. We compared (i) allergy symptoms between patients with and without AIT and (ii) different drug classes used in co-medication.Results: We analysed 269,837 days from 10,860 users. Most days (52.7%) involved medication use. Median VAS levels were significantly higher in co-medication than in monotherapy (including the fixed combination azelastine-fluticasone) schemes. In adjusted models, azelastine-fluticasone was associated with lower average VAS global allergy symptoms than all other medication schemes, while the contrary was observed for oral corticosteroids. AIT was associated with a decrease in allergy symptoms in some medication schemes. A difference larger than the MID compared to no treatment was observed for oral steroids. Azelastine-fluticasone was the drug class with the lowest chance of being used in co-medication (adjusted OR = 0.75; 95% CI = 0.71–0.80).Conclusion: Median VAS levels were higher in co-medication than in monotherapy. Patients with more severe symptoms report a higher treatment, which is currently not reflected in guidelines.
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| 5. |
- Sousa-Pinto, Bernardo, et al.
(författare)
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Consistent trajectories of rhinitis control and treatment in 16,177 weeks : the MASK-air® longitudinal study
- 2023
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Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : John Wiley & Sons. - 0105-4538 .- 1398-9995. ; 78:4, s. 968-983
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Data from mHealth apps can provide valuable information on rhinitis control and treatment patterns. However, in MASK-air®, these data have only been analyzed cross-sectionally, without considering the changes of symptoms over time. We analyzed data from MASK-air® longitudinally, clustering weeks according to reported rhinitis symptoms. Methods: We analyzed MASK-air® data, assessing the weeks for which patients had answered a rhinitis daily questionnaire on all 7 days. We firstly used k-means clustering algorithms for longitudinal data to define clusters of weeks according to the trajectories of reported daily rhinitis symptoms. Clustering was applied separately for weeks when medication was reported or not. We compared obtained clusters on symptoms and rhinitis medication patterns. We then used the latent class mixture model to assess the robustness of results. Results: We analyzed 113,239 days (16,177 complete weeks) from 2590 patients (mean age ± SD = 39.1 ± 13.7 years). The first clustering algorithm identified ten clusters among weeks with medication use: seven with low variability in rhinitis control during the week and three with highly-variable control. Clusters with poorly-controlled rhinitis displayed a higher frequency of rhinitis co-medication, a more frequent change of medication schemes and more pronounced seasonal patterns. Six clusters were identified in weeks when no rhinitis medication was used, displaying similar control patterns. The second clustering method provided similar results. Moreover, patients displayed consistent levels of rhinitis control, reporting several weeks with similar levels of control. Conclusions: We identified 16 patterns of weekly rhinitis control. Co-medication and medication change schemes were common in uncontrolled weeks, reinforcing the hypothesis that patients treat themselves according to their symptoms.
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| 6. |
- Sousa-Pinto, Bernardo, et al.
(författare)
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Development and validation of combined symptom-medication scores for allergic rhinitis*
- 2022
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Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : John Wiley & Sons. - 0105-4538 .- 1398-9995. ; 77:7, s. 2147-2162
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Tidskriftsartikel (refereegranskat)abstract
- Background: Validated combined symptom-medication scores (CSMSs) are needed to investigate the effects of allergic rhinitis treatments. This study aimed to use real-life data from the MASK-air® app to generate and validate hypothesis- and data-driven CSMSs.Methods: We used MASK-air® data to assess the concurrent validity, test-retest reliability and responsiveness of one hypothesis-driven CSMS (modified CSMS: mCSMS), one mixed hypothesis- and data-driven score (mixed score), and several data-driven CSMSs. The latter were generated with MASK-air® data following cluster analysis and regression models or factor analysis. These CSMSs were compared with scales measuring (i) the impact of rhinitis on work productivity (visual analogue scale [VAS] of work of MASK-air®, and Work Productivity and Activity Impairment: Allergy Specific [WPAI-AS]), (ii) quality-of-life (EQ-5D VAS) and (iii) control of allergic diseases (Control of Allergic Rhinitis and Asthma Test [CARAT]).Results: We assessed 317,176 days of MASK-air® use from 17,780 users aged 16-90 years, in 25 countries. The mCSMS and the factor analyses-based CSMSs displayed poorer validity and responsiveness compared to the remaining CSMSs. The latter displayed moderate-to-strong correlations with the tested comparators, high test-retest reliability and moderate-to-large responsiveness. Among data-driven CSMSs, a better performance was observed for cluster analyses-based CSMSs. High accuracy (capacity of discriminating different levels of rhinitis control) was observed for the latter (AUC-ROC = 0.904) and for the mixed CSMS (AUC-ROC = 0.820).Conclusion: The mixed CSMS and the cluster-based CSMSs presented medium-high validity, reliability and accuracy, rendering them as candidates for primary endpoints in future rhinitis trials.
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| 7. |
- Braun, Christoph, et al.
(författare)
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Controls on Subtropical Cloud Reflectivity during a Waterbelt Scenario for the Cryogenian Glaciations
- 2022
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Ingår i: Journal of Climate. - 0894-8755 .- 1520-0442. ; 35:21, s. 3457-3476
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Tidskriftsartikel (refereegranskat)abstract
- Waterbelt climate states with an ice-free tropical ocean provide a straightforward explanation for the survival of advanced marine species during the Cryogenian glaciations (720–635 million years ago). Previous work revealed that stable waterbelt states require the presence of highly reflective low-level mixed-phase clouds with a high abundance of supercooled liquid in the subtropics. However, the high uncertainty associated with representing mixed-phase clouds in coarse-scale general circulation models (GCMs) that parameterize atmospheric convection has prohibited assessment of whether waterbelt states are a robust feature of Earth’s climate. Here we investigate whether resolving convective-scale motion at length scales of hectometers helps us to assess the plausibility of a waterbelt scenario. First, we show that substantial differences in cloud reflectivity among GCMs do not arise from the resolved atmospheric circulation. Second, we conduct a hierarchy of simulations using the Icosahedral Nonhydrostatic (ICON) modeling framework, ranging from coarse-scale GCM simulations with parameterized convection to large-eddy simulations that explicitly resolve atmospheric convective-scale motions. Our hierarchy of simulations supports the existence of highly reflective subtropical clouds if we apply moderate ice nucleating particle (INP) concentrations. Third, we test the sensitivity of cloud reflectivity to the INP concentration. In the presence of high but justifiable INP concentrations, cloud reflectivity is strongly reduced. Hence, the existence of stable waterbelt states is controlled by the abundance of INPs. We conclude that explicitly resolving convection can help to constrain Cryogenian cloud reflectivity, but limited knowledge concerning Cryogenian aerosol conditions hampers strong constraints. Thus, waterbelt states remain an uncertain feature of Earth’s climate.
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| 8. |
- Hochman, Assaf, et al.
(författare)
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A new view of heat wave dynamics and predictability over the eastern Mediterranean
- 2021
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Ingår i: Earth System Dynamics. - : Copernicus Publications. - 2190-4979 .- 2190-4987. ; 12:1, s. 133-149
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Tidskriftsartikel (refereegranskat)abstract
- Skillful forecasts of extreme weather events have a major socioeconomic relevance. Here, we compare two complementary approaches to diagnose the predictability of extreme weather: recent developments in dynamical systems theory and numerical ensemble weather forecasts. The former allows us to define atmospheric configurations in terms of their persistence and local dimension, which provides information on how the atmosphere evolves to and from a given state of interest. These metrics may be used as proxies for the intrinsic predictability of the atmosphere, which only depends on the atmosphere's properties. Ensemble weather forecasts provide information on the practical predictability of the atmosphere, which partly depends on the performance of the numerical model used. We focus on heat waves affecting the eastern Mediterranean. These are identified using the climatic stress index (CSI), which was explicitly developed for the summer weather conditions in this region and differentiates between heat waves (upper decile) and cool days (lower decile). Significant differences are found between the two groups from both the dynamical systems and the numerical weather prediction perspectives. Specifically, heat waves show relatively stable flow characteristics (high intrinsic predictability) but comparatively low practical predictability (large model spread and error). For 500 hPa geopotential height fields, the intrinsic predictability of heat waves is lowest at the event's onset and decay. We relate these results to the physical processes governing eastern Mediterranean summer heat waves: adiabatic descent of the air parcels over the region and the geographical origin of the air parcels over land prior to the onset of a heat wave. A detailed analysis of the mid-August 2010 record-breaking heat wave provides further insights into the range of different regional atmospheric configurations conducive to heat waves. We conclude that the dynamical systems approach can be a useful complement to conventional numerical forecasts for understanding the dynamics and predictability of eastern Mediterranean heat waves.
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| 9. |
- Hochman, Assaf, et al.
(författare)
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Do Atlantic-European Weather Regimes Physically Exist?
- 2021
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Ingår i: Geophysical Research Letters. - 0094-8276 .- 1944-8007. ; 48:20
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Tidskriftsartikel (refereegranskat)abstract
- The subseasonal variability of the extratropical large-scale atmospheric flow is characterized by recurrent or quasi-stationary circulation anomalies, termed weather regimes. Despite the usefulness of these regimes in numerous meteorological and socioeconomic applications, there is an ongoing debate as to whether they represent physical modes of the atmosphere, or are merely useful statistical categorizations. Here, we answer this question for wintertime Atlantic-European regimes. We argue that dynamical systems theory applied to a refined regime definition provides strong evidence in support of most weather regimes being physically meaningful. This finding underpins the broad relevance of weather regimes, for understanding the response of the atmosphere to external forcing, supporting subseasonal weather forecasting, and down scaling of climate projections.
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| 10. |
- Hochman, Assaf, et al.
(författare)
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Do Atlantic‐European weather regimes physically exist?
- 2021
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Ingår i: Geophysical Research Letters. - : American Geophysical Union (AGU). - 0094-8276 .- 1944-8007. ; 48:20
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Tidskriftsartikel (refereegranskat)abstract
- The sub-seasonal variability of the extra-tropical large-scale atmospheric flow is characterized by recurrent or quasi-stationary circulation anomalies, termed weather regimes. Despite the usefulness of these regimes in numerous meteorological and socioeconomic applications, there is an ongoing debate as to whether they represent physical modes of the atmosphere, or are merely useful statistical categorizations. Here, we answer this question for wintertime Atlantic-European regimes. We argue that dynamical systems theory applied to a refined regime definition provides strong evidence in support of most weather regimes being physically meaningful. This finding underpins the broad relevance of weather regimes, for understanding the response of the atmosphere to external forcing, supporting sub-seasonal weather forecasting, and down-scaling of climate projections.
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