| 1. |
- Neves, Ana Luisa, et al.
(författare)
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Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma : Secondary Analysis of Observational Studies
- 2021
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 23:9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were <= 40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.
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| 2. |
- Amaral, Rita, et al.
(författare)
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Profiling Persistent Asthma Phenotypes in Adolescents : A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:3
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.
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| 3. |
- Jacome, Cristina, et al.
(författare)
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Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App : Analysis of Real-World, Medium-Term Feasibility Studies
- 2021
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Ingår i: Frontiers in Medical Technology. - : Frontiers Media S.A.. - 2673-3129. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support.Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use.Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app =30 days was used as the cut-off for higher app use.Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen.Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.
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| 4. |
- Proletov, Ian, et al.
(författare)
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Primary and secondary glomerulonephritides 1.
- 2014
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Ingår i: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. - : Oxford University Press (OUP). - 1460-2385. ; 29 Suppl 3:May, s. 186-200
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Tidskriftsartikel (refereegranskat)
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| 5. |
- Boulet, Anne Karine, et al.
(författare)
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Agro-ecological services delivered by legume cover crops grown in succession with grain corn crops in the Mediterranean region
- 2021
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Ingår i: OPEN AGRICULTURE. - : Walter de Gruyter GmbH. - 2391-9531. ; 6:1, s. 609-626
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Tidskriftsartikel (refereegranskat)abstract
- Grain corn is the main cereal produced in Portugal. It is grown in intensive monoculture cropping systems that may have negative effects on soil quality, affecting long-term fertility and productivity, and, therefore, the sustainability of the production. A promising management practice to mitigate soil degradation is to grow winter cover crops used as green manure. This study examined the effectiveness of six legume cover crops (LCCs) species in providing agro-ecological services for grain corn systems in the Mediterranean region, specifically in terms of nutrient leaching, nutrient recycling, weed control, and soil fertility. The study was performed in Central Portugal during 2 years, and it assessed legumes/weeds dry biomass yield, their nutrients content, and soil organic matter evolution. Results show that, in general, LCC are well adapted to Mediterranean conditions, yielding large amounts of biomass (up to 8 ton/ha for some clover species). In terms of nutrient leaching mitigation, the overall N-P-K nutrient uptake was 176-20-172 kg/ha. Green manure services enabled a reduction of 35% of N, 50% of P, and 100% of mineral fertilizers for a grain corn production of 12 ton/ha. Weed control by LCC was effective only in the second year of the study and for three clover species (crimson, balansa, and arrowleaf) due to their early establishment and/or high biomass production competing with weeds. Soil fertility was not improved in the short term, LCC incorporation into the soil to a slight depletion of the soil organic matter content.
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| 6. |
- Boulet, Anne-Karine, et al.
(författare)
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Hydrological Processes in Eucalypt and Pine Forested Headwater Catchments within Mediterranean Region
- 2021
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Ingår i: Water. - : MDPI AG. - 2073-4441. ; 13:10
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Tidskriftsartikel (refereegranskat)abstract
- Mediterranean headwater catchments have experienced major land-use changes in recent centuries, namely characterized by afforestation with fast-growing tree species (e.g., pine and eucalyptus). This paper investigates differences in the hydrological response of two forested catchments with distinct Pinus pinaster Aiton (PIN) and Eucalyptus globulus Labill. (EUC) covers over 6 hydrological years, from 2010 to 2016. The study was developed in paired catchments located in North-Central Portugal, under wet Mediterranean climate and schist bedrock. Based on rainfall and streamflow measurements, the hydrological responses were analyzed through the water-balance calculations, rainfall-runoff event analyses, and correlations between rainfall characteristics, evapotranspiration, soil moisture, overland flow, and land-cover parameters. The study period recorded a wide range of annual rainfall, between 984 and 2127 mm per years. The annual streamflow displayed greater inter-annual variation, from 208 to 1430 mm for PIN and from 217 to 1291 mm for EUC. The runoff coefficient was higher in the wettest years, with a maximum of 58% for PIN and 61% for EUC, and decreased substantially in the driest year, representing only 17% of the rainfall in PIN and 22% in EUC. Rainfall was predominant during the winter season (41%), followed by autumn (30%) and spring (24%). The streamflow displayed a seasonal behavior in both catchments, with higher runoff coefficient for EUC that for PIN. Half of the annual streamflow occurs during the winter, with the highest average runoff coefficient attained for EUC and PIN respectively being 68% and 64% of the rainfall amount. Annual evapotranspiration was relatively constant through the six years of study and showed higher average values in PIN (907 mm) than EUC (739 mm), highlighting the importance of forest type and showing that mature pine plantations lead to higher water consumption than eucalypt stands. Annual rainfall amount affects evapotranspiration rate (%), the percentage of ET increasing from 37% to 78% for PIN and from 34% to 73% for EUC between the wettest and the driest years, which raises concerns regarding the impact of climate changes on water availability in the mountain areas of the Mediterranean region.
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| 7. |
- Ferreira, Carla S. S., et al.
(författare)
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Effectiveness of Nature-Based Solutions in Mitigating Flood Hazard in a Mediterranean Peri-Urban Catchment
- 2020
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Ingår i: Water. - : MDPI AG. - 2073-4441. ; 12:10
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Tidskriftsartikel (refereegranskat)abstract
- Urbanization alters natural hydrological processes and enhances runoff, which affects flood hazard. Interest in nature-based solutions (NBS) for sustainable mitigation and adaptation to urban floods is growing, but the magnitudes of NBS effects are still poorly investigated. This study explores the potential of NBS for flood hazard mitigation in a small peri-urban catchment in central Portugal, prone to flash floods driven by urbanization and short but intense rainfall events typical of the Mediterranean region. Flood extent and flood depth are assessed by manually coupling the hydrologic HEC-HMS and hydraulic HEC-RAS models. The coupled model was run for single rainfall events with recurrence periods of 10-, 20-, 50-, and 100-years, considering four simulation scenarios: current conditions (without NBS), and with an upslope NBS, a downslope NBS, and a combination of both. The model-simulation approach provides good estimates of flood magnitude (NSE = 0.91, RMSE = 0.08, MAE = 0.07, R-2 = 0.93), and shows that diverting streamflow into abandoned fields has positive impacts in mitigating downslope flood hazard. The implementation of an upslope NBS can decrease the water depth at the catchment outlet by 0.02 m, whereas a downslope NBS can reduce it from 0.10 m to 0.23 m for increasing return periods. Combined upslope and downslope NBS have a marginal additional impact in reducing water depth, ranging from 0.11 m to 0.24 m for 10- and 100-year floods. Decreases in water depth provided by NBS are useful in flood mitigation and adaptation within the peri-urban catchment. A network of NBS, rather than small isolated strategies, needs to be created for efficient flood-risk management at a larger scale.
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| 8. |
- Gomes Marques, Inês, et al.
(författare)
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The ADnet Bayesian belief network for alder decline : integrating empirical data and expert knowledge
- 2024
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Ingår i: Science of the Total Environment. - : Elsevier. - 0048-9697 .- 1879-1026. ; 947
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Tidskriftsartikel (refereegranskat)abstract
- The globalization in plant material trading has caused the emergence of invasive pests in many ecosystems, such as the alder pathogen Phytophthora ×alni in European riparian forests. Due to the ecological importance of alder to the functioning of rivers and the increasing incidence of P. ×alni-induced alder decline, effective and accessible decision tools are required to help managers and stakeholders control the disease. This study proposes a Bayesian belief network methodology to integrate diverse information on the factors affecting the survival and infection ability of P. ×alni in riparian habitats to help predict and manage disease incidence. The resulting Alder Decline Network (ADnet) management tool integrates information about alder decline from scientific literature, expert knowledge and empirical data. Expert knowledge was gathered through elicitation techniques that included 19 experts from 12 institutions and 8 countries. An original dataset was created covering 1189 European locations, from which P. ×alni occurrence was modeled based on bioclimatic variables. ADnet uncertainty was evaluated through its sensitivity to changes in states and three scenario analyses. The ADnet tool indicated that mild temperatures and high precipitation are key factors favoring pathogen survival. Flood timing, water velocity, and soil type have the strongest influence on disease incidence. ADnet can support ecosystem management decisions and knowledge transfer to address P. ×alni-induced alder decline at local or regional levels across Europe. Management actions such as avoiding the planting of potentially infected trees or removing man-made structures that increase the flooding period in disease-affected sites could decrease the incidence of alder disease in riparian forests and limit its spread. The coverage of the ADnet tool can be expanded by updating data on the pathogen's occurrence, particularly from its distributional limits. Research on the role of genetic variability in alder susceptibility and pathogen virulence may also help improve future ADnet versions.
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| 9. |
- Kalantari, Zahra, et al.
(författare)
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URBANIZATION DEVELOPMENT UNDER CLIMATE CHANGE : HYDROLOGICAL RESPONSES IN A PERI-URBAN MEDITERRANEAN CATCHMENT
- 2017
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Ingår i: Land Degradation and Development. - : Wiley. - 1085-3278 .- 1099-145X. ; 28:7, s. 2207-2221
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Tidskriftsartikel (refereegranskat)abstract
- Relatively few studies have so far investigated the hydrological impacts of urbanization in Mediterranean catchments, and particularly in peri-urban catchments experiencing relatively rapid and large changes in their land-use mosaic. This study uses data-based model simulations to investigate such impacts, with the Ribeira dos Covoes catchment in Portugal as a concrete Mediterranean peri-urban catchment example. We distinguish the impacts of urbanization from those of climatic change on the water flux partitioning and connectivity in the catchment over the period 1958-2013. Decrease in precipitation over this period has primarily driven decreases in annual runoff and actual evapotranspiration, while the urbanization development has primarily changed the relative flux partitioning and connectivity pattern in the catchment. The relative contribution of overland flow to annual and seasonal runoff has increased, keeping the absolute overland flow more or less intact, while the baseflow contribution to the stream network has decreased. Methodologically, the present simulation approach provides a relevant means for distinguishing main drivers of change in hydrological flux partitioning and connectivity under concurrent urbanization and climatic changes.
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| 10. |
- Kennedy, Patrick J., et al.
(författare)
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Fab-conjugated PLGA nanoparticles effectively target cancer cells expressing human CD44v6
- 2018
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Ingår i: Acta Biomaterialia. - : Elsevier BV. - 1742-7061 .- 1878-7568. ; 81, s. 208-218
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Tidskriftsartikel (refereegranskat)abstract
- Targeting of CD44 isoforms containing exon v6 (CD44v6) represents a viable strategy for the therapy and/or early diagnosis of metastatic cancers of the epithelium (e.g. gastric and colorectal cancer). We developed and characterized poly(lactic-co-glycolic acid) (PLGA)-based nanoparticles (NPs) modified with polyethylene glycol (PEG) and engrafted, by site-directed conjugation, with an engineered human Fab that specifically target human CD44v6 (v6 Fab-PLGA NPs). The v6 Fab-PLGA NPs displayed spherical morphology around 300 nm and were negatively charged. They strongly bound to a CD44v6-derived peptide and, more importantly, to cells that endogenously and exogenously express CD44v6, but not to non expressing cells and cells expressing the standard isoform of CD44. The v6 Fab-PLGA NPs also recognized CD44v6 in tumor sections from cells grown subcutaneously within mice. The NPs had nominal cytotoxicity at 50 mu g/mL and withstood simulated intestinal fluid exposure. Interestingly, v6 Fab-PLGA NPs cryopreserved in 10% trehalose and stored maintained specific cell binding. In conclusion, we envision NPs targeting CD44v6 as potential in vivo diagnostic agents and/or as anti-cancer agents in patients previously stratified with CD44v6(+) carcinomas. Statement of Significance The v6 Fab-PLGA NPs displayed many favorable qualities as a potential CD44v6-targeted drug and/or diagnostic delivery agent. The NPs were designed for optimal ligand orientation and for immediate administration into humans. v6 Fab-PLGA NPs strongly bound to cells that endogenously and exogenously express CD44v6, but not to non-expressing cells and cells expressing the standard isoform of CD44. Binding ability was retained after freeze-drying and long-term storage, providing evidences on the stability of Fab-functionalized NPs. These NPs can potentially be used as an in vivo diagnostic from parenteral or oral/rectal administration.
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