| 1. |
- Jacome, Cristina, et al.
(author)
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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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In: Frontiers in Medical Technology. - : Frontiers Media S.A.. - 2673-3129. ; 3
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Journal article (peer-reviewed)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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| 2. |
- Jacome, Cristina, et al.
(author)
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Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence : Mixed Methods Study
- 2021
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In: JMIR mhealth and uhealth. - : JMIR Publications. - 2291-5222. ; 9:5
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Journal article (peer-reviewed)abstract
- Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring >= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app.
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| 3. |
- Neves, Ana Luisa, et al.
(author)
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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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In: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 23:9
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Journal article (peer-reviewed)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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| 4. |
- Amaral, Rita, et al.
(author)
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Profiling Persistent Asthma Phenotypes in Adolescents : A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies
- 2021
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:3
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Journal article (peer-reviewed)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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| 5. |
- Bousquet, Jean, et al.
(author)
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ARIA digital anamorphosis : Digital transformation of health and care in airway diseases from research to practice
- 2021
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In: Allergy. European Journal of Allergy and Clinical Immunology. - : John Wiley & Sons. - 0105-4538 .- 1398-9995. ; 76:1, s. 168-190
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Research review (peer-reviewed)abstract
- Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.
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| 6. |
- Bousquet, J. Jean, et al.
(author)
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Next-generation ARIA care pathways for rhinitis and asthma : a model for multimorbid chronic diseases
- 2019
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In: Clinical and Translational Allergy. - : BMC. - 2045-7022. ; 9
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Research review (peer-reviewed)abstract
- Background: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy.Main body: As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted "patient activation", (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Sante as a Good Practice in the field of digitally-enabled, integrated, person-centred care.Conclusion: In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
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| 7. |
- Simoes Cunha, Mafalda, et al.
(author)
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Symptoms of anxiety and depression in patients with persistent asthma : a cross-sectional analysis of the INSPIRERS studies
- 2023
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:5
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Journal article (peer-reviewed)abstract
- ObjectivesAnxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms.MethodsThis is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6 +/- 16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score >= 8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built.ResultsAccording to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression.ConclusionAt least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.
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| 8. |
- Cachim, Afonso, et al.
(author)
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Measuring adherence to inhaled control medication in patients with asthma : Comparison among an asthma app, patient self-report and physician assessment
- 2023
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In: Clinical and Translational Allergy. - : John Wiley & Sons. - 2045-7022. ; 13:2
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Journal article (peer-reviewed)abstract
- BackgroundPrevious studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment.MethodsThis study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0–100).ResultsA total of 193 patients (72% female; median [P25–P75] age 28 [19–41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0–71]%; 1 month: 18 [0–48]%) than patient self-report (80 [60–95]) and physician assessment (82 [51–94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118–0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001).ConclusionsAdherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.
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| 9. |
- Cerca, Jose, et al.
(author)
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The genomic basis of the plant island syndrome in Darwin's giant daisies
- 2022
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In: Nature Communications. - : Springer Nature. - 2041-1723. ; 13:1
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Journal article (peer-reviewed)abstract
- Many island plant species share a syndrome of characteristic phenotype and life history. Cerca et al. find the genomic basis of the plant island syndrome in one of Darwin's giant daisies, while separating ancestral genomes in a chromosome-resolved polyploid assembly. The repeated, rapid and often pronounced patterns of evolutionary divergence observed in insular plants, or the 'plant island syndrome', include changes in leaf phenotypes, growth, as well as the acquisition of a perennial lifestyle. Here, we sequence and describe the genome of the critically endangered, Galapagos-endemic species Scalesia atractyloides Arnot., obtaining a chromosome-resolved, 3.2-Gbp assembly containing 43,093 candidate gene models. Using a combination of fossil transposable elements, k-mer spectra analyses and orthologue assignment, we identify the two ancestral genomes, and date their divergence and the polyploidization event, concluding that the ancestor of all extant Scalesia species was an allotetraploid. There are a comparable number of genes and transposable elements across the two subgenomes, and while their synteny has been mostly conserved, we find multiple inversions that may have facilitated adaptation. We identify clear signatures of selection across genes associated with vascular development, growth, adaptation to salinity and flowering time, thus finding compelling evidence for a genomic basis of the island syndrome in one of Darwin's giant daisies.
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| 10. |
- Loureiro, Sandra Maria Correia, et al.
(author)
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Engaging with (vs. avoiding) personalized advertising on social media
- 2023
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In: Journal of Marketing Communications. - : Routledge. - 1352-7266 .- 1466-4445.
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Journal article (peer-reviewed)abstract
- This study investigates binomial consumer brand engagement (vs. advertising avoidance) in the social media context. Grounded in social exchange theory, the relationships between personalized advertising, information control, privacy concerns, advertising avoidance, and consumer brand engagement are analyzed by drawing on a survey comprising n = 429 participants. The findings reveal that personalized advertising boosts brand engagement while also reducing privacy concerns. Additionally, it has been discovered that privacy concerns do not have a significant impact on consumers’ engagement with a brand. Overall, this study demonstrates that consumers can recognize personalized advertising and are open to relying on it.
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| 11. |
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| 12. |
- Muniz Rocha, João Victor, 1990-
(author)
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Hospitalizations for Ambulatory Care-Sensitive Conditions in Brazil and Portugal : A Comparative Study
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Background: Ambulatory Care Sensitive Conditions (ACSC) are health conditions for which adequate management, treatment and interventions delivered in outpatient setting could avoid the need of hospital admission. Hospitalizations for ACSC have been used to assess access, quality, and performance of the Primary Health Care (PHC). Portugal and Brazil have carried out reforms in their PHC delivery system in the last years, with similar organizational characteristics and objectives. While inter-country comparison provides opportunities for cross-country learning, ACSC have limitations as an indicator for quality of care. The aim of this thesis was to analyze the dynamics of hospitalizations for Ambulatory Care Sensitive Conditions in Brazil and Portugal.Methods: Firstly, a literature review was conducted to identify the conceptual, methodological, contextual and policy dimensions and factors that need to be accounted for when comparing hospitalizations for ACSC across countries. Secondly, hospitalizations for ACSC in Brazil and Portugal were compared in the dimensions of occurrence, rates, causes, sociodemographic characteristics, costs of hospitalizations and economic impact, geographic distribution and variations, and identification of spatial clusters. The data for this comparison was obtained from administrative databases of all hospitalizations in public hospital in each country for the year 2015. ACSC were classified according to the methodology by the Agency for Healthcare Research and Quality. Thirdly, a longitudinal analysis was carried out to investigate if expansion of PHC reform in Brazil and Portugal (using coverage of Family Health Units as proxy) was associated to hospitalizations for ACSC. This analysis was conducted for the period 2007 and 2016 using the same administrative databases, and possible associations analyzed using Spearman’s correlation analysis, Kruskal-Wallis tests, and linear regressions.Results: The inter-country comparison of hospitalizations for ACSC can suggest health policy implications and potential points of improvements to reduce these events; however there are factors in the dimension of methods, population and health system that need to be accounted for. Hospitalizations for ACSC accounted for around 7 and 10% of all hospitalizations in Brazil and Portugal in 2015, respectively. Both countries have similarities in standardized rates and which conditions were more common, and differences in crude rates and age distribution. Each hospitalization for ACSC had an estimated cost of US$ PPP 1,919 and 4,278 in Brazil and Portugal, respectively. Both countries presented expressive geographic variations in rates of hospitalizations for ACSC. These indicate room of improvement and efficiency gains in Brazil and Portugal. Rates of hospitalizations for ACSC between 2007 and 2016 decreased in Brazil and increased in Portugal; although there were indications that expansion of PHC reform may be associated to reductions in ACSC hospitalizations, these results only applied for specific conditions and geographic areas within each country, and for some conditions results were discordant between the two countries.Conclusions: It is important to reduce ACSC hospitalizations given the impact these events represent for health systems and for society. The existing literature on inter-country comparison of hospitalizations for ACSC agree that strengthening PHC and promoting access provides opportunities to reduce these events. There was no robust evidence of the association between expansion of PHC reforms in Brazil and Portugal and reduction of hospitalizations for ACSC, indicating that the PHC reforms did not produce the same results neither within or between countries and not for all conditions. Findings indicate that focused actions can be more effective to reduce such events, with examples in both countries serving as valuable clues for the learning process and improvement.
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| 13. |
- Tovar, Eduardo, et al.
(author)
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Networked Embedded Systems for Active Flow Control in Aircraft
- 2012
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Reports (peer-reviewed)abstract
- Abstract— Aerodynamic drag is known to be one of the factorscontributing more to increased aircraft fuelconsumption. Theprimary source of skin friction drag during flight is theboundary layer separation. This is the layer ofair movingsmoothly in the immediate vicinity of the aircraft. In this paperwe discuss a cyber-physical system approachable ofperforming an efficient suppression of the turbulent flow byusing a dense sensing deployment to detect the lowpressureregion and a similarly dense deployment of actuators tomanage the turbulent flow. With this concept, onlytheactuators in the vicinity of a separation layer are activated,minimizing power consumption and also the induced drag.
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| 14. |
- Williams, James Henty, et al.
(author)
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Roadmap for action on the environmental risk assessment of chemicals for insect pollinators (IPol-ERA)
- 2023
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Reports (other academic/artistic)abstract
- Approaches integrating interdisciplinary perspectives are necessary to address current and future health and environmental challenges. Many policy initiatives have embraced more holistic approaches to tackle these challenges, e.g., the One Health concept, the Farm to Fork (F2F), Biodiversity and Chemical strategies within the European Green Deal and the global Sustainable Development Goals (SDGs). Insect pollinators are an excellent example of the One Health concept and have gained renewed focus through the EU Pollinator Initiative. Insect pollinators are essential for healthy diets by providing pollination services and maintaining biodiversity and healthy ecosystem functions. For this reason, they are part of the Environmental Risk Assessment (ERA) of chemicals, such as plant protection products (PPPs). However, an ERA of PPPs can align with and embrace these more holistic concepts and strategies by evolving towards a systems-based approach that recognises the diversity and the important role played by insect pollinators (e.g., pollination services for food security), as well as the variety of habitats and contexts they live in with their multiple stressors, and where PPPs may be used. A roadmap has been developed to determine the steps and actions needed to progress ERA methodologies and tools for insect pollinators. This roadmap is based on a review of the latest scientific knowledge, determining key areas for development to advance ERA, and identifying expertise and networks needed to foster progressive dialogue and public acceptance. The roadmap proposes several actions to generate the necessary knowledge to advance methodologies and tools within the current ERA framework, initially for chemical PPPs but extendable to other regulated chemicals. In addition, it outlines the actions needed to build the framework and the collaborative activities required to realise the transition to a systems-based ERA for insect pollinators by 2030.
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