Browsing by Author "Carvalho, Joana"
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- Determinants of the use of health and fitness mobile apps by patients with asthma: secondary analysis of observational studiesPublication . Neves, Ana Luísa; Jácome, Cristina; Taveira-Gomes, Tiago; Pereira, Ana Margarida; Almeida, Rute; Amaral, Rita; Alves-Correia, Magna; Mendes, Sandra; Chaves-Loureiro, Cláudia; Valério, Margarida; Lopes, Cristina; Carvalho, Joana; Mendes, Ana; Ribeiro, Carmelita; Prates, Sara; Ferreira, José Alberto; Teixeira, Maria Fernanda; Branco, Joana; Santalha, Marta; Vasconcelos, Maria João; Lozoya, Carlos; Santos, Natacha; Cardia, Francisca; Moreira, Ana Sofia; Taborda-Barata, Luís; Pinto, Cláudia Sofia; Ferreira, Rosário; Silva, Pedro Morais; Ferreira, Tânia Monteiro; Câmara, Raquel; Lobo, Rui; Bordalo, Diana; Guimarães, Cristina; Santo, Maria Espírito; Oliveira, José Ferraz de; Augusto, Maria José Cálix; Gomes, Ricardo; Vieira, Inês; Silva, Sofia da; Marques, Maria; Cardoso, João; Morete, Ana; Aroso, Margarida; Cruz, Ana Margarida; Nunes, Carlos; Câmara, Rita; Rodrigues, Natalina; Abreu, Carmo; Albuquerque, Ana Luísa; Vieira, Claúdia; Santos, Carlos; Páscoa, Rosália; Chaves-Loureiro, Carla; Alves, Adelaide; Neves, Ângela; Marques, José Varanda; Reis, Bruno; Ferreira-Magalhães , Manuel; Fonseca, João AlmeidaHealth 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.
- Evaluation of physical activity programmes for the elderly - exploring the lessons from other sectors and examining the general characteristics of the programmes.Publication . Marques, Ana I.; Soares, Pedro; Soares-Miranda, Luísa; Moreira, Carla; Oliveira-Tavares, António; Santos, Paula Clara; Vale, Susana; Santos, Rute; Carvalho, JoanaIn Portugal, there are several physical activity (PA) programmes for elderly people developed by the local government. The importance of these programmes has been increasing since the evidence has shown that this type of health promotion interventions may reduce the deleterious effects of the ageing process. However, no study has already identified the general characteristics of these programmes nor if they use any scheme to assess the quality of the service provided. A widely-used scheme is the EFQM Excellence Model, which will be in the core of our present work. Thus, the main aims of this preliminary study were 1) to identify the general characteristics of the PA programmes developed by the Portuguese Local Public Administration 2) to determine the extent of implementation of quality initiatives in these programmes. Data were collected by an on-line questionnaire sent to all Continental Municipalities (n = 278). Categorical data were expressed as absolute counts and percentages. Continuous data were expressed as the mean and SD. An open-ended question was analysed using qualitative content analysis with QSR NVivo software. Associations between categorical variables were tested by the use of contingency tables and the calculation of chi-square tests. Significance level was set at p ≤ 0.05. Results showed: i) a total of 125 PA programmes were identified in the 18 districts of the Portugal mainland; ii) the main goal of the majority (95.2%) was the participants' health promotion; iii) different characteristics of the programmes were found according to different regions of the country; iv) certain characteristics of the programmes were associated to the existence of other features; v) only one PA programme developed quality initiatives. In conclusion, although there are many PA programmes for elderly people spread throughout the country, aiming at improving the health of participants, the overwhelming majority does not adopt quality control initiatives. Considering that the quality of a service increases customer satisfaction, the continuous quality improvement of the PA programmes for elderly people should therefore be implemented since they can be useful and critical for elderly satisfaction and adherence.
- Feasibility and acceptability of an asthma app to monitor medication adherence: mixed methods studyPublication . Jácome, Cristina; Almeida, Rute; Pereira, Ana Margarida; Amaral, Rita; Mendes, Sandra; Alves-Correia, Magna; Vidal, Carmen; Freire, Sara López; Brea, Paula Méndez; Araújo, Luís; Couto, Mariana; Antolín-Amérigo, Darío; Caballer, Belén de la Hoz; Castro, Alicia Barra; Gonzalez-De-Olano, David; Bom, Ana Todo; Azevedo, João; Pinto, Paula Leiria; Pinto, Nicole; Neves, Ana Castro; Palhinha, Ana; Bom, Filipa Todo; Costa, Alberto; Loureiro, Cláudia Chaves; Santos, Lilia Maia; Arrobas, Ana; Valério, Margarida; Cardoso, João; Emiliano, Madalena; Gerardo, Rita; Rodrigues, José Carlos Cidrais; Oliveira, Georgeta; Carvalho, Joana; Mendes, Ana; Lozoya, Carlos; Santos, Natacha; Menezes, Fernando; Gomes, Ricardo; Câmara, Rita; Alves, Rodrigo Rodrigues; Moreira, Ana Sofia; Bordalo, Diana; Alves, Carlos; Ferreira, José Alberto; Lopes, Cristina; Silva, Diana; Vasconcelos, Maria João; Teixeira, Maria Fernanda; Ferreira-Magalhães, Manuel; Taborda-Barata, Luís; Cálix, Maria José; Alves, Adelaide; Fonseca, João AlmeidaPoor 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. 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). 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. 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%). 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.
- Imbalance and fall—risk improvements in the elderly: effects of combined strength and aerobic trainingPublication . Carmo, Paulo Jorge Quintela Cardoso do; Carvalho, Joana; Santos, Rubim; Cesar, AdjaneFalls among the elderly are an important clinical and health problem due to their high incidence and their functional and social repercussions. The aim of this study was to examine the effects of a combined strength and aerobic exercise program (EP) on the fall risk (FR) in older adults by use of a measure of postural stability.
- Mutant KRAS modulates colorectal cancer cells invasive response to fibroblast-secreted factors through the HGF/C-MET axisPublication . Carvalho, Patrícia Dias; Martins, Flávia; Mendonça, Susana; Ribeiro, Andreia; Machado, Ana Luísa; Carvalho, Joana; Oliveira, Maria José; Velho, SérgiaGenetic alterations influence the malignant potential of cancer cells, and so does thetumor microenvironment. Herein, we combined the study of KRAS oncogenic effectsin colorectal cancer cells with the influence of fibroblast-derived factors. Resultsrevealed that mutant KRAS regulates cell fate through both autonomous and nonau-tonomous signaling mechanisms. Specifically, processes such as proliferation andcell-cell aggregation were autonomously controlled by mutant KRAS independentlyof the stimulation with fibroblasts conditioned media. However, cancer cell invasionrevealed to be a KRAS-dependent nonautonomous effect, resulting from the cooper-ation between fibroblast-derived HGF and mutant KRAS regulation of C-METexpression. C-MET downregulation upon KRAS silencing rendered cells less respon-sive to HGF and thus less invasive. Yet, in one cell line, KRAS inhibition triggeredinvasion upon stimulation with fibroblasts conditioned media. Inhibition of PIK3CAoncogene did not promote invasion, thus showing a KRAS-specific effect. Moreover,the invasive capacity also depended on the HGF-C-MET axis. Overall, our studyawards oncogenic KRAS an important role in modulating the response to fibroblast-secreted factors either by promoting or impairing invasion, and depicts the HGF-C-MET axis as a putative therapeutic target to impair the invasive properties of mutantKRAS cancer cells.
- Profiling persistent asthma phenotypes in adolescents: A longitudinal diagnostic evaluation from the INSPIRERS StudiesPublication . Amaral, Rita; Jácome, Cristina; Almeida, Rute; Pereira, Ana M.; Alves-Correia, Magna; Mendes, Sandra; Rodrigues, José C.; Carvalho, Joana; Araújo, Luís; Costa, Alberto; Silva, Armandina; Teixeira, Maria F.; Ferreira-Magalhães, Manuel; Alves, Rodrigo R.; Moreira, Ana S.; Fernandes, Ricardo M.; Ferreira, Rosário; Pinto, Paula L.; Neuparth, Nuno; Bordalo, Diana; Bom, Ana T.; Cálix, Maria J.; Ferreira, Tânia; Gomes, Joana; Vidal, Carmen; Mendes, Ana; Vasconcelos, Maria J.; Silva, Pedro M.; Ferraz, José; Morête, Ana; Pinto, Claúdia S.; Santos, Natacha; Loureiro, Carla C.; Câmara, Raquel; Vieira, Inês; Silva, Sofia D.; Silva, Eurico; Rodrigues, Natalina; Fonseca, João A.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.
- Role-Play como prática pedagógica em Terapia da FalaPublication . Cunha, Maria João; Pinto, Marta; Carvalho, JoanaO processo de ensino-aprendizagem em que estudante e professor são agentes ativos implica substituir os processos clássicos por práticas que reúnam saberes. O protagonista (role-player) é um estudante ou professor que desempenha o papel de um dos integrantes da situação clínica (i.e. profissional de saúde, utente) que participa numa simulação de uma interação terapêutica. Este estudo pretende perceber o impacto do uso do role-play na participação dos estudantes nas aulas práticas, para melhoria das aprendizagens e domínio das competências.
- Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studiesPublication . Cunha, Mafalda Simões; Amaral, Rita; Pereira, Ana Margarida; Almeida, Rute; Alves-Correia, Magna; Loureiro, Cláudia Chaves; Lopes, Cristina; Carvalho, Joana; Ribeiro, Carmelita; Vidal, Carmen; Antolín-Amérigo, Dario; Pinto, Diana; Ferreira-Magalhães, Manuel; Vasconcelos, Maria João; Lozoya, Carlos; Santos, Natacha; Cardia, Francisca; Taborda-Barata, Luís; Ferreira, Rosário; Silva, Pedro Morais; Ferreira, Tania Monteiro; Câmara, Raquel; Silva, Eurico; Bordalo, Diana; Guimarães, Cristina; Calix, Maria José; Silva, Sofia da; Marques, Maria Luís; Morete, Ana; Nunes, Carlos; Vieira, Cláudia; Páscoa, Rosália; Alves, Adelaide; Marques, José Varanda; Reis, Bruno; Monteiro, Luís; Monteiro, Rosário; Cepa, Margarida; Valentim, Bruno; Coelho, Daniela Sousa; Fernandes, Sara; Meireles, Patrícia; Aguiar, Margarida Abreu; Mourão, Ana Rita; Fonseca, João A; Jácome, CristinaAnxiety 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. This 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. According 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. At 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.