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- Comparison of allergic rhinitis treatments on patient satisfaction: A MASK-air and EAACI Methodological Committee ReportPublication . Bousquet, Jean; Amaral, RitaSatisfaction with treatments may affect medication adherence and use patterns, including the use of comedication. We aimed to compare different medications for allergic rhinitis (AR) on (i) patients' satisfaction and (ii) co-medication use frequency. We assessed data from the mHealth app MASK-air. We evaluated days on which users with self-reported AR had used—alone or in co-medication—intranasal corticosteroids (INCS), intranasal antihistamines (INAH), fixed combinations of INAH+INCS, or oral antihistamines (OAH). We built multivariable regression models to compare these different AR medication classes (as well as individual medications) on their (i) treatment satisfaction levels (measured using a specific daily visual analogue scale [‘VAS satisfaction’]) and (ii) odds of being used in co-medication. We assessed 28,177days reported by 1691 MASK-air users. For all medication classes, co-medication usage was associated with lower treatment satisfaction. When used in monotherapy, OAH were associated with lower VAS satisfaction than INCS (−1.7 points; 95% CI=–2.7; –0.7) or INAH+INCS (−2.1 points; 95% CI=–3.5; –0.7). INCS displayed higher odds of being used in co-medication than OAH (OR=1.3; 95% CI=1.0; 1.6) or INAH+INCS (OR=1.3; 95% CI=0.8; 1.8). When comparing individual intranasal medications, fluticasone furoate and fluticasone propionate tended to be more frequently used in co-medication. Among individual OAH, desloratadine and rupatadine were associated with higher satisfaction, while fexofenadine was more frequently used in co-medication. Using patient-reported data, we evaluated different medication classes and treatments in terms of satisfaction and co-medication frequency. These results provide key insights into the acceptability of AR treatments and will contribute to future treatment guidelines.
- Control of allergic rhinitis and asthma test for children (CARATkids): A systematic review and meta-analysis of its measurement propertiesPublication . Didi, Hadla Sami El; Pereira, Ana Margarida; Jácome, Cristina; Amaral, Rita; Wandalsen, Gustavo F.; Emons, Joyce; Grutta, Stefania La; Cilluffo, Giovanna; Batmaz, Sehra Birgül; Linhares, Daniela; Sole, Dirceu; Pinto, Bernardo Sousa; Fonseca, João Almeida; Vieira, Rafael José; Amaral, RitaControl of Allergic Rhinitis and Asthma Test for Children (CARATkids) is the first patient-reported outcome measure (PROM) designed to assess both allergic rhinitis and asthma simultaneously in children aged 6 to 12 years. CARATkids has been validated in several languages and countries, highlighting the need for a review of its psychometric properties. This study aims to evaluate the measurement properties of CARATkids. This systematic review follows PRISMA and COSMIN guidelines. A systematic search was performed across three databases (Ovid/MEDLINE, Web of Science, and Scopus in October 2023, updated in June 2025). We included studies focused on the development, cultural adaptation, or validation of CARATkids, as well as studies comparing CARATkids with other PROMs. We evaluated the quality of CARATkids development, the methodological quality of primary studies, the overall rating, and the certainty of evidence for each CARATkids measurement property and performed a meta-analysis of its measurement properties. Our search retrieved 193 results. We included nine studies. CARATkids displayed sufficient content validity. Regarding internal consistency, we found a meta-analytical Cronbach alpha of 0.81 (95% CI = 0.79; 0.83). CARATkids displayed sufficient reliability (meta-analytical intraclass correlation coefficient 0.86 [95% CI = 0.61; 0.96]). The minimal clinically important difference was 2.76. Construct validity had sufficient evidence for most correlations, with absolute meta-analytical Spearman coefficients from 0.37 to 0.71. Responsiveness showed strong correlations between CARATkids and most outcome measurement instruments. These findings support CARATkids as a suitable tool for assessing asthma and allergic rhinitis in children aged 6 to 12 years who present both conditions simultaneously.
- ERS International Congress 2023: highlights from the Allied Respiratory Professionals AssemblyPublication . Jacinto, Tiago; Smith, Elizabeth; Diciolla, Nicola S.; Herck, Maarten van; Silva, Liliana; Santiago, Maria Granados; Volpato, Eleonora; Verkleij, Marieke; Peters, Jeannette B.; Sylvester, Karl; Inal-Ince, Deniz; Padilha, José Miguel; Langer, Daniel; Demeyer, Heleen; Grønhaug, Louise Muxoll; Cruz, JoanaThis article summarises some of the outstanding sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2023 European Respiratory Society International Congress. Two sessions from each Assembly group are outlined, covering the following topics: Group 9.01 focuses on respiratory physiology techniques, specifically on predicted values and reference equations, device development and novel applications of cardiopulmonary exercise tests; Group 9.02 presents an overview of the talks given at the mini-symposium on exercise training, physical activity and self-management at home and outlines some of the best abstracts in respiratory physiotherapy; Group 9.03 highlights the nursing role in global respiratory health and presents nursing interventions and outcomes; and Group 9.04 provides an overview of the best abstracts and recent advances in behavioural science and health psychology. This Highlights article provides valuable insight into the latest scientific data and emerging areas affecting the clinical practice of Allied Respiratory Professionals.
- Prospective validation and usability evaluation of a mobile diagnostic App for Obstructive Sleep ApneaPublication . Amorim, Pedro; Santos, Daniela Ferreira; Drummond, Marta; Rodrigues, Pedro PereiraObstructive sleep apnea (OSA) classification relies on polysomnography (PSG) results. Current guidelines recommend the development of clinical prediction algorithms in screening prior to PSG. A recent intuitive and user-friendly tool (OSABayes), based on a Bayesian network model using six clinical variables, has been proposed to quantify the probability of OSA. Our aims are (1) to validate OSABayes prospectively, (2) to build a smartphone app based on the proposed model, and (3) to evaluate app usability. We prospectively included adult patients suspected of OSA, without suspicion of other sleep disorders, who underwent level I or III diagnostic PSG. Apnea–hypopnea index (AHI) and OSABayes probabilities were obtained and compared using the area under the ROC curve (AUC [95%CI]) for OSA diagnosis (AHI ≥ 5/h) and higher severity levels (AHI ≥ 15/h) prediction. We built the OSABayes app on ‘App Inventor 2’, and the usability was assessed with a cognitive walkthrough method and a general evaluation. 216 subjects were included in the validation cohort, performing PSG levels I (34%) and III (66%). OSABayes presented an AUC of 83.6% [77.3–90.0%] for OSA diagnosis and 76.3% [69.9–82.7%] for moderate/severe OSA prediction, showing good response for both types of PSG. The OSABayes smartphone application allows one to calculate the probability of having OSA and consult information about OSA and the tool. In the usability evaluation, 96% of the proposed tasks were carried out. These results show the good discrimination power of OSABayes and validate its applicability in identifying patients with a high pre-test probability of OSA. The tool is available as an online form and as a smartphone app, allowing a quick and accessible calculation of OSA probability
- Impact of the 2022 ATS/ERS update criteria on the bronchodilator responsiveness test resultPublication . Martins, B.; Marinho, A.; Amorim, PedroBronchodilator response (BDR) is a measurement of the degree of volume and airflow improvement in response to an inhaled short-acting bronchodilator. It is widely used in clinical practice to diagnose respiratory diseases such as chronic obstructive pulmonary disease (COPD) or asthma, to assess asthma control, and predict the response to inhaled treatment.
- mINSPIRERS – Estudo da exequibilidade de uma aplicação móvel para medição e melhoria da adesão à medicação inalada de controlo em adolescentes e adultos com asma persistente. Protocolo de um estudo observacional multicêntricoPublication . Jácome, Cristina; Guedes, Rui; Almeida, Rute; Teixeira, João Fonseca; Pinho, Bernardo; Vieira -Marques, Pedro; Vilaça, Rita; Fernandes, José; Ferreira, Ana; Couto, Mariana; Jacinto, Tiago; Pereira, Altamiro da Costa; Fonseca, João AlmeidaA má adesão à medicação inalada é um dos principais fatores que limita a melhoria clínica nos doentes com asma. Desta forma, é fundamental o desenvolvimento de ferramentas de monitorização de adesão à medicação objetivas e de fácil disseminação e a promoção de estratégias de adesão à medicação facilmente integráveis no dia a dia dos doentes. Os smartphones e jogos em comunidade virtual podem ter um papel relevante para a adoção de comportamentos promotores da saúde. Com bases nestes pressupostos foi desenvolvida a aplicação móvel InspirerMundi, com as suas componentes de monitorização, jogo e suporte por pares, para monitorizar e melhorar a adesão à medicação inalada de controlo em adolescentes e adultos com asma. O objetivo do estudo mINSPIRERS é avaliar a exequibilidade desta aplicação móvel. Estudo observacional prospetivo, multicêntrico composto por uma visita inicial e por três entrevistas telefónicas (após 1 semana, 1 mês e 4 meses) em cerca de 25 centros (Imunoalergologia, Pediatria, Pneumologia) de cuidados secundários em Portugal. Serão incluídos um mínimo de 20 adolescentes e 20 adultos com asma persistente. As principais dimensões avaliadas serão: adesão à medicação, crenças sobre a medicação, satisfação com o inalador, controlo da asma, exequibilidade técnica e padrões de utilização da aplicação, e a satisfação com a aplicação. A aplicação InspirerMundi pretende transformar a adesão à medicação inalada numa experiência positiva através de elementos de gamificação e suporte social, permitindo simultaneamente a monitorização verificada da adesão ao tratamento. É expectável que os resultados deste estudo contribuam não só para o aperfeiçoamento da aplicação InspirerMundi, mas também para informar o desenvolvimento de soluções mHealth e intervenções de melhoria da adesão à medicação em doentes com asma.
- FRASIS - Monitorização da função respiratória na asma utilizando os sensores integrados do smartphonePublication . Almeida, Rute; Amaral, Rita; Jacinto, Tiago; Amaral, RitaO projeto FRASIS pretende desenvolver, integrar e validar um conjunto de tecnologias de informação e comunicação (TIC) de saúde móvel (mHealth) para a monitorização remota da função respiratória na asma, usando apenas o smartphone e os seus sensores integrados. As ferramentas atuais de automonitorização e autogestão da asma são complexas, pouco atrativas, não individualizadas e obrigam os profissionais de saúde a análises trabalhosas, desmotivando a sua utilização e integração nos cuidados de saúde. Existe uma clara oportunidade para soluções tecnológicas avançadas económicas para os doentes e atrativas para os diferentes intervenientes do setor da saúde. A estratégia do FRASIS é desenvolver e integrar tecnologias de automonitorização e autogestão sem a necessidade de dispositivos adicionais, fazendo uso da presença dos smartphones na vida diária e da sua futura integração com sensores ambientais em cidades inteligentes. O FRASIS pretende assim contribuir para a concretização dos princípios da saúde digital e inovar nas tecnologias de monitorização remota da função respiratória. Espera - se que os resultados do FRASIS tenham um impacto relevante na inovação em serviços de saúde para a asma, com maior envolvimento e capacitação do doente, fornecendo informação prospetiva e de qualidade para uma melhor decisão clínica, tornando assim os cuidados de saúde mais eficientes e sustentáveis.
- Monitoring adherence to asthma inhalers using the InspirerMundi App: Analysis of real-world, Medium-term feasibility studiesPublication . Jàcome, Cristina; Amaral, Rita; Amaral, Rita"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. 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. 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. 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. 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. "
- Understanding beliefs about inhaled medication in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studiesPublication . Novais, Catarina; Cruz, Ana Margarida; Pereira, Ana Margarida; Almeida, Rute; Amaral, Rita; Fonseca, João Almeida; Jácome, CristinaIdentifying factors influencing adherence, such as patients’ beliefs about medication, is essential for effective asthma management. This study aims to assess and gain insight into the beliefs of patients with asthma regarding inhaled medication. This is a secondary analysis of the INSPIRERS studies. Patients aged ≥ 13 y.o., with persistent asthma and a prescription for inhaled controller were recruited from 60 primary and secondary care centres in Portugal from 2017 to 2020. Demographic and clinical characteristics were collected in a face-to-face visit. The Specific-Beliefs about Medicine Questionnaire was administered 1-week later by telephone interview. Mann-Whitney U and Kruskal-Wallis tests were used to explore relations between patients’ beliefs and characteristics. A total of 552 participants (mean 32.8 ± 17.3 y.o.; 64.5% female) were analysed. The Necessity score (Median 19 [p25-p75 16,22]) was significantly higher than the Concerns score (15 [16,22], p < 0.001), resulting in a positive Necessity-Concern differential (Median 4 [0,7]). Acceptance (high necessity, low concerns) characterized 61% of participants, while 19% were ambivalent (high necessity, high concerns). Adolescents exhibited lower Necessity (Median 16 vs 20; p < 0.001) and Concerns scores (Median 11 vs 15; p = 0.002) than adults. In primary care setting, patients had significantly lower Necessity (Median 18 vs 19; p = 0.027) and Concerns (Median 14 vs 15; p = 0.05) compared to the secondary care. A predominantly positive perception of inhaled asthma medication necessity was found, although ambivalence or indifference exists in about 1/5 of patients. Our findings highlight the importance of personalized approaches to address beliefs and optimise patient education.
- Patients' health care resources utilization and costs estimation across cardiovascular risk categories: insights from the LATINO studyPublication . Gavina, Cristina; Borges, Alexandra; Afonso-Silva, Marta; Fortuna, Inês; Canelas-Pais, Mariana; Amaral, Rita; Costa, Inês; Seabra, Daniel; Araújo, Francisco; Taveira-Gomes, Tiago; Amaral, Rita"Atherosclerotic Cardiovascular Disease (ASCVD) is a global public health concern. This study aimed to estimate the healthcare resource utilization (HRU) and costs stratified by cardiovascular disease (CVD) risk categories using real-world evidence, in a regional population in Portugal. This is a retrospective observational study, using data from Electronic Health Records between 2017 and 2021. Patients aged≥40 years, and with at least one general practitioner (GP) appointment in the 3 years before 31st of December 2019, were included. CVD risk categories were determined based on 2021 ESC prevention guidelines. HRU encompassed hospital data (hospitalizations, outpatient and emergency room visits) and GP appointments. Total direct costs per patient were calculated based on the reference cost of the Portuguese legislation for payment methodology on Diagnosis-Related Groups (DRGs). Analysis of 3 122 695 episodes, revealed consistent HRU and costs across the five years. Very high-risk patients, showed higher HRU, particularly in hospital admissions. Costs tended to rise with higher CVD risk level. Very high-risk patients with ASCVD had higher costs for hospital admissions, while low-to-moderate risk patients had higher costs for GP visits. Despite a smaller proportion, very high-risk patients with prior ASCVD represent the highest costs per patient across healthcare settings (from 115€ in emergency visits to 2 673€ in hospitalizations), followed by very high-risk patients without prior ASCVD (ASCVD-risk equivalents). This study revealed a substantial HRU and costs by patients with very high CVD risk, particularly those with prior ASCVD. Moreover, ASCVD-risk equivalents emerge as notable consumers, emphasizing the importance of risk assessment and preventive measures in cost-effective management of these patients. "