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- Comparison of hypothesis- and data-driven asthma phenotypes in NHANES 2007–2012: the importance of comprehensive data availabilityPublication . Amaral, Rita; Pereira, Ana M.; Jacinto, Tiago; Malinovschi, Andrei; Janson, Christer; Alving, Kjell; Fonseca, João A.Half of the adults with current asthma among the US National Health and Nutrition Examination Survey (NHANES) participants could be classified in more than one hypothesis-driven phenotype. A data-driven approach applied to the same subjects may allow a more useful classification compared to the hypothesis-driven one. To compare previously defined hypothesis-driven with newly derived data-driven asthma phenotypes, identified by latent class analysis (LCA), in adults with current asthma from NHANES 2007–2012. Adults (≥ 18 years) with current asthma from the NHANES were included (n = 1059). LCA included variables commonly used to subdivide asthma. LCA models were derived independently according to age groups: < 40 and ≥ 40 years old. Two data-driven phenotypes were identified among adults with current asthma, for both age groups. The proportions of the hypothesis-driven phenotypes were similar among the two data-driven phenotypes (p > 0.05). Class A < 40 years (n = 285; 75%) and Class A ≥ 40 years (n = 462; 73%), respectively, were characterized by a predominance of highly symptomatic asthma subjects with poor lung function, compared to Class B < 40 years (n = 94; 25%) and Class B ≥ 40 years (n = 170; 27%). Inflammatory biomarkers, smoking status, presence of obesity and hay fever did not markedly differ between the phenotypes. Both data- and hypothesis-driven approaches using clinical and physiological variables commonly used to characterize asthma are suboptimal to identify asthma phenotypes among adults from the general population. Further studies based on more comprehensive disease features are required to identify asthma phenotypes in population-based studies.
- Combined image-based approach for monitoring the adherence to inhaled medicationsPublication . Vieira-Marques, Pedro; Teixeira, João Fonseca; Valente, José; Pinho, Bernardo; Guedes, Rui; Almeida, Rute; Jácome, Cristina; Pereira, Ana; Jacinto, Tiago; Amaral, Rita; Gonçalves, Ivânia; Sousa, Ana Sá; Couto, Mariana; Magalhães, Manuel; Bordalo, Diana; Silva, Luís Nogueira; Fonseca, J. AlmeidaThe adherence to inhaled controller medications is of critical importance to achieve good clinical results in patients with chronic respiratory diseases. To objectively verify the adherence, a detection tool was previously developed and integrated in the mobile application InspirerMundi, based on image processing methods. In this work, a new approach for enhanced adherence verification was developed. In a first phase template matching is employed to confirm the inhaler positioning and to locate the dose counter. In a second phase Google ML Kit framework is used for the detection of each numerical dose in the dose counter. The proposed approach was validated through a new detection tool pilot implementation, using a set of images collected by patients using the application in their daily life. Performance of each of the two phases was evaluated for a set of commonly used inhaler devices. Promising results were achieved showing the potential of mobile embedded sensors without the need for external devices.
- Influência da utilização noturna de dispositivos eletrónicos no sono de crianças em idade pré-escolarPublication . Oliveira, Anabela Pereira; Tavares, Diana; Freitas, Mónica; Jacinto, TiagoO sono e a sua progressão têm grande importância no crescimento infantil, podendo isto ser afetado por vários fatores. Os dispositivos eletrónicos, principalmente quando utilizados no período noturno, alteram o sono das crianças por emitirem luz azul de baixo comprimento de onda que suprime a secreção da melatonina, atrasando a hora de adormecer, interferindo em todo o sono e conduzindo a distúrbios do sono. Caracterização do comportamento das crianças em idade pré-escolar (3-6 anos) relativamente à utilização dos dispositivos eletrónicos, comparando o efeito da utilização reduzida e prolongada e observando as suas repercussões no sono. Numa amostra de 192 indivíduos, foram analisadas associações entre as respostas dos pais de crianças de três instituições de ensino pré-escolar relativamente às perguntas do Questionário de Hábitos de Sono das Crianças (CSHQ) e do Zero to Eight: Children’s Media Use in America 2013. O score do CSHQ≥48 (característico de perturbações do sono) mostrou associação estatística significativa com o facto de as crianças possuírem o seu próprio telemóvel (smartphone) e consola portátil, de verem programas televisivos para adultos e utilizarem jogos ou programas educativos no computador. No período noturno, a utilização de smartphones, a visualização de vídeos e o tempo prolongado de utilização dos dispositivos também mostraram associação estatística significativa com o score≥48. O estudo demonstrou que a utilização noturna dos dispositivos eletrónicos alterou o sono das crianças desta amostra. O tempo prolongado de utilização mostrou ser o fator mais significativo no aparecimento de perturbações do sono.
- Having concomitant asthma phenotypes is common and independently relates to poor lung function in NHANES 2007-2012Publication . Amaral, Rita; Fonseca, João A; Jacinto, Tiago; Pereira, Ana M; Malinovschi, Andrei; Janson, Christer; Alving, KjellEvidence for distinct asthma phenotypes and their overlap is becoming increasingly relevant to identify personalized and targeted therapeutic strategies. In this study, we aimed to describe the overlap of five commonly reported asthma phenotypes in US adults with current asthma and assess its association with asthma outcomes. Data from the National Health and Nutrition Examination Surveys (NHANES) 2007–2012 were used (n = 30,442). Adults with current asthma were selected. Asthma phenotypes were: B-Eos-high [if blood eosinophils (B-Eos) ≥ 300/mm3]; FeNO-high (FeNO ≥ 35 ppb); B-Eos&FeNO-low (B-Eos < 150/mm3 and FeNO < 20 ppb); asthma with obesity (AwObesity) (BMI ≥ 30 kg/m2); and asthma with concurrent COPD. Data were weighted for the US population and analyses were stratified by age (< 40 and ≥ 40 years old). Of the 18,619 adults included, 1059 (5.6% [95% CI 5.1–5.9]) had current asthma. A substantial overlap was observed both in subjects aged < 40 years (44%) and ≥ 40 years (54%). The more prevalent specific overlaps in both age groups were AwObesity associated with either B-Eos-high (15 and 12%, respectively) or B-Eos&FeNO-low asthma (13 and 11%, respectively). About 14% of the current asthma patients were “non-classified”. Regardless of phenotype classification, having concomitant phenotypes was significantly associated with (adjusted OR, 95% CI) ≥ 2 controller medications (2.03, 1.16–3.57), and FEV1 < LLN (3.21, 1.74–5.94), adjusted for confounding variables. A prevalent overlap of commonly reported asthma phenotypes was observed among asthma patients from the general population, with implications for objective asthma outcomes. A broader approach may be required to better characterize asthma patients and prevent poor asthma outcomes.
- Real-time clinical decision support at the point of carePublication . Pereira, Ana Margarida; Jácome, Cristina; Amaral, Rita; Jacinto, Tiago; Fonseca, João A.This chapter starts by introducing the complex process of shared clinical decision-making, the value of incorporating patient-reported outcome measures into clinical decisions and the increasing usefulness of clinical decision support systems to enhance the quality and safety of healthcare. It then gives examples of three tools for clinical decision support at the point of care, which were designed to support health professionals and patients in the assessment, treatment and long-term management of chronic respiratory diseases.
- Adult asthma scores—development and validation of multivariable scores to identify asthma in surveysPublication . Sá-Sousa, Ana; Pereira, Ana Margarida; Almeida, Rute; Araújo, Luís; Couto, Mariana; Jacinto, Tiago; Freitas, Alberto; Bousquet, Jean; Fonseca, João A.One of the questions in epidemiology is the identification of adult asthma in studies. To develop and validate multivariable scores for adult asthma identification in epidemiological studies and to explore cutoffs to rule in/rule out asthma, compared with asthma diagnosed by a physician after clinical examination and diagnostic tests, blinded to the self-administered questions. We analyzed data (n = 711 adults) from a nationwide population-based study. The predictors were self-administered questions identified in a literature review (the Adult Asthma Epidemiological Score [A2 score]) and from the Global Allergy and Asthma Network of Excellence (GA2LEN) questionnaire (the GA2LEN Asthma Epidemiological Score [GA2LEN score]). Scores were developed using exploratory factor analysis. Internal consistency, discriminative power, and diagnostic accuracy were assessed. The A2 score comprises 8 questions (including “Did a physician confirm you had asthma?”) and the GA2LEN score comprises 6 questions (including “Have you ever had asthma?”). Both had high Cronbach α (0.89 and 0.85, respectively, for the A2 score and the GA2LEN score) and good area under the receiver-operating characteristic curve (90.4% and 89.0%). The scoring is the sum of positive answers. Asthma is present (rule in) for scores of 4 or more (specificity, 99.2%; PPV, 93.3% and 91.7%; accuracy, 89.4% and 87.4%, respectively, for the A2 score and the GA2LEN score). Asthma is excluded (rule out) for A2 scores of 0 to 1 and a GA2LEN score of 0 (sensitivity, 93.1%; NPV, 98.2% and 98.0%; accuracy 89.4% and 82.8%, respectively, for the A2 score and the GA2LEN score). These practical scores can be used to rule in/rule out asthma in epidemiological studies and clinical screening/triage settings. They may help physicians in primary care or other specialties to screen patients with asthma using a simple score with a high level of discrimination and to identify the best candidates to be referred for a diagnostic workup. Moreover, their use may contribute to reducing the inconsistencies of operational definitions of asthma across studies and surveys.
- A relação dos Sintomas do Trato Urinário Baixo com os achados Urodinâmicos na Doença de ParkinsonPublication . Rodrigues, Ana Catarina; Lopes, Ana; Jacinto, TiagoA Doença de Parkinson (PD) é uma doença neurodegenerativa que se manifesta através de distúrbios motores e autonómicos, sendo a disfunção da bexiga um dos mais frequentes. A disfunção da bexiga leva ao surgimento de sintomas do Trato Urinário Baixo (LUTS), sendo a prevalência de LUTS em pacientes com PD de 27-63%. A etiologia dos LUTS nesta patologia não está totalmente esclarecida, porém pensa-se que a redução de recetores dopaminérgicos leva a que os gânglios da base deixem de inibir o reflexo miccional, originando o surgimento de contrações involuntárias do detrusor. Relacionar os LUTS e os achados urodinâmicos apresentados por indivíduos com PD, seguidos na consulta externa de Urologia no Centro Hospital Universitário do Porto (CHUP). Estudar a influência do sexo, da idade e duração da doença nos LUTS e nos achados Urodinâmicos apresentados pelos indivíduos. Este estudo realizado com recurso à análise dos dados de 23 indivíduos com PD, obtidos após a realização do estudo Urodinâmico (EUD) no Serviço de Urologia do CHUP, presentes na base de dados do serviço. A disfunção urinária demonstrou afetar principalmente a fase de armazenamento, sendo o LUTS mais frequente a urgência urinária e o achado urodinâmico mais comum a diminuição da acomodação vesical. O sexo e a idade não demonstraram influência sobre os parâmetros estudados. O estudo permitiu reparar na importância da realização do EUD em indivíduos com PD, uma vez que possibilita a caracterização da disfunção urinária e consequentemente a aplicação de uma terapia adequada.
- Allergen sensitization associates with worse lung function parametersPublication . Gonçalves, I.; Pereira, A. M.; Jacinto, Tiago; Amaral, Rita; Fonseca, J. de Almeida Lopes daTo assess the association between the number of allergen sensitizations and lung function variables in individuals with airway symptoms. Methods. Retrospective study with all individuals who performed lung function and skin-prick tests at CUF-Porto (01/2011-06/2016). Six allergen groups were considered. % predicted Pre-Bronchodilator test (BD) and % change after BD were analysed for spirometry and plethysmography parameters. Results. A total of 1293 individuals were included, 54% (n = 698) adults and 69% (n = 891) with sensitization to ≥ 1 allergen group. % FEV1 was significantly higher and % change in FEV1 significantly lower in non-sensitized individuals. % sRaw was higher in polysensitized (vs non-sensitized). Conclusions. The presence of allergen sensitizations was significantly associated with worse key lung function parameters.
- The treatment of acute bronchiolitis: past, present and futurePublication . Petrarca, Laura; Jacinto, Tiago; Nenna, RaffaellaLower respiratory tract infections are a common cause of hospitalisation in infants. It is estimated that infants younger than 12 months with bronchiolitis account for 18% of all paediatric admission, representing a great burden to industrialised healthcare systems each winter. Bronchiolitis is defined as the first respiratory tract infection in infants younger than 12 months. Clinically, it can be manifested by cough, tachypnoea, apnoea, increased respiratory effort, fever, nasal congestion and rhinorrhoea. On chest auscultation, the key feature is diffuse bilateral inspiratory crackles. The most common virus detected in children with bronchiolitis is respiratory syncytial virus (RSV)
- What physical education teachers know about asthma: impact of a training coursePublication . Couto, M; Marques, J; Silva, D; Paiva, M; Jacinto, Tiago; Câmara, RGiven the current prevalence of asthma in developed countries, there are likely to be at least 2 or 3 asthmatic children in most classes. However, few teachers have received training on how to manage the disease. A previous study in Portugal showed teacher knowledge of asthma to be deficient.