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Vieira RJ, Leemann L, Briggs A, Pereira AM, Savouré M, Kuna P, Morais-Almeida M, Bewick M, Azevedo LF, Louis R, Klimek L, Bahbah F, Samolinski B, Anto JM, Zuberbier T, Fonseca JA, Bousquet J, Sousa-Pinto B. Poor rhinitis and asthma control is associated with decreased health-related quality-of-life and utilities: A MASK-air study. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00329-5. [PMID: 38561141 DOI: 10.1016/j.jaip.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Allergic rhinitis (AR) and asthma may impact health-related quality-of-life. However, national estimates on the quality-of-life of patients with AR or asthma are lacking. OBJECTIVE To provide estimates for utility scores and EQ-5D Visual Analog Scale (VAS) for patients with AR or asthma. METHODS We conducted a cross-sectional study using direct patient data from the MASK-air® app on European MASK-air® users with self-reported AR or asthma. We used a multiattribute instrument (EQ-5D) to measure quality-of-life (as utility scores and EQ-5D VAS values). Mean scores were calculated per country and disease control level using multilevel regression models with post-stratification, accounting for age and sex biases. RESULTS We assessed data from up to 7905 MASK-air® users reporting a total of up to 82,737 days. For AR, utilities ranged from 0.86-0.99 for good control versus 0.72-0.85 for poor control; EQ-5D VAS levels ranged from 78.9-87.9 for good control versus 55.3-64.2 for poor control. For asthma, utilities ranged from 0.84-0.97 for good control versus 0.73-0.87 for poor control; EQ-5D VAS levels ranged from 68.4-81.5 for good control versus 51.4-64.2 for poor control. Poor disease control was associated with a mean loss of 0.14 utilities for both AR and asthma. For the same control levels, AR and asthma were associated with similar utilities and EQ-5D VAS levels. However, lower values were observed for asthma+AR when compared to AR alone. CONCLUSION Poor AR or asthma control are associated with reduced quality-of-life. The estimates obtained from mHealth data may provide valuable insights for health technology assessment studies.
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Affiliation(s)
- Rafael José Vieira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lucas Leemann
- Department of Political Science, University of Zurich, Zurich, Switzerland
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ana Margarida Pereira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marine Savouré
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France; Université Paris-Saclay, UVSQ, Université Paris-Sud, Villejuif, France
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | | | - Michael Bewick
- University of Central Lancashire Medical School, Preston, United Kingdom
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Liège, Liège, Belgium; GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - João A Fonseca
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; MASK-air SAS, Montpellier, France.
| | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
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Costa C, Silva J, Azevedo LF, de Lemos MS, Paneque M. A collaborative model for Medical Genetics services delivery in Portugal: a multidisciplinary perspective. J Community Genet 2024:10.1007/s12687-024-00703-0. [PMID: 38451397 DOI: 10.1007/s12687-024-00703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
- Catarina Costa
- i3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
- IBMC - Institute of Molecular and Cellular Biology, University of Porto, Porto, Portugal
- CGPP - Center for Predictive and Preventive Genetics, University of Porto, Porto, Portugal
- FMUP - Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Silva
- CI-IPOP - Cancer Genetics Group, IPO-Porto Research Center/RISE@CI-IPOP - Health Research Network, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal
- Department of Medical Genetics, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal
| | - Luís Filipe Azevedo
- MEDCIDS - Department of Community Medicine, Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Marina Serra de Lemos
- FPCEUP - Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
- CPUP - Center for Psychology at the University of Porto, Porto, Portugal
| | - Milena Paneque
- i3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal.
- IBMC - Institute of Molecular and Cellular Biology, University of Porto, Porto, Portugal.
- CGPP - Center for Predictive and Preventive Genetics, University of Porto, Porto, Portugal.
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
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Costa C, Guimarães L, Baião RL, Lemos MSD, Azevedo LF, Paneque M. The urgency for a change in genetics healthcare provision: views from Portuguese medical geneticists. J Community Genet 2024:10.1007/s12687-024-00702-1. [PMID: 38427313 DOI: 10.1007/s12687-024-00702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
In the last decades, genetics has experienced significant technological advancements worldwide. However, in Portugal, serious limitations persist, compromising the functioning of healthcare in medical genetics. This study aimed to promote sharing and discussion among genetic medical professionals, to outline concrete actions to address gaps in clinical practice. Three focus groups were conducted with 19 specialists in medical genetics. The data were analyzed using the thematic analysis method to extract the main themes from the discussions. From the analysis, four conceptual themes emerged: (i) framing Portuguese genetic services in light of the European context; (ii) improvement of medical genetics education and population literacy; (iii) transforming of medical genetics services; and (iv) operationalizing the change. The results demonstrated that increasing training resources and strengthening multiprofessional teams by hiring more genetic professionals, such as clinical geneticists, molecular geneticists, and other genetic specialists, is crucial to enhancing the responsiveness of genetic services. Integrating medical genetics into all specialties and primary care, as well as updating the national network of medical genetics, are critical points for increasing equity and enabling healthcare to be provided more fairly. Including other medical genetics professionals such as genetic counsellors, nurses and psychologists also plays a significant role in providing comprehensive and quality care. This collaborative approach aims to provide effective genetic assistance and enhance the adequacy of genetic healthcare. The findings are compiled as recommendations to support the profession moving forward that can be applied to other healthcare contexts worldwide.
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Affiliation(s)
- Catarina Costa
- i3S-Institute for Research and Innovation in Health, University of Porto, R. Júlio Amaral de Carvalho, 45, Porto, 4200-135, Portugal
- IBMC-Institute of Molecular and Cellular Biology, University of Porto, Porto, Portugal
- CGPP-Center for Predictive and Preventive Genetics, University of Porto, Porto, Portugal
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lídia Guimarães
- ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- AAJUDE - Associação de Apoio à Juventude Deficiente, Porto, Portugal
| | - Ruxanda Lungu Baião
- ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Marina Serra de Lemos
- FPCEUP-Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
- CPUP-Center for Psychology, University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- MEDCIDS-Department of Community Medicine, Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE-Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Milena Paneque
- i3S-Institute for Research and Innovation in Health, University of Porto, R. Júlio Amaral de Carvalho, 45, Porto, 4200-135, Portugal.
- IBMC-Institute of Molecular and Cellular Biology, University of Porto, Porto, Portugal.
- CGPP-Center for Predictive and Preventive Genetics, University of Porto, Porto, Portugal.
- ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
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Rodrigues MG, Rodrigues JD, Moreira JA, Clemente F, Dias CC, Azevedo LF, Rodrigues PP, Areias JC, Areias ME. A randomized controlled trial to assess the impact of psychoeducation on the quality of life of parents with children with congenital heart defects-Quantitative component. Child Care Health Dev 2024; 50:e13199. [PMID: 37967565 DOI: 10.1111/cch.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/30/2023] [Accepted: 10/19/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To develop, implement and assess the results of psychoeducation to improve the QoL of parents with CHD newborns. METHODS Participants were parents of inpatient newborns with the diagnosis of non-syndromic CHD. We conducted a parallel RCT with an allocation ratio of 1:1 (intervention vs. control), considering the newborns, using mixed methods research. The intervention group received psychoeducation (Parental Psychoeducation in CHD [PPeCHD]) and the usual routines, and the control group received just the regular practices. The allocation concealment was assured. PI was involved in enrolling participants, developing and implementing the intervention, data collection and data analysis. We followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. RESULTS Parents of eight newborns were allocated to the intervention group (n = 15 parents) and eight to the control group (n = 13 parents). It was performed as an intention-to-treat (ITT) analysis. In M2 (4 weeks), the intervention group presented better QoL levels in the physical, psychological, and environmental domains of World Health Organization Quality of Life instrument (WHOQOL-Bref). In M3 (16 weeks), scores in physical and psychological domains maintained a statistically significant difference between the groups. CONCLUSIONS The PPeCHD, the psychoeducational intervention we developed, positively impacted parental QoL. These results support the initial hypothesis. This study is a fundamental milestone in this research field, adding new essential information to the literature.
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Affiliation(s)
- Marisa Garcia Rodrigues
- Department of Pediatric Cardiology, University Hospital Center of São João (CHUSJ), Porto, Portugal
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University (FMUP), Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS) - EvidenS&HTA, FMUP, Porto, Portugal
| | - José Daniel Rodrigues
- Center for Health Technology and Services Research (CINTESIS) - EvidenS&HTA, FMUP, Porto, Portugal
| | - Jorge Antunes Moreira
- Department of Pediatric Cardiology, University Hospital Center of São João (CHUSJ), Porto, Portugal
| | - Fátima Clemente
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University (FMUP), Porto, Portugal
- Neonatal Intensive Care Unit, Neonatology Department, CHUSJ, Porto, Portugal
- São João Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Training Center, CHUSJ, Porto, Portugal
| | - Cláudia Camila Dias
- Knowledge Management Unit and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), FMUP, Porto, Portugal
- RISE@CINTESIS, FMUP, Porto, Portugal
| | - Luís Filipe Azevedo
- RISE@CINTESIS, FMUP, Porto, Portugal
- Department of Community Medicine, MEDCIDS, FMUP, Porto, Portugal
- Clinical and Health Services Research (PDICSS), FMUP, Porto, Portugal
| | - Pedro Pereira Rodrigues
- RISE@CINTESIS, FMUP, Porto, Portugal
- Department of Community Medicine, MEDCIDS, FMUP, Porto, Portugal
- Health Data Science (PDCDS), FMUP, Porto, Portugal
| | | | - Maria Emília Areias
- Cardiovascular R&D Unit (UnIC), FMUP, Porto, Portugal
- University Institute of Health Sciences (IUCS), Gandra, Portugal
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Baptista R, Silva Cardoso J, Canhão H, Maria Rodrigues A, Kislaya I, Franco F, Bernardo F, Pimenta J, Mendes L, Gonçalves S, Teresa Timóteo A, Andrade A, Moura B, Fonseca C, Aguiar C, Brito D, Ferreira J, Filipe Azevedo L, Peres M, Santos P, Moraes Sarmento P, Cernadas R, Santos M, Fontes-Carvalho R, Campos Fernandes A, Martinho H, González-Juanatey JR, Filipe Pereira L, Gil V, Raquel Marques C, Almeida M, Pardal M, Barbosa V, Gavina C. Portuguese Heart Failure Prevalence Observational Study (PORTHOS) rationale and design - A population-based study. Rev Port Cardiol 2023; 42:985-995. [PMID: 37918783 DOI: 10.1016/j.repc.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Current epidemiological data on heart failure (HF) in Portugal derives from studies conducted two decades ago. The main aim of this study is to determine HF prevalence in the Portuguese population. Using current standards, this manuscript aims to describe the methodology and research protocol applied. METHODS The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) is a large, three-stage, population-based, nationwide, cross-sectional study. Community-dwelling citizens aged 50 years and older will be randomly selected via stratified multistage sampling. Eligible participants will be invited to attend a screening visit at a mobile clinic for HF symptom assessment, anthropomorphic assessment, N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, one-lead electrocardiogram (ECG) and a sociodemographic and health-related quality of life questionnaire (EQ-5D). All subjects with NT-proBNP ≥125 pg/mL or with a prior history of HF will undergo a diagnostic confirmatory assessment at the mobile clinic composed of a 12-lead ECG, comprehensive echocardiography, HF questionnaire (KCCQ) and blood sampling. To validate the screening procedure, a control group will undergo the same diagnostic assessment. Echocardiography results will be centrally validated, and HF diagnosis will be established according to the European Society of Cardiology HF guidelines. A random subsample of patients with an equivocal HF with preserved ejection fraction diagnosis based on the application of the Heart Failure Association preserved ejection fraction diagnostic algorithm will be invited to undergo an exercise echocardiography. CONCLUSIONS Through the application of current standards, appropriate methodologies, and a strong research protocol, the PORTHOS study will determine the prevalence of HF in mainland Portugal and enable a comprehensive characterization of HF patients, leading to a better understanding of their clinical profile and health-related quality of life.
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Affiliation(s)
- Rui Baptista
- Department of Cardiology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.
| | - José Silva Cardoso
- Faculdade de Medicina, Universidade do Porto, Oporto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Oporto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Oporto, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Rheumatology Unit, Centro Hospitalar Universitário de Lisboa Central, Santo António Capuchos Hospital, Lisbon, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Irina Kislaya
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal; Public Health Research Center, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Fátima Franco
- Unidade de Tratamento de Insuficiência Cardiaca Avançada (UTICA), Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Joana Pimenta
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Oporto, Portugal; Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Lígia Mendes
- Department of Cardiology, Hospital da Luz Setúbal, Setúbal, Portugal; Faculdade de Medicina, Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Sara Gonçalves
- Unidade Integrada de Insuficiência Cardíaca (UNIICA), Department of Cardiology, Centro Hospitalar de Setúbal EPE, Setúbal, Portugal
| | - Ana Teresa Timóteo
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Aurora Andrade
- Clínica de Insuficiência Cardíaca, Department of Cardiology, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | | | - Cândida Fonseca
- Department of Medicine, Clínica de Insuficiência Cardiaca, Hospital S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Clínica de Insuficiência Cardiaca, Department of Cardiology, Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carlos Aguiar
- Unidade de Insuficiência Cardíaca Avançada, Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Dulce Brito
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), CAML, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIS), Faculdade de Medicina da Universidade do Porto (FMUP), Oporto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde & Laboratório Associado - Rede de Investigação em Saúde (CINTESIS@RISE), Faculdade de Medicina da Universidade do Porto (FMUP), Oporto, Portugal
| | - Marisa Peres
- Department of Cardiology, Hospital de Santarém, Santarém, Portugal
| | - Paulo Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIS), Faculdade de Medicina da Universidade do Porto (FMUP), Oporto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Oporto, Portugal
| | - Pedro Moraes Sarmento
- Clínica de Insuficiência Cardiaca, Department of Cardiology, Hospital da Luz, Lisbon, Portugal; Faculdade de Medicina, Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal; Centro de Investigação Clinica, Hospital da Luz Learning Health, Lisbon, Portugal
| | - Rui Cernadas
- Serviços de Saúde Ocupacional, Continental Mabor, Lousado, Portugal
| | - Mário Santos
- Department of Cardiology, Pulmonary Vascular Disease Unit, Centro Hospitalar Universitário de Santo António, Oporto, Portugal; CAC ICBAS-CHP - Centro Académico Clínico Instituto de Ciências Biomédicas Abel Salazar - Centro Hospitalar Universitário de Santo António, Oporto, Portugal; Department of Immuno-Physiology and Pharmacology, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Oporto, Portugal; ITR - Laboratory for Integrative and Translational Research in Population Health, Oporto, Portugal
| | - Ricardo Fontes-Carvalho
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Oporto, Portugal; Department of Cardiology, Centro Hospitalar Vila Nova de Gaia-Espinho, Oporto, Portugal
| | | | | | - José Ramon González-Juanatey
- Cardiology Department, Complejo Hospitalario de la Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Luís Filipe Pereira
- Associação de Apoio aos Doentes com Insuficiência Cardiaca (AADIC), Lisbon, Portugal
| | - Victor Gil
- Cardiovascular Department, Hospital da Luz-Lisboa, Lisbon, Portugal; Faculdade de Medicina, Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Cláudia Raquel Marques
- National Center for Data Collection in Cardiology, Portuguese Society of Cardiology, Coimbra, Portugal
| | | | | | | | - Cristina Gavina
- Pedro Hispano Hospital - ULS Matosinhos, Matosinhos, Portugal; Cardiology Department, Faculty of Medicine, University of Porto, Oporto, Portugal; RISE- Health Research Network, Faculty of Medicine, University of Porto, Oporto, Portugal
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Rodrigues MG, Rodrigues JD, Soares MM, Azevedo LF, Rodrigues PP, Areias JC, Areias ME. Improving the quality of life of parents of patients with congenital abnormalities using psychoeducational interventions: a systematic review. Qual Life Res 2023; 32:3027-3037. [PMID: 37329433 PMCID: PMC10522751 DOI: 10.1007/s11136-023-03452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To identify psychoeducational interventions that target parents of children with congenital abnormalities (CA) and evaluate their impact on quality of life (QoL). METHODS The search was conducted in six electronic databases, complemented by references of the studies found, studies of evidence synthesis, a manual search of relevant scientific meetings' abstracts and contact with experts. We included primary studies on parents of children with CA that studied psychoeducational interventions versus standard care. We assessed the risk of bias using Cochrane Collaboration's tool. RESULTS We included six studies focusing on congenital heart defects (CHD). They described four different psychoeducational strategies. In four studies, statistically significant differences were found. For clinical practice, we considered three interventions as more feasible: the Educational program for mothers, with a group format of four sessions weekly; CHIP-Family intervention, which includes a parental group workshop followed by an individual follow-up booster session; and WeChat educational health program with an online format. CONCLUSIONS This review is the first that assesses the impact of psychoeducational interventions targeted at parents of children with CA on their QoL. The best approach to intervention is multiple group sessions. Two essential strategies were to give support material, enabling parents to review, and the possibility of an online program application, increasing accessibility. However, because all included studies focus on CHD, generalizations should be made carefully. These findings are crucial to guide future research to promote and improve comprehensive and structured support for families and integrate them into daily practice.
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Affiliation(s)
- Marisa Garcia Rodrigues
- Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
- Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - José Daniel Rodrigues
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - Matilde Monteiro Soares
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
- Departamento Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS), Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - Luís Filipe Azevedo
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
- Departamento Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS), Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - Pedro Pereira Rodrigues
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
- Departamento Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS), Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - José Carlos Areias
- Unidade de Investigação Cardiovascular da Faculdade de Medicina da Universidade do Porto (UnIC), Porto, Portugal
- Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - Maria Emília Areias
- Unidade de Investigação Cardiovascular da Faculdade de Medicina da Universidade do Porto (UnIC), Porto, Portugal
- Instituto Universitário de Ciências da Saúde (IUCS), Gandra, Portugal
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Sousa-Pinto B, Jácome C, Pereira AM, Regateiro FS, Almeida R, Czarlewski W, Kulus M, Shamji MH, Boulet LP, Bonini M, Brussino L, Canonica GW, Cruz AA, Gemicioglu B, Haahtela T, Kupczyk M, Kvedariene V, Larenas-Linnemann D, Louis R, Niedoszytko M, Pham-Thi N, Puggioni F, Romantowski J, Sastre J, Scichilone N, Taborda-Barata L, Ventura MT, Vieira RJ, Agache I, Bedbrook A, Bergmann KC, Amaral R, Azevedo LF, Bosnic-Anticevich S, Brusselle G, Buhl R, Cecchi L, Charpin D, Loureiro CC, de Blay F, Del Giacco S, Devillier P, Jassem E, Joos G, Jutel M, Klimek L, Kuna P, Laune D, Luna Pech J, Makela M, Morais-Almeida M, Nadif R, Neffen HE, Ohta K, Papadopoulos NG, Papi A, Pétré B, Pfaar O, Yeverino DR, Cordeiro CR, Roche N, Sá-Sousa A, Samolinski B, Sheikh A, Ulrik CS, Usmani OS, Valiulis A, Vandenplas O, Vieira-Marques P, Yorgancioglu A, Zuberbier T, Anto JM, Fonseca JA, Bousquet J. Development and validation of an electronic daily control score for asthma (e-DASTHMA): a real-world direct patient data study. Lancet Digit Health 2023; 5:e227-e238. [PMID: 36872189 DOI: 10.1016/s2589-7500(23)00020-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Validated questionnaires are used to assess asthma control over the past 1-4 weeks from reporting. However, they do not adequately capture asthma control in patients with fluctuating symptoms. Using the Mobile Airways Sentinel Network for airway diseases (MASK-air) app, we developed and validated an electronic daily asthma control score (e-DASTHMA). METHODS We used MASK-air data (freely available to users in 27 countries) to develop and assess different daily control scores for asthma. Data-driven control scores were developed based on asthma symptoms reported by a visual analogue scale (VAS) and self-reported asthma medication use. We included the daily monitoring data from all MASK-air users aged 16-90 years (or older than 13 years to 90 years in countries with a lower age of digital consent) who had used the app in at least 3 different calendar months and had reported at least 1 day of asthma medication use. For each score, we assessed construct validity, test-retest reliability, responsiveness, and accuracy. We used VASs on dyspnoea and work disturbance, EQ-5D-VAS, Control of Allergic Rhinitis and Asthma Test (CARAT), CARAT asthma, and Work Productivity and Activity Impairment: Allergy Specific (WPAI:AS) questionnaires as comparators. We performed an internal validation using MASK-air data from Jan 1 to Oct 12, 2022, and an external validation using a cohort of patients with physician-diagnosed asthma (the INSPIRERS cohort) who had had their diagnosis and control (Global Initiative for Asthma [GINA] classification) of asthma ascertained by a physician. FINDINGS We studied 135 635 days of MASK-air data from 1662 users from May 21, 2015, to Dec 31, 2021. The scores were strongly correlated with VAS dyspnoea (Spearman correlation coefficient range 0·68-0·82) and moderately correlated with work comparators and quality-of-life-related comparators (for WPAI:AS work, we observed Spearman correlation coefficients of 0·59-0·68). They also displayed high test-retest reliability (intraclass correlation coefficients range 0·79-0·95) and moderate-to-high responsiveness (correlation coefficient range 0·69-0·79; effect size measures range 0·57-0·99 in the comparison with VAS dyspnoea). The best-performing score displayed a strong correlation with the effect of asthma on work and school activities in the INSPIRERS cohort (Spearman correlation coefficients 0·70; 95% CI 0·61-0·78) and good accuracy for the identification of patients with uncontrolled or partly controlled asthma according to GINA (area under the receiver operating curve 0·73; 95% CI 0·68-0·78). INTERPRETATION e-DASTHMA is a good tool for the daily assessment of asthma control. This tool can be used as an endpoint in clinical trials as well as in clinical practice to assess fluctuations in asthma control and guide treatment optimisation. FUNDING None.
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Affiliation(s)
- Bernardo Sousa-Pinto
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cristina Jácome
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Margarida Pereira
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal; Patient Centred Innovation and Technology, Centro de Investigação em Tecnologias e Serviços de Saúde, Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra and Institute of Immunology, and Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Rute Almeida
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Marek Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College & National Institutes for Health Imperial Biomedical Research Centre, London, UK
| | | | - Matteo Bonini
- Department of Cardiovascular and Respiratory Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurological, Ear, Nose, and Throat, and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; National Heart and Lung Institute, Imperial College London, London, UK
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and Global Alliance Against Chronic Respiratory Diseases and WHO Planning Group, Salvador, Bahia, Brazil
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology and Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Desirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Renaud Louis
- Department of Pulmonary Medicine, Centre Hospitalier Universitaire Liege, and GIGA Infection, Immunity, Inflammation Laboratories research group, University of Liege, Liege, Belgium
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Nhân Pham-Thi
- Institut de Recherche bio-Médicale des Armées, Bretigny sur Orge, France; École Polytechnique de Palaiseau, Palaiseau, France; Université Paris Cité, Paris, France
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Jan Romantowski
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Joaquin Sastre
- Allergy Service, Fundacion Jimenez Diaz, Faculty of Medicine Universidad Autonoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | - Luis Taborda-Barata
- University of Beira Interior Air, Clinical & Experimental Lung Centre and Centro de Investigação em Ciências da Saúde-University of Beira Interior Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - Rafael José Vieira
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ioana Agache
- Faculty of Medicine, Transylvania University Brasov, Brasov, Romania
| | - Anna Bedbrook
- Allergic Rhinitis and its Impact on Asthma, Montpellier, France
| | - Karl C Bergmann
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - Rita Amaral
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, and Sydney Local Health District, Sydney, NSW, Australia
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Roland Buhl
- Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - Lorenzo Cecchi
- Struttura Organizzativa Semplice Allergology and Clinical Immunology Unita Sanitaria Locale, Toscana Centro, Prato, Italy
| | - Denis Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France
| | - Claudia Chaves Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Frédéric de Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France; Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital Duilio Casula, University of Cagliari, Cagliari, Italy
| | - Philippe Devillier
- Virologie et Immunologie Moléculaires Suresnes, Unités Mixtes de Recherche 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - Ewa Jassem
- Medical University of Gdańsk, Department of Pneumonology, Gdansk, Poland
| | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland; All-Medicine Medical Research Institute, Wroclaw, Poland
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | | | | | - Mika Makela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Rachel Nadif
- Université Paris-Saclay, Université Versailles-St Quentin, Université Paris-Sud, Paris, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, Villejuif, France
| | - Hugo E Neffen
- Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
| | - Ken Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan; JATA Fukujuji Hospital, Tokyo, Japan
| | | | - Alberto Papi
- Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Benoit Pétré
- Department of Public Health, University of Liege, Liege, Belgium
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Daniela Rivero Yeverino
- Allergy and Clinical Immunology Department, Hospital Universitario de Puebla, Puebla, Mexico
| | | | - Nicolas Roche
- Pneumologie, Assistance Publique - Hôpitaux de Paris, Centre Université de Paris Cité, Hôpital Cochin, Paris, France
| | - Ana Sá-Sousa
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal; Patient Centred Innovation and Technology, Centro de Investigação em Tecnologias e Serviços de Saúde, Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London, London, UK; Royal Brompton Hospital, Airways Disease Section, London, UK
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences and Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, Belgium; Université Catholique de Louvain, Yvoir, Belgium
| | - Pedro Vieira-Marques
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Türkiye
| | - Torsten Zuberbier
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Barcelona, Spain
| | - João A Fonseca
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Bousquet
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, Villejuif, France; University Hospital Montpellier, Montpellier, France.
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Costa R, Moreira E, Silva Cardoso J, Azevedo LF, Ribeiro JA, Pinto R. Effectiveness of Exercise-Based Cardiac Rehabilitation for Heart
Transplant Recipients: A Systematic Review and Meta-Analysis. Health Serv Insights 2023; 16:11786329231161482. [PMID: 36968658 PMCID: PMC10034295 DOI: 10.1177/11786329231161482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/16/2023] [Indexed: 03/24/2023] Open
Abstract
Background: Heart Transplant (HTx) is the ultimate chance of life for end stage Heart
Failure (HF). Exercise training has consistently shown the potential to
improve functional capacity in various chronic heart diseases. Still, the
evidence in HTx recipients is scarcer. This study aims to systematically
review the literature to evaluate the effectiveness and safety of
Exercise-based Cardiac Rehabilitation (EBCR) in HTx recipients and to
identify possible moderators of success. Methods: We conducted a systematic review and meta-analysis of randomized controlled
trials on the effect and safety of EBCR in adult HTx recipients. The primary
outcome was functional capacity, measured by Peak Oxygen Uptake (pVO2). We
searched CENTRAL, MEDLINE, Embase, Scopus, and Web of Knowledge databases
until December 2020, reviewed references of relevant articles and contacted
experts. Usual care (UC), the different dosages of exercise regimens and
alternative settings were allowed as comparators. A quantitative synthesis
of evidence was performed using random-effects meta-analyses. Results: A total of 11 studies with 404 patients were included. Nine studies
comprising 306 patients compared EBCR with usual care. They showed that EBCR
improved pVO2 compared to usual care (Mean Difference [MD] 3.03 mL/kg/min,
95% CI [2.28-3.77]; I2 = 32%). In the subgroup
analysis, including length of intervention and timing of enrollment after
HTx, no significant moderator was found. Two trials, with 98 patients total,
compared High Intensity Interval Training (HIIT) and Moderate Intensity
Continuous Training (MICT). HIIT attained a significant edge over MICT (MD
2.23 mL/kg/min, 95% CI [1.79-2.67]; I2 = 0%). No
major adverse events associated with EBCR were reported. Conclusion: We found moderate quality evidence suggesting EBCR has a significant benefit
on functional capacity improvement HTx recipients at the short-term. HIIT
showed superiority when compared to MICT. Research focusing long term
outcomes and standardized protocols are needed to improve evidence on EBCR
effectiveness.
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Affiliation(s)
- Rúben Costa
- Faculty of Medicine, University of
Porto, Porto, Portugal
- Department of Dermatology and
Venereology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Rúben Alexandre Nogueira Costa, Centre for
Health Technology and Services Research, Centro Hospitalar Universitário São
João, Rua Dr. Plácido da Costa, Porto 4200-450, Portugal.
| | - Emília Moreira
- CINTESIS, Centre for Health Technology
and Services Research, Faculty of Medicine, University of Porto, Porto,
Portugal
- RISE: Health Research Network
| | - José Silva Cardoso
- CINTESIS, Centre for Health Technology
and Services Research, Faculty of Medicine, University of Porto, Porto,
Portugal
- RISE: Health Research Network
- Department of Medicine, Faculty of
Medicine, University of Porto, Porto, Portugal
- Department of Cardiology, Centro
Hospitalar Universitário de São João, Porto, Portugal
| | - Luís Filipe Azevedo
- CINTESIS, Centre for Health Technology
and Services Research, Faculty of Medicine, University of Porto, Porto,
Portugal
- RISE: Health Research Network
- Department of Community Medicine,
Information and Health Decision Sciences, Faculty of Medicine, University of Porto,
Portugal
| | - João Alves Ribeiro
- Faculty of Engineering, University of
Porto, Porto, Portugal
- MIT Portugal Ph.D. candidate, Faculty
of Engineering, University of Porto, Porto, Portugal
| | - Roberto Pinto
- Department of Cardiology, Centro
Hospitalar Universitário de São João, Porto, Portugal
- Department of Biomedicine, Faculty of
Medicine, University of Porto, Porto, Portugal
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Valdiviesso R, Moreira E, Martins S, Azevedo LF, Ataíde R, Fernandes L, Silva-Cardoso J, Borges N. Frailty phenotype in heart failure: A condition that transcends age. Rev Port Cardiol 2023; 42:225-234. [PMID: 36623639 DOI: 10.1016/j.repc.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Studies on younger frail and pre-frail subjects suffering from heart failure (HF) are scarce, except for those focusing on the critically ill. This work aims to describe differences between younger (<65 years) and older (≥65 years) pre-frail and frail HF outpatients regarding their nutritional, functional and clinical statuses. METHODS In this cross-sectional study, a sample of 99 HF frail and pre-frail patients (aged 24-81 years, 38.4% women, 21.2% frail, 59.6% <65 years) was recruited from an HF outpatients' clinic in northern Portugal. Muscle mass was estimated from mid-upper arm muscle circumference. Weight status was assessed using body mass index. Hand grip strength and gait speed were measured. Medical records were reviewed. Associations between participants' characteristics and age were calculated using binary logistic regression. RESULTS Age was associated with hand grip strength (OR=0.90), gait speed (OR=0.01) and diabetes (OR=4.95). Obesity, muscle mass or heart failure functional classes were not associated with age categories. CONCLUSION There is an overall lack of differentiation between younger and older HF patients with the frailty phenotype. Therefore, frailty phenotype should be assessed in all patients, regardless of age. Hand grip strength seems to be a good predictor for older age and more studies are needed to define age-specific hand grip strength cut-offs for HF populations.
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Affiliation(s)
- Rui Valdiviesso
- FCNAUP - Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.
| | - Emília Moreira
- CINTESIS@RISE, Knowledge Management Unit, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sónia Martins
- ISSSP - Instituto Superior de Serviço Social do Porto, Porto, Portugal; CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rosário Ataíde
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Lia Fernandes
- CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Porto, Portugal; Psychiatry Service, University Hospital Center of São João, Porto, Portugal
| | - José Silva-Cardoso
- CINTESIS@RISE, Department of Medicine, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Cardiology, University Hospital Center of São João, Porto, Portugal
| | - Nuno Borges
- FCNAUP - Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal; CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
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Barros Ferreira N, Pereira H, Pereira AM, Azevedo LF, Santos M, Maranhão P, Correia R, Fonseca JA, Canedo P, da Costa Pereira A, Sousa-Pinto B. Seroprevalence of SARS-CoV-2 and assessment of epidemiologic determinants in Portuguese municipal workers. Int J Occup Med Environ Health 2022; 35:297-307. [PMID: 35142298 PMCID: PMC10464733 DOI: 10.13075/ijomeh.1896.01878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To assess the seroprevalence of SARS-CoV-2 antibodies in municipal employees of Northern Portugal during the first pandemic wave (May-June 2020) and its association with potentially related risk factors for infection. MATERIAL AND METHODS The authors assessed municipal employees of 2 cities in Northern Portugal, in whom serological tests to SARS-CoV-2 and an epidemiological survey were applied. The authors assessed the proportion of individuals presenting IgM and/or IgG antibodies to SARS-CoV-2, and evaluated the association between having positive serological test results, epidemiologic variables and clinical presentations. Reported symptoms were evaluated on their sensitivity, specificity, and predictive values. RESULTS The authors assessed 1696 employees, of whom 22.0% were firefighters, 10.4% were police officers, 10.3% were maintenance workers, and 8.1% were administrative assistants. The seroprevalence of SARS-CoV-2 infection was 2.9% (95% CI: 2.1-3.7%). Administrative assistants comprised the professional group with highest seroprevalence of SARS-CoV-2 (OR = 1.9 in the comparison with other occupational groups, 95% CI: 0.8-4.3, p = 0.126). The seroprevalence of SARS-CoV-2 infection among those who were in direct contact with COVID-19 patients in their professional activity was 3.9%, compared to 2.7% among those who were not in direct contact with such patients (OR = 1.5, 95% CI: 0.8-2.8, p = 0.222). The highest risk of infection was associated with the presence of a confirmed SARS-CoV-2 infection in the household (OR = 17.4, 95% CI: 8.3-36.8, p < 0.001). Living with a healthcare professional was not associated with a higher risk of infection (OR = 1.0, 95% CI: 0.4-2.5, p = 0.934). Anosmia/ dysgeusia was the symptom with the highest positive predictive value (52.2%, 95% CI: 31.8-72.6, p < 0.001) and specificity (99.3%, 95% CI: 98.9-99.7, p < 0.001), while cough was the most prevalent symptom among SARS-CoV-2 seropositive participants (36%). CONCLUSIONS The authors observed a SARS-CoV-2 seroprevalence of 2.9% among assessed municipal employees. Anosmia/dysgeusia was the COVID-19 symptom which displayed the highest positive predictive value and specificity. Int J Occup Med Environ Health. 2022;35(3):297-307.
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Affiliation(s)
| | - Helena Pereira
- University of Porto, Porto, Portugal (Faculty of Medicine)
| | - Ana Margarida Pereira
- University of Porto, Porto, Portugal (MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine)
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Luís Filipe Azevedo
- University of Porto, Porto, Portugal (MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine)
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Mariana Santos
- University of Porto, Porto, Portugal (MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine)
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Priscila Maranhão
- University of Porto, Porto, Portugal (MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine)
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Ricardo Correia
- University of Porto, Porto, Portugal (MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine)
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - João Almeida Fonseca
- University of Porto, Porto, Portugal (MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine)
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Paulo Canedo
- University of Porto, Porto, Portugal (IPATIMUP, Institute of Molecular Pathology and Immunology)
| | - Altamiro da Costa Pereira
- University of Porto, Porto, Portugal (Faculty of Medicine)
- University of Porto, Porto, Portugal (MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine)
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Bernardo Sousa-Pinto
- University of Porto, Porto, Portugal (Faculty of Medicine)
- University of Porto, Porto, Portugal (MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine)
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
- University of Porto, Porto, Portugal (Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine)
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11
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Garcia Rodrigues M, Rodrigues JD, Pereira AT, Azevedo LF, Pereira Rodrigues P, Areias JC, Areias ME. Impact in the quality of life of parents of children with chronic diseases using psychoeducational interventions - A systematic review with meta-analysis. Patient Educ Couns 2022; 105:869-880. [PMID: 34389225 DOI: 10.1016/j.pec.2021.07.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 06/20/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to identify psychoeducational interventions applied to parents of children with chronic diseases and evaluate their impact on their quality of life (QoL). METHODS It was conducted in six databases, complemented by references from the included studies and other reviews, manual search, and contact with experts. We included primary studies on parents of children with chronic diseases that studied psychoeducational interventions versus standard care. RESULTS We screened 6604 titles and abstracts, reviewed the full text of 60 records, and included 37 primary studies. Half of the studies were on Asthma. We found three intervention formats: one-to-one (43%), groups (49%), and combined approach with individual and group settings (8%). More than 60% of the included studies found statistically significant differences between the intervention and the control group (p < 0.05). CONCLUSION Several interventions have shown efficacy in improving parental QoL. Despite that, there is insufficient evidence of interventions' implementation. PRACTICE IMPLICATIONS A holistic approach encompassing the patient and the family's biopsychosocial dimensions is fundamental in successfully managing chronic disease in children. It is vital to design and implement interventions accommodating the common issues experienced by children, parents, and families that deal with chronic childhood conditions. Systematic review registration number PROSPERO 2018 CRD42018092135.
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Affiliation(s)
- Marisa Garcia Rodrigues
- Department of Pediatric Cardiology, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - José Daniel Rodrigues
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Ana Teresa Pereira
- Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal.
| | - Luís Filipe Azevedo
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Pedro Pereira Rodrigues
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - José Carlos Areias
- Cardiovascular R&D Unit (UnIC), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Maria Emília Areias
- Cardiovascular R&D Unit (UnIC), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Instituto Universitário de Ciências da Saúde (IUCS), Portugal.
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12
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Sousa-Pinto B, Azevedo LF, Sá-Sousa A, Vieira RJ, Amaral R, Klimek L, Czarlewski W, Anto JM, Bedbrook A, Kvedariene V, Ventura MT, Ansotegui IJ, Bergmann KC, Brussino L, Canonica GW, Cardona V, Carreiro-Martins P, Casale T, Cecchi L, Chivato T, Chu DK, Cingi C, Costa EM, Cruz AA, De Feo G, Devillier P, Fokkens WJ, Gaga M, Gemicioğlu B, Haahtela T, Ivancevich JC, Ispayeva Z, Jutel M, Kuna P, Kaidashev I, Kraxner H, Larenas-Linnemann DE, Laune D, Lipworth B, Louis R, Makris M, Monti R, Morais-Almeida M, Mösges R, Mullol J, Odemyr M, Okamoto Y, Papadopoulos NG, Patella V, Pham-Thi N, Regateiro FS, Reitsma S, Rouadi PW, Samolinski B, Sova M, Todo-Bom A, Taborda-Barata L, Tomazic PV, Toppila-Salmi S, Sastre J, Tsiligianni I, Valiulis A, Wallace D, Waserman S, Yorgancioglu A, Zidarn M, Zuberbier T, Fonseca JA, Bousquet J, Pfaar O. Allergen immunotherapy in MASK-air users in real-life: Results of a Bayesian mixed-effects model. Clin Transl Allergy 2022; 12:e12128. [PMID: 35344295 PMCID: PMC8967259 DOI: 10.1002/clt2.12128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Evidence regarding the effectiveness of allergen immunotherapy (AIT) on allergic rhinitis has been provided mostly by randomised controlled trials, with little data from real‐life studies. Objective To compare the reported control of allergic rhinitis symptoms in three groups of users of the MASK‐air® app: those receiving sublingual AIT (SLIT), those receiving subcutaneous AIT (SCIT), and those receiving no AIT. Methods We assessed the MASK‐air® data of European users with self‐reported grass pollen allergy, comparing the data reported by patients receiving SLIT, SCIT and no AIT. Outcome variables included the daily impact of allergy symptoms globally and on work (measured by visual analogue scales—VASs), and a combined symptom‐medication score (CSMS). We applied Bayesian mixed‐effects models, with clustering by patient, country and pollen season. Results We analysed a total of 42,756 days from 1,093 grass allergy patients, including 18,479 days of users under AIT. Compared to no AIT, SCIT was associated with similar VAS levels and CSMS. Compared to no AIT, SLIT‐tablet was associated with lower values of VAS global allergy symptoms (average difference = 7.5 units out of 100; 95% credible interval [95%CrI] = −12.1;−2.8), lower VAS Work (average difference = 5.0; 95%CrI = −8.5;−1.5), and a lower CSMS (average difference = 3.7; 95%CrI = −9.3;2.2). When compared to SCIT, SLIT‐tablet was associated with lower VAS global allergy symptoms (average difference = 10.2; 95%CrI = −17.2;−2.8), lower VAS Work (average difference = 7.8; 95%CrI = −15.1;0.2), and a lower CSMS (average difference = 9.3; 95%CrI = −18.5;0.2). Conclusion In patients with grass pollen allergy, SLIT‐tablet, when compared to no AIT and to SCIT, is associated with lower reported symptom severity. Future longitudinal studies following internationally‐harmonised standards for performing and reporting real‐world data in AIT are needed to better understand its ‘real‐world’ effectiveness.
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Affiliation(s)
- Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Ana Sá-Sousa
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Rafael José Vieira
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Rita Amaral
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Maria Teresa Ventura
- University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Bilbao, Spain
| | - Karl-Christian Bergmann
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Corporate Member of Freie Universität Berlin, Berlin, Germany.,Humboldt-Universität zu Berlin, Berlin, Germany
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL Research Network, Barcelona, Spain
| | - Pedro Carreiro-Martins
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
| | - Thomas Casale
- Division of Allergy/immunology, University of South Florida, Tampa, Florida, USA
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Tomás Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Derek K Chu
- Department of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cemal Cingi
- Eskisehir Osmangazi University, Medical Faculty, ENT Department, Eskisehir, Turkey
| | - Elisio M Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia, Salvador, Bahia, Brazil.,GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - Giulia De Feo
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Salerno, Italy
| | - Philippe Devillier
- VIM Suresnes, UMR_0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - Mina Gaga
- ERS President 2017-2018, Athens Chest Hospital, 7th Respiratory Medicine Department and Asthma Center, Athens, Greece
| | - Bilun Gemicioğlu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Zhanat Ispayeva
- Department of Allergology and Clinical Immunology of the Kazakh National Medical University, Almaty, Kazakhstan
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.,ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | | | - Helga Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Désirée E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | | | - Brian Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, Belgium.,GIGA I3 Research Group, Liege, Belgium
| | - Michaël Makris
- Allergy Unit 'D Kalogeromitros', 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, 'Attikon' University Hospital, Chaidari, Greece
| | - Riccardo Monti
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Ralph Mösges
- ClinCompetence Cologne GmbH, Cologne, Germany.,IMSB, Medical Faculty, University of Cologne, Cologne, Germany
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain.,Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Mikaëla Odemyr
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | | | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, Agency of Health ASL Salerno, 'Santa Maria della Speranza' Hospital, Salerno, Italy
| | - Nhân Pham-Thi
- Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France
| | - Frederico S Regateiro
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Sietze Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - Philip W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.,ENT Department, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Milan Sova
- Department of Pulmonary Medicine and Tuberculosis, University Hospital Brno, Liskovec, Czech Republic
| | - Ana Todo-Bom
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luis Taborda-Barata
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,UBIAir-Clinical & Experimental Lung Centre, University of Beira Interior, Covilhã, Portugal.,Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Peter Valentin Tomazic
- Department of General ORL, H&NS, Medical University of Graz, ENT-University Hospital Graz, Graz, Austria
| | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Joaquin Sastre
- Fundacion Jimenez Diaz, CIBERES, Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
| | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Rethymno, Greece.,International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | | | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Corporate Member of Freie Universität Berlin, Berlin, Germany.,Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - João Almeida Fonseca
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,Medicina, EDucação, I&D e Avaliação, Lda (MEDIDA), Porto, Portugal
| | - Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Corporate Member of Freie Universität Berlin, Berlin, Germany.,Humboldt-Universität zu Berlin, Berlin, Germany.,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,University Hospital Montpellier, Montpellier, France
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
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13
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Sousa‐Pinto B, Azevedo LF, Jutel M, Agache I, Canonica GW, Czarlewski W, Papadopoulos NG, Bergmann K, Devillier P, Laune D, Klimek L, Anto A, Anto JM, Eklund P, Almeida R, Bedbrook A, Bosnic‐Anticevich S, Brough HA, Brussino L, Cardona V, Casale T, Cecchi L, Charpin D, Chivato T, Costa EM, Cruz AA, Dramburg S, Durham SR, De Feo G, Gerth van Wijk R, Fokkens WJ, Gemicioglu B, Haahtela T, Illario M, Ivancevich JC, Kvedariene V, Kuna P, Larenas‐Linnemann DE, Makris M, Mathieu‐Dupas E, Melén E, Morais‐Almeida M, Mösges R, Mullol J, Nadeau KC, Pham‐Thi N, O’Hehir R, Regateiro FS, Reitsma S, Samolinski B, Sheikh A, Stellato C, Todo‐Bom A, Tomazic PV, Toppila‐Salmi S, Valero A, Valiulis A, Ventura MT, Wallace D, Waserman S, Yorgancioglu A, Vries G, Eerd M, Zieglmayer P, Zuberbier T, Pfaar O, Almeida Fonseca J, Bousquet J. Development and validation of combined symptom-medication scores for allergic rhinitis. Allergy 2021; 77:2147-2162. [PMID: 34932829 DOI: 10.1111/all.15199] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Validated combined symptom-medication scores (CSMSs) are needed to investigate the effects of allergic rhinitis treatments. This study aimed to use real-life data from the MASK-air® app to generate and validate hypothesis- and data-driven CSMSs. METHODS We used MASK-air® data to assess the concurrent validity, test-retest reliability and responsiveness of one hypothesis-driven CSMS (modified CSMS: mCSMS), one mixed hypothesis- and data-driven score (mixed score), and several data-driven CSMSs. The latter were generated with MASK-air® data following cluster analysis and regression models or factor analysis. These CSMSs were compared with scales measuring (i) the impact of rhinitis on work productivity (visual analogue scale [VAS] of work of MASK-air® , and Work Productivity and Activity Impairment: Allergy Specific [WPAI-AS]), (ii) quality-of-life (EQ-5D VAS) and (iii) control of allergic diseases (Control of Allergic Rhinitis and Asthma Test [CARAT]). RESULTS We assessed 317,176 days of MASK-air® use from 17,780 users aged 16-90 years, in 25 countries. The mCSMS and the factor analyses-based CSMSs displayed poorer validity and responsiveness compared to the remaining CSMSs. The latter displayed moderate-to-strong correlations with the tested comparators, high test-retest reliability and moderate-to-large responsiveness. Among data-driven CSMSs, a better performance was observed for cluster analyses-based CSMSs. High accuracy (capacity of discriminating different levels of rhinitis control) was observed for the latter (AUC-ROC = 0.904) and for the mixed CSMS (AUC-ROC = 0.820). CONCLUSION The mixed CSMS and the cluster-based CSMSs presented medium-high validity, reliability and accuracy, rendering them as candidates for primary endpoints in future rhinitis trials.
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Affiliation(s)
- Bernardo Sousa‐Pinto
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision Sciences Faculty of Medicine University of Porto Porto Portugal
- CINTESIS ‐ Center for Health Technology and Services Research University of Porto Porto Portugal
| | - Luís Filipe Azevedo
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision Sciences Faculty of Medicine University of Porto Porto Portugal
- CINTESIS ‐ Center for Health Technology and Services Research University of Porto Porto Portugal
| | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wroclaw Poland
- ALL‐MED Medical Research Institute Wroclaw Poland
| | - Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - G. Walter Canonica
- Department of Biomedical Sciences Humanitas University Milan Italy
- Personalized Medicine Asthma & Allergy ‐Humanitas Clinical & Research Centre IRCCS Rozzano Italy
| | | | - Nikolaos G. Papadopoulos
- Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital “P&A Kyriakou” University of Athens Athens Greece
| | - Karl‐Christian Bergmann
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
- Institute for Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | - Philippe Devillier
- UPRES EA220 Pôle des Maladies des Voies Respiratoires Hôpital Foch Université Paris‐Saclay Suresnes France
| | | | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery Universitätsmedizin Mainz Mainz Germany
- Center for Rhinology and Allergology Wiesbaden Germany
| | | | - Josep M. Anto
- ISGlobAL Barcelona Institute for Global Health Barcelona Spain
- IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Patrik Eklund
- Computing Science Department Umeå University Umeå Finland
| | - Rute Almeida
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision Sciences Faculty of Medicine University of Porto Porto Portugal
- CINTESIS ‐ Center for Health Technology and Services Research University of Porto Porto Portugal
| | | | - Sinthia Bosnic‐Anticevich
- Quality Use of Respiratory Medicine Group Woolcock Institute of Medical Research The University of Sydney Sydney New South Wales Australia
- Sydney Local Health District Sydney New South Wales Australia
| | - Helen A. Brough
- Division of Allergy/Immunology University of South Florida Tampa Florida USA
| | - Luisa Brussino
- Department of Medical Sciences Allergy and Clinical Immunology Unit University of Torino & Mauriziano Hospital Torino Italy
| | - Victoria Cardona
- Allergy Section Department of Internal Medicine Hospital Vall d'Hebron & ARADyAL Research Network Barcelona Spain
| | - Thomas Casale
- Division of Allergy/Immunology University of South Florida Tampa Florida USA
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology USL Toscana Centro Prato Italy
| | - Denis Charpin
- Clinique des Bronches Allergie et Sommeil Hôpital Nord Marseille France
| | - Tomás Chivato
- School of Medicine University CEU San Pablo Madrid Spain
| | - Elisio M. Costa
- Faculty of Pharmacy and Competence Center on Active and Healthy Ageing University of Porto (Porto4Ageing) UCIBIOREQUINTE Porto Portugal
| | - Alvaro A. Cruz
- Fundaçao ProAR Federal University of Bahia and GARD/WHO Planning Group Salvador Brazil
| | - Stephanie Dramburg
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine Charité Medical University Berlin Germany
| | - Stephen R. Durham
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - Giulia De Feo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno Salerno Italy
| | - Roy Gerth van Wijk
- Section of Allergology Department of Internal Medicine Erasmus MC Rotterdam The Netherlands
| | - Wystke J. Fokkens
- Department of Otorhinolaryngology Amsterdam University Medical Centres Amsterdam The Netherlands
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases Cerrahpasa Faculty of Medicine Istanbul University‐Cerrahpasa Istanbul Turkey
| | - Tari Haahtela
- Skin and Allergy Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Maddalena Illario
- Department of Public Health and Research and Development Unit Federico II University and Hospital Naples Italy
| | | | - Violeta Kvedariene
- Department of Pathology Faculty of Medicine Institute of Biomedical Sciences Vilnius University Vilnius Lithuania
- Faculty of Medicine Institute of Clinical Medicine Clinic of Chest Diseases and Allergology Vilnius University Vilnius Lithuania
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Barlicki University Hospital Medical University of Lodz Poland
| | | | - Michael Makris
- Allergy Unit “D Kalogeromitros” 2nd Department of Dermatology and Venereology National & Kapodistrian University of Athens, “Attikon” University Hospital Athens Greece
| | | | - Erik Melén
- Sachs’ Children and Youth Hospital Södersjukhuset Stockholm Sweden
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | | | - Ralph Mösges
- CRI‐Clinical Research International‐Ltd Hamburg Germany
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic ENT Department Hospital Clínic Barcelona Spain
- Clinical & Experimental Respiratory Immunoallergy IDIBAPSCIBERESUniversity of Barcelona Barcelona Spain
| | - Kari C. Nadeau
- Sean N. Parker Center for Allergy and Asthma Research Stanford University School of Medicine Stanford California USA
| | - Nhân Pham‐Thi
- IRBA (Institut de Recherche bio‐Médicale des Armées) Ecole Polytechnique Palaiseau Bretigny France
| | - Robyn O’Hehir
- Department of Allergy, Immunology and Respiratory Medicine Central Clinical School Monash University and Alfred Health Melbourne Victoria Australia
| | - Frederico S. Regateiro
- Allergy and Clinical Immunology Unit Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
- Institute of Immunology Faculty of Medicine University of Coimbra Portugal
- ICBR ‐ Coimbra Institute for Clinical and Biomedical Research CIBB Coimbra Portugal
| | - Sietze Reitsma
- Department of Otorhinolaryngology Amsterdam University Medical CentresAMC Amsterdam The Netherlands
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology Medical University of Warsaw Warsaw Poland
| | - Aziz Sheikh
- Usher Institute The University of Edinburgh Edinburgh UK
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno Salerno Italy
| | - Ana Todo‐Bom
- Imunoalergologia Centro Hospitalar Universitário de Coimbra and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Peter Valentin Tomazic
- Department of General ORL, H&NS Medical University of GrazENT‐University Hospital Graz Austria
| | - Sanna Toppila‐Salmi
- Skin and Allergy Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Antonio Valero
- Pneumology and Allergy Department CIBERES and Clinical & Experimental Respiratory Immunoallergy IDIBAPSUniversity of Barcelona Spain
| | - Arunas Valiulis
- Faculty of Medicine Institute of Clinical Medicine & Institute of Health Sciences Vilnius University Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS‐SP) Brussels Belgium
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy
| | - Dana Wallace
- Nova Southeastern University Fort Lauderdale Florida USA
| | - Susan Waserman
- Department of Medicine Clinical Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases Faculty of Medicine Celal Bayar University Manisa Turkey
| | | | | | - Petra Zieglmayer
- Vienna Challenge Chamber Vienna Austria
- Competence Center for Allergology and Immunology Karl Landsteiner University Krems Austria
| | - Torsten Zuberbier
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
- Institute for Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | - Oliver Pfaar
- Section of Rhinology and Allergy Department of Otorhinolaryngology, Head and Neck Surgery University Hospital MarburgPhilipps‐Universität Marburg Marburg Germany
| | - João Almeida Fonseca
- Departamento Medicina da Comunidade Informaçao e Decisao em Saude (MEDCIDS) Faculdada de Medicina da Universidade do Porto Porto Portugal
- Medicina, EDucaçao, I&D e Avaliaçao Lda (MEDIDA) Porto Portugal
- Imunoalergologia CUF Porto Portugal
| | - Jean Bousquet
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
- Institute for Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- MACVIA‐France Montpellier France
- University Hospital Montpellier Montpellier France
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14
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Pozza DH, Azevedo LF, Castro Lopes JM. Pain as the fifth vital sign-A comparison between public and private healthcare systems. PLoS One 2021; 16:e0259535. [PMID: 34731211 PMCID: PMC8565736 DOI: 10.1371/journal.pone.0259535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background The assessment of pain as the fifth vital sign (P5VS) is of paramount importance since it leads to the management of undertreated pain, consequently reducing suffering, readmissions and emergency department visits after hospital discharge. Objective To evaluate the implementation of P5VS in public and private hospitals. Methods Data analysis on validated questionnaires was sent to all 171 Portuguese hospitals via an official letter. Results When compared to private hospitals, public hospitals presented a higher adherence to the process related to the P5VS. It has demonstrated superiority in the charts properly placed to record P5VS, in the number of emergency departments recording P5VS, in the regularity of audits, and in the existence of guidelines and staff training on pain assessment and management. Conclusion The standardization of both evaluation and recording of pain intensity constitutes a measure of good clinical practice. Public hospitals demonstrated better commitment to these procedures that should be properly carried out in all health care institutions.
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Affiliation(s)
- Daniel Humberto Pozza
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Histology, Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health-I3s, University of Porto, Porto, Portugal
- * E-mail:
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - José Manuel Castro Lopes
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health-I3s, University of Porto, Porto, Portugal
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15
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Teixeira A, Teixeira M, Bento C, Azevedo LF, Vasconcelos V, Bahia MF, Torres T, Morna C, Castro E, Vidal DG, E Sousa HFP, Dinis MAP, Almeida IF, Almeida V. Patterns of dosage regimen instructions regarding topical medicines: how is the information perceived by patients? J DERMATOL TREAT 2021; 33:2325-2330. [PMID: 34334082 DOI: 10.1080/09546634.2021.1960262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The communication of dosage regimen instructions by physicians is of utmost importance on treatment adherence. Few studies until now have approached the topical treatment adherence subject. OBJECTIVE This study aims the characterization of dosage regimen instructions given by physicians and the assessment of chronic dermatological patients' perception regarding these instructions. METHODS Two instruments one for physicians (PHYSDOSAGE) and one for patients (PATIENTDOSAGE) were developed and applied in a cross-sectional, descriptive and exploratory study to two independent samples composed by 91 physicians and 43 patients. RESULTS Most of physicians reported to provide dosage regimen instructions. When cross checking information from both studied samples, physicians and patients, it was concluded that physicians reported to provide more frequently oral and written treatment instructions, e.g. electronic prescription, than patients reported having received it. Also, physicians claimed to often provide information about the duration of treatment and the frequency of topical medicines' application, which was not acknowledged by patients. CONCLUSIONS Contradictory results were found between the physicians' information input and the patients' perception about dosage regimen instructions provided during the consultation. These findings could negatively influence the treatment adherence and the clinical outcomes. Thus, it is of paramount importance the implementation of strategies to improve optimal communication of dosage regimen instructions for topical medicines.
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Affiliation(s)
- Ana Teixeira
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal.,UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
| | - Maribel Teixeira
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal
| | - Carmen Bento
- Universitary Clinic of Paediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Luís Filipe Azevedo
- Department of Health Information and Decision Sciences (CIDES) and Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Portugal
| | - Viviana Vasconcelos
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal
| | - Maria Fernanda Bahia
- UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
| | - Tiago Torres
- Serviço de Dermatologia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Carla Morna
- USF das Ondas, Aces Grande Porto IV-Póvoa de Varzim/Vila do Conde, Vila do Conde, Portugal
| | - Eunice Castro
- Serviço de Imunoalergologia, Centro Hospitalar de S. João, Porto, Portugal
| | - Diogo Guedes Vidal
- UFP Energy, Environment and Health Research Unit (FP-ENAS, University Fernando Pessoa (UFP), Porto, Portugal)
| | | | - Maria Alzira Pimenta Dinis
- UFP Energy, Environment and Health Research Unit (FP-ENAS, University Fernando Pessoa (UFP), Porto, Portugal)
| | - Isabel F Almeida
- UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
| | - Vera Almeida
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal.,UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
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16
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Cavalheiro AH, Silva Cardoso J, Rocha A, Moreira E, Azevedo LF. Effectiveness of Tele-rehabilitation Programs in Heart Failure: A Systematic Review and Meta-analysis. Health Serv Insights 2021; 14:11786329211021668. [PMID: 34188484 PMCID: PMC8212368 DOI: 10.1177/11786329211021668] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Tele-rehabilitation (TR) may be an effective alternative or complement to centre-based cardiac rehabilitation (CBCR) with heart failure (HF) patients, helping overcome accessibility problems to CBCR. The aim of this study is to systematically review the literature in order to assess the clinical effectiveness of TR programs in the management of chronic HF patients, compared to standard of care and standard rehabilitation (CBCR). Methods and Results We conducted a systematic review and meta-analysis of randomized controlled trials on the effect and safety of TR programs in HF patients, regarding cardiovascular death, heart failure-related hospitalizations, functional capacity and quality of life. We searched 4 electronic databases up until May 2020, reviewed references of relevant articles and contacted experts. A quantitative synthesis of evidence was performed by means of random-effects meta-analyses. We included 17 primary studies, comprising 2206 patients. Four studies reported the number of hospitalizations (TR: 301; Control: 347). TR showed to be effective in the improvement of HF patients' functional capacity in the 6 Minute Walk-Test (Mean Difference (MD) 15.86; CI 95% [7.23; 24.49]; I2 = 74%) and in peak oxygen uptake (pVO2) results (MD 1.85; CI 95% [0.16; 3.53]; I2 = 93%). It also improved patients' quality of life (Minnesota Living with Heart Failure Questionnaire: MD -6.62; CI 95% [-11.40; -1.84]; I2 = 99%). No major adverse events were reported during TR exercise. Conclusion TR showed to be superior than UC without CR on functional capacity improvement in HF patients. There is still scarce evidence of TR impact on hospitalization and cv death reduction. Further research and more standardized protocols are needed to improve evidence on TR effectiveness, safety and cost-effectiveness.
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Affiliation(s)
- Ana Helena Cavalheiro
- Department of Physical Rehabilitation, Centro Hospitalar Universitário do Porto, Porto, Portugal.,CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Silva Cardoso
- CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Afonso Rocha
- CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Physical Rehabilitation, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Emília Moreira
- CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal
| | - Luís Filipe Azevedo
- CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal
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17
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Cardoso‐Fernandes A, Blumenthal KG, Chiriac AM, Tarrio I, Afonso‐João D, Delgado L, Fonseca JA, Azevedo LF, Sousa‐Pinto B. Frequency of severe reactions following penicillin drug provocation tests: A Bayesian meta-analysis. Clin Transl Allergy 2021; 11:e12008. [PMID: 34161664 PMCID: PMC8215894 DOI: 10.1002/clt2.12008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Patients with a penicillin allergy label tend to have worse clinical outcomes and increased healthcare use. Drug provocation tests (DPT) are the gold-standard in the diagnostic workup of penicillin allergy, but safety concerns may hinder their performance. We aimed to assess the frequency of severe reactions following a DPT in patients with reported allergy to penicillins or other β-lactams. METHODS We performed a systematic review, searching MEDLINE, Scopus, and Web of Science. We included primary studies assessing participants with a penicillin allergy label who underwent a DPT. We performed a Bayesian meta-analysis to estimate the pooled frequency of severe reactions to penicillin DPTs. Sources of heterogeneity were explored by subgroup and metaregression analyses. RESULTS We included 112 primary studies which included a total of 26,595 participants. The pooled frequency of severe reactions was estimated at 0.06% (95% credible interval [95% CrI] = 0.01%-0.13%; I2 = 57.9%). Most severe reactions (80/93; 86.0%) consisted of anaphylaxis. Compared to studies where the index reaction was immediate, we observed a lower frequency of severe reactions for studies assessing non-immediate index reactions (OR = 0.05; 95% CrI = 0-0.31). Patients reporting anaphylaxis as their index reaction were found to be at increased risk of developing severe reactions (OR = 13.5; 95% CrI = 7.7-21.5; I2 = 0.3%). Performance of direct DPTs in low-risk patients or testing with the suspected culprit drug were not associated with clinically relevant increased risk of severe reactions. CONCLUSIONS In patients with a penicillin allergy label, severe reactions resulting from DPTs are rare. Therefore, except for patients with potentially life-threatening index reactions or patients with positive skin tests-who were mostly not assessed in this analysis -, the safety of DPTs supports their performance in the diagnostic assessment of penicillin allergy.
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Affiliation(s)
- António Cardoso‐Fernandes
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of Medicine, University of PortoPortoPortugal
- Center for Health Technology and Services Research (CINTESIS)Faculty of Medicine, University of PortoPortoPortugal
| | - Kimberly G. Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolHarvard UniversityBostonMassachusettsUSA
| | - Anca Mirela Chiriac
- Department of PulmonologyDivision of Allergy, Hôpital Arnaud de VilleneuveUniversity Hospital of MontpellierMontpellierFrance
- UMR‐S 1136 INSERM‐Sorbonne UniversitéEquipe Epidémiologie des Maladies Allergiques et Respiratoires (EPAR)Institut Pierre Louis d’Epidémiologie et de Santé PubliqueParisFrance
| | - Isabel Tarrio
- Center for Health Technology and Services Research (CINTESIS)Faculty of Medicine, University of PortoPortoPortugal
| | - David Afonso‐João
- Center for Health Technology and Services Research (CINTESIS)Faculty of Medicine, University of PortoPortoPortugal
| | - Luís Delgado
- Center for Health Technology and Services Research (CINTESIS)Faculty of Medicine, University of PortoPortoPortugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of MedicineUniversity of PortoPortoPortugal
| | - João Almeida Fonseca
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of Medicine, University of PortoPortoPortugal
- Center for Health Technology and Services Research (CINTESIS)Faculty of Medicine, University of PortoPortoPortugal
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of Medicine, University of PortoPortoPortugal
- Center for Health Technology and Services Research (CINTESIS)Faculty of Medicine, University of PortoPortoPortugal
| | - Bernardo Sousa‐Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of Medicine, University of PortoPortoPortugal
- Center for Health Technology and Services Research (CINTESIS)Faculty of Medicine, University of PortoPortoPortugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of MedicineUniversity of PortoPortoPortugal
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18
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Sousa-Pinto B, Blumenthal KG, Macy E, Pereira AM, Azevedo LF, Delgado L, Fonseca JA. Penicillin Allergy Testing Is Cost-Saving: An Economic Evaluation Study. Clin Infect Dis 2021; 72:924-938. [PMID: 32107530 DOI: 10.1093/cid/ciaa194] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Having a penicillin allergy label is associated with the use of less appropriate and more expensive antibiotics and increased healthcare utilization. Penicillin allergy testing results in delabeling most allergy claimants and may be cost-saving. This study aimed to project whether penicillin allergy testing in patients reporting a penicillin allergy is cost-saving. METHODS In this economic evaluation study, we built decision models to project the economic impact of 2 strategies for a patient with a penicillin allergy label: (1) perform diagnostic testing (drug challenges, with or without skin tests); and (2) do not perform diagnostic testing. The health service perspective was adopted, considering costs with penicillin allergy tests, and with hospital bed-days/outpatient visits, antibiotic use, and diagnostic testing. Twenty-four base case decision models were built, accounting for differences in the diagnostic workup, setting (inpatient vs outpatient) and geographic region. Uncertainty was explored via probabilistic sensitivity analyses. RESULTS Penicillin allergy testing was cost-saving in all decision models built. For models assessing the performance of both skin tests and drug challenges, allergy testing resulted in average savings (in United States [US] dollars) of $657 for inpatients (US: $1444; Europe: $489) and $2746 for outpatients (US: $256; Europe: $6045). 75% of simulations obtained through probabilistic sensitivity analysis identified testing as the less costly option. CONCLUSIONS Penicillin allergy testing was projected to be cost-saving across different scenarios. These results are devised to inform guidelines, supporting the adoption of policies promoting widespread testing of patients with a penicillin allergy label.
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Affiliation(s)
- Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research, Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Macy
- Department of Allergy, Southern California Permanente Medical Group, San Diego Medical Center, San Diego, California, USA
| | - Ana Margarida Pereira
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research, Porto, Portugal
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research, Porto, Portugal
| | - Luís Delgado
- Center for Health Technology and Services Research, Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Almeida Fonseca
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research, Porto, Portugal
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19
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Sousa-Pinto B, Tarrio I, Blumenthal KG, Araújo L, Azevedo LF, Delgado L, Fonseca JA. Accuracy of penicillin allergy diagnostic tests: A systematic review and meta-analysis. J Allergy Clin Immunol 2020; 147:296-308. [PMID: 32446963 DOI: 10.1016/j.jaci.2020.04.058] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/15/2020] [Accepted: 04/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Having a penicillin allergy label associates with a higher risk for antibiotic resistance and increased health care use. OBJECTIVE We sought to assess the accuracy of skin tests and specific IgE quantification in the diagnostic evaluation of patients reporting a penicillin/β-lactam allergy. METHODS We performed a systematic review and diagnostic accuracy meta-analysis, searching on MEDLINE, Scopus, and Web of Science. We included studies conducted in patients reporting a penicillin allergy and in whom skin tests and/or specific IgE quantification were performed and compared with drug challenge results. We quantitatively assessed the accuracy of diagnostic tests with bivariate random-effects meta-analyses. Meta-regression and subgroup analyses were performed to explore causes of heterogeneity. Studies' quality was evaluated using QUADAS-2 criteria. RESULTS We included 105 primary studies, assessing 31,761 participants. Twenty-seven studies were assessed by bivariate meta-analysis. Skin tests had a summary sensitivity of 30.7% (95% CI, 18.9%-45.9%) and a specificity of 96.8% (95% CI, 94.2%-98.3%), with a partial area under the summary receiver-operating characteristic curve of 0.686 (I2 = 38.2%). Similar results were observed for subanalyses restricted to patients reporting nonimmediate maculopapular exanthema or urticaria/angioedema. Specific IgE had a summary sensitivity of 19.3% (95% CI, 12.0%-29.4%) and a specificity of 97.4% (95% CI, 95.2%-98.6%), with a partial area under the summary receiver-operating characteristic curve of 0.420 (I2 = 8.5%). Projected predictive values mainly reflect the low frequency of true penicillin allergy. CONCLUSIONS Skin tests and specific IgE quantification appear to have low sensitivity and high specificity. Because current evidence is insufficient for assessing the role of these tests in stratifying patients for delabeling, we identified key requirements needed for future studies.
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Affiliation(s)
- Bernardo Sousa-Pinto
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Isabel Tarrio
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Luís Araújo
- CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Delgado
- CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Almeida Fonseca
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
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20
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Sampaio R, Azevedo LF, Dias CC, Castro Lopes JM. Non-Adherence to Pharmacotherapy: A Prospective Multicentre Study About Its Incidence and Its Causes Perceived by Chronic Pain Patients. Patient Prefer Adherence 2020; 14:321-332. [PMID: 32109998 PMCID: PMC7037084 DOI: 10.2147/ppa.s232577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Pharmacological interventions remain the cornerstone of chronic pain treatment; however, nearly 40% of the prescription medicines are not taken as prescribed. The present study aims at understanding and describing non-adherence from the perspective of chronic pain patients during a 1-year follow-up study. METHODS A cohort of 950 consecutive patients referred to a first consultation in Multidisciplinary Chronic Pain Clinics was followed with a standardized protocol for 1 year. This included assessment of pain characteristics; prescribed medication; therapeutic adherence; effectiveness of treatment, non-adherence and its perceived reasons; clinical outcomes and quality of life. We used a mixed methods approach, including qualitative and quantitative analyses. RESULTS Forty-nine percent of the 562 patients who responded to all assessments during follow-up were adherent after 1 year of chronic pain treatment. The core associations between each "non-adherence reason" and Anatomical Therapeutic Chemical Code (ATC) group were perceived side effects (p=0.019) and delayed start (p=0.022) for narcotic analgesics (opioids); perceived non-efficacy (p=0.017) and delayed start (p=0.004) for antiepileptics and anticonvulsants; perceived low necessity (p=0.041) and delayed start (p=0.036) for analgesics antipyretics; change in prescriptions because of a new clinical condition for antidepressants (p=0.024); high concerns (p=0.045) and change in prescriptions because of a new clinical condition (p<0.001) for non-steroidal anti-inflammatory drugs; delayed start (p=0.016) and financial constraints (p=0.018) for other medications. DISCUSSION This study emphasizes the patient's perspective regarding non-adherence to pharmacological treatment of chronic pain, providing valuable and novel information to be used in future interventions to help patients make an informed choice about their adherence behavior.
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Affiliation(s)
- Rute Sampaio
- Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
- Correspondence: Rute Sampaio Faculty of Medicine of Porto University, Department of Biomedicine – 5 Floor, Alameda Hernani Monteiro, Porto4200-319, Portugal Email
| | - Luís Filipe Azevedo
- Centro Nacional de Observação em Dor - OBSERVDOR, Porto, Portugal
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto (MEDCIDS), Porto, Portugal
- Centro de Investigação Em Tecnologias e em Serviços de Saúde (CINTESIS), Porto, Portugal
| | - Cláudia Camila Dias
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto (MEDCIDS), Porto, Portugal
- Centro de Investigação Em Tecnologias e em Serviços de Saúde (CINTESIS), Porto, Portugal
| | - José M Castro Lopes
- Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
- Centro Nacional de Observação em Dor - OBSERVDOR, Porto, Portugal
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de Carvalho C, Pinto IR, Azevedo LF, Guerreiro A, Ramos JP, Barbosa MR, Pinto M. PROTOCOL: Psychosocial processes and intervention strategies behind islamist deradicalisation: A scoping review. Campbell Syst Rev 2019; 15:e1036. [PMID: 37131511 PMCID: PMC8356520 DOI: 10.1002/cl2.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Cátia de Carvalho
- Centre of Psychology of University of Porto, Centre of Deviant Behaviour Sciences, Center for Health Technology and Services Research (CINTESIS)Faculty of Psychology and Education Sciences of University of PortoPortoPortugal
| | - Isabel Rocha Pinto
- Centre of Psychology of University of PortoFaculty of Psychology and Education Sciences of University of PortoPortoPortugal
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information and Health Decision Science (MECIDS) & Center for Health Technology and Services Research (CINTESIS) & Cochrane PortugalFaculty of Medicine of University of PortoPortoPortugal
| | | | - João Pedro Ramos
- Centre of Deviant Behaviour SciencesFauclty of Psychology and Education Sciences of University of PortoPortoPortugal
| | - Mariana Reis Barbosa
- Center for Studies in Human Development, Faculty of Education and PsychologyCatholic University of PortugalPortoPortugal
| | - Marta Pinto
- Centre of Deviant Behaviour Sciences, Center for Health Technology and Services Research (CINTESIS)Faculty of Psychology and Education Sciences of University of PortoPortoPortugal
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Moreira-Rosário A, Marques C, Pinheiro H, Norberto S, Sintra D, Teixeira JA, Calhau C, Azevedo LF. Daily intake of wheat germ-enriched bread may promote a healthy gut bacterial microbiota: a randomised controlled trial. Eur J Nutr 2019; 59:1951-1961. [PMID: 31325040 DOI: 10.1007/s00394-019-02045-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 06/30/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Wheat bran fibre has a beneficial effect on gastrointestinal function, but evidence for wheat germ is scarce. Accordingly, we evaluated the effects of daily intake of wheat germ on gastrointestinal discomfort and gut microbiota by adding wheat germ to refined (white) wheat bread, the most consumed bread type. We hypothesised that an improvement in the composition of refined bread could beneficially affect intestinal health without compromising consumers' acceptance. METHODS Fifty-five healthy adults were recruited for a randomised, double-blind, crossover, controlled trial comprising two 4-week intervention periods separated by a 5-week washout stage. During the first 4-week period, one group consumed wheat bread enriched with 6 g of wheat germ and the control group consumed non-enriched wheat bread. RESULTS Wheat germ-enriched bread was well-appreciated and the number of participants that demonstrated minimal gastrointestinal improvements after wheat-germ intake was higher than in the control arm. Importantly, intake of wheat germ-enriched bread decreased the perceived gastrointestinal discomfort-related quality of life (subscale worries and concerns) over refined white bread. The improvements in the gastrointestinal function were accompanied by favourable changes in gut microbiota, increasing the number of Bacteroides spp. and Bifidobacterium spp. CONCLUSIONS Adding wheat germ to industrially made white bread without altering sensory properties may promote a healthy gut bacterial microbiota and the gastrointestinal health.
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Affiliation(s)
- André Moreira-Rosário
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal. .,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Cláudia Marques
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Nutrition and Metabolism, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Helder Pinheiro
- Nutrition and Metabolism, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal.,Infectious Diseases Service, Hospital Curry Cabral, Lisbon, Portugal
| | - Sónia Norberto
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Diana Sintra
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - José António Teixeira
- Center of Biological Engineering, University of Minho, Campus of Gualtar, Braga, Portugal
| | - Conceição Calhau
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Nutrition and Metabolism, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal.,José de Mello Saúde by NOVA Medical School, University Unit of Lifestyle Medicine, Lisbon, Portugal
| | - Luís Filipe Azevedo
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
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Vila-Chã N, Cavaco S, Mendes A, Gonçalves A, Moreira I, Fernandes J, Damásio J, Azevedo LF, Castro-Lopes J. Sleep disturbances in Parkinson's disease are associated with central parkinsonian pain. J Pain Res 2019; 12:2137-2144. [PMID: 31372031 PMCID: PMC6635894 DOI: 10.2147/jpr.s206182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Sleep disturbances and pain are common non-motor symptoms in Parkinson’s disease (PD). This study aimed to explore the association between these two symptoms in a cohort of patients with PD. Materials and methods The Parkinson’s Disease Sleep Scale (PDSS-2) was used to identify sleep disturbances in a series of 229 PD patients. The identification and characterization of pain was performed by a semi-structured interview and by the application of the Ford classification and the Brief Pain Inventory (BPI). The Unified Parkinson’s Disease Rating Scale-III, Hoehn & Yahr (H&Y), and Schwab and England Independence Scale were used to assess motor symptoms and functional independence in off and on conditions. The Hospital Anxiety and Depression Scale (HADS) and SF-36 were applied to screen for anxiety and depression and to evaluate the quality of life. Non-parametric tests were used for group comparisons and logistic regressions were applied to explore predictors of sleep disturbances. Results Seventy-five (33%) patients had clinically relevant sleep disturbances (PDSS-2≥18) and 162 patients (71%) reported pain. Of those with pain, 38 (24%) had central parkinsonian pain. PD patients with sleep disturbances experienced more pain and had more severe motor symptoms, lower functional independence, more anxiety and depression symptoms, and worst quality of life. Among patients with pain, central parkinsonian pain was the subtype of pain with the highest odds of sleep disturbances, even when taking into account motor symptoms (H&Y off), motor fluctuations, intensity of pain (BPI), and symptoms of anxiety and depression (HADS). Conclusions The association between pain and sleep disturbances in PD appears to be dependent on subtype of pain. The close relationship between central parkinsonian pain and sleep disturbances in PD raises the possibility of common pathophysiological mechanisms. A better understanding of the relationship between sleep disturbances and central parkinsonian pain may contribute to the development of new care strategies in PD patients.
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Affiliation(s)
- N Vila-Chã
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - S Cavaco
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal
| | - A Mendes
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - A Gonçalves
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - I Moreira
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - J Fernandes
- Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - J Damásio
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal
| | - L F Azevedo
- Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.,National Observatory for Pain - NOPain, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - J Castro-Lopes
- National Observatory for Pain - NOPain, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
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Vila-Chã N, Cavaco S, Mendes A, Gonçalves A, Moreira I, Fernandes J, Damásio J, Azevedo LF, Castro-Lopes J. Unveiling the relationship between central parkinsonian pain and motor symptoms in Parkinson's disease. Eur J Pain 2019; 23:1475-1485. [PMID: 31070825 DOI: 10.1002/ejp.1413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/30/2019] [Accepted: 05/05/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pain in Parkinson's disease (PD) is a common and heterogeneous non-motor symptom. Although the characteristics and predictors of pain in general and of central pain in particular are still largely unknown. METHODS A semi-structured interview, the Brief Pain Inventory and the Pain Disability Index were used to identify and characterize pain in a consecutive series of 292 PD patients. Unified PD Rating Scale-III, Hoehn & Yahr, Schwab and England Independence Scale and Freezing of Gait Questionnaire were applied to assess motor symptoms and functional independence in off and on conditions. Hospital Anxiety and Depression Scale and Questionnaire of Impulsive-Compulsive Control Disorders were used to screen for anxiety, depression and impulse control disorders. RESULTS Two hundred and twelve patients (73%) reported pain, which was classified as: musculoskeletal (63%), dystonia-related (27%), central parkinsonian (22%) and/or radicular or neuropathic (9%). Patients with pain had more comorbidities and more severe motor symptoms. Patients with central parkinsonian pain were significantly younger, had earlier disease onset, fewer comorbidities, greater non-axial motor symptom severity in on, more pain-related disability and more relief of pain with antiparkinsonian medication than patients with non-central parkinsonian pain. CONCLUSIONS PD patients with central parkinsonian pain have some distinctive demographic and clinical features, including lower levodopa responsiveness of motor appendicular/limb symptoms to levodopa, associated with greater responsiveness of pain symptoms to these same medications. These findings suggest the need for a more integrated approach to motor and non-motor symptoms in these patients' clinical care. SIGNIFICANCE In a consecutive series of 292 patients with PD, almost three quarters of patients with PD reported pain. The study results revealed that pain was related to more severe motor symptoms, anxiety symptoms and comorbidities. Among patients with pain, those with central parkinsonian subtype had distinct demographic and clinical features, including lower levodopa responsiveness for non-axial motor symptoms and greater responsiveness of pain to antiparkinsonian treatment.
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Affiliation(s)
- Nuno Vila-Chã
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - Sara Cavaco
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal
| | - Alexandre Mendes
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Alexandra Gonçalves
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Inês Moreira
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Joana Fernandes
- Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Joana Damásio
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.,National Observatory for Pain-NOPain, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Castro-Lopes
- National Observatory for Pain-NOPain, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal
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Conde B, Winck JC, Azevedo LF. Estimating Amyotrophic Lateral Sclerosis and Motor Neuron Disease Prevalence in Portugal Using a Pharmaco-Epidemiological Approach and a Bayesian Multiparameter Evidence Synthesis Model. Neuroepidemiology 2019; 53:73-83. [PMID: 31117082 DOI: 10.1159/000499485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a rare and progressive neurodegenerative disease involving the upper and lower motor neurons. It is also the most common and the one with the worst prognosis among the motor neuron diseases (MND). ALS invariably progresses to respiratory failure, which is an essential factor affecting the prognosis of this disease. Its prevalence in the world is heterogeneous and, in many countries, is even unknown, since national registries are not mandatory or comprehensive enough. Worldwide, the ALS/MND prevalence is estimated between 4 and 8 cases per 100,000 inhabitants, but in Portugal the prevalence was never studied. Because ALS and MND are rare diseases, population-based studies are very difficult to perform. In Portugal, there are no systematic patient registries. OBJECTIVE We aimed to obtain the best available indirect estimates of ALS/MND prevalence, using a pharmaco-epidemiological approach. METHOD We developed a Bayesian multiparameter evidence synthesis model based on nationwide data of riluzole consumption, a drug highly specific for ALS/MND, combined with data from a nationwide hospital administrative database, data from the national institute of statistics, and data from other scientific articles focused on ALS/MND epidemiology, to estimate ALS/MND prevalence in Portugal. RESULTS We found an estimated ALS/MND prevalence in Portugal steadily increasing from 6.74 per 100,000 inhabitants (Bayesian 95% Credible Interval [95% CI] 5.39-9.37) in 2009 to 10.32 (95% CI 8.27-14.27) in 2016. In 2016, the estimated ALS/MND prevalence was higher in men, 12.08 per 100,000 (9.66-17.15), than in women, 8.56 (6.84-12.32). Regarding age groups, the estimated prevalence per 100,000 inhabitants were, in 2016 for women, 1.19 (0.78-1.85) for the <50 years' group, 8.48 (6.00-12.76) for the 51-60 group, 23.47 (18.05-33.88) for the 61-70 group, 28.77 (22.02-41.31) for the 71-80 group, and 14.45 (9.97-21.63) for the >80 group. For men, the prevalence estimates were 1.90 (1.32-2.84), 12.89 (9.44-19.16), 32.18 (24.91-45.74), 48.85 (38.72-71.40), and 31.27 (21.73-46.41), respectively, for each age group. We also observed a relevant variability across the country, with prevalence estimates, in 2016, of 9.31 cases per 100,000 inhabitants (7.45-12.86) in the Northern region of Portugal, 11.15 (8.9-15.34) in the Centre region, 10.74 (8.6-14.82) in Lisbon and Alentejo regions, and 5.55 (4.35-7.83) in the Algarve region. CONCLUSION Overall, and even though we must account for the limitations of the indirect methods and models used for prevalence estimation, we probably have a very high ALS/MND prevalence in Portugal. It would be important to create registries, particularly in rare diseases, for better organization and distribution of healthcare services and resources, particularly at the level of ventilatory support.
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Affiliation(s)
- Bebiana Conde
- Department of Pulmonology, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Vila Real, Portugal, .,Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen, Porto, Portugal, .,Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal,
| | - João Carlos Winck
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen, Porto, Portugal.,Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS) Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal.,Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), University of Porto, R. Dr. Plácido da Costa, Porto, Portugal
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Sampaio R, Azevedo LF, Dias CC, Horne R, Castro Lopes JM. Portuguese version of the Medication Adherence Report Scale (MARS-9): Validation in a population of chronic pain patients. J Eval Clin Pract 2019; 25:346-352. [PMID: 30648328 DOI: 10.1111/jep.13098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 01/01/2023]
Abstract
AIM The aim of present study was to perform the translation, cultural adaptation, and validation of the Medication Adherence Report Scale (MARS-P9) for the European Portuguese language in a sample of chronic pain patients. METHODS A Portuguese version of the nine-item MARS (©Professor Rob Horne) scale (MARS-P9) was constructed through a process of translation, back translation, and experts' panel evaluation. A total of 141 chronic pain patients were subsequently evaluated at four time assessments during a 1-year pain medication treatment. The protocol interview included the assessment of pain intensity and interference (BPI), clinical outcomes and quality of life (S-TOPS), and MARS-P9. RESULTS The internal consistency coefficient was acceptable for the total scale (α = 0.84). Exploratory factor analysis revealed a two-factor structure (intentional and unintentional nonadherence) that explained 61% of the variance. Convergent and discriminant validity were demonstrated by correlations between MARS scores and pain interference (r = 0.180, P ≤ 0.01) and S-TOPS (r = 0.242, P ≤ 0.05). CONCLUSION MARS-P9 has been shown to be an adequate instrument for Portuguese researchers and clinicians to assess the pattern of adherence during the management of chronic pain.
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Affiliation(s)
- Rute Sampaio
- Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- Centro Nacional de Observação em Dor-OBSERVDOR, Porto, Portugal.,Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina (MEDCIDS), Universidade do Porto, Porto, Portugal.,Centro de Investigação em Tecnologias e em Serviços de Saúde (CINTESIS), Porto, Portugal
| | - Cláudia Camila Dias
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina (MEDCIDS), Universidade do Porto, Porto, Portugal.,Centro de Investigação em Tecnologias e em Serviços de Saúde (CINTESIS), Porto, Portugal
| | - Rob Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK.,Centre for Advancement of Sustainable Medical Innovation (CASMI), Oxford, UK
| | - José M Castro Lopes
- Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal.,Centro Nacional de Observação em Dor-OBSERVDOR, Porto, Portugal
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Moreira-Rosário A, Pinheiro H, Marques C, Teixeira JA, Calhau C, Azevedo LF. Does intake of bread supplemented with wheat germ have a preventive role on cardiovascular disease risk markers in healthy volunteers? A randomised, controlled, crossover trial. BMJ Open 2019; 9:e023662. [PMID: 30659039 PMCID: PMC6340436 DOI: 10.1136/bmjopen-2018-023662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Intake of whole grains is associated with a reduced risk of cardiovascular disease (CVD). This evidence is also strong for bran alone, but findings about germ are conflicting. Our aim was to elucidate the role of germ in primary prevention of cardiovascular events, and therefore, a staple food was selected for 6 g of germ supplementation. This corresponds to sixfold increase in the global mean consumption of germ, while preserving the sensory proprieties of refined bread which is crucial for consumer's acceptance. DESIGN Randomised, double-blinded, crossover, controlled clinical trial with 15-week follow-up comprising a 2-week run-in, two intervention periods of 4 weeks each and a 5-week washout period. SETTING A single centre in the north of Portugal. PARTICIPANTS 55 eligible healthy adults (mean age of 34 years and body mass index between 19 and 38 kg/m2) were randomly assigned. INTERVENTIONS The study consisted of two intervention periods including daily intake of refined wheat bread enriched with 6 g of wheat germ and control (non-enriched bread). OUTCOMES Changes in fasting cholesterol and triglycerides, fasting and postprandial glucose, insulin sensitivity and C reactive protein. RESULTS We observed no significant effect of daily intake of wheat germ on cholesterol and triglycerides levels, on postprandial glucose response and on insulin sensitivity. Incremental area under curve glucose and homeostasis model assessment for insulin resistance did not change, suggesting that 6 g of wheat germ have no effect on glucose metabolism. No effect was also observed in the subgroup of participants who complied with the protocol (n=47). CONCLUSIONS The absence of alterations on lipid and glucose profiles suggests that germ up to 6 g/day may have no preventive effect on CVD risk. However, it is important to investigate other food vehicles that can accommodate higher doses of wheat germ in future studies. TRIAL REGISTRATION NUMBER NCT02405507.
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Affiliation(s)
- André Moreira-Rosário
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Universidade do Porto, Porto, Portugal
| | - Helder Pinheiro
- Nutrition & Metabolism, NOVA University of Lisbon, NOVA Medical School, Lisbon, Portugal
- Infectious Diseases Service, Hospital Curry Cabral, Lisboa, Portugal
| | - Cláudia Marques
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Nutrition & Metabolism, NOVA University of Lisbon, NOVA Medical School, Lisbon, Portugal
| | | | - Conceição Calhau
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Nutrition & Metabolism, NOVA University of Lisbon, NOVA Medical School, Lisbon, Portugal
| | - Luís Filipe Azevedo
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Universidade do Porto, Porto, Portugal
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Mendonça L, Monteiro-Soares M, Azevedo LF. Prediction of clinical outcomes in individuals with chronic low back pain: a protocol for a systematic review with meta-analysis. Syst Rev 2018; 7:149. [PMID: 30285903 PMCID: PMC6169105 DOI: 10.1186/s13643-018-0818-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 09/17/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most prevalent and recurrent conditions in the general population, with personal, professional, social and economic impact. However, there is a lack of consistent evidence about chronic low back pain (CLBP) prognosis, especially highlighting predictors that influence CLBP outcome. Existing systematic reviews are scarce, outdated and incomplete. The primary aim of this systematic review is to identify multivariable models and/or predictors associated with clinical outcomes in subjects with CLBP (namely pain intensity, disability, return to work, psychological well-being and quality of life). METHODS We will systematically search Ovid MEDLINE (PubMed), Scopus and Web of Science databases for longitudinal studies, published until June 2017, including adults with CLBP (defined as persistent pain with ≥ 3 months duration), which studied the association between multivariable models and/or predictors with at least one of the selected clinical outcomes after ≥ 3 months of follow-up. Articles' screening and selection will be conducted by two reviewers, blindly and independently. Disagreements will be resolved by a third reviewer. Models' discriminative ability will be assessed using C-statistic. The link between multivariable models and predictors with the clinical outcome will be analysed through association measures. Qualitative and quantitative synthesis of the available evidence will be performed. Meta-analysis will be conducted to aggregate each type of measure. In the absence or in the presence of only slight to moderate of heterogeneity, we will use the fixed or random effects model, respectively. In case of moderate to severe heterogeneity, an attempt to explain variability in detail will be made through subgroups and sensitivity analyses. Subgroup analysis will be conducted according to clinical outcome, follow-up duration (≤ 6 months versus > 6 months) and type of context (pain management clinics versus other therapeutic settings). DISCUSSION We consider that it is urgent to highlight the available evidence about CLBP prognosis. This systematic review will help identify multivariable models and individual predictors that may enhance pain management success. One potential limitation will be the difficulty of aggregating quantitative measures from several prognostic models and predictors, with different clinical outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017079233.
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Affiliation(s)
- Liliane Mendonça
- OBSERVDOR - Centro Nacional de Observação em Dor / NOPain - National Observatory for Pain, Porto, Portugal
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Matilde Monteiro-Soares
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
- MEDCIDS - Departamento Medicina da Comunidade, Informação e Decisão em Saúde, Oporto, Portugal
| | - Luís Filipe Azevedo
- OBSERVDOR - Centro Nacional de Observação em Dor / NOPain - National Observatory for Pain, Porto, Portugal
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
- MEDCIDS - Departamento Medicina da Comunidade, Informação e Decisão em Saúde, Oporto, Portugal
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Baptista S, Teles Sampaio E, Heleno B, Azevedo LF, Martins C. Web-Based Versus Usual Care and Other Formats of Decision Aids to Support Prostate Cancer Screening Decisions: Systematic Review and Meta-Analysis. J Med Internet Res 2018; 20:e228. [PMID: 29945857 PMCID: PMC6043730 DOI: 10.2196/jmir.9070] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/14/2018] [Accepted: 05/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prostate cancer is a leading cause of cancer among men. Because screening for prostate cancer is a controversial issue, many experts in the field have defended the use of shared decision making using validated decision aids, which can be presented in different formats (eg, written, multimedia, Web). Recent studies have concluded that decision aids improve knowledge and reduce decisional conflict. OBJECTIVE This meta-analysis aimed to investigate the impact of using Web-based decision aids to support men's prostate cancer screening decisions in comparison with usual care and other formats of decision aids. METHODS We searched PubMed, CINAHL, PsycINFO, and Cochrane CENTRAL databases up to November 2016. This search identified randomized controlled trials, which assessed Web-based decision aids for men making a prostate cancer screening decision and reported quality of decision-making outcomes. Two reviewers independently screened citations for inclusion criteria, extracted data, and assessed risk of bias. Using a random-effects model, meta-analyses were conducted pooling results using mean differences (MD), standardized mean differences (SMD), and relative risks (RR). RESULTS Of 2406 unique citations, 7 randomized controlled trials met the inclusion criteria. For risk of bias, selective outcome reporting and participant/personnel blinding were mostly rated as unclear due to inadequate reporting. Based on seven items, two studies had high risk of bias for one item. Compared to usual care, Web-based decision aids increased knowledge (SMD 0.46; 95% CI 0.18-0.75), reduced decisional conflict (MD -7.07%; 95% CI -9.44 to -4.71), and reduced the practitioner control role in the decision-making process (RR 0.50; 95% CI 0.31-0.81). Web-based decision aids compared to printed decision aids yielded no differences in knowledge, decisional conflict, and participation in decision or screening behaviors. Compared to video decision aids, Web-based decision aids showed lower average knowledge scores (SMD -0.50; 95% CI -0.88 to -0.12) and a slight decrease in prostate-specific antigen screening (RR 1.12; 95% CI 1.01-1.25). CONCLUSIONS According to this analysis, Web-based decision aids performed similarly to alternative formats (ie, printed, video) for the assessed decision-quality outcomes. The low cost, readiness, availability, and anonymity of the Web can be an advantage for increasing access to decision aids that support prostate cancer screening decisions among men.
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Affiliation(s)
- Sofia Baptista
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Serpa Pinto Family Health Unit, Agrupamento de Centros de Saúde Porto Ocidental, Porto, Portugal
| | - Elvira Teles Sampaio
- Serpa Pinto Family Health Unit, Agrupamento de Centros de Saúde Porto Ocidental, Porto, Portugal
| | - Bruno Heleno
- Chronic Diseases Research Centre, NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Carlos Martins
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
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Lobo MF, Azzone V, Azevedo LF, Melica B, Freitas A, Bacelar-Nicolau L, Rocha-Gonçalves FN, Nisa C, Teixeira-Pinto A, Pereira-Miguel J, Resnic FS, Costa-Pereira A, Normand SL. A comparison of in-hospital acute myocardial infarction management between Portugal and the United States: 2000-2010. Int J Qual Health Care 2017; 29:669-678. [PMID: 28992151 DOI: 10.1093/intqhc/mzx092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 07/04/2017] [Indexed: 12/26/2022] Open
Abstract
Objective To compare healthcare in acute myocardial infarction (AMI) treatment between contrasting health systems using comparable representative data from Europe and USA. Design Repeated cross-sectional retrospective cohort study. Setting Acute care hospitals in Portugal and USA during 2000-2010. Participants Adults discharged with AMI. Interventions Coronary revascularizations procedures (percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery). Main Outcome Measures In-hospital mortality and length of stay. Results We identified 1 566 601 AMI hospitalizations. Relative to the USA, more hospitalizations in Portugal presented with elevated ST-segment, and fewer had documented comorbidities. Age-sex-adjusted AMI hospitalization rates decreased in USA but increased in Portugal. Crude procedure rates were generally lower in Portugal (PCI: 44% vs. 47%; CABG: 2% vs. 9%, 2010) but only CABG rates differed significantly after standardization. PCI use increased annually in both countries but CABG decreased only in the USA (USA: 0.95 [0.94, 0.95], Portugal: 1.04 [1.02, 1.07], odds ratios). Both countries observed annual decreases in risk-adjusted mortality (USA: 0.97 [0.965, 0.969]; Portugal: 0.99 [0.979, 0.991], hazard ratios). While between-hospital variability in procedure use was larger in USA, the risk of dying in a high relative to a low mortality hospital (hospitals in percentiles 95 and 5) was 2.65 in Portugal when in USA was only 1.03. Conclusions Although in-hospital mortality due to an AMI improved in both countries, patient management in USA seems more effective and alarming disparities in quality of care across hospitals are more likely to exist in Portugal.
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Affiliation(s)
- Mariana F Lobo
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Vanessa Azzone
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
| | - Luís Filipe Azevedo
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Bruno Melica
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Serviço de Cardiologia, Unidade de Diagnóstico e Intervenção Cardiovascular, Centro Hospitalar de Vila Nova de Gaia e Espinho, R. Conceição Fernandes 1079, Vila Nova de Gaia Portugal
| | - Alberto Freitas
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Leonor Bacelar-Nicolau
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisbon, Portugal
| | - Francisco N Rocha-Gonçalves
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Portuguese Institute of Oncology Porto, R. Dr. António Bernardino de Almeida 62, 4200-162 Porto, Portugal
| | - Cláudia Nisa
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine, Edward Ford Building (A27), The University of Sidney, NSW 2006, Australia
| | - José Pereira-Miguel
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisbon, Portugal
| | - Frederic S Resnic
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.,Tufts University School of Medicine, Boston, MA 02111, USA
| | - Altamiro Costa-Pereira
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.,Department of Biostatistics, Havard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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31
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Lobo MF, Azzone V, Resnic FS, Melica B, Teixeira-Pinto A, Azevedo LF, Freitas A, Nisa C, Bacelar-Nicolau L, Rocha-Gonçalves FN, Pereira-Miguel J, Costa-Pereira A, Normand SL. The Atlantic divide in coronary heart disease: Epidemiology and patient care in the US and Portugal. Rev Port Cardiol 2017; 36:583-593. [PMID: 28886892 DOI: 10.1016/j.repc.2016.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES We aimed to compare access to new health technologies to treat coronary heart disease (CHD) in the health systems of Portugal and the US, characterizing the needs of the populations and the resources available. METHODS We reviewed data for 2000 and 2010 on epidemiologic profiles of CHD and on health care available to patients. Thirty health technologies (16 medical devices and 14 drugs) introduced during the period 1980-2015 were identified by interventional cardiologists. Approval and marketing dates were compared between countries. RESULTS Relative to the US, Portugal has lower risk profiles and less than half the hospitalizations per capita, but fewer centers per capita provide catheterization and cardiothoracic surgery services. More than 70% of drugs were available sooner in the US, whereas 12 out of 16 medical devices were approved earlier in Portugal. Nevertheless, at least five of these devices were adopted first or diffused faster in the US. Mortality due to CHD and myocardial infarction (MI) was lower in Portugal (CHD: 72.8 vs. 168 and MI: 48.7 vs. 54.1 in Portugal and the US, respectively; age- and gender-adjusted deaths per 100000 population, 2010); but only CHD deaths exhibited a statistically significant difference between the countries. CONCLUSIONS Differences in regulatory mechanisms and price regulations have a significant impact on the types of health technologies available in the two countries. However, other factors may influence their adoption and diffusion, and this appears to have a greater impact on mortality, due to acute conditions.
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Affiliation(s)
- Mariana F Lobo
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Vanessa Azzone
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Frederic S Resnic
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington and Tufts University School of Medicine, Boston, MA, United States
| | - Bruno Melica
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Serviço de Cardiologia, Unidade de Diagnóstico e Intervenção Cardiovascular, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Luís Filipe Azevedo
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Freitas
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cláudia Nisa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Leonor Bacelar-Nicolau
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Francisco Nuno Rocha-Gonçalves
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Portuguese Institute of Oncology Porto (IPO-Porto), Porto, Portugal
| | - José Pereira-Miguel
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Altamiro Costa-Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Barbosa JP, Ferreira-Magalhães M, Sá-Sousa A, Azevedo LF, Fonseca JA. Cost of asthma in Portuguese adults: A population-based, cost-of-illness study. Rev Port Pneumol (2006) 2017; 23:323-330. [PMID: 28807558 DOI: 10.1016/j.rppnen.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/01/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Asthma is one of the most frequent chronic diseases, putting a considerable economic burden on societies and individuals. We aimed to estimate the total cost of adult asthma in Portugal, as well as the extent to which direct and indirect costs are influenced by the level of asthma control. METHODS A nationwide, prevalence-based, cost-of-illness study using a bottom-up approach to calculate direct and indirect costs of asthma was conducted, using participant data from the Portuguese National Asthma Survey (INAsma). Direct (healthcare service usage, diagnostic tests and treatment) and indirect (absenteeism and transportation) costs were measured. Decision analytic modelling was used to perform multivariate deterministic sensitivity analysis. RESULTS On average, each adult costs 708.16€ (95%CI: 594.62-839.30) a year, with direct costs representing 93% (658.46€; 95%CI: 548.99-791.29) and indirect costs representing 7% (49.70€; 95%CI: 32.08-71.56). This amounts to a grand total of 386,197,211.25€ (95%CI: 324,279,674.31-457,716,500.18), with direct costs being 359,093,559.82€ (95%CI: 299,391,930.03-431,533,081.07). Asthma direct costs are 2.04% of the total Portuguese healthcare expense in 2010. The major cost domains were acute care usage (30.7%) and treatment (37.4%). Asthma control was significantly associated with higher costs throughout several domains, most notably in acute medical care. CONCLUSIONS Asthma in adults poses a significant economic burden on the Portuguese healthcare system, accounting for over 2% of the total healthcare expenditure in Portugal in 2010. It is important to note that a considerable portion of this burden might be eased by improving asthma control in patients, as uncontrolled patients' costs are more than double those of controlled asthma patients.
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Affiliation(s)
- J P Barbosa
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal.
| | - M Ferreira-Magalhães
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Department of Pediatrics, Centro Hospitalar de São João, Porto, Portugal
| | - A Sá-Sousa
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - L F Azevedo
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - J A Fonseca
- MEDCIDS: Department of Community Medicine, Information and Decision in Health (MEDCIDS), Faculdade de Medicina, Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Centro de Investigação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Dueñas M, Mendonça L, Sampaio R, Gouvinhas C, Oliveira D, Castro-Lopes JM, Azevedo LF. Reliability and validity of the Bowel Function Index for evaluating opioid-induced constipation: translation, cultural adaptation and validation of the Portuguese version (BFI-P). Curr Med Res Opin 2017; 33:563-572. [PMID: 27981871 DOI: 10.1080/03007995.2016.1273204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The Bowel Function Index (BFI) is a simple and sound bowel function and opioid-induced constipation (OIC) screening tool. We aimed to develop the translation and cultural adaptation of this measure (BFI-P) and to assess its reliability and validity for the Portuguese language and a chronic pain population. METHODS The BFI-P was created after a process including translation, back translation and cultural adaptation. Participants (n = 226) were recruited in a chronic pain clinic and were assessed at baseline and after one week. Internal consistency, test-retest reliability, responsiveness, construct (convergent and known groups) and factorial validity were assessed. RESULTS Test-retest reliability had an intra-class correlation of 0.605 for BFI mean score. Internal consistency of BFI had Cronbach's alpha of 0.865. The construct validity of BFI-P was shown to be excellent and the exploratory factor analysis confirmed its unidimensional structure. The responsiveness of BFI-P was excellent, with a suggested 17-19 point and 8-12 point change in score constituting a clinically relevant change in constipation for patients with and without previous constipation, respectively. CONCLUSIONS This study had some limitations, namely, the criterion validity of BFI-P was not directly assessed; and the absence of a direct criterion for OIC precluded the assessment of the criterion based responsiveness of BFI-P. Nevertheless, BFI may importantly contribute to better OIC screening and its Portuguese version (BFI-P) has been shown to have excellent reliability, internal consistency, validity and responsiveness. Further suggestions regarding statistically and clinically important change cut-offs for this instrument are presented.
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Affiliation(s)
- María Dueñas
- a Salus Infirmorum Faculty of Nursing , University of Cádiz , Cádiz , Spain
- b The Observatory of Pain (External Chair of Pain) , University of Cádiz , Cádiz , Spain
| | - Liliane Mendonça
- c Centro Nacional de Observação em Dor - OBSERVDOR (National Observatory for Pain - NOPain) , Portugal
| | - Rute Sampaio
- d Department of Experimental Biology, Faculty of Medicine , University of Porto , Portugal
- e IBMC - Institute for Molecular and Cell Biology, University of Porto , Portugal
| | - Cláudia Gouvinhas
- d Department of Experimental Biology, Faculty of Medicine , University of Porto , Portugal
| | - Daniela Oliveira
- d Department of Experimental Biology, Faculty of Medicine , University of Porto , Portugal
| | - José Manuel Castro-Lopes
- c Centro Nacional de Observação em Dor - OBSERVDOR (National Observatory for Pain - NOPain) , Portugal
- d Department of Experimental Biology, Faculty of Medicine , University of Porto , Portugal
- e IBMC - Institute for Molecular and Cell Biology, University of Porto , Portugal
| | - Luís Filipe Azevedo
- c Centro Nacional de Observação em Dor - OBSERVDOR (National Observatory for Pain - NOPain) , Portugal
- f Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine , University of Porto , Portugal
- g CINTESIS - Centre for Health Technology and Services Research, University of Porto , Portugal
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Pinto-Lopes R, Sousa-Pinto B, Azevedo LF. Single dose versus multiple dose of antibiotic prophylaxis in caesarean section: a systematic review and meta-analysis. BJOG 2017; 124:595-605. [PMID: 27885778 DOI: 10.1111/1471-0528.14373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prophylactic antibiotics are traditionally given as a single dose for caesarean section. However, inconsistent application of recommendations and recent evidence prompted a literature review. OBJECTIVES To assess the optimal regimen for antibiotic prophylaxis in caesarean section by comparing single versus multiple doses of the same intervention. SEARCH STRATEGY MEDLINE, Web of Knowledge, SCOPUS, CENTRAL and ongoing trials databases were searched. Reference lists were reviewed and international groups contacted. SELECTION CRITERIA Randomised controlled trials (RCT) comparing single with multiple dose regimens of the same antibiotic prophylaxis. Quasi-RCT and abstracts were suitable for inclusion. DATA COLLECTION AND ANALYSIS Reviewers independently extracted data and assessed quality of evidence. A random-effects model was used and results presented as risk ratio (RR) with 95% confidence intervals (CI). MAIN RESULTS Sixteen studies were included, involving 2695 women. Nonsignificant differences were observed between single dose and multiple dose antibiotic prophylaxis in the incidence of postpartum infectious morbidity (RR 0.95, 95% CI 0.75-1.20, I2 = 25%), endometritis (RR 1.03, 95% CI 0.74-1.42, I2 = 0%) and wound infection (RR 1.22, 95% CI 0.72-2.08, I2 = 0%). A trend towards lower risk of urinary tract infection was seen with multiple dose (RR 0.65, 95% CI 0.34-1.24, I2 = 0%). CONCLUSIONS There was insufficient evidence to determine whether there is a difference between single and multiple dose regimens in reducing the incidence of infectious morbidity after caesarean section. The quality of evidence was very low and well-designed RCTs are needed. TWEETABLE ABSTRACT Insufficient evidence of difference between dosage regimens of antibiotic prophylaxis in caesarean section.
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Affiliation(s)
- R Pinto-Lopes
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - B Sousa-Pinto
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - L F Azevedo
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
- Portuguese Branch of the Iberoamerican Cochrane Centre, Porto, Portugal
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Pires da Rosa G, Libânio D, Azevedo LF. Analysis of the Cochrane Review: Fibrates for secondary prevention of cardiovascular disease and stroke. Revista Portuguesa de Cardiologia (English Edition) 2017. [DOI: 10.1016/j.repce.2016.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Azevedo LF, Sampaio R, Camila Dias C, Romão J, Lemos L, Agualusa L, Vaz-Serra S, Patto T, Costa-Pereira A, Castro-Lopes JM. Portuguese Version of the Pain Beliefs and Perceptions Inventory: A Multicenter Validation Study. Pain Pract 2016; 17:808-819. [PMID: 27770601 DOI: 10.1111/papr.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 08/22/2016] [Accepted: 09/04/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to perform the translation, cultural adaptation, and validation of the Pain Beliefs and Perceptions Inventory (PBPI) for the European Portuguese language and chronic pain population. METHODS This is a longitudinal multicenter validation study. A Portuguese version of the PBPI (PBPI-P) was created through a process of translation, back translation, and expert panel evaluation. The PBPI-P was administered to a total of 122 patients from 13 chronic pain clinics in Portugal, at baseline and after 7 days. Internal consistency and test-retest reliability were assessed by Cronbach's alpha (α) and intraclass correlation coefficient (ICC). Construct (convergent and discriminant) validity was assessed based on a set of previously developed theoretical hypotheses about interrelations between the PBPI-P and other measures. Exploratory and confirmatory factor analyses were performed to test the theoretical structure of the PBPI-P. RESULTS The internal consistency and test-retest reliability coefficients for each respective subscale were α = 0.620 and ICC = 0.801 for mystery; α = 0.744 and ICC = 0.841 for permanence; α = 0.778 and ICC = 0.791 for constancy; and α = 0.764 and ICC = 0.881 for self-blame. Exploratory and confirmatory factor analysis revealed a four-factor structure (performance, constancy, self-blame, and mystery) that explained 63% of the variance. The construct validity of the PBPI-P was shown to be adequate, with more than 90% of the previously defined hypotheses regarding interrelations with other measures confirmed. CONCLUSION The PBPI-P has been shown to be adequate and to have excellent reliability, internal consistency, and validity. It may contribute to a better pain assessment and is suitable for research and clinical use.
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Affiliation(s)
- Luís Filipe Azevedo
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal.,National Observatory of Pain - NOPain (OBSERVDOR), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rute Sampaio
- Department of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal.,IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - Cláudia Camila Dias
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - José Romão
- Pain Medicine Unit, Department of Anesthesiology, Porto Hospital Center (Centro Hospitalar do porto, EPE), Porto, Portugal
| | - Laurinda Lemos
- Multidisciplinary Chronic Pain Management Unit and Department of Anesthesiology, Senhora da Oliveira Hospital, Guimaraes (Centro Hospitalar Alto Ave EPE - Guimaraes), Guimaraes, Portugal
| | - Luís Agualusa
- Pain Medicine Unit, Pedro Hispano Hospital (Unidade Local de Saśde de Matosinhos EPE), Matosinhos, Portugal
| | - Sílvia Vaz-Serra
- Pain Medicine Unit, General Hospital, Coimbra University Hospital Centre (Centro Hospitalar e Universitįrio de Coimbra EPE), Coimbra, Portugal
| | - Teresa Patto
- Pain Medicine Unit, Santo António dos Capuchos Hospital - Lisboa Central Hospital Centre (Centro Hospitalar Lisboa Central, EPE), Lisboa, Portugal
| | - Altamiro Costa-Pereira
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal.,National Observatory of Pain - NOPain (OBSERVDOR), Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Manuel Castro-Lopes
- National Observatory of Pain - NOPain (OBSERVDOR), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal.,IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
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Pires da Rosa G, Libânio D, Filipe Azevedo L. Analysis of the Cochrane Review: Fibrates for secondary prevention of cardiovascular disease and stroke. Rev Port Cardiol 2016; 36:55-58. [PMID: 27979321 DOI: 10.1016/j.repc.2016.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/31/2016] [Indexed: 10/20/2022] Open
Abstract
The influence of fibrates on cardiovascular risk has been the focus of several clinical trials. This Cochrane Collaboration Systematic Review evaluated the efficacy of fibrates for secondary prevention of cardiovascular events and stroke, analyzing 13 randomized controlled trials, in a total of 16 112 participants with a history of cardiovascular disease. Fibrates showed a protective effect for the composite outcome of non-fatal stroke, non-fatal myocardial infarction (MI) and vascular death, mainly due to reduction in the risk of non-fatal or fatal MI. Nonetheless, these results largely relied on studies including clofibrate, a drug withdrawn from the market in 2002. No statistically significant differences regarding adverse events were found between fibrates and placebo. Although insufficient to support the routine prescription of fibrates in this setting, this evidence should be taken into account when deciding on lipid-modifying therapy in dyslipidemic patients with a history of cardiovascular disease.
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Affiliation(s)
| | - Diogo Libânio
- Serviço de Gastrenterologia, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Luís Filipe Azevedo
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Informação e da Decisão em Saúde (CIDES), Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Cochrane Portugal - Unidade do Porto, Porto, Portugal.
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Moreira-Rosário A, Pinheiro H, Calhau C, Azevedo LF. Can wheat germ have a beneficial effect on human health? A study protocol for a randomised crossover controlled trial to evaluate its health effects. BMJ Open 2016; 6:e013098. [PMID: 28157671 PMCID: PMC5129044 DOI: 10.1136/bmjopen-2016-013098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVD) are the leading cause of mortality worldwide and diet is an important contributor to CVD risk. Thus, several food derivatives are being investigated for their beneficial impact on reducing cardiometabolic risk factors, either in risk groups or in healthy population as a preventive measure. Wheat germ is a food by-product with high nutritional value, especially as a concentrated source of dietary fibre and essential fatty acids, but its incorporation into the diet has been rare up to now. Previous studies do not clarify the hypothesised potential causal relationship between the consumption of wheat germ and benefits for human health. METHODS AND ANALYSIS We are conducting a randomised, double-blinded, crossover, placebo-controlled clinical trial designed to assess the physiological effects of daily consumption of wheat germ-enriched bread (containing 6 g of wheat germ) compared with non-enriched bread, over a 4-week period with a 15-week follow-up, in a healthy human population. A total of 55 participants (healthy volunteers, aged 18-60) have been recruited from the Porto metropolitan area in northern Portugal. Our aim is to evaluate the health effects of wheat germ on blood cholesterol and triglycerides, postprandial glycaemic response, gastrointestinal function and discomfort, and changes in intestinal microbiota and insulin resistance as secondary outcomes. The study follows the best practices for evaluating health claims in food according to the European Food Safety Authority (EFSA) scientific opinion, namely random allocation, double blinding, reporting methods to measure and maximise compliance, and validated outcomes with beneficial physiological effects as recommended by EFSA. ETHICS AND DISSEMINATION The study has been approved by the Health Ethics Committee of São João Hospital Centre (156-15) and the Ethics Committee of Faculty of Medicine of the University of Porto (PCEDCSS-FMUP07/2015). Results will be disseminated through peer-reviewed publications and presentations at international scientific meetings. TRIAL REGISTRATION NUMBER NCT02405507; pre-results.
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Affiliation(s)
- André Moreira-Rosário
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Helder Pinheiro
- Serviço de Doenças Infecciosas, Centro Hospitalar de Lisboa Central, Hospital de Curry Cabral, Lisbon, Portugal
| | - Conceição Calhau
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Nutrition and Metabolism, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Luís Filipe Azevedo
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal
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Sá L, Ribeiro O, Azevedo LF, Couto L, Costa-Pereira A, Hespanhol A, Santos P, Martins C. Patients' estimations of the importance of preventive health services: a nationwide, population-based cross-sectional study in Portugal. BMJ Open 2016; 6:e011755. [PMID: 27707825 PMCID: PMC5073585 DOI: 10.1136/bmjopen-2016-011755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine, in the context of primary care preventive health services, the level of importance that Portuguese patients attribute to different preventive activities. DESIGN Cross-sectional study. SETTING Primary Healthcare, Portugal. PARTICIPANTS 1000 Portuguese adults selected by a stratified cluster sampling design were invited to participate in a computer-assisted telephone survey. Persons with a cognitive or physical disability that hampered the ability to complete a telephone interview and being a nursing home resident or resident in any other type of collective dwelling were excluded. OUTCOMES Mean level of importance assigned to 20 different medical preventive activities, using a scale of 1-10, with 1 corresponding to 'no importance for you and your health' and 10 indicating 'very important'. RESULTS The mean level of importance assigned to medical preventive activity was 7.70 (95% CI 7.60 to 7.80). Routine blood and urine tests were considered the most important, with an estimated mean of 9.15 (95% CI 9.07 to 9.24), followed by female-specific interventions (Pap smear, mammography and gynaecological and breast ultrasounds), with mean importance ranging from 8.45 (95% CI 8.23 to 8.63) for mammography to 8.56 (95% CI 8.36 to 8.76) for Pap smear. Advice regarding alcohol consumption (6.18; 95% CI 5.96 to 6.39) and tobacco consumption (5.99; 95% CI 5.75 to 6.23) were considered much less important. CONCLUSIONS Our results reveal that Portuguese patients overestimate the importance of preventive medical activities, tend to give more importance to diagnostic and laboratory tests than to lifestyle measures, do not discriminate tests that are important and evidence-based, and seem not be aware of the individualisation of risk. Family physicians should be aware of these optimistic expectations, because these can influence the doctor-patient relationship when discussing these interventions and incorporating personalised risk.
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Affiliation(s)
- Luísa Sá
- Family Medicine Unit, Social Sciences and Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
- Family Health Unit Nova Via, Porto, Portugal
| | - Orquídea Ribeiro
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
| | - Luciana Couto
- Family Medicine Unit, Social Sciences and Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Altamiro Costa-Pereira
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
| | - Alberto Hespanhol
- Family Medicine Unit, Social Sciences and Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
| | - Paulo Santos
- Family Medicine Unit, Social Sciences and Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
| | - Carlos Martins
- Family Medicine Unit, Social Sciences and Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
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40
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Libânio D, Azevedo LF. [Analysis of the Cochrane Review: Chromoscopy Versus Conventional Endoscopy for the Detection of Polyps in the Colon and Rectum. Cochrane Database Syst Rev. 2016;4:CD006439]. ACTA MEDICA PORT 2016; 29:583-586. [PMID: 28103453 DOI: 10.20344/amp.7968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 11/20/2022]
Abstract
Although colonoscopy is considered the most accurate test for the investigation of colorectal polyps, lesions ≤ 10 mm may be missed in approximately 10%. Chromoscopy may increase the detection of colorectal polyps. A systematic review and meta-analysis was performed to investigate the benefit of cromoscopy in colorectal polyps detection. Seven randomized controlled trials were included (incuding 2,727 participants) comparing polyp detection (both neoplastic and non- neoplastic polyps) in patients submitted to conventional colonoscopy or colonoscopy with chromoscopy. Chromoscopy was associated with a significant improvement in all detection endpoints (number of polyps, number of neoplastic polyps, number of diminutive polyps, number of neoplastic diminutive polyps, proportion of patients with at least one polyp and proportion of patients with at least one neoplastic polyp). However, when highdefinition colonoscopes were used in the control group, chromoscopy benefit does not seem to be significant. Besides, routine use of chromoscopy may have implications in the accessibility of colonoscopy and in the effectiveness of screening programs. Moreover, the benefit of chromoscopy in the era of high-definition colonoscopy is questionable.
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Affiliation(s)
- Diogo Libânio
- Serviço de Gastrenterologia. Instituto Português de Oncologia do Porto. Porto. Portugal; CINTESIS - Center for Health Technology and Services Research. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Luís Filipe Azevedo
- CINTESIS - Center for Health Technology and Services Research. Faculdade de Medicina. Universidade do Porto. Porto. Portugal; CIDES - Departamento de Ciências da Informação e da Decisão em Saúde. Faculdade de Medicina. Universidade do Porto. Porto. Portugal; Cochrane Portugal - Unidade do Porto. Centro Cochrane Iberoamericano. Porto. Portugal
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41
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Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM. The economic impact of chronic pain: a nationwide population-based cost-of-illness study in Portugal. Eur J Health Econ 2016; 17:87-98. [PMID: 25416319 DOI: 10.1007/s10198-014-0659-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 11/11/2014] [Indexed: 06/04/2023]
Abstract
In addition to its high frequency and relevant individual and social impact, chronic pain (CP) has been shown to be a major contributor to increased healthcare utilisation, reduced labour productivity, and consequently large direct and indirect costs. In the context of a larger nationwide study, we aimed to assess the total annual direct and indirect costs associated with CP in Portugal. A population-based study was conducted in a representative sample of the Portuguese adult population. The 5,094 participants were selected using random digit dialling and contacted by computer-assisted telephone interviews. Questionnaires included the brief pain inventory and pain disability index. Estimates were adequately weighted for the population. From all CP subjects identified, a subsample (n = 562) accepted to participate in this economic study. Mean total annualised costs per CP subject of €1,883.30 were observed, amounting to €4,611.69 million nationally, with 42.7% direct and 57.3% indirect costs, and corresponding to 2.71% of the Portuguese annual GDP in 2010. Only socio-demographic variables were significantly and independently associated with CP costs, and not CP severity, raising the possibility of existing inequalities in the distribution of healthcare in Portugal. The high economic impact of CP in Portugal was comprehensively demonstrated. Given the high indirect costs observed, restricting healthcare services is not a rational response to these high societal costs; instead improving the quality of CP prevention and management is recommended.
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Affiliation(s)
- Luís Filipe Azevedo
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-319, Porto, Portugal.
- Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal.
- Centro Nacional de Observação em Dor (OBSERVDOR, Portuguese National Pain Observatory), Porto, Portugal.
| | - Altamiro Costa-Pereira
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-319, Porto, Portugal
- Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal
- Centro Nacional de Observação em Dor (OBSERVDOR, Portuguese National Pain Observatory), Porto, Portugal
| | - Liliane Mendonça
- Centro Nacional de Observação em Dor (OBSERVDOR, Portuguese National Pain Observatory), Porto, Portugal
| | - Cláudia Camila Dias
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-319, Porto, Portugal
- Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal
| | - José M Castro-Lopes
- Centro Nacional de Observação em Dor (OBSERVDOR, Portuguese National Pain Observatory), Porto, Portugal
- Department of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal
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42
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Libãnio D, Azevedo LF. [Analysis of the Cochrane Review: Helicobacter pylori Eradication for the Prevention of Gastric Neoplasia. Cochrane Database Syst Rev. 2015;7:CD005583]. ACTA MEDICA PORT 2015. [PMID: 26849750 DOI: 10.20344/amp.7128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Helicobacter pylori infection is a risk factor for gastric adenocarcinoma. Identification of individuals with this infection and its eradication may be considered as a primary prevention strategy to reduce the incidence of gastric adenocarcinoma; however, the magnitude of benefit and the effectiveness of this strategy are still unclear. A systematic review and meta-analysis of randomized clinical trials was conducted comparing the incidence of gastric adenocarcinoma in infected individuals submitted to Helicobacter pylori eradication and individuals not submitted to this therapy. The results of the six included randomized clinical trials (all conducted in countries with high gastric cancer incidence) suggest that Helicobacter pylori eradication is associated with a relative risk reduction of 34% in gastric cancer incidence. However, generalization of the results to countries with lower gastric cancer incidence should be cautious and the cost-effectiveness of this strategy in this context remains uncertain.
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Affiliation(s)
- Diogo Libãnio
- Serviço de Gastrenterologia. Instituto Português de Oncologia do Porto (IPO-Porto). Porto. Portugal
| | - Luís Filipe Azevedo
- CINTESIS ' Center for Health Technology and Services Research. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. CIDES ' Departamento de Ciências da Informação e da Decisão em Saúde. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. Unidade do Porto. Cochrane Portugal. Porto. Portugal
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43
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Carneiro F, Sousa N, Azevedo LF, Saliba D. Vulnerability in elderly patients with gastrointestinal cancer--translation, cultural adaptation and validation of the European Portuguese version of the Vulnerable Elders Survey (VES-13). BMC Cancer 2015; 15:723. [PMID: 26475578 PMCID: PMC4609118 DOI: 10.1186/s12885-015-1739-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/08/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND "Vulnerable Elders Survey" (VES-13) is a questionnaire accurate in predicting functional decline and highly correlated with comprehensive geriatric assessment in identifying vulnerable elderly. The purpose of this study was to translate, cultural adapt and validate the first Portuguese cross-cultural version of VES-13 and to estimate the prevalence of vulnerability in Portuguese elderly gastrointestinal (GI) cancer patients. METHODS VES-13 European Portuguese translation and cultural adaptation was developed according to internationally accepted guidelines. Test-retest reliability and internal consistency were assessed by calculating the Kappa statistic and by analyzing the inter-item and item-total correlation matrices and calculation of Cronbach's alpha coefficients, respectively. Construct and criterion validity was assessed by Spearman's correlation coefficient between VES-13 and each EQ-5D-5 L dimension, clinical judgment and performance status. RESULTS The translated and culturally adapted version of VES-13 revealed high test-retest reliability (test-retest Kappa ≥ 0.612; p < 0.001) in the pilot study (n = 22). For the validation phase 206 patients with GI cancer were recruited (median age: 73 years; colo-rectal cancer: 63 %). Criterion validity was confirmed by adequate correlations between VES-13 and clinical judgment of vulnerability, ECOG and KPS scores. Construct validity was confirmed by moderate correlations with most of EQ-5D-5 L dimensions. Cronbach's alpha of the questionnaire was 0.848. The estimated prevalence of vulnerability is 50 % (CI95% 0.43-0.56). CONCLUSIONS The European Portuguese version of VES-13 is a valid and reliable approach to screening elderly cancer patients for geriatric needs. In our setting, one in two elderly patients was likely to be vulnerable or frail which stresses the importance of their correct identification to better inform cancer management.
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Affiliation(s)
- F Carneiro
- Department of Medical Oncology, Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.
| | - N Sousa
- Department of Medical Oncology, Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal. .,Department of Health Information and Decision Sciences (CIDES) and Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal. .,Faculdade de Medicina da Universidade do Porto (CIM - FMUP), Rua Dr. Plácido da Costa, s/n, Porto, 4200-450, Portugal.
| | - L F Azevedo
- Department of Health Information and Decision Sciences (CIDES) and Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal. .,Faculdade de Medicina da Universidade do Porto (CIM - FMUP), Rua Dr. Plácido da Costa, s/n, Porto, 4200-450, Portugal.
| | - D Saliba
- The University of Los Angeles Borun Center, The VA Greater Los Angeles GRECC and RAND Santa Monica, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA, 90095, USA.
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Ferreira-Magalhães M, Pereira AM, Sa-Sousa A, Morais-Almeida M, Azevedo I, Azevedo LF, Fonseca JA. Asthma control in children is associated with nasal symptoms, obesity, and health insurance: a nationwide survey. Pediatr Allergy Immunol 2015; 26:466-73. [PMID: 25939454 DOI: 10.1111/pai.12395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to estimate the prevalence of asthma control and determinants of poor control in the Portuguese pediatric population (<18 years); secondarily, we described asthma-related healthcare services and medication use. METHODS Data of 98 children with current asthma, from the second phase of a nationwide population-based telephone survey (INAsma study), were analyzed. Asthma control definition was based on GINA criteria, grouping partially controlled and uncontrolled asthma as 'not-controlled asthma' (NCA). We used multivariate logistic regression to study factors associated with NCA and with unscheduled medical visits for asthma. RESULTS About half of the children had NCA (49%, 95% CI 39-59%). In the multivariate model, risk factors for NCA were as follows: substantial nasal symptoms (a OR 6.80), overweight/obesity (a OR 3.44), and not having health insurance (a OR 3.78). All the children with NCA had nasal symptoms, and the lack of asthma control was also associated with the increasing number of nasal symptoms (p < 0.001). In the previous year, 90% (95% CI 84-96%) of children with current asthma had healthcare visits and 67% (95% CI 58-77%) used medication for asthma. The risk of unscheduled medical visits was higher in children with nasal symptoms (a OR 3.63) and in those without health insurance (a OR 2.79), and lower in adolescents (a OR 0.19). CONCLUSIONS Half of the children with asthma were poorly controlled. Nasal symptoms and obesity are important determinants of asthma control. Children without health insurance are at greater risk of poor asthma outcomes; this association is reported for the first time in a European country.
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Affiliation(s)
- Manuel Ferreira-Magalhães
- Department of Pediatrics, Centro Hospitalar de S. João, Porto, Portugal.,CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Pediatrics - Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Margarida Pereira
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, CUF Institute & Hospital, Porto, Portugal
| | - Ana Sa-Sousa
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mário Morais-Almeida
- Allergy and Clinical Immunology Division Unit, CUF Descobertas and CUF Infante Santo Hospital, Lisbon, Portugal.,Sociedade Portuguesa de Alergologia e Imunologia Clínica, Lisbon, Portugal
| | - Inês Azevedo
- Department of Pediatrics, Centro Hospitalar de S. João, Porto, Portugal.,Department of Pediatrics - Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Health Information and Decision Sciences Department - Faculty of Medicine, Porto University, Porto, Portugal
| | - João Almeida Fonseca
- CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, CUF Institute & Hospital, Porto, Portugal.,Health Information and Decision Sciences Department - Faculty of Medicine, Porto University, Porto, Portugal
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Ferreira-Magalhães M, Sá-Sousa A, Morais-Almeida M, Azevedo LF, Azevedo I, Pereira AM, Fonseca JA. High prevalence of hospitalisation for asthma in a population-based paediatric sample. Arch Dis Child 2015; 100:507-8. [PMID: 25568081 DOI: 10.1136/archdischild-2014-307675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/04/2022]
Affiliation(s)
- Manuel Ferreira-Magalhães
- Paediatric Department, Centro Hospitalar de S. João, Porto, Portugal CINTESIS-Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal Paediatric Department-Faculty of Medicine, Porto University, Porto, Portugal
| | - Ana Sá-Sousa
- CINTESIS-Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal
| | - Mário Morais-Almeida
- Allergy and Clinical Immunology Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Luís Filipe Azevedo
- CINTESIS-Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal Health Information and Decision Sciences Department-Faculty of Medicine, Porto University, Porto, Portugal
| | - Inês Azevedo
- Paediatric Department, Centro Hospitalar de S. João, Porto, Portugal Paediatric Department-Faculty of Medicine, Porto University, Porto, Portugal
| | - Ana Margarida Pereira
- CINTESIS-Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal Allergy Unit, Instituto & Hospital CUF, Porto, Portugal
| | - João Almeida Fonseca
- CINTESIS-Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal Health Information and Decision Sciences Department-Faculty of Medicine, Porto University, Porto, Portugal Allergy Unit, Instituto & Hospital CUF, Porto, Portugal
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46
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Sousa AS, Pereira AM, Fonseca JA, Azevedo LF, Abreu C, Arrobas A, Calvo T, Silvestre MJ, Cunha L, Falcão H, Drummond M, Geraldes L, Loureiro C. Asthma control and exacerbations in patients with severe asthma treated with omalizumab in Portugal. Rev Port Pneumol (2006) 2015; 21:S2173-5115(15)00080-9. [PMID: 25926263 DOI: 10.1016/j.rppnen.2015.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/13/2015] [Accepted: 03/08/2015] [Indexed: 01/31/2023] Open
Abstract
The analysis of outcomes from patients with severe asthma treated with omalizumab, using real-life prospective data, should contribute to future informed decisions about this treatment in Portugal. The aim of this study was to assess the clinical effect of omalizumab in Portuguese patients with severe persistent allergic asthma, considering specifically asthma control and exacerbations. This was an observational, prospective, multicentre study. Data were collected at routine care over a 12-month period. Disease control was defined by Control of Allergic Rhinitis and Asthma Test (CARAT) global score >24. All asthma patients already under treatment with omalizumab in 7 departments from 6 Portuguese hospitals were included (n=48). Most (77%) patients were female and the mean (SD) age was 51.9 (10.2) years old. During the study period, asthma was controlled in 34% of the visits and the 12-month exacerbation rate was 1.7 per patient (0.6 with unscheduled medical care). One-third of the patients needed unscheduled medical care because of asthma and 29% had to start or increase oral corticosteroid. There was still a 41% reduction in the total sum of oral corticosteroids usage from the first to the last trimester of the study. During routine treatment with omalizumab, Portuguese patients with severe asthma achieved asthma control in 1/3 of the visits and only 1/3 needed unscheduled or Emergency Room care because of asthma exacerbations. These outcomes support the maintenance of the clinical effect during treatment with omalizumab in routine care in Portugal.
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Affiliation(s)
- A S Sousa
- Center for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - A M Pereira
- Allergy Department, Centro Hospitalar de São João, EPE, Porto, Portugal; Allergy Unit, CUF Porto Instituto e CUF Porto Hospital, Portugal; Health Information and Decision Sciences Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - J A Fonseca
- Center for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Allergy Unit, CUF Porto Instituto e CUF Porto Hospital, Portugal; Health Information and Decision Sciences Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - L F Azevedo
- Center for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Health Information and Decision Sciences Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - C Abreu
- Allergy Department, Hospital Pedro Hispano Unidade Local de Saúde de Matosinhos, EPE, Matosinhos, Portugal.
| | - A Arrobas
- Pulmonology Department, Hospital Geral de Coimbra Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.
| | - T Calvo
- Pulmonology Department, Centro Hospitalar de Trás os Montes e Alto Douro, EPE, Vila Real, Portugal.
| | - M J Silvestre
- Pulmonology Department, Centro Hospitalar de Trás os Montes e Alto Douro, EPE, Vila Real, Portugal.
| | - L Cunha
- Allergy Department, Centro Hospitalar do Porto, EPE, Porto, Portugal.
| | - H Falcão
- Allergy Department, Centro Hospitalar do Porto, EPE, Porto, Portugal.
| | - M Drummond
- Pulmonology Department, Centro Hospitalar de São João, EPE, Porto, Portugal.
| | - L Geraldes
- Allergy Department, Centro Hospitalar do Alto Ave, EPE, Guimarães, Portugal.
| | - C Loureiro
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.
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Sá-Sousa A, Amaral R, Morais-Almeida M, Araújo L, Azevedo LF, Bugalho-Almeida A, Bousquet J, Fonseca JA. Asthma control in the Portuguese National Asthma Survey. Rev Port Pneumol (2006) 2015; 21:209-13. [PMID: 25926249 DOI: 10.1016/j.rppnen.2014.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/19/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We aimed (1) to measure asthma control using a structure-questionnaire and patient self-perception of asthma-control in the Portuguese National Asthma Survey (INAsma) and (2) to study the relationship between asthma control and asthma-related quality of life. METHODS We analyze data of asthma patients from a cross-sectional, nationwide telephone interview study - INAsma. Controlled asthma was defined as CARAT global score >24 or CARAT lower airways score ≥16. Mini-AQLQ was used to measure quality of life. RESULTS Two hundred and seven (56.9% [95%CI: 51.8-62.0]) of the 364 patients had controlled asthma. Most patients with non-controlled asthma (88%) perceived their disease as controlled. Patients with controlled asthma presented higher mini-AQLQ scores (median, P25-P75; 6.6, 6.0-6.9) than those with non-controlled asthma (4.9, 3.7-5.7) (p<0.001) and a significant positive correlation between CARAT and mini-AQLQ scores was observed (r=0.706; p<0.001). CONCLUSION More than half of the Portuguese patients presented controlled asthma and showed significantly better asthma-related quality of life. Almost 9 out of 10 patients with non-controlled disease have poor perception of their asthma control, which may hinder them from seeking better asthma control.
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Affiliation(s)
- A Sá-Sousa
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal
| | - R Amaral
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal
| | - M Morais-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisboa, Portugal; Sociedade Portuguesa de Alergologia e Imunologia Clínica, Lisbon, Portugal
| | - L Araújo
- Immunology Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal
| | - L F Azevedo
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - A Bugalho-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisboa, Portugal; Comissão de Acompanhamento do Programa Nacional de Controlo da Asma, Lisbon, Portugal
| | - J Bousquet
- Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire Montpellier, Montpellier, France; Centre de recherche en Epidémiologie et Santé des Populations - CESP Inserm U1018, Villejuif, France
| | - J A Fonseca
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal; Sociedade Portuguesa de Alergologia e Imunologia Clínica, Lisbon, Portugal; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal.
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Sá-Sousa A, Jacinto T, Azevedo LF, Morais-Almeida M, Robalo-Cordeiro C, Bugalho-Almeida A, Bousquet J, Fonseca JA. Operational definitions of asthma in recent epidemiological studies are inconsistent. Clin Transl Allergy 2014; 4:24. [PMID: 25136441 PMCID: PMC4136946 DOI: 10.1186/2045-7022-4-24] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/15/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The best combination of questions to define asthma in epidemiological asthma studies is not known. We summarized the operational definitions of asthma used in prevalence studies and empirically assess how asthma prevalence estimates vary depending on the definition used. METHODS We searched the Thomson Reuters ISI Web of knowledge and included (1) cross-sectional studies (2) on asthma prevalence (3) conducted in the general population and (4) containing an explicit definition of asthma. The search was limited to the 100 most-cited papers or published since January 2010. For each paper, we recorded the asthma definition used and other variables. Then we applied the definitions to the data of the Portuguese National Asthma survey (INAsma) and of the 2005-2006 National Health and Nutrition Examination Survey (NHANES) computing asthma prevalence estimates for the different definitions. RESULTS Of 1738 papers retrieved, 117 were included for analysis. Lifetime asthma, diagnosed asthma and current asthma were defined in 8, 12 and 29 different ways, respectively. By applying definitions of current asthma on INAsma and NHANES data, the prevalence ranged between 5.3%-24.4% and 1.1%-17.2%, respectively. CONCLUSIONS There is considerable heterogeneity in the definitions of asthma used in epidemiological studies leading to highly variable estimates of asthma prevalence. Studies to inform a standardized operational definition are needed. Meanwhile, we propose a set of questions to be reported when defining asthma in epidemiological studies.
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Affiliation(s)
- Ana Sá-Sousa
- Center for research in health technologies and information systems.– CINTESIS, Universidade do Porto, Porto, Portugal
| | - Tiago Jacinto
- Center for research in health technologies and information systems.– CINTESIS, Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- Center for research in health technologies and information systems.– CINTESIS, Universidade do Porto, Porto, Portugal
- Health Information and Decision Sciences Department – CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Mário Morais-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisboa, Portugal
| | - Carlos Robalo-Cordeiro
- Allergy and Clinical Immunology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | | | - Jean Bousquet
- Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire Montpellier, Montpellier, France
- Centre de recherche en Epidémiologie et Santé des Populations, CESP Inserm U1018, Villejuif, France
| | - João Almeida Fonseca
- Center for research in health technologies and information systems.– CINTESIS, Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal
- Health Information and Decision Sciences Department – CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
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Azevedo LF, Perlingeiro PS, Hachul DT, Gomes-Santos IL, Brum PC, Allison TG, Negrão CE, De Matos LDNJ. Sport modality affects bradycardia level and its mechanisms of control in professional athletes. Int J Sports Med 2014; 35:954-9. [PMID: 24886917 DOI: 10.1055/s-0033-1364024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We investigated the influence of sport modalities in resting bradycardia and its mechanisms of control in highly trained athletes. In addition, the relationships between bradycardia mechanisms and cardiac structural adaptations were tested. Professional male athletes (13 runners, 11 cyclists) were evaluated. Heart rate (HR) was recorded at rest on beat-to-beat basis (ECG). Selective pharmacological blockade was performed with atropine and esmolol. Vagal effect, intrinsic heart rate (IHR), parasympathetic (n) and sympathetic (m) modulations, autonomic influence (AI) and autonomic balance (Abal) were calculated. Plasmatic norepinephrine (high-pressure liquid chromatography) and cardiac structural adaptations (echocardiography) were evaluated. Runners presented lower resting HR, higher vagal effect, parasympathetic modulation (n), AI and IHR than cyclists (P<0.05). Abal, sympathetic modulation (m) and norepinephrine level were similar within athletes regardless of modality. The cardiac chambers were also similar between runners and cyclists (P=0.30). However, cyclists displayed higher septum and posterior wall thickness than runners (P=0.04). Further analysis showed a trend towards inverse correlation between IHR with septum wall thickness and posterior wall thickness (P=0.056). Type of sport influences the resting bradycardia level and its mechanisms of control in professional athletes. Resting bradycardia in runners is mainly dependent on an autonomic mechanism. In contrast, a cyclist's resting bradycardia relies on a non-autonomic mechanism probably associated with combined eccentric and concentric hypertrophy.
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Affiliation(s)
- L F Azevedo
- Heart Institute (InCor), Medical School of University of São Paulo, Cardiovascular Rehabilitation and Exercise Physiology Unit, São Paulo, Brazil
| | - P S Perlingeiro
- Heart Institute (InCor), Medical School of University of São Paulo, Cardiovascular Rehabilitation and Exercise Physiology Unit, São Paulo, Brazil
| | - D T Hachul
- Heart Institute (InCor), Medical School of University of São Paulo, Clinical -Arrhythmia Unit, São Paulo, Brazil
| | - I L Gomes-Santos
- Heart Institute (InCor), Medical School of University of São Paulo, Cardiovascular Rehabilitation and Exercise Physiology Unit, São Paulo, Brazil
| | - P C Brum
- School of Physical Education and Sport, University of São Paulo, -Biodynamic of the Movement of the Human Body, São Paulo, Brazil
| | - T G Allison
- Mayo Clinic, Division of Cardiovascular Diseases and Internal Medicine, Rochester, United States
| | - C E Negrão
- Heart Institute (InCor), Medical School of University of São Paulo, Cardiovascular Rehabilitation and Exercise Physiology Unit, São Paulo, Brazil
| | - L D N J De Matos
- Heart Institute (InCor), Medical School of University of São Paulo, Cardiovascular Rehabilitation and Exercise Physiology Unit, São Paulo, Brazil
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50
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Martins C, Azevedo LF, Santos C, Sá L, Santos P, Couto M, Pereira A, Hespanhol A. Preventive health services implemented by family physicians in Portugal-a cross-sectional study based on two clinical scenarios. BMJ Open 2014; 4:e005162. [PMID: 24861550 PMCID: PMC4039810 DOI: 10.1136/bmjopen-2014-005162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess whether Portuguese family physicians perform preventive health services in accordance with scientific evidence, based on the recommendations of the United States Preventive Services Task Force (USPSTF). DESIGN Cross-sectional study. SETTING Primary healthcare, Portuguese National Health Service. PARTICIPANTS 255 Portuguese family physicians selected by a stratified cluster sampling design were invited to participate in a computer-assisted telephone survey. OUTCOMES Prevalence of compliance with USPSTF recommendations for screening, given a male and female clinical scenario and a set of proposed medical interventions, including frequency of the intervention and performance in their own daily practice. RESULTS A response rate of 95.7% was obtained (n=244). 98-100% of family physicians answered according to the USPSTF recommendations in most interventions. In the male scenario, the lowest concordance was observed in the evaluation of prostate-specific antigen with 37% of family physicians answering according to the USPSTF recommendations. In the female scenario, the lowest concordance was for cholesterol testing with 2% of family physicians complying. Family physicians younger than 50 years had significantly better compliance scores than older ones (mean 77% vs 72%; p<0.001). CONCLUSIONS We found a high degree of agreement with USPSTF recommendations among Portuguese family physicians. However, we also found results suggesting excessive use of some medical interventions, raising concerns related to possible harm associated with overdiagnosis and overtreatment.
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Affiliation(s)
- Carlos Martins
- Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal
| | - Cristina Santos
- Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal
| | - Luísa Sá
- Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal
| | - Paulo Santos
- Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal
| | - Maria Couto
- Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal
| | - Altamiro Pereira
- Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal
| | - Alberto Hespanhol
- Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal
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