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Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support., Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication)., Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements., Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring ≥4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%)., Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app., (©Cristina Jácome, Rute Almeida, Ana Margarida Pereira, Rita Amaral, Sandra Mendes, Magna Alves-Correia, Carmen Vidal, Sara López Freire, Paula Méndez Brea, Luís Araújo, Mariana Couto, Darío Antolín-Amérigo, Belén de la Hoz Caballer, Alicia Barra Castro, David Gonzalez-De-Olano, Ana Todo Bom, João Azevedo, Paula Leiria Pinto, Nicole Pinto, Ana Castro Neves, Ana Palhinha, Filipa Todo Bom, Alberto Costa, Cláudia Chaves Loureiro, Lilia Maia Santos, Ana Arrobas, Margarida Valério, João Cardoso, Madalena Emiliano, Rita Gerardo, José Carlos Cidrais Rodrigues, Georgeta Oliveira, Joana Carvalho, Ana Mendes, Carlos Lozoya, Natacha Santos, Fernando Menezes, Ricardo Gomes, Rita Câmara, Rodrigo Rodrigues Alves, Ana Sofia Moreira, Diana Bordalo, Carlos Alves, José Alberto Ferreira, Cristina Lopes, Diana Silva, Maria João Vasconcelos, Maria Fernanda Teixeira, Manuel Ferreira-Magalhães, Luís Taborda-Barata, Maria José Cálix, Adelaide Alves, João Almeida Fonseca. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 25.05.2021.)

Background: The Southern European Atlantic Diet (SEAD) is the traditional diet of Northern Portugal and North-Western Spain. Higher adherence to the SEAD has been associated with lower levels of some cardiovascular risk factors and reduced risk for myocardial infarction, but whether this translates into lower all-cause mortality is uncertain. We hence examined the association between adherence to the SEAD and all-cause mortality in older adults., Methods: Data were taken from the Seniors-ENRICA-1 cohort, which included 3165 individuals representative of the non-institutionalized population aged ≥ 60 years in Spain. Food consumption was assessed with a validated diet history, and adherence to the SEAD was measured with an index comprising 9 food components: fresh fish, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine. Vital status was ascertained with the National Death Index of Spain. Statistical analyses were performed with Cox regression models and adjusted for the main confounders., Results: During a median follow-up of 10.9 years, 646 deaths occurred. Higher adherence to the SEAD was associated with lower all-cause mortality (fully adjusted hazard ratio [95% confidence interval] per 1-SD increment in the SEAD score 0.86 [0.79, 0.94]; p-trend < 0.001). Most food components of the SEAD showed some tendency to lower all-cause mortality, especially moderate wine consumption (hazard ratio [95% confidence interval] 0.71 [0.59, 0.86]). The results were robust in several sensitivity analyses. The protective association between SEAD and all-cause death was of similar magnitude to that found for the Mediterranean Diet Adherence Screener (hazard ratio [95% confidence interval] per 1-SD increment 0.89 [0.80, 0.98]) and the Alternate Healthy Eating Index (0.83 [0.76, 0.92])., Conclusions: Adherence to the SEAD is associated with a lower risk of all-cause death among older adults in Spain.

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included ( n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact ( n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 ( n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 ( n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms ( p < 0.001). Class 3 ( n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month ( p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

Reuse and valorisation of fish by-products is a key process for marine resources conservation. Usually, fishmeal and oil processing factories collect the by-products generated by fishing port and industry processing activities, producing an economical benefit to both parts. In the same way, different added-value products can be recovered by the valorisation industries whereas fishing companies save the costs associated with the management of those wastes. However, it is important to estimate the advantages of valorisation processes not only in terms of economic income, but also considering the environmental impacts. This would help to know if the valorisation of a residue provokes higher impact than other waste management options, which means that its advantages are probably not enough for guarantying a sustainable waste reuse. To that purpose, there are several methodologies to evaluate the environmental impacts of processes, including those of waste management, providing different indicators which give information on relevant environmental aspects. In the current study, a comparative environmental assessment between a valorisation process (fishmeal and oil production) and different waste management scenarios (composting, incineration and landfilling) was developed. This comparison is a necessary step for the development and industrial implementation of these processes as the best alternative treatment for fish by-products. The obtained results showed that both valorisation process and waste management treatments presented similar impacts. However, a significant benefit can be achieved through valorisation of fish by-products. Additionally, the implications of the possible presence of pollutants were discussed., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: The Southern European Atlantic Diet (SEAD) is the traditional diet of Northern Portugal and Galicia, a region in northwest Spain. The SEAD has been associated with a lower risk of non-fatal acute myocardial infarction, but the mechanisms of this association have not yet been investigated. Thus, we examined the association between the SEAD and numerous biomarkers of coronary risk, blood pressure and anthropometrics., Methods: Cross-sectional study conducted in 2008-2010 among 10,231 individuals representative of the population aged 18 years and older in Spain. Diet was assessed with a validated computerized diet history. SEAD adherence was measured with an index including 9 food components (fresh fish, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine), which ranges from 0 (lowest adherence) to 9 (highest adherence). C-reactive protein, uric acid, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, glucose, glycated hemoglobin, insulin, leptin, fibrinogen, were determined in 12-h fasting blood samples, while creatinine and urine albumin were determined in urine., Results: Mean SEAD score was 2.9 points (inter-quartile range 2-4 points). Higher SEAD adherence was associated with a lower level of plasma C-reactive protein (adjusted difference in geometric means between the highest and lowest SEAD quartiles -0.2 mg/l; p for trend <0.001), plasma triglycerides (-3.4 mg/dl; p for trend 0.012), insulin (-0.5 mU/l; p for trend <0.001), HOMA-IR (-0.12; p for trend <0.001), urine albumin (-0.8 mg/l; p for trend <0.001), urine albumin-creatinine ratio (-0.3 mg/g creatinine; p for trend <0.034), and systolic blood pressure (-1.6 mm Hg; p for trend <0.001)., Conclusions: This study identifies possible mediators of the effect of SEAD on myocardial infarction, because SEAD is associated with a lower concentration of markers of inflammation and with reduced triglycerides, insulin, insulin resistance, and systolic blood pressure., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: The Southern European Atlantic Diet (SEAD) is the traditional diet in northern Portugal and Galicia, a region in northwest Spain., Objective: The objective was to examine the association between adherence to the SEAD and the occurrence of nonfatal acute myocardial infarction (AMI)., Design: This was a population-based case-control study in Porto, Portugal. Cases were patients aged > or =18 y who were hospitalized with an incident AMI (n = 820), and controls were individuals without AMI selected at random from the resident population of the participating hospitals' catchment area (n = 2196). A validated food-frequency questionnaire was administered in face-to-face interviews to assess dietary intake in the previous year. We developed an SEAD adherence index with 9 key components: fresh fish excluding cod, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine. A score of 1 or 0 was assigned to each food consumed and reflected consumption that was higher or lower, respectively, than the sex-specific median in controls., Results: After adjustment for the main confounders, a 1-point increment in the SEAD score was associated with a 10% reduced odds of AMI [odds ratio (OR): 0.90; 95% CI: 0.85, 0.96]. In comparison with individuals in the lower quartile of the SEAD index (lowest adherence), those in the upper quartile had a 33% lower likelihood of experiencing an AMI (OR: 0.67; 95% CI: 0.51, 0.88; P for trend = 0.003). An SEAD index calculated by reverse scoring for red meat and pork products and potatoes led to an even stronger inverse association between the SEAD and AMI (OR for the upper compared with the lower quartile of SEAD index: 0.40; 95% CI: 0.30, 0.52; P for trend < 0.001)., Conclusions: Adherence to the SEAD was associated with lower odds of nonfatal AMI. However, some but not all food components of the SEAD may contribute to the very low coronary mortality in northern Portugal and Galicia.