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ObjectivesAnxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms.MethodsThis is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen’s kappa. Two multivariable logistic regressions were built.ResultsAccording to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression.ConclusionAt least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.

Background Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13&ndash, 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 &lt, 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.

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia). © 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified. publishersversion published

BACKGROUND Health and fitness apps have potential benefits to improve self-management and disease control in patients with asthma. However, inconsistent use rates have been reported across studies, regions and health systems. A better understanding of the characteristics of users and non-users is critical to design solutions that are effectively integrated in patients daily life, and to ensure that these equitably reach out to different groups of patients, improving rather than entrenching health inequities. OBJECTIVE To evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. METHODS A secondary analysis of Inspirers observational studies was conducted using face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and/or depression, postcode, socio-economic index, digital literacy, health services use, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. RESULTS A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were 40 years or less (66.4%), had at least 10 years of education (57.4%) and were in the three higher quintiles of the socio-economic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale-VAS > 70 in 93.1%) and the prevalence of anxiety and depression was, respectively, 34.3% and 11.9%. The proportion of participants that reported using health and fitness mobile apps was 41.1% (n=211). The multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted OR 2.22 (95%CI [1.05-4.75]) and 1.95 (95%CI [1.12-3.45]), respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third and fourth quartiles showing, respectively, adjusted ORs of 6.74 (95%CI [2.90-17.40]), 10.30 (95%CI [4.28-27.56]), and 11.52 (95%CI [4.78-30.87]). Participants with depression symptoms had lower odds of using mobile health and fitness apps (adjusted OR 0.32, 95%CI [0.12-0.83]). CONCLUSIONS A better understanding of the barriers and enhancers of app use by patients with lower education, lower digital literacy, or with depressive symptoms, is key to design tailored interventions to improve a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior, as well as their interest and concerns about digital tools specifically. These factors may impact both initial engagement and sustained use. CLINICALTRIAL

Unsupervised methods may unveil the potential of the INSPIRERS studies to comprehend the heterogeneous characteristics of asthma. Therefore, we aimed to identify distinct classes of asthma among the participants, using latent class analysis (LCA), and to compare their characteristics across classes. We applied LCA to 308 adults (≥18 years) with persistent asthma (treated with daily inhaled medication) participants in the observational and prospective INSPIRERS studies, conducted in 26 secondary care outpatient clinics from Portugal and Spain. The classifying variables included asthma-related demographics, unscheduled healthcare use, Control of Allergic Rhinitis and Asthma Test (CARAT), and EuroQol 5 dimensions (EQ-5D) questionnaires. A three-class model was identified. Class 1 (21%) and Class 2 (26%) were characterized by highly symptomatic and uncontrolled asthma, with concomitant upper airways symptoms and reporting problems across all EQ-5D dimensions; they differed on high unscheduled healthcare use (Class 1) and early asthma onset (Class 2). Class 3 (53%): early asthma onset, controlled asthma with upper airways symptoms and without problems in EQ-5D dimensions. Compared to other classes, Class 1 had a higher proportion of subjects with FEV1 Three distinct and clinically meaningful unsupervised classes of asthma were identified among participants of the INSPIRERS studies, revealing the studies’ potential to support and enable patient-centered care and further research.

Objective: We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. Design: Baseline data from two prospective multicentre observational studies. Setting: 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. Participants: 395 patients (≥13 years old) with persistent asthma. Measures: Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. Results: High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p

Foot plantar pressure monitoring is an important tool for biomechanical assessment of posture, foot complications due to callus formation and wounds and for sports applications. The pronounced cost associated with commercial plantar pressure monitoring systems and inflexibility of custom analyzing data in such systems prompted the development of a versatile system with minimized cost. This study focuses on the development of such a system with high speed data acquisition providing analysis tools for assessing plantar pressure variations of diabetic patients with calloused feet. The new system is capable of achieving a frame rate of 155 Hz which is ideal for pressure monitoring during both standing and walking. The system was verified using 10 normal subjects and 5 diabetic subjects with calluses on in their feet. Results indicate significantly high mechanical stresses on skin beneath callus and postural disorders during standing, in subjects with calluses., 5 pages, 7 figures, 2018 IEEE Region Ten Symposium (Tensymp), pp 202-206 2018

Background: Monoclonal anti-IgE antibody omalizumab is a promising therapeutic option in patients with chronic urticaria (CU) resistant to non-sedating H1-antihistamines (nsAH). However, data about its long-term efficacy and safety are still scant. Objective: We retrospectively analysed the clinical course of patients with severe recalcitrant CU that were treated in our department with omalizumab for a period greater than 24 months. Methods and patients: Seven patients (six females, median 43 years) treated for a median of 35 months have been evaluated. Before treatment, all suffered from persistent symptoms despite receiving high doses of nsAH [4×/day], leukotriene antagonists and prednisolone (10---30 mg/day for a median duration of 48 months). Response to treatment was assessed using urticaria activity score (UAS) and a combined symptom/medication score. Results: There was a complete remission of disease in four patients after the first dose of omalizumab. Before the 5th administration, all patients had a UAS of 0. We found a significant improvement in UAS between pre-treatment and first dose (p = 0.017) and a gradual decrease in the symptom/medication score over the course of the first five administrations. Tapering of prednisolone was possible in all patients. Administration intervals were gradually increased, although all experienced resurgence of symptoms in cycles greater than six weeks. There were no reported adverse reactions attributable to the drug. Conclusion: Omalizumab was a safe and effective corticosteroid alternative for maintaining long-term remission of symptoms in these patients. Treatment intervals required individual patient-by-patient determination. The drug did not seem to alter the natural history of the disease.

Apresentam-se os casos de duas jovens, com diagnóstico de dermatite atópica grave medicadas com anti-histamínicos orais, corticóides tópicos, ciclos de corticoterapia sistémica em doses elevadas e/ou ciclosporina oral, sem melhoria e com agravamento clínico após redução da dose de corticóides sistémicos e/ou da ciclosporina. Na consulta de imunoalergologia efectuaram-se vários reajustes terapêuticos sem sucesso antes de iniciar terapêutica com omalizumab subcutâneo. Descreve-se a evolução clínica destas 2 doentes sob terapêutica com omalizumab e discute-se o seu papel no tratamento da dermatite atópica.

A urticária crónica (UC) consiste num quadro cutâneo de duração superior a 6 semanas, caracterizada pelo aparecimento de lesões máculo-papulares eritematosas e pruriginosas, com uma duração individual inferior a 24 horas. É uma patologia relativamente frequente que causa morbilidade significativa. Atualmente, o seu tratamento com fármacos para além dos anti-histamínicos-H1 não foi exaustivamente estudada. Descrevemos um caso de UC grave, resistente à terapêutica convencional com doses elevadas de anti-histamínicos-H1, corticodependente, no qual o tratamento com o anticorpo monoclonal anti-IgE omalizumab permitiu o controlo da urticária e a interrupção de corticoides sistémicos. Não se observaram reações adversas e o fármaco permaneceu eficaz ao longo de 18 meses de terapia. É posteriormente apresentada uma revisão da literatura relativa à utilização deste fármaco, com ênfase nas suas características a longo prazo.

We tested 1052 patients (64% female, mean age 34 years) and found 47 (4.5%) Pru p 3 and 42 (4%) Pru p 4 sensitizations. Co-sensitization was present in 7 patients. Polinosis was present in 70% of the LTP-sensitized, 80% of profilinsensitized and 86% of the co-sensitized groups, whereas plant food allergy was present in 48%, 23% and 71.4% respectively. Cutaneous, respiratory and gastrointestinal manifestations of food allergy were significantly more frequent in the LTP and co-sensitized groups (p

Metalworking Industry as a traditional industry is suffering lots of changes in the last decades, but the changes suffered in the last one had forced it to modernize itself to guarantee the adequate response to market's needs. Costumers requirements on customized products of high quality and reduced lead-time, together with environmental awareness are driving the increasingly use of Information and Communication Technologies (ICT) systems, IoT devices. This led to changes in the entire value chain, and the need to have ICT tools that allow the integration of all the information of the company. Cloud Collaborative Manufacturing Networks (C2NET) propose a cloud solution to enable collaboration between Metalworking SMEs. This paper presents C2NETproject solution to help Metalworking SMEs to improve their business and be competitive in a fast changing market.