Publications by authors named "Elisio Costa"

116 Publications

Intradialytic exercise in end-stage renal disease: An umbrella review of systematic reviews and/or meta-analytical studies.

Clin Rehabil 2021 Feb 3:269215520986784. Epub 2021 Feb 3.

Research Unit on Applied Molecular Biosciences, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto, Porto, Portugal.

Objectives: This umbrella review aimed to understand the clinical benefits and adverse events associated with different modalities of intradialytic exercise in patients with end-stage renal disease undergoing hemodialysis.

Data Sources: The search was performed until September 10th, 2020 on Scopus, Web of Science, the Cochrane Database, CINAHL, and PubMed.

Methods: This umbrella review was conducted following the PRISMA guideline statement. The methodological quality of the reviews was assessed with the AMSTAR-2. Standardized mean differences with 95% confidence intervals were estimated. The I-squared statistic was used to assess heterogeneity and the Eggers' test was performed to test asymmetry/small-study effects.

Results: Eleven reviews were included and 48 unique meta-analyses were examined. Nine were supported by suggestive evidence ( < 0.05, small heterogeneity, absence of small-study effects, and excess significance bias). Clinical benefits were found for functional capacity associated with aerobic exercise ( = 0.81;  = 6), resistance training ( = 0.58;  = 6), neuromuscular electrical stimulation ( = 0.70;  = 5), and inspiratory muscle training ( = 1.13;  = 2), measured by the distance covered in the 6-minutes walking test. This outcome was also associated with aerobic exercise ( = 0.28;  = 7) and combined exercise, measured by VO2peak ( = 1.01;  = 5) and by the duration of the cardiopulmonary test ( = 1.07;  = 4). Isometric quadriceps muscle strength improved with neuromuscular electrical stimulation ( = 1.19;  = 7) while patients' perception of vitality improved with combined exercise ( = 0.60;  = 3).

Conclusions: Suggestive evidence was found for the associations between various modalities of intradialytic exercise and functional capacity. Combined exercise was associated with improvements in physical and psychosocial variables. Few or no adverse events were reported.
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http://dx.doi.org/10.1177/0269215520986784DOI Listing
February 2021

[A New Paradigm in Health Research: FAIR Data (Findable, Accessible, Interoperable, Reusable)].

Acta Med Port 2020 Dec 2;33(12):828-834. Epub 2020 Dec 2.

UCIBIO/REQUIMTE. Faculty of Pharmacy and Competences Centre on Active and Healthy Ageing (Porto4Ageing). University of Porto. Porto. Biochemistry Laboratory. Biological Sciences Department. Faculty of Pharmacy. University of Porto. Porto. Portugal.

The digital era, that we are living nowadays, is transforming health, health care models and services, and the role of society in this new reality. We currently have a large amount of stored health data, including clinical, biometric, and scientific research data. Nonetheless, its potential is not being fully exploited. It is essential to foster the sharing and reuse of this data not only in research but also towards the development of health technologies in order to improve health care efficiency, as well as products, services or digital health apps, to promote preventive and individualized medicine and to empower citizens in health literacy and self-management. In this sense, the FAIR concept has emerged, which implies that health data is findable, accessible, shared and reusable, facilitating interoperability between systems, ensuring the protection of personal and sensitive data. In this paper we review the FAIR concept, 'FAIRification' process, FAIR data versus open access data, ethical issues and the general data protection regulation, and digital health and citizen science.
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http://dx.doi.org/10.20344/amp.12910DOI Listing
December 2020

[ARIA 2019: An Integrated Care Pathway for Allergic Rhinitis in Portugal].

Acta Med Port 2021 Feb 4;34(2):144-157. Epub 2020 Dec 4.

MACVIA-France. Fondation Partenariale FMC VIA-LR. Centre Hospitalier Arnaud de Villeneuve. Montpellier. INSERM U 1168. Université Versailles St-Quentin-en-Yvelines. Montigny le Bretonneux. France. Charité. Universitätsmedizin Berlin. Humboldt-Universität zu Berlin. Berlin. Alemanha.

The Allergic Rhinitis and Its Impact on Asthma (ARIA) initiative started more than 20 years ago and has developed and disseminated evidence-based guidelines and projects in the field of allergic rhinitis. This initiative is currently focused on providing patient-centred guidelines that contribute to an integrated care pathway between the various levels of care and take advantage of digital solutions, and the introduction of integrated care pathways in clinical practice has been recommended. In this article we describe the adaptation for Portugal of the ARIA Integrated Care Pathways document. After a brief review of the epidemiology and impact of allergic rhinitis in Portugal and the activities carried out in Portugal within the ARIA initiative, we describe the broad knowledge base used for the development of recommendations for the pharmacological treatment of allergic rhinitis, and these recommendations are based on the GRADE methodology, real world evidence acquired by mobile technology (mHealth) and resulting from allergenic exposure chamber studies. What follows is a summary of integrated care pathways for allergen immunotherapy produced in 2019. Allergen immunotherapy is considered an example of precision medicine where the use of mHealth technologies will improve stratification for patient selection and response monitoring. These recommendations were considered as best practices of integrated patient-centred care supported by digital systems from Directorate General for Health and Food Safety of the European Union (DG Santé) and represent the ARIA Phase 4 Change Management strategy.
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http://dx.doi.org/10.20344/amp.13777DOI Listing
February 2021

Instrumental Activities of Daily Living (iADL) Limitations in Europe: An Assessment of SHARE Data.

Int J Environ Res Public Health 2020 10 10;17(20). Epub 2020 Oct 10.

Applied Molecular Biosciences Unit (UCIBIO) Requimte (Rede de Química e Tecnologia), Porto4Ageing, Faculdade de Farmácia da Universidade do Porto, 4050-047 Porto, Portugal.

This study aims to evaluate the instrumental activities of daily living (iADLs) limitations in Europe and its association with socio-demographic characteristics, economic parameters and physical and mental health status. We used data from the wave 6 of SHARE database. Individuals were classified as having either none or one or more limitations on iADLs. Participants aged 65 or more years who answered all questions for the variables included in this work were selected. A total of 54.8% of participants were female and had a mean age of 74.37 (SD = 7.08) years. A global prevalence of 1 or more iADLs in Europe was shown to be 23.8% and more prevalent in women than in men (27.1% vs. 17.6%) and in people aged 85 years or more (51.5%). Older age, female gender, lower education, physical inactivity, frailty, having two or more chronic diseases, presence of depression, polypharmacy, poor self-perception of health and lower network satisfaction were found to be factors associated with the presence of 1 or more iADLs limitation. This study highlights the burden of iADLs limitations at the European level. These are based on a multidimensional biopsychosocial model and are associated with both health conditions and environmental factors. This intersection between the physical and social world underscores its potential as a health indicator and can, to some extent, explain some of the pronounced differences seen among European countries. Different inter-tasks can also stress different dimensions of health indicators in distinct and specific groups of individuals. Minimizing the impact of iADL limitations can improve the quality and sustainability of public health systems.
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http://dx.doi.org/10.3390/ijerph17207387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599802PMC
October 2020

Allergic rhinitis characterization in community pharmacy customers: a cross-sectional study.

Int J Clin Pharm 2021 Feb 20;43(1):118-127. Epub 2020 Sep 20.

School of Health Sciences, Polytechnic Institute of Guarda, Rua da Cadeia, 6300-035, Guarda, Portugal.

Background Allergic rhinitis represents a public health problem that is significantly prevalent in the global population and has been associated with asthma, a strong desire to sleep and a low quality of life. Objective This study aims to evaluate the prevalence, symptoms, control strategies and treatment, as well as the control of this condition and its impact on the quality of life of customers of community pharmacies with allergic rhinitis. Setting A questionnaire survey was carried out in nine community pharmacies in the city of Guarda, Portugal. Method In this cross-sectional study, data was collected by an interview between May 2014 and December 2014. The control of the illness and the impact of allergic rhinitis on the quality of life were assessed through a CARAT10 test and a WHOQOL-BREF instrument, respectively. Main outcome measure The impact of allergic rhinitis on the patient's quality of life. Results The estimated prevalence of allergic rhinitis was between 10.8% and 15.4%, from which 63 and 42 individuals were medically and symptomatically diagnosed, respectively, from a study population of 804 respondents. The majority of participants (57.1%) suffered from the symptoms more than twice a year. The symptoms, such as difficulty in falling asleep, repeated and continuous sneezing and bilateral nasal obstruction, were severe. There were patients with uncontrolled allergic rhinitis symptoms after the CARAT10 test, even when the individual's perception of the quality of life was good according to the WHOQOL-BREF score, with gender differences in the psychological domain. It should also be emphasized that there was a significant association between higher education levels with better control of the illness/quality of life. Additionally, most participants used pharmacological treatment (not alternative therapies) and the adoption of self-management measures to relieve their symptoms. Conclusions The findings of this study showed that the estimated prevalence of allergic rhinitis seems to be apparently lower in Guarda than that found in the general Portuguese population. From the data, some patients showed uncontrolled allergic rhinitis symptoms, strengthening the importance of the role of intervention by a health professional.
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http://dx.doi.org/10.1007/s11096-020-01115-zDOI Listing
February 2021

Being on hemodialysis during the COVID-19 outbreak: A mixed-methods' study exploring the impacts on dialysis adequacy, analytical data, and patients' experiences.

Semin Dial 2021 01 16;34(1):66-76. Epub 2020 Sep 16.

Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal.

For individuals with end-stage renal disease (ESRD), the novel coronavirus can present several additional challenges in disease self-management. This study aimed to explore the impacts of the COVID-19 pandemic in non-COVID-19 patients with ESRD undergoing in-center hemodialysis (HD). A mixed-methods study was conducted with a purposive sample recruited from one dialysis unit in Portugal. Quantitative data were collected retrospectively from patients' medical records from February 2020 (T1-before the outbreak) and from April 2020 (T2-during lockdown). Semi-structured interviews were conducted with 20 patients (66.9 ± 11.9 years old) undergoing HD for an average of 46.1 months (±39.5) in April 2020. Overall results suggested that dialysis adequacy and serum albumin levels decreased significantly at T2, while phosphorus levels increased. The findings from thematic analysis suggested several psychosocial negative impacts and impacts on disease and treatment-related health behaviors (eg, difficulties managing dietary restrictions during the lockdown and diminished physical activity), which can partially explain these quantitative results. However, some patients were also able to find positive impacts in this experience and problem-focused and emotional strategies were identified to cope with the demands of COVID-19. Several recommendations have been made to mitigate patients' emotional, relational, and educational unmet needs during the current pandemic and in the event of new outbreaks.
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http://dx.doi.org/10.1111/sdi.12914DOI Listing
January 2021

Cognitive performance in older adults across Europe based on the SHARE database.

Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2020 Aug 3:1-16. Epub 2020 Aug 3.

UCIBIO REQUIMTE, Faculty of Pharmacy, Competences Center on Active and Healthy Ageing, University of Porto , Porto, Portugal.

With ageing mental health issues, as age-related cognitive decline, increase. This study aims to evaluate the prevalence of cognitive impairment among older European adults and to evaluate its association with clinical and sociodemographic variables, using SHARE. Numeracy, temporal orientation, verbal fluency, and memory were the measures used to evaluate cognitive performance. From 44 963 individuals included, mean age was 70.0±9.0 years old and 56.3% were female. Overall prevalence of impairment was of 13.0% (temporal orientation), 24.8% (numeracy), 27.6% (verbal fluency) and 50.5% (memory). Men showed higher impairment prevalence in temporal orientation and memory and lower in numeracy and verbal fluency. Age, fewer years of education, difficulties performing iADLs, physical inactivity, and poor self-perceived health were independently associated with impairment in all cognitive abilities. These results showed the burden of cognitive impairment across Europe. Factors identified as associated should be taken in consideration to develop effective interventions to prevent cognitive decline.
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http://dx.doi.org/10.1080/13825585.2020.1799927DOI Listing
August 2020

The Need to Develop Standard Measures of Patient Adherence for Big Data: Viewpoint.

J Med Internet Res 2020 08 27;22(8):e18150. Epub 2020 Aug 27.

AARDEX Group, Seraing, Belgium.

Despite half a century of dedicated studies, medication adherence remains far from perfect, with many patients not taking their medications as prescribed. The magnitude of this problem is rising, jeopardizing the effectiveness of evidence-based therapies. An important reason for this is the unprecedented demographic change at the beginning of the 21st century. Aging leads to multimorbidity and complex therapeutic regimens that create a fertile ground for nonadherence. As this scenario is a global problem, it needs a worldwide answer. Could this answer be provided, given the new opportunities created by the digitization of health care? Daily, health-related information is being collected in electronic health records, pharmacy dispensing databases, health insurance systems, and national health system records. These big data repositories offer a unique chance to study adherence both retrospectively and prospectively at the population level, as well as its related factors. In order to make full use of this opportunity, there is a need to develop standardized measures of adherence, which can be applied globally to big data and will inform scientific research, clinical practice, and public health. These standardized measures may also enable a better understanding of the relationship between adherence and clinical outcomes, and allow for fair benchmarking of the effectiveness and cost-effectiveness of adherence-targeting interventions. Unfortunately, despite this obvious need, such standards are still lacking. Therefore, the aim of this paper is to call for a consensus on global standards for measuring adherence with big data. More specifically, sound standards of formatting and analyzing big data are needed in order to assess, uniformly present, and compare patterns of medication adherence across studies. Wide use of these standards may improve adherence and make health care systems more effective and sustainable.
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http://dx.doi.org/10.2196/18150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484771PMC
August 2020

ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice.

Authors:
Jean Bousquet Josep M Anto Claus Bachert Tari Haahtela Torsten Zuberbier Wienczyslawa Czarlewski Anna Bedbrook Sinthia Bosnic-Anticevich G Walter Canonica Victoria Cardona Elisio Costa Alvaro A Cruz Marina Erhola Wytske J Fokkens Joao A Fonseca Maddalena Illario Juan-Carlos Ivancevich Marek Jutel Ludger Klimek Piotr Kuna Violeta Kvedariene Ltt Le Désirée E Larenas-Linnemann Daniel Laune Olga M Lourenço Erik Melén Joaquim Mullol Marek Niedoszytko Mikaëla Odemyr Yoshitaka Okamoto Nikos G Papadopoulos Vincenzo Patella Oliver Pfaar Nhân Pham-Thi Christine Rolland Boleslaw Samolinski Aziz Sheikh Mikhail Sofiev Charlotte Suppli Ulrik Ana Todo-Bom Peter-Valentin Tomazic Sanna Toppila-Salmi Ioanna Tsiligianni Arunas Valiulis Erkka Valovirta Maria-Teresa Ventura Samantha Walker Sian Williams Arzu Yorgancioglu Ioana Agache Cezmi A Akdis Rute Almeida Ignacio J Ansotegui Isabella Annesi-Maesano Sylvie Arnavielhe Xavier Basagaña Eric D Bateman Annabelle Bédard Martin Bedolla-Barajas Sven Becker Kazi S Bennoor Samuel Benveniste Karl C Bergmann Michael Bewick Slawomir Bialek Nils E Billo Carsten Bindslev-Jensen Leif Bjermer Hubert Blain Matteo Bonini Philippe Bonniaud Isabelle Bosse Jacques Bouchard Louis-Philippe Boulet Rodolphe Bourret Koen Boussery Fluvio Braido Vitalis Briedis Andrew Briggs Christopher E Brightling Jan Brozek Guy Brusselle Luisa Brussino Roland Buhl Roland Buonaiuto Moises A Calderon Paulo Camargos Thierry Camuzat Luis Caraballo Ana-Maria Carriazo Warner Carr Christine Cartier Thomas Casale Lorenzo Cecchi Alfonso M Cepeda Sarabia Niels H Chavannes Ekaterine Chkhartishvili Derek K Chu Cemal Cingi Jaime Correia de Sousa David J Costa Anne-Lise Courbis Adnan Custovic Biljana Cvetkosvki Gennaro D'Amato Jane da Silva Carina Dantas Dejan Dokic Yves Dauvilliers Giulia De Feo Govert De Vries Philippe Devillier Stefania Di Capua Gerard Dray Ruta Dubakiene Stephen R Durham Mark Dykewicz Motohiro Ebisawa Mina Gaga Yehia El-Gamal Enrico Heffler Regina Emuzyte John Farrell Jean-Luc Fauquert Alessandro Fiocchi Antje Fink-Wagner Jean-François Fontaine José M Fuentes Perez Bilun Gemicioğlu Amiran Gamkrelidze Judith Garcia-Aymerich Philippe Gevaert René Maximiliano Gomez Sandra González Diaz Maia Gotua Nick A Guldemond Maria-Antonieta Guzmán Jawad Hajjam Yunuen R Huerta Villalobos Marc Humbert Guido Iaccarino Despo Ierodiakonou Tomohisa Iinuma Ewa Jassem Guy Joos Ki-Suck Jung Igor Kaidashev Omer Kalayci Przemyslaw Kardas Thomas Keil Musa Khaitov Nikolai Khaltaev Jorg Kleine-Tebbe Rostislav Kouznetsov Marek L Kowalski Vicky Kritikos Inger Kull Stefania La Grutta Lisa Leonardini Henrik Ljungberg Philip Lieberman Brian Lipworth Karin C Lodrup Carlsen Catarina Lopes-Pereira Claudia C Loureiro Renaud Louis Alpana Mair Bassam Mahboub Michaël Makris Joao Malva Patrick Manning Gailen D Marshall Mohamed R Masjedi Jorge F Maspero Pedro Carreiro-Martins Mika Makela Eve Mathieu-Dupas Marcus Maurer Esteban De Manuel Keenoy Elisabete Melo-Gomes Eli O Meltzer Enrica Menditto Jacques Mercier Yann Micheli Neven Miculinic Florin Mihaltan Branislava Milenkovic Dimitirios I Mitsias Giuliana Moda Maria-Dolores Mogica-Martinez Yousser Mohammad Steve Montefort Ricardo Monti Mario Morais-Almeida Ralph Mösges Lars Münter Antonella Muraro Ruth Murray Robert Naclerio Luigi Napoli Leyla Namazova-Baranova Hugo Neffen Kristoff Nekam Angelo Neou Björn Nordlund Ettore Novellino Dieudonné Nyembue Robyn O'Hehir Ken Ohta Kimi Okubo Gabrielle L Onorato Valentina Orlando Solange Ouedraogo Julia Palamarchuk Isabella Pali-Schöll Peter Panzner Hae-Sim Park Gianni Passalacqua Jean-Louis Pépin Ema Paulino Ruby Pawankar Jim Phillips Robert Picard Hilary Pinnock Davor Plavec Todor A Popov Fabienne Portejoie David Price Emmanuel P Prokopakis Fotis Psarros Benoit Pugin Francesca Puggioni Pablo Quinones-Delgado Filip Raciborski Rojin Rajabian-Söderlund Frederico S Regateiro Sietze Reitsma Daniela Rivero-Yeverino Graham Roberts Nicolas Roche Erendira Rodriguez-Zagal Christine Rolland Regina E Roller-Wirnsberger Nelson Rosario Antonino Romano Menachem Rottem Dermot Ryan Johanna Salimäki Mario M Sanchez-Borges Joaquin Sastre Glenis K Scadding Sophie Scheire Peter Schmid-Grendelmeier Holger J Schünemann Faradiba Sarquis Serpa Mohamed Shamji Juan-Carlos Sisul Mikhail Sofiev Dirceu Solé David Somekh Talant Sooronbaev Milan Sova François Spertini Otto Spranger Cristiana Stellato Rafael Stelmach Michel Thibaudon Teresa To Mondher Toumi Omar Usmani Antonio A Valero Rudolph Valenta Marylin Valentin-Rostan Marilyn Urrutia Pereira Rianne van der Kleij Michiel Van Eerd Olivier Vandenplas Tuula Vasankari Antonio Vaz Carneiro Giorgio Vezzani Frédéric Viart Giovanni Viegi Dana Wallace Martin Wagenmann De Yun Wang Susan Waserman Magnus Wickman Dennis M Williams Gary Wong Piotr Wroczynski Panayiotis K Yiallouros Osman M Yusuf Heather J Zar Stéphane Zeng Mario E Zernotti Luo Zhang Nan Shan Zhong Mihaela Zidarn

Allergy 2021 01 23;76(1):168-190. Epub 2020 Oct 23.

University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.
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http://dx.doi.org/10.1111/all.14422DOI Listing
January 2021

Managing Allergic Rhinitis in the Pharmacy: An ARIA Guide for Implementation in Practice.

Pharmacy (Basel) 2020 May 16;8(2). Epub 2020 May 16.

MACVIA-France, 34295 Montpellier, France.

The paradigm of how we manage allergic rhinitis is shifting with a growing understanding that it is a complex process, requiring a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Community pharmacists are the most accessible healthcare professionals to the public and allergic rhinitis is one of the most common diseases managed by pharmacists. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed over the past 20 years have improved the care of allergic rhinitis patients through an evidence-based, integrated care approach. In this paper, we propose an integrated approach to allergic rhinitis management in community pharmacy following the 2019 ARIA in the pharmacy guidelines.
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http://dx.doi.org/10.3390/pharmacy8020085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355936PMC
May 2020

Methodological features of quantitative studies on medication adherence in older patients with chronic morbidity: A systematic review.

Patient Educ Couns 2020 10 6;103(10):2132-2141. Epub 2020 May 6.

Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Montescano, Pavia, Italy. Electronic address:

Objectives: The growing number of chronic, multimorbid older adults encourages healthcare systems to cope with polypharmacy and non-adherence. However, methodology on how to provide effective interventions to enhance medication adherence is still object of debate.

Methods: To describe methodological features of quantitative studies concerning older adults' medication adherence, by means of a PRISMA systematic review (Scopus, PubMed, Medline). A specific focus was devoted to theoretical models and to the ABC Taxonomy model, as stated by the EMERGE guidelines.

Results: 55 papers were included. Most of the studies were conducted using randomized control trials (63.6%) and focused on a single disease only (72.7%). Most of the interventions were provided by a single professional figure (70.9%). Medication adherence was mainly evaluated by means of questionnaires (61.8%) and by clinical records (30.9%). Sixteen studies considered a theoretical model in the intervention framework. The Initiation phase (ABC Taxonomy) was the most neglected.

Conclusions: Future studies upon medication adherence should account real-life challenges such as multimorbidity, polypharmacy and interdisciplinarity, analyzing adherence as a complex, holistic process.

Practice Implications: Theoretical models may be useful to enhance the soundness of the results, to ease their comparability, to calibrate tailored strategies and to plan patient-centered interventions.
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http://dx.doi.org/10.1016/j.pec.2020.04.006DOI Listing
October 2020

Patient Centric Pharmaceutical Drug Product Design-The Impact on Medication Adherence.

Pharmaceutics 2020 Jan 3;12(1). Epub 2020 Jan 3.

UCIBIO/REQUIMTE, MedTech-Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.

Medication adherence is a growing concern for public health and poor adherence to therapy has been associated with poor health outcomes and higher costs for patients. Interventions for improving adherence need to consider the characteristics of the individual therapeutic regimens according to the needs of the patients. In particular, geriatric and paediatric populations as well as dermatological patients have special needs/preferences that should be considered when designing drug products. Patient Centric Drug Product Pharmaceutical Design (PCDPD) offers the opportunity to meet the needs and preferences of patients. Packaging, orodispersible formulations, fixed dose combinations products, multiparticulate formulations, topical formulations and 3D printing are of particular relevance in a PCDPD process. These will be addressed in this review as well as their impact on medication adherence.
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http://dx.doi.org/10.3390/pharmaceutics12010044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023035PMC
January 2020

Next-generation care pathways for allergic rhinitis and asthma multimorbidity: a model for multimorbid non-communicable diseases-Meeting Report (Part 2).

J Thorac Dis 2019 Sep;11(9):4072-4084

Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Member of GA2LEN, Berlin, Germany.

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http://dx.doi.org/10.21037/jtd.2019.09.38DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790426PMC
September 2019

Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence.

Authors:
Jean Bousquet Holger J Schünemann Akdis Togias Claus Bachert Martina Erhola Peter W Hellings Ludger Klimek Oliver Pfaar Dana Wallace Ignacio Ansotegui Ioana Agache Anna Bedbrook Karl-Christian Bergmann Mike Bewick Philippe Bonniaud Sinthia Bosnic-Anticevich Isabelle Bossé Jacques Bouchard Louis-Philippe Boulet Jan Brozek Guy Brusselle Moises A Calderon Walter G Canonica Luis Caraballo Vicky Cardona Thomas Casale Lorenzo Cecchi Derek K Chu Elisio M Costa Alvaro A Cruz Wienczyslawa Czarlewski Gennaro D'Amato Philippe Devillier Mark Dykewicz Motohiro Ebisawa Jean-Louis Fauquert Wytske J Fokkens Joao A Fonseca Jean-François Fontaine Bilun Gemicioglu Roy Gerth van Wijk Tari Haahtela Susanne Halken Despo Ierodiakonou Tomohisa Iinuma Juan-Carlos Ivancevich Marek Jutel Igor Kaidashev Musa Khaitov Omer Kalayci Jorg Kleine Tebbe Marek L Kowalski Piotr Kuna Violeta Kvedariene Stefania La Grutta Désirée Larenas-Linnemann Susanne Lau Daniel Laune Lan Le Philipp Lieberman Karin C Lodrup Carlsen Olga Lourenço Gert Marien Pedro Carreiro-Martins Erik Melén Enrica Menditto Hugo Neffen Gregoire Mercier Ralph Mosgues Joaquim Mullol Antonella Muraro Leyla Namazova Ettore Novellino Robyn O'Hehir Yoshitaka Okamoto Ken Ohta Hae Sim Park Petr Panzner Giovanni Passalacqua Nhan Pham-Thi David Price Graham Roberts Nicolas Roche Christine Rolland Nelson Rosario Dermot Ryan Boleslaw Samolinski Mario Sanchez-Borges Glenis K Scadding Mohamed H Shamji Aziz Sheikh Ana-Maria Todo Bom Sanna Toppila-Salmi Ioana Tsiligianni Marylin Valentin-Rostan Arunas Valiulis Erkka Valovirta Maria-Teresa Ventura Samantha Walker Susan Waserman Arzu Yorgancioglu Torsten Zuberbier

J Allergy Clin Immunol 2020 01 15;145(1):70-80.e3. Epub 2019 Oct 15.

Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, member of GA(2)LEN, Berlin, Germany.

The selection of pharmacotherapy for patients with allergic rhinitis aims to control the disease and depends on many factors. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines have considerably improved the treatment of allergic rhinitis. However, there is an increasing trend toward use of real-world evidence to inform clinical practice, especially because randomized controlled trials are often limited with regard to the applicability of results. The Contre les Maladies Chroniques pour un Vieillissement Actif (MACVIA) algorithm has proposed an allergic rhinitis treatment by a consensus group. This simple algorithm can be used to step up or step down allergic rhinitis treatment. Next-generation guidelines for the pharmacologic treatment of allergic rhinitis were developed by using existing GRADE-based guidelines for the disease, real-world evidence provided by mobile technology, and additive studies (allergen chamber studies) to refine the MACVIA algorithm.
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http://dx.doi.org/10.1016/j.jaci.2019.06.049DOI Listing
January 2020

Next-generation care pathways for allergic rhinitis and asthma multimorbidity: a model for multimorbid non-communicable diseases-Meeting Report (Part 1).

J Thorac Dis 2019 Aug;11(8):3633-3642

Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Member of GA2LEN, Berlin, Germany.

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http://dx.doi.org/10.21037/jtd.2019.08.64DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753463PMC
August 2019

A Microfluidic Deformability Assessment of Pathological Red Blood Cells Flowing in a Hyperbolic Converging Microchannel.

Micromachines (Basel) 2019 Sep 25;10(10). Epub 2019 Sep 25.

MEtRICs, Mechanical Engineering Department, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal.

The loss of the red blood cells (RBCs) deformability is related with many human diseases, such as malaria, hereditary spherocytosis, sickle cell disease, or renal diseases. Hence, during the last years, a variety of technologies have been proposed to gain insights into the factors affecting the RBCs deformability and their possible direct association with several blood pathologies. In this work, we present a simple microfluidic tool that provides the assessment of motions and deformations of RBCs of end-stage kidney disease (ESKD) patients, under a well-controlled microenvironment. All of the flow studies were performed within a hyperbolic converging microchannels where single-cell deformability was assessed under a controlled homogeneous extensional flow field. By using a passive microfluidic device, RBCs passing through a hyperbolic-shaped contraction were measured by a high-speed video microscopy system, and the velocities and deformability ratios (DR) calculated. Blood samples from 27 individuals, including seven healthy controls and 20 having ESKD with or without diabetes, were analysed. The obtained data indicates that the proposed device is able to detect changes in DR of the RBCs, allowing for distinguishing the samples from the healthy controls and the patients. Overall, the deformability of ESKD patients with and without diabetes type II is lower in comparison with the RBCs from the healthy controls, with this difference being more evident for the group of ESKD patients with diabetes. RBCs from ESKD patients without diabetes elongate on average 8% less, within the hyperbolic contraction, as compared to healthy controls; whereas, RBCs from ESKD patients with diabetes elongate on average 14% less than the healthy controls. The proposed strategy can be easily transformed into a simple and inexpensive diagnostic microfluidic system to assess blood cells deformability due to the huge progress in image processing and high-speed microvisualization technology.
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http://dx.doi.org/10.3390/mi10100645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843121PMC
September 2019

Next-generation ARIA care pathways for rhinitis and asthma: a model for multimorbid chronic diseases.

Authors:
J Jean Bousquet Holger J Schünemann Alkis Togias Marina Erhola Peter W Hellings Torsten Zuberbier Ioana Agache Ignacio J Ansotegui Josep M Anto Claus Bachert Sven Becker Martin Bedolla-Barajas Michael Bewick Sinthia Bosnic-Anticevich Isabelle Bosse Louis P Boulet Jean Marc Bourrez Guy Brusselle Niels Chavannes Elisio Costa Alvaro A Cruz Wienczyslawa Czarlewski Wytske J Fokkens Joao A Fonseca Mina Gaga Tari Haahtela Maddalena Illario Ludger Klimek Piotr Kuna Violeta Kvedariene L T T Le Desiree Larenas-Linnemann Daniel Laune Olga M Lourenço Enrica Menditto Joaquin Mullol Yashitaka Okamoto Nikos Papadopoulos Nhân Pham-Thi Robert Picard Hilary Pinnock Nicolas Roche Regina E Roller-Wirnsberger Christine Rolland Boleslaw Samolinski Aziz Sheikh Sanna Toppila-Salmi Ioanna Tsiligianni Arunas Valiulis Erkka Valovirta Tuula Vasankari Maria-Teresa Ventura Samantha Walker Sian Williams Cezmi A Akdis Isabella Annesi-Maesano Sylvie Arnavielhe Xavier Basagana Eric Bateman Anna Bedbrook K S Bennoor Samuel Benveniste Karl C Bergmann Slawomir Bialek Nils Billo Carsten Bindslev-Jensen Leif Bjermer Hubert Blain Mateo Bonini Philippe Bonniaud Jacques Bouchard Vitalis Briedis Christofer E Brightling Jan Brozek Roland Buhl Roland Buonaiuto Giorgo W Canonica Victoria Cardona Ana M Carriazo Warner Carr Christine Cartier Thomas Casale Lorenzo Cecchi Alfonso M Cepeda Sarabia Eka Chkhartishvili Derek K Chu Cemal Cingi Elaine Colgan Jaime Correia de Sousa Anne Lise Courbis Adnan Custovic Biljana Cvetkosvki Gennaro D'Amato Jane da Silva Carina Dantas Dejand Dokic Yves Dauvilliers Antoni Dedeu Giulia De Feo Philippe Devillier Stefania Di Capua Marc Dykewickz Ruta Dubakiene Motohiro Ebisawa Yaya El-Gamal Esben Eller Regina Emuzyte John Farrell Antjie Fink-Wagner Alessandro Fiocchi Jean F Fontaine Bilun Gemicioğlu Peter Schmid-Grendelmeir Amiran Gamkrelidze Judith Garcia-Aymerich Maximiliano Gomez Sandra González Diaz Maia Gotua Nick A Guldemond Maria-Antonieta Guzmán Jawad Hajjam John O'B Hourihane Marc Humbert Guido Iaccarino Despo Ierodiakonou Maddalena Illario Juan C Ivancevich Guy Joos Ki-Suck Jung Marek Jutel Igor Kaidashev Omer Kalayci Przemyslaw Kardas Thomas Keil Mussa Khaitov Nikolai Khaltaev Jorg Kleine-Tebbe Marek L Kowalski Vicky Kritikos Inger Kull Lisa Leonardini Philip Lieberman Brian Lipworth Karin C Lodrup Carlsen Claudia C Loureiro Renaud Louis Alpana Mair Gert Marien Bassam Mahboub Joao Malva Patrick Manning Esteban De Manuel Keenoy Gailen D Marshall Mohamed R Masjedi Jorge F Maspero Eve Mathieu-Dupas Poalo M Matricardi Eric Melén Elisabete Melo-Gomes Eli O Meltzer Enrica Menditto Jacques Mercier Neven Miculinic Florin Mihaltan Branislava Milenkovic Giuliana Moda Maria-Dolores Mogica-Martinez Yousser Mohammad Steve Montefort Ricardo Monti Mario Morais-Almeida Ralf Mösges Lars Münter Antonella Muraro Ruth Murray Robert Naclerio Luigi Napoli Leila Namazova-Baranova Hugo Neffen Kristoff Nekam Angelo Neou Enrico Novellino Dieudonné Nyembue Robin O'Hehir Ken Ohta Kimi Okubo Gabrielle Onorato Solange Ouedraogo Isabella Pali-Schöll Susanna Palkonen Peter Panzner Hae-Sim Park Jean-Louis Pépin Ana-Maria Pereira Oliver Pfaar Ema Paulino Jim Phillips Robert Picard Davor Plavec Ted A Popov Fabienne Portejoie David Price Emmanuel P Prokopakis Benoit Pugin Filip Raciborski Rojin Rajabian-Söderlund Sietze Reitsma Xavier Rodo Antonino Romano Nelson Rosario Menahenm Rottem Dermot Ryan Johanna Salimäki Mario M Sanchez-Borges Juan-Carlos Sisul Dirceu Solé David Somekh Talant Sooronbaev Milan Sova Otto Spranger Cristina Stellato Rafael Stelmach Charlotte Suppli Ulrik Michel Thibaudon Teresa To Ana Todo-Bom Peter V Tomazic Antonio A Valero Rudolph Valenta Marylin Valentin-Rostan Rianne van der Kleij Olivier Vandenplas Giorgio Vezzani Frédéric Viart Giovanni Viegi Dana Wallace Martin Wagenmann De Y Wang Susan Waserman Magnus Wickman Dennis M Williams Gary Wong Piotr Wroczynski Panayiotis K Yiallouros Arzu Yorgancioglu Osman M Yusuf Heahter J Zar Stéphane Zeng Mario Zernotti Luo Zhang Nan S Zhong Mihaela Zidarn

Clin Transl Allergy 2019 9;9:44. Epub 2019 Sep 9.

260University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.

Background: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy.

Main Body: As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted "patient activation", (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Santé as a Good Practice in the field of digitally-enabled, integrated, person-centred care.

Conclusion: In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
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http://dx.doi.org/10.1186/s13601-019-0279-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734297PMC
September 2019

Social support and treatment adherence in patients with end-stage renal disease: A systematic review.

Semin Dial 2019 11 15;32(6):562-574. Epub 2019 Jul 15.

School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.

Successful dialysis in end-stage renal disease (ESRD) largely depends on the patients' ability to adhere to several clinical requirements and life-style changes. Social support has been consistently linked to better health outcomes in a number of chronic diseases. The current study presents a systematic review of the literature on the relationship between social support and treatment adherence in ESRD. The search was performed on Web of Science, PsycInfo, ScienceDirect, and Scopus from January 19 to May 15, 2019. Two hundred and twenty-four records were identified. After quality assessment, 17 studies were included for qualitative synthesis. This review comprised a total of 2362 patients. Most patients were on hemodialysis (97.5%) for an average of 58.2 months. Results suggested an overall pattern of mixed findings regarding the association between social support and treatment adherence. Adherence to fluid restrictions was the type of adherence with more significant associations with social support (63%). Mixed results were found for adherence to dialysis sessions (50%) and to medication (50%). Associations between adherence to diet restrictions and social support were found in 44% of the included studies. No significant associations were found between social support and adherence to follow-up consults. All of the included studies combining several types of adherence into an overall score found significant associations with social support. Findings suggested that it might be particularly beneficial to focus future research and clinical efforts toward social support from family, significant others, and health professionals, to improve patient's with ESRD treatment adherence.
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http://dx.doi.org/10.1111/sdi.12831DOI Listing
November 2019

Dairy Product Intake in Older Adults across Europe Based On the SHARE Database.

J Nutr Gerontol Geriatr 2019 Jul-Sep;38(3):297-306. Epub 2019 Jun 22.

a UCIBIO/REQUINTE, Faculty of Pharmacy , Porto.

To evaluate dairy intake patterns in older adults across Europe. We conducted cross-sectional analysis using data from the fourth wave (2011/2012) of the Survey of Health, Aging and Retirement in Europe (SHARE) database. Prevalence rates regarding the number of weekly servings of dairy in individuals ≥50 years old were calculated for 16 European countries. The overall prevalence rate of daily dairy product intake in Europe was 66.95% (CI95%: 66.28-67.63%). Global prevalence in men was 63.35% (CI95%:62.37-64.35%) and in women 69.80% (CI95%:68.86-70.71%). Among men, this type of intake was highest in Denmark (84.89% [CI95%: 79.11-90.66%]) and lowest in Poland (26.15% [CI95%: 22.71-29.58%]). Among women, the highest prevalence was found in Spain (89.51% [CI95%: 85.16-93.86%]) and the lowest in Poland (31.33% [CI95%: 27.05-35.61%]). The overall prevalence rate of dairy product intake less than once a week was 3.99% (CI95%: 3.83-4.16%). In terms of gender, men in Hungary (11.02% [CI95%: 9.16-12.89%]) and women in Slovenia (8.76% [CI95%: 7.26-10.25%]) had the lowest such intake. Dairy intake is very heterogeneous across Europe, with overall intake levels lower than recommended. Differences were also observed between genders, with a lower intake in men, and with age, with the intake lower in older individuals.
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http://dx.doi.org/10.1080/21551197.2019.1627972DOI Listing
April 2020

Prevalence of frailty status among the European elderly population: Findings from the Survey of Health, Aging and Retirement in Europe.

Geriatr Gerontol Int 2019 Aug 30;19(8):723-729. Epub 2019 May 30.

UCIBIO REQUIMTE, Porto4Ageing and Faculty of Pharmacy, University of Porto, Porto, Portugal.

Aim: In the present study, we aimed to update the data of frailty status in the European community-dwelling population of older adults, based on the latest data released (wave 6) of the Survey of Health, Aging and Retirement in Europe database, and to study the impact of each criterion on frailty assessment.

Methods: Frailty status was assessed applying a version of the Fried phenotype operationalized for the Survey of Health, Aging and Retirement in Europe. We included all participants who answered all the questions used in a frailty assessment and who disclosed their sex and, furthermore, who were aged ≥50 years. Our final sample was 60 816 individuals. Of these, the mean age was 67.45 ± 9.71 years; 38 497 (56.4%) were women.

Results: The overall prevalence of pre-frailty was 42.9% (ranging from 34.0% in Austria to 52.8% in Estonia), and frailty was 7.7% (ranging from 3.0% in Switzerland to 15.6% in Portugal). Pre-frailty and frailty prevalence increased along with age, and were more frequent among women. Regarding the five criteria considered on frailty assessment, exhaustion seems to be the criterion that contributes most to frailty status, followed by low activity, weakness, loss of appetite and slowness.

Conclusions: With this work, we showed that >50% of the European population aged >50 years are pre-frail/frail, which must be considered when designing interventions to reduce/postpone/mitigate the progression of this condition, thus reducing the burden associated with it. Geriatr Gerontol Int 2019; 19: 723-729.
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http://dx.doi.org/10.1111/ggi.13689DOI Listing
August 2019

2019 ARIA Care pathways for allergen immunotherapy.

Authors:
Jean Bousquet Oliver Pfaar Alkis Togias Holger J Schünemann Ignacio Ansotegui Nikolaos G Papadopoulos Ioanna Tsiligianni Ioana Agache Josep M Anto Claus Bachert Anna Bedbrook Karl-Christian Bergmann Sinthia Bosnic-Anticevich Isabelle Bosse Jan Brozek Moises A Calderon Giorgio W Canonica Luigi Caraballo Victoria Cardona Thomas Casale Lorenzo Cecchi Derek Chu Elisio Costa Alvaro A Cruz Wienczyslawa Czarlewski Stephen R Durham George Du Toit Mark Dykewicz Motohiro Ebisawa Jean Luc Fauquert Montserrat Fernandez-Rivas Wytske J Fokkens João Fonseca Jean-François Fontaine Roy Gerth van Wijk Tari Haahtela Susanne Halken Peter W Hellings Despo Ierodiakonou Tomohisa Iinuma Juan Carlos Ivancevich Lars Jacobsen Marek Jutel Igor Kaidashev Musa Khaitov Omer Kalayci Jörg Kleine Tebbe Ludger Klimek Marek L Kowalski Piotr Kuna Violeta Kvedariene Stefania La Grutta Désirée Larenas-Linemann Susanne Lau Daniel Laune Lan Le Karin Lodrup Carlsen Olga Lourenço Hans-Jørgen Malling Gert Marien Enrica Menditto Gregoire Mercier Joaquim Mullol Antonella Muraro Robyn O'Hehir Yoshitaka Okamoto Giovanni B Pajno Hae-Sim Park Petr Panzner Giovanni Passalacqua Nhan Pham-Thi Graham Roberts Ruby Pawankar Christine Rolland Nelson Rosario Dermot Ryan Bolesław Samolinski Mario Sanchez-Borges Glenis Scadding Mohamed H Shamji Aziz Sheikh Gunter J Sturm Ana Todo Bom Sanna Toppila-Salmi Maryline Valentin-Rostan Arunas Valiulis Erkka Valovirta Maria-Teresa Ventura Ulrich Wahn Samantha Walker Dana Wallace Susan Waserman Arzu Yorgancioglu Torsten Zuberbier

Allergy 2019 11 15;74(11):2087-2102. Epub 2019 Jul 15.

Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Comprehensive Allergy Centre, Member of GA2LEN, Humboldt-Uniersität zu Berlin, Berlin, Germany.

Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.
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http://dx.doi.org/10.1111/all.13805DOI Listing
November 2019

Mobile technology offers novel insights into the control and treatment of allergic rhinitis: The MASK study.

J Allergy Clin Immunol 2019 07 3;144(1):135-143.e6. Epub 2019 Apr 3.

MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France; University Hospital, Montpellier, France; INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and Public Health Approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, and Euforea, Brussels, Belgium. Electronic address:

Background: Mobile health can be used to generate innovative insights into optimizing treatment to improve allergic rhinitis (AR) control.

Objectives: A cross-sectional real-world observational study was undertaken in 22 countries to complement a pilot study and provide novel information on medication use, disease control, and work productivity in the everyday life of patients with AR.

Methods: A mobile phone app (Allergy Diary, which is freely available on Google Play and Apple stores) was used to collect the data of daily visual analogue scale (VAS) scores for (1) overall allergic symptoms; (2) nasal, ocular, and asthma symptoms; (3) work; and (4) medication use by using a treatment scroll list including all allergy medications (prescribed and over-the-counter) customized for 22 countries. The 4 most common intranasal medications containing intranasal corticosteroids and 8 oral H-antihistamines were studied.

Results: Nine thousand one hundred twenty-two users filled in 112,054 days of VASs in 2016 and 2017. Assessment of days was informative. Control of days with rhinitis differed between no (best control), single (good control for intranasal corticosteroid-treated days), or multiple (worst control) treatments. Users with the worst control increased the range of treatments being used. The same trend was found for asthma, eye symptoms, and work productivity. Differences between oral H-antihistamines were found.

Conclusions: This study confirms the usefulness of the Allergy Diary in accessing and assessing behavior in patients with AR. This observational study using a very simple assessment tool (VAS) on a mobile phone had the potential to answer questions previously thought infeasible.
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http://dx.doi.org/10.1016/j.jaci.2019.01.053DOI Listing
July 2019

Adherence to treatment in allergic rhinitis using mobile technology. The MASK Study.

Clin Exp Allergy 2019 04 12;49(4):442-460. Epub 2019 Mar 12.

MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France.

Background: Mobile technology may help to better understand the adherence to treatment. MASK-rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient-centred ICT system. A mobile phone app (the Allergy Diary) central to MASK is available in 22 countries.

Objectives: To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App.

Methods: An observational cross-sectional study was carried out on all users who filled in the Allergy Diary from 1 January 2016 to 1 August 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio (MPR) and the Proportion of days covered (PDC) approach.

Results: A total of 12 143 users were registered. A total of 6 949 users reported at least one VAS data recording. Among them, 1 887 users reported ≥7 VAS data. About 1 195 subjects were included in the analysis of adherence. One hundred and thirty-six (11.28%) users were adherent (MPR ≥70% and PDC ≤1.25), 51 (4.23%) were partly adherent (MPR ≥70% and PDC = 1.50) and 176 (14.60%) were switchers. On the other hand, 832 (69.05%) users were non-adherent to medications (MPR <70%). Of those, the largest group was non-adherent to medications and the time interval was increased in 442 (36.68%) users.

Conclusion And Clinical Relevance: Adherence to treatment is low. The relative efficacy of continuous vs on-demand treatment for allergic rhinitis symptoms is still a matter of debate. This study shows an approach for measuring retrospective adherence based on a mobile app. This also represents a novel approach for analysing medication-taking behaviour in a real-world setting.
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http://dx.doi.org/10.1111/cea.13333DOI Listing
April 2019

ARIA pharmacy 2018 "Allergic rhinitis care pathways for community pharmacy": AIRWAYS ICPs initiative (European Innovation Partnership on Active and Healthy Ageing, DG CONNECT and DG Santé) POLLAR (Impact of Air POLLution on Asthma and Rhinitis) GARD Demonstration project.

Authors:
Sinthia Bosnic-Anticevich Elisio Costa Enrica Menditto Olga Lourenço Ettore Novellino Slawomir Bialek Vitalis Briedis Roland Buonaiuto Henry Chrystyn Biljana Cvetkovski Stefania Di Capua Vicky Kritikos Alpana Mair Valentina Orlando Ema Paulino Johanna Salimäki Rojin Söderlund Rachel Tan Dennis M Williams Piotr Wroczynski Ioana Agache Ignacio J Ansotegui Josep M Anto Anna Bedbrook Claus Bachert Mike Bewick Carsten Bindslev-Jensen Jan L Brozek Giorgio Walter Canonica Victoria Cardona Warner Carr Thomas B Casale Niels H Chavannes Jaime Correia de Sousa Alvaro A Cruz Wienczyslawa Czarlewski Giuseppe De Carlo Pascal Demoly Philippe Devillier Mark S Dykewicz Mina Gaga Yehia El-Gamal João Fonseca Wytske J Fokkens Maria Antonieta Guzmán Tari Haahtela Peter W Hellings Maddalena Illario Juan Carlos Ivancevich Jocelyne Just Igor Kaidashev Musa Khaitov Nikolai Khaltaev Thomas Keil Ludger Klimek Marek L Kowalski Piotr Kuna Violeta Kvedariene Désirée E Larenas-Linnemann Daniel Laune Lan T T Le Karin C Lodrup Carlsen Bassam Mahboub Dieter Maier Joao Malva Patrick J Manning Mário Morais-Almeida Ralph Mösges Joaquim Mullol Lars Münter Ruth Murray Robert Naclerio Leyla Namazova-Baranova Kristof Nekam Tshipukane Dieudonné Nyembue Kimi Okubo Robyn E O'Hehir Ken Ohta Yoshitaka Okamoto Gabrielle L Onorato Susanna Palkonen Petr Panzner Nikolaos G Papadopoulos Hae-Sim Park Ruby Pawankar Oliver Pfaar Jim Phillips Davor Plavec Todor A Popov Paul C Potter Emmanuel P Prokopakis Regina E Roller-Wirnsberger Menachem Rottem Dermot Ryan Bolesław Samolinski Mario Sanchez-Borges Holger J Schunemann Aziz Sheikh Juan Carlos Sisul David Somekh Cristiana Stellato Teresa To Ana Maria Todo-Bom Peter Valentin Tomazic Sanna Toppila-Salmi Antonio Valero Arunas Valiulis Errka Valovirta Maria Teresa Ventura Martin Wagenmann Dana Wallace Susan Waserman Magnus Wickman Panayiotis K Yiallouros Arzu Yorgancioglu Osman M Yusuf Heather J Zar Mario E Zernotti Luo Zhang Mihaela Zidarn Torsten Zuberbier Jean Bousquet

Allergy 2019 07 30;74(7):1219-1236. Epub 2019 Apr 30.

MACVIA-France, Fondation Partenariale FMC VIA-LR, Montpellier, France.

Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.
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http://dx.doi.org/10.1111/all.13701DOI Listing
July 2019

Adherence to chronic medication in older populations: application of a common protocol among three European cohorts.

Patient Prefer Adherence 2018 5;12:1975-1987. Epub 2018 Oct 5.

Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Madrid, Spain.

Purpose: The purpose of this study was to evaluate and compare medication adherence to chronic therapies in older populations across different regions in Europe.

Methods: This explorative study applied a harmonized method of data extraction and analysis from pharmacy claims databases of three European countries to compare medication adherence at a cross-country level. Data were obtained for the period between January 1, 2010, and December 31, 2011. Patients (aged ≥65 years) who newly initiated to oral antidiabetics, antihyperlipidemics, or antiosteoporotics were identified and followed for over a 12-month period. Main outcome measures were medication adherence (medication possession ratio, [MPR]; implementation) and persistence on index treatment. All country-specific data sets were prepared by employing a common data input model. Outcome measures were calculated for each country and pooled using random effect models.

Results: In total, 39,186 new users were analyzed. In pooled data from the three countries, suboptimal implementation (MPR <80%) was 52.45% (95% CI: 33.43-70.79) for antihy-perlipidemics, 61.35% (95% CI: 52.83-69.22) for antiosteoporotics, and 30.33% (95% CI: 25.53-35.60) for oral antidiabetics. Similarly, rates of non-persistence (discontinuation) were 55.63% (95% CI: 35.24-74.29) for antihyperlipidemics, 60.24% (95% CI: 45.35-73.46) for antiosteoporotics, and 46.80% (95% CI: 36.40-57.4) for oral antidiabetics.

Conclusion: Medication adherence was suboptimal with >50% of older people non-adherent to antihyperlipidemics and antiosteoporotics in the three European cohorts. However, the degree of variability in adherence rates among the three countries was high. A harmonized method of data extraction and analysis across health-related database in Europe is useful to compare medication-taking behavior at a cross-country level.
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http://dx.doi.org/10.2147/PPA.S164819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179242PMC
October 2018

Allergic Rhinitis and its Impact on Asthma (ARIA) Phase 4 (2018): Change management in allergic rhinitis and asthma multimorbidity using mobile technology.

Authors:
Jean Bousquet Peter W Hellings Ioana Agache Flore Amat Isabella Annesi-Maesano Ignacio J Ansotegui Josep M Anto Claus Bachert Eric D Bateman Anna Bedbrook Kazi Bennoor Mickael Bewick Carsten Bindslev-Jensen Sinthia Bosnic-Anticevich Isabelle Bosse Jan Brozek Luisa Brussino Giorgio W Canonica Victoria Cardona Thomas Casale Alfonso M Cepeda Sarabia Niels H Chavannes Lorenzo Cecchi Jaime Correia de Sousa Elisio Costa Alvaro A Cruz Wienczyslawa Czarlewski Giuseppe De Carlo Giulia De Feo Pascal Demoly Philippe Devillier Mark S Dykewicz Yehia El-Gamal Esben E Eller Joao A Fonseca Jean-François Fontaine Wytske J Fokkens Maria-Antonieta Guzmán Tari Haahtela Maddalena Illario Juan-Carlos Ivancevich Jocelyne Just Igor Kaidashev Musa Khaitov Omer Kalayci Thomas Keil Ludger Klimek Marek L Kowalski Piotr Kuna Violeta Kvedariene Desiree Larenas-Linnemann Daniel Laune Lan T T Le Karin Lodrup Carlsen Olga Lourenço Bassam Mahboub Alpana Mair Enrica Menditto Branislava Milenkovic Mario Morais-Almeida Ralph Mösges Joaquim Mullol Ruth Murray Robert Naclerio Leyla Namazova-Baranova Ettore Novellino Robyn E O'Hehir Ken Ohta Yoshitaka Okamoto Kimi Okubo Gabrielle L Onorato Susanna Palkonen Petr Panzner Nikos G Papadopoulos Hae-Sim Park Ema Paulino Ruby Pawankar Oliver Pfaar Davor Plavec Ted A Popov Paul Potter Emmanuel P Prokopakis Menachem Rottem Dermot Ryan Johanna Salimäki Boleslaw Samolinski Mario Sanchez-Borges Holger J Schunemann Aziz Sheikh Juan-Carlos Sisul Rojin Rajabian-Söderlund Talant Sooronbaev Cristiana Stellato Teresa To Ana-Maria Todo-Bom Peter-Valentin Tomazic Sanna Toppila-Salmi Antonio Valero Arunas Valiulis Erkka Valovirta Maria-Teresa Ventura Martin Wagenmann De Yun Wang Dana Wallace Susan Waserman Magnus Wickman Arzu Yorgancioglu Luo Zhang Nanshan Zhong Mihaela Zidarn Torsten Zuberbier

J Allergy Clin Immunol 2019 03 29;143(3):864-879. Epub 2018 Sep 29.

Comprehensive Allergy Center Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, and Global Allergy and Asthma European Network (GA2LEN), Berlin, Germany.

Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional.
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http://dx.doi.org/10.1016/j.jaci.2018.08.049DOI Listing
March 2019

Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe.

Arch Gerontol Geriatr 2018 Sep - Oct;78:213-220. Epub 2018 Jun 30.

UCIBIO, REQUIMTE and Faculty of Pharmacy, University of Porto, Porto, Portugal. Electronic address:

Polypharmacy, a common condition among the elderly, is associated with adverse outcomes, including increased healthcare costs, due to higher mortality, falls and hospitalizations rates, adverse drug reactions, drug-drug reactions and medication nonadherence. This study aims to evaluate the prevalence and factors related to polypharmacy in older adults across 17 European countries, plus Israel. In this cross-sectional analysis, we used data from participants aged 65 or more years from Wave 6 of the Survey of Health, Ageing, and Retirement in Europe (SHARE) database. Polypharmacy was defined as the concurrent use of five or more medications. Age, gender, education, physical inactivity, number of limitations with activities of daily living, network satisfaction, quality of life, depression, number of chronic diseases and difficulty taking medication variables were found to be associated with polypharmacy. Our results showed a prevalence of polypharmacy ranging from 26.3 to 39.9%. Switzerland, Croatia and Slovenia were the countries with the lowest prevalence, whereas Portugal, Israel and the Czech Republic were the countries where the prevalence of polypharmacy was the highest. Age, gender, number of limitations with activities of daily living, number of chronic diseases, quality of life, depression, physical inactivity, network satisfaction, difficulty in taking medications, years of education and shortage of money were significant variables associated with polypharmacy. Polypharmacy is a highly prevalent condition in the elderly population. Identification of variables associated with polypharmacy, such as those identified in this study, is important to identify and monitor elderly groups, which are most vulnerable to polypharmacy.
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http://dx.doi.org/10.1016/j.archger.2018.06.018DOI Listing
April 2019

Nutritional, chemical and antioxidant/pro-oxidant profiles of silverskin, a coffee roasting by-product.

Food Chem 2018 Nov 21;267:28-35. Epub 2017 Mar 21.

REQUIMTE/LAQV, Department of Chemical Sciences, Faculty of Pharmacy of University of Porto, R. Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal. Electronic address:

Coffee silverskin (a coffee roasting by-product) contains high amounts of dietary fibre (49% insoluble and 7% soluble) and protein (19%). Potassium (∼5g/100g), magnesium (2g/100g) and calcium (0.6g/100g) are the major macrominerals. The vitamin E profile of silverskin comprises α-tocopherol, β-tocopherol, ɣ-tocopherol, δ-tocopherol, β-tocotrienol, ɣ-tocotrienol, and δ-tocotrienol. The fatty acid profile is mainly saturated (C16:0 and C22:0), but the total amount of fat is low (2.4%). Caffeine (1.25g/100g), chlorogenic acid (246mg/100g), and 5-hydroxymethylfurfural (5.68mg/100g) are also present in silverskin. Total phenolics and flavonoids are partially responsible for the in vitro antioxidant activity. Silverskin extracts protected erythrocytes from oxidative AAPH- and HO-induced hemolysis, but at high concentrations a pro-oxidant effect on erythrocyte morphology was observed.
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http://dx.doi.org/10.1016/j.foodchem.2017.03.106DOI Listing
November 2018

A cornerstone of healthy aging: do we need to rethink the concept of adherence in the elderly?

Patient Prefer Adherence 2018 11;12:1003-1005. Epub 2018 Jun 11.

Elísio Costa, UCIBIO-REQUIMTE, Faculty of Pharmacy and Porto4Ageing EIP-AHA Reference Site, University of Porto, Porto, Portugal.

Worldwide, the population is aging and this trend will increase in the future due to medical, technological and scientific advancements. To take care of the elderly is highly demanding and challenging for the health care system due to their frequent condition of chronicity, multimorbidity and the consequent complex management of polypharmacy. Nonadherence to medications and to medical plans is a well-recognized public health problem and a very urgent issue in this population. For this reason, some considerations to identify a new shared approach to integrated care of older people are described. The concept of adherence should be considered as a complex and continuous process where family, caregivers and patients' beliefs come into play. Moreover, a new culture of adherence should contemplate the complexity of multimorbidity, as well as the necessity to renegotiate the medication regimen on the basis of each patient's needs.
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http://dx.doi.org/10.2147/PPA.S164686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001841PMC
June 2018

Vascular biosafety of commercial hydroxyapatite particles: discrepancy between blood compatibility assays and endothelial cell behavior.

J Nanobiotechnology 2018 Mar 22;16(1):27. Epub 2018 Mar 22.

Faculdade de Medicina Dentária, U. Porto, Rua Dr. Manuel Pereira da Silva, 4200-393, Porto, Portugal.

Background: Vascular homeostasis is ensured by a dynamic interplay involving the endothelium, the platelets and the coagulation system. Thus, the vascular safety of particulate materials must address this integrated system, an approach that has been largely neglected. This work analysed the effects of commercial hydroxyapatite (HA) particles in blood compatibility and in endothelial cell behavior, due to their clinical relevance and scarcity of data on their vascular biosafety.

Results: Particles with similar chemical composition and distinct size and morphology were tested, i.e. rod-like, nano dimensions and low aspect ratio (HAp1) and needle-shape with wider size and aspect ratio (HAp2). HAp1 and HAp2, at 1 to 10 mg/mL, did not affect haemolysis, platelet adhesion, aggregation and activation, or the coagulation system (intrinsic and extrinsic pathways), although HAp2 exhibited a slight thrombogenic potential at 10 mg/mL. Notwithstanding, significantly lower levels presented dose-dependent toxicity on endothelial cells' behavior. HAp1 and HAp2 decreased cell viability at levels ≥ 250 and ≥ 50 μg/mL, respectively. At 10 and 50 μg/mL, HAp1 did not interfere with the F-actin cytoskeleton, apoptotic index, cell cycle progression, expression of vWF, VECad and CD31, and the ability to form a network of tubular-like structures. Comparatively, HAp2 caused dose-dependent toxic effects in these parameters in the same concentration range.

Conclusion: The most relevant observation is the great discrepancy of HA particles' levels that interfere with the routine blood compatibility assays and the endothelial cell behavior. Further, this difference was also found to be dependent on the particles' size, morphology and aspect ratio, emphasizing the need of a complementary biological characterization, taking into consideration the endothelial cells' functionality, to establish the vascular safety of particulate HA.
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http://dx.doi.org/10.1186/s12951-018-0357-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863823PMC
March 2018