Publications by authors named "Rute Almeida"

18 Publications

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Profiling Persistent Asthma Phenotypes in Adolescents: A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies.

Int J Environ Res Public Health 2021 Jan 24;18(3). Epub 2021 Jan 24.

Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.

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 ( = 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 ( = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 ( = 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 ( = 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 ( < 0.001). Class 3 ( = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month ( = 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.
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http://dx.doi.org/10.3390/ijerph18031015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908090PMC
January 2021

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

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts.

BMJ Open 2019 11 7;9(11):e031732. Epub 2019 Nov 7.

Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal

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 (FEV) 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 (r=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R=44%).

Conclusion: Although both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.
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http://dx.doi.org/10.1136/bmjopen-2019-031732DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858182PMC
November 2019

High oral corticosteroid exposure and overuse of short-acting beta-2-agonists were associated with insufficient prescribing of controller medication: a nationwide electronic prescribing and dispensing database analysis.

Clin Transl Allergy 2019 23;9:47. Epub 2019 Sep 23.

1CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.

Background: Recurrent use of oral corticosteroids (OCS) and over-use of short-acting beta-2-agonists (SABA) are factors associated with adverse side effects and asthma-related death. We aim to quantify high OCS exposure, SABA over-use and its association with prescription and adherence to maintenance treatment for respiratory disease, among patients with prescriptions for respiratory disease, from the Portuguese electronic prescription and dispensing database (BDNP).

Methods: This was a 1-year (2016) retrospective population-based analysis of a random sample of adult patients from the BDNP, the nationwide compulsory medication prescription system. We assessed high OCS exposure (dispensing ≥ 4 packages containing 20 doses of 20 mg each of prednisolone-equivalent, ≥ 1600 mg/year) on patients on persistent respiratory treatment (PRT-prescription for > 2 packages of any respiratory maintenance medications). Excessive use of SABA was defined as having a ratio of SABA-to-maintenance treatment > 1 or having SABA over-use (dispensing of > 1 × 200 dose canister/month, of 100 μg of salbutamol-equivalent). Factors associated with high OCS exposure were assessed by multinomial logistic regression.

Results: The estimated number of patients on PRT was 4786/100,000 patients. OCS was prescribed to more than 1/5 of the patients on PRT and 101/100,000 were exposed to a high-dose (≥ 1600 mg/year). SABA excessive use was found in 144/100,000 patients and SABA over-use in 24/100,000. About 1/6 of SABA over-users were not prescribed any controller medication and 7% of them had a ratio maintenance-to-total ≥ 70% (high prescription of maintenance treatment). Primary adherence (median%) to controller medication was 66.7% for PRT patients, 59.6% for patients exposed to high OCS dose and 75.0% for SABA over-users. High OCS exposure or SABA over-use were not associated with primary adherence. High OCS exposure was associated with a maintenance-to-total medication ratio < 70% (insufficient prescription of maintenance treatment), age > 45 years old and male sex.

Conclusions: Exposure to high-dose of OCS (101 per 100,000 patients) and SABA over-use (24 per 100,000) were frequent, and were associated with a low maintenance-to-total prescription ratio but not with primary non-adherence. These results suggest there is a need for initiatives to reduce OCS and SABA inappropriate prescribing.
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http://dx.doi.org/10.1186/s13601-019-0286-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755705PMC
September 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

Newly undergraduate nurses and intensive care in units of non-critical patients.

Rev Bras Enferm 2019 Feb;72(suppl 1):243-251

Universidade Federal do Rio de Janeiro, Anna Nery Nursing School. Rio de Janeiro, Rio de Janeiro, Brazil.

Objective: To identify the social representations of newly undergraduate nurses on the intensive care of Nursing to critical patients hospitalized in non-critical patient units.

Method: Qualitative and descriptive research. Twenty-six newly undergraduate nurses from a private university participated. An in-depth interview was conducted with semi-structured script. The analysis was of lexical type with the help of Alceste 2012 software.

Results: The social representations were built according to the image of the intensive care unit, although patients were out of this environment. Care is understood as complex and specialized, requiring graduate training. Therefore, undergraduation training was considered insufficient to provide this type of care, creating fear and insecurity in the newly undergraduate nurses.

Final Considerations: Intensive care confronts newly undergraduate nurses with feelings of unpreparedness to care for, but it mobilizes to broaden the knowledge to provide care. There is evidence of a theory-practice dichotomy and weaknesses in teaching-learning experiences in undergraduate education.
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http://dx.doi.org/10.1590/0034-7167-2017-0713DOI Listing
February 2019

Disentangling the heterogeneity of allergic respiratory diseases by latent class analysis reveals novel phenotypes.

Allergy 2019 04 5;74(4):698-708. Epub 2018 Dec 5.

CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.

Background: Refined phenotyping of allergic diseases may unravel novel phenotypes. Conjunctivitis as an independent disorder has never been approached.

Aim: To identify distinct classes of allergic respiratory diseases using latent class analysis (LCA) and distinguish each class using classification and regression tree (CART) analysis.

Methods: Seven hundred and twenty-eight adults from the Portuguese general population study ICAR had a structured medical interview combined with blood collection, skin prick tests, spirometry with bronchodilation, and exhaled nitric oxide. LCA was applied to 19 variables. The CART algorithm selected the most likely variables distinguishing LCA-classes.

Results: A six-class model was obtained. Class 1 (25%): nonallergic participants without bronchial or ocular symptoms. Classes 2 (22%) and 3 (11%): nasal and ocular (low levels) symptoms without nasal impairment, monosensitized (Class 2) or polysensitized (Class 3). Class 4 (13%): polysensitized participants with high levels of nasal and ocular symptoms, and nasal impairment. Classes 5 (16%) and 6 (14%): high level of nasal, bronchial and ocular symptoms with nasal impairment (non-allergic or polysensitized, respectively). Participants in classes 5 and 6 had more bronchial exacerbations and unscheduled medical visits (P < 0.001). Ocular symptoms were significantly higher in classes with nasal impairment, compared to those without impairment (P < 0.001) or no nasal symptom (P < 0.001). CART highlighted ocular symptoms as the most relevant variable in distinguishing LCA-classes.

Conclusion: Novel severe phenotypes of participants with co-occurrence of ocular, nasal and bronchial symptoms, and exacerbation-prone were identified. The tree algorithm showed the importance of the ocular symptoms in the expression of allergic diseases phenotypes.
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http://dx.doi.org/10.1111/all.13670DOI Listing
April 2019

How the Smartphone Is Changing Allergy Diagnostics.

Curr Allergy Asthma Rep 2018 10 25;18(12):69. Epub 2018 Oct 25.

Allergy Unit, Instituto and Hospital CUF, Porto, Portugal.

Purpose Of Review: Evidence-based clinical diagnosis of allergic disorders is increasingly challenging. Clinical decision support systems implemented in mobile applications (apps) are being developed to assist clinicians in diagnostic decisions at the point of care. We reviewed apps for allergic diseases general diagnosis, diagnostic refinement and diagnostic personalisation. Apps designed for specific medical devices are not addressed.

Recent Findings: Apps with potential usefulness in the initial diagnosis and diagnostic refinement of respiratory, food, skin and drug allergies are described. Apps to support diagnostic personalisation are not yet available. There is an urgent need to increase the scientific evidence on the real usefulness of these apps, as well as to develop new scientifically grounded apps designed and validated to support all allergic diseases and diagnostic levels. Apps have the potential to change the diagnosis of allergic diseases becoming part of the routine diagnostics toolset, but its usefulness needs to be established.
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http://dx.doi.org/10.1007/s11882-018-0824-4DOI Listing
October 2018

Adult Asthma Scores-Development and Validation of Multivariable Scores to Identify Asthma in Surveys.

J Allergy Clin Immunol Pract 2019 01 18;7(1):183-190.e6. Epub 2018 Jul 18.

CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal. Electronic address:

Background: One of the questions in epidemiology is the identification of adult asthma in studies.

Objective: To develop and validate multivariable scores for adult asthma identification in epidemiological studies and to explore cutoffs to rule in/rule out asthma, compared with asthma diagnosed by a physician after clinical examination and diagnostic tests, blinded to the self-administered questions.

Methods: We analyzed data (n = 711 adults) from a nationwide population-based study. The predictors were self-administered questions identified in a literature review (the Adult Asthma Epidemiological Score [A2 score]) and from the Global Allergy and Asthma Network of Excellence (GA2LEN) questionnaire (the GA2LEN Asthma Epidemiological Score [GA2LEN score]). Scores were developed using exploratory factor analysis. Internal consistency, discriminative power, and diagnostic accuracy were assessed.

Results: The A2 score comprises 8 questions (including "Did a physician confirm you had asthma?") and the GA2LEN score comprises 6 questions (including "Have you ever had asthma?"). Both had high Cronbach α (0.89 and 0.85, respectively, for the A2 score and the GA2LEN score) and good area under the receiver-operating characteristic curve (90.4% and 89.0%). The scoring is the sum of positive answers. Asthma is present (rule in) for scores of 4 or more (specificity, 99.2%; PPV, 93.3% and 91.7%; accuracy, 89.4% and 87.4%, respectively, for the A2 score and the GA2LEN score). Asthma is excluded (rule out) for A2 scores of 0 to 1 and a GA2LEN score of 0 (sensitivity, 93.1%; NPV, 98.2% and 98.0%; accuracy 89.4% and 82.8%, respectively, for the A2 score and the GA2LEN score).

Conclusions: These practical scores can be used to rule in/rule out asthma in epidemiological studies and clinical screening/triage settings. They may help physicians in primary care or other specialties to screen patients with asthma using a simple score with a high level of discrimination and to identify the best candidates to be referred for a diagnostic workup. Moreover, their use may contribute to reducing the inconsistencies of operational definitions of asthma across studies and surveys.
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http://dx.doi.org/10.1016/j.jaip.2018.06.024DOI Listing
January 2019

Implant Stability in the Posterior Maxilla: A Controlled Clinical Trial.

Biomed Res Int 2017 25;2017:6825213. Epub 2017 May 25.

Department of Oral Surgery, Faculty of Dental Medicine, University of Porto, Rua Manuel Pereira da Silva, 4200-393 Porto, Portugal.

Aim: To evaluate the primary and secondary stability of implants in the posterior maxilla.

Methods: Patients were allocated into three groups: (A) native bone, (B) partially regenerated bone, and (C) nearly totally regenerated bone. Insertion torque (IT) and implant stability quotient (ISQ) were measured at placement, to evaluate whether satisfactory high primary stability (IT ≥ 45 N/cm; ISQ ≥ 60) was achieved; ISQ was measured 15, 30, 45, and 60 days after placement, to investigate the evolution to secondary stability.

Results: 133 implants (Anyridge®, Megagen) were installed in 59 patients: 55 fixtures were placed in Group A, 57 in Group B, and 21 in Group C. Fifty-two implants had satisfactory high primary stability (IT ≥ 45 N/cm; ISQ ≥ 60). A positive correlation was found between all variables (IT, ISQ at = 0, = 60), and statistically higher IT and ISQ values were found for implants with satisfactory high primary stability. Significant differences were found for IT and ISQ between the groups (A, B, and C); however, no drops were reported in the median ISQ values during the healing period.

Conclusions: The evaluation of the primary and secondary implant stability may contribute to higher implant survival/success rates in critical areas, such as the regenerated posterior maxilla. The present study is registered in the ISRCTN registry with ID ISRCTN33469250.
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http://dx.doi.org/10.1155/2017/6825213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463151PMC
March 2018

Validation of Heart Rate Monitor Polar RS800 for Heart Rate Variability Analysis During Exercise.

J Strength Cond Res 2018 Mar;32(3):716-725

Biomedical Signal Interpretation & Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain.

Hernando, D, Garatachea, N, Almeida, R, Casajús, JA, and Bailón, R. Validation of heart rate monitor Polar RS800 for heart rate variability analysis during exercise. J Strength Cond Res 32(3): 716-725, 2018-Heart rate variability (HRV) analysis during exercise is an interesting noninvasive tool to measure the cardiovascular response to the stress of exercise. Wearable heart rate monitors are a comfortable option to measure interbeat (RR) intervals while doing physical activities. It is necessary to evaluate the agreement between HRV parameters derived from the RR series recorded by wearable devices and those derived from an electrocardiogram (ECG) during dynamic exercise of low to high intensity. Twenty-three male volunteers performed an exercise stress test on a cycle ergometer. Subjects wore a Polar RS800 device, whereas ECG was also recorded simultaneously to extract the reference RR intervals. A time-frequency spectral analysis was performed to extract the instantaneous mean heart rate (HRM), and the power of low-frequency (PLF) and high-frequency (PHF) components, the latter centered on the respiratory frequency. Analysis was done in intervals of different exercise intensity based on oxygen consumption. Linear correlation, reliability, and agreement were computed in each interval. The agreement between the RR series obtained from the Polar device and from the ECG is high throughout the whole test although the shorter the RR is, the more differences there are. Both methods are interchangeable when analyzing HRV at rest. At high exercise intensity, HRM and PLF still presented a high correlation (ρ > 0.8) and excellent reliability and agreement indices (above 0.9). However, the PHF measurements from the Polar showed reliability and agreement coefficients around 0.5 or lower when the level of the exercise increases (for levels of O2 above 60%).
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http://dx.doi.org/10.1519/JSC.0000000000001662DOI Listing
March 2018

University students' attitudes toward same-sex parenting and gay and lesbian rights in Portugal.

J Homosex 2014 ;61(12):1667-86

a University of Beira Interior , Lisbon , Portugal.

The purpose of this study was to explore university students' attitudes toward same-sex parenting and toward gay and lesbian rights. A total of 292 participants, aged between 18 and 27 (M = 21) responded to a questionnaire measuring attitudes toward parenting by gay men and lesbians, gay and lesbian rights, and beliefs about the etiology of homosexuality. Results revealed that the majority of students were against gay and lesbian parenting, gay and lesbian equal rights, and believed that homosexuality has a social/environmental basis. It was found that sexual prejudice is highly prevalent in Portuguese university students, and implications of these findings are discussed.
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http://dx.doi.org/10.1080/00918369.2014.951253DOI Listing
June 2015

Fetal QRS detection and heart rate estimation: a wavelet-based approach.

Physiol Meas 2014 Aug 29;35(8):1723-35. Epub 2014 Jul 29.

Centro de Matemática da Universidade do Porto (CMUP), Faculdade de Ciências, Rua do Campo Alegre, 687, 4169-007 Porto, Portugal. The Biomedical Research Networking center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Aragón, Spain. BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Aragón, Spain Zaragoza, Spain.

Fetal heart rate monitoring is used for pregnancy surveillance in obstetric units all over the world but in spite of recent advances in analysis methods, there are still inherent technical limitations that bound its contribution to the improvement of perinatal indicators. In this work, a previously published wavelet transform based QRS detector, validated over standard electrocardiogram (ECG) databases, is adapted to fetal QRS detection over abdominal fetal ECG. Maternal ECG waves were first located using the original detector and afterwards a version with parameters adapted for fetal physiology was applied to detect fetal QRS, excluding signal singularities associated with maternal heartbeats. Single lead (SL) based marks were combined in a single annotator with post processing rules (SLR) from which fetal RR and fetal heart rate (FHR) measures can be computed. Data from PhysioNet with reference fetal QRS locations was considered for validation, with SLR outperforming SL including ICA based detections. The error in estimated FHR using SLR was lower than 20 bpm for more than 80% of the processed files. The median error in 1 min based FHR estimation was 0.13 bpm, with a correlation between reference and estimated FHR of 0.48, which increased to 0.73 when considering only records for which estimated FHR > 110 bpm. This allows us to conclude that the proposed methodology is able to provide a clinically useful estimation of the FHR.
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http://dx.doi.org/10.1088/0967-3334/35/8/1723DOI Listing
August 2014

Microgravity effects on ventricular response to heart rate changes.

Annu Int Conf IEEE Eng Med Biol Soc 2012 ;2012:3424-7

Communications Technology Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain. jbolea@lagunaat unizar.es

The effect of simulated microgravity on ventricular repolarization (VR) has been evaluated on healthy volunteers by a 5-day Head Down (-6°) Bed Rest (HDBR) maneuver. QT to RR and QT(p) (measured until the peak of the T wave) to RR hystereses have been measured during a tilt table test, and differences between them have been studied to better understand possible changes in the final part of the repolarization. To characterize the hystereses, two indices have been computed: M(90), quantifying adaptation lag in beats, and α evaluating the slope of parabolic regression fitting. Significant differences between QT and QT(p) were found before, but not after HDBR. Specifically, before HDBR was considerable lower for QT(p) than for QT, while α was significantly higher. After HDBR, M(90) and a took essentially the same values for QT and QT(p). This fact evidenced the different effect of HDBR on QT to RR and QT(p) to RR adaptations, and suggest HDBR could lead to an impairment in ventricular repolarization dispersion.
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http://dx.doi.org/10.1109/EMBC.2012.6346701DOI Listing
July 2013

Respiration effect on wavelet-based ECG T-wave end delineation strategies.

IEEE Trans Biomed Eng 2012 Jul 27;59(7):1818-28. Epub 2011 May 27.

Communications and Electronical Department, Oriente University, Santiago de Cuba 90400, Cuba.

The main purpose of this paper is to study the influence of the mechanical effect of respiration over the T-wave end delineation. We compared the performance of an automatic delineation system based on the wavelet transform (WT), considering single lead (SL), global delineation locations obtained from SL annotations (SLR), and multilead (ML) approaches. The linear relation between the variations on T-wave end locations obtained with each of the methods and the mechanical effect of respiration was quantified using spectral coherence and ARARX modeling both in simulated signals and in real data. We also explored the evolution of the vectorcardiographic spatial loop using the projection on the main direction of the WT in the region close to the T-wave end ( T(e)) and its relation with respiration. The dispersion of the additional T-wave end location error due to respiration was reduced by 15% using SLR with respect to SL, while ML allows for a reduction of around 40%. The percentage of that error correlated with respiration was in average 99% using SL while 82% and 72% using SLR and ML, respectively. Thus, results suggest that ML is the most adequate strategy for T-wave delineation, allowing the reduction of the instability of T-wave end location caused by respiration.
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http://dx.doi.org/10.1109/TBME.2011.2157824DOI Listing
July 2012

Multilead ECG delineation using spatially projected leads from wavelet transform loops.

IEEE Trans Biomed Eng 2009 Aug 12;56(8):1996-2005. Epub 2009 May 12.

Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain.

In this paper, a novel multilead (ML) based automatic strategy for delineation of ECG boundaries is proposed and evaluated with respect to the QRS and T-wave boundaries. The ML strategy is designed from a single-lead (SL) wavelet-transform-based delineation system. It departs from three orthogonal leads and takes advantage of the spatial information provided using a derived lead better fitted for delineation. SL delineation is then applied over this optimal derived lead. The ML strategy produces a reduced error dispersion compared to SL results, thus providing more robust, accurate, and stable boundary locations than any electrocardiographic lead by itself and outperforming strategies based on lead selection rules after SL delineation.
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http://dx.doi.org/10.1109/TBME.2009.2021658DOI Listing
August 2009

QT variability and HRV interactions in ECG: quantification and reliability.

IEEE Trans Biomed Eng 2006 Jul;53(7):1317-29

Departamento de Matemática Aplicada, Faculdade de Ciências da Universidade do Porto and Centro de Matemática da UP, Rua Campo Alegre 687, 4169-007 Porto, Portugal.

In this paper, a dynamic linear approach was used over QT and RR series measured by an automatic delineator, to explore the interactions between QT interval variability (QTV) and heart rate variability (HRV). A low-order linear autoregressive model allowed to separate and quantify the QTV fractions correlated and not correlated with HRV, estimating their power spectral density measures. Simulated series and artificial ECG signals were used to assess the performance of the methods, considering a respiratory-like electrical axis rotation effect and noise contamination with a signal-to-noise ratio (SNR) from 30 to 10 dB. The errors found in the estimation of the QTV fraction related to HRV showed a nonrelevant performance decrease from automatic delineation. The joint performance of delineation plus variability analysis achieved less than 20% error in over 75% of cases for records presenting SNRs higher than 15 dB and QT standard deviation higher than 10 ms. The methods were also applied to real ECG records from healthy subjects where it was found a relevant QTV fraction not correlated with HRV (over 40% in 19 out of 23 segments analyzed), indicating that an important part of QTV is not linearly driven by HRV and may contain complementary information.
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http://dx.doi.org/10.1109/TBME.2006.873682DOI Listing
July 2006

A wavelet-based ECG delineator: evaluation on standard databases.

IEEE Trans Biomed Eng 2004 Apr;51(4):570-81

Communications Technology Group, Aragon Institute of Engineering Research, University of Zaragoza, Maria de Luna, 1, 50015 Zaragoza, Spain.

In this paper, we developed and evaluated a robust single-lead electrocardiogram (ECG) delineation system based on the wavelet transform (WT). In a first step, QRS complexes are detected. Then, each QRS is delineated by detecting and identifying the peaks of the individual waves, as well as the complex onset and end. Finally, the determination of P and T wave peaks, onsets and ends is performed. We evaluated the algorithm on several manually annotated databases, such as MIT-BIH Arrhythmia, QT, European ST-T and CSE databases, developed for validation purposes. The QRS detector obtained a sensitivity of Se = 99.66% and a positive predictivity of P+ = 99.56% over the first lead of the validation databases (more than 980,000 beats), while for the well-known MIT-BIH Arrhythmia Database, Se and P+ over 99.8% were attained. As for the delineation of the ECG waves, the mean and standard deviation of the differences between the automatic and manual annotations were computed. The mean error obtained with the WT approach was found not to exceed one sampling interval, while the standard deviations were around the accepted tolerances between expert physicians, outperforming the results of other well known algorithms, especially in determining the end of T wave.
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http://dx.doi.org/10.1109/TBME.2003.821031DOI Listing
April 2004