Rute Almeida

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Papers by Rute Almeida

From MASK-air® and SILAM to CATALYSE (Climate Action to Advance HeaLthY Societies in Europe)

Journal of Investigational Allergology and Clinical Immunology

Table 2. Maturity level of MASK-air® (modified from 1 ). Rhinitis platform TRL* Asthma platform T... more Table 2. Maturity level of MASK-air® (modified from 1 ). Rhinitis platform TRL* Asthma platform TRL App for rhinitis and asthma (MASK-air ® ): 28 countries, 17 languages, >50,000 users 9 19-21 Adaptation of the MASK-air app for severe asthma: DHE SA-TWINNING 8 PROMs for rhinitis 9 PROMS for asthma 9 22 CARAT questionnaire for screening and control of rhinitis and asthma, 20 countries 9 23-26 The same questionnaire will be used 9 23-25 e-physician questionnaire for rhinitis (available on the MASK-air website) deployed in 28 countries and 17 languages 9 27

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Delineación Wavelet-Multiderivación De Ecg y Su Relación Con La Respiración

MOESM3 of 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

Additional file 3: Table S3. Frequency of patients by number of SABA canisters dispensed in one-y... more

Quality assessment and feedback of Smart Device Microphone Spirometry executed by children

2019 IEEE 6th Portuguese Meeting on Bioengineering (ENBENG), 2019

Smart device microphone spirometry, based on the audio recording of forced expiratory maneuver (F... more Smart device microphone spirometry, based on the audio recording of forced expiratory maneuver (FEM), can be a simple, ubiquitous and easy tool for patients to self-monitor their asthma. Automatic validity assessment is crucial to guarantee that the global effort of the FEM fulfil the admissible minimum or if the maneuver needs to be repeated. In this work an automatic method to classify the sounds from FEM with respect to global effort was developed and evaluated using data from 54 children (5-10 years). The method proposed was able to correctly classify the microphone spirometry with respect to admissible minimum of effort with an accuracy of 86% (specificity 87% and sensitivity 86%). This method can be used to provide immediate feedback of the correct execution of the maneuver, improving the clinical value and utility of this self-monitoring tool.

mHealth to Securely Coach Chronic Patients

Engagement with an asthma app to monitor medication adherence and its association with patients’ characteristics

m-Health/e-health, 2021

A comparison of unsupervised methods based on dichotomous data to identify clusters of airways symptoms: latent class analysis and partitioning around medoids methods

Monitoring Airway Disease, 2018

Latent class analysis (LCA) and partitioning around medoids (PAM) are popular data-driven methods... more Latent class analysis (LCA) and partitioning around medoids (PAM) are popular data-driven methods for partitioning objects based on dichotomous data, remaining not clear which is better for large epidemiological datasets. Hence, we compared these methods in the identification of clusters of subjects with airways symptoms, using a large population-based data from the U.S. National Health and Nutrition Examination Surveys (NHANES).info:eu-repo/semantics/publishedVersio

Forecasting the local risk for asthma hospitalizations from georeferenced environmental data – a pilot model

Occupational and Environmental Health, 2017

Meteorological conditions and air pollutants, such as high air temperatures, low vegetation densi... more Meteorological conditions and air pollutants, such as high air temperatures, low vegetation density and high atmospheric nitrogen dioxide levels are positively correlated with Asthma Hospital Admissions (AHA). However, the predictive value of these environmental factors for AHA is yet to be established. Our aim was to forecast the risk of AHA for the municipalities of Lisbon metropolitan area based on environmental factors. National (public) Health Service AHA in Lisbon (Portugal) in [2003,2008] were used, representing about 25% of the total AHA in the country. Monthly averages of air temperature, index vegetation and nitrogen dioxide in [2003,2008] from each of the 16 municipalities of Lisbon were used in linear discriminant analysis to classify combinations of months/municipalities as having or not having admissions (classes 1 and 0). Data from the periods of [2003,2007] and 2008 were used as training and test sets, respectively, with the former based on monthly 5-years based averages. A 24% apparent error rate, the misclassification error based on the training data, was found (Table 1), with 73% of accuracy in the testing set. We were able to identify correctly ~2/3 (sensitivity) of the combinations with AHA, with less than 10% of false positives (positive predictivity). This pilot model exhibited good ability to predict AHA, suggesting that georeferenced environmental data have great potential to be included in guided self-management tools to predict risk of asthma exacerbations in the near future.

Estudo exploratório das qualidades psicométricas da escala de competências sociais (EHS)

Laboratório de Psicologia, 2013

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A parametric model approach for quantification of short term QT variability uncorrelated with heart rate variability

In this work we propose to assess the relation between HRV and QTV measured by an automatic delin... more In this work we propose to assess the relation between HRV and QTV measured by an automatic delineator. A low order linear autoregressive model on RR versus QT interactions was used to explore short term relations and quantify the fractions of QTV correlated and not correlated with HRV. Power spectral density measures were estimated from the total QTV and from the two separated fractions using the proposed model. Simulated RR and QT series were used to quantify the error bounds associated to the method performance. ECG records of young normal subjects were processed to obtain the RR and QT series. The high QTV fraction not correlated with RR found i n these records (over 40% in 98% of the segments) indicates that an important part of QTV can be driven by other factors rather than by heart rate, and may contain complementary information.

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Forecasting Asthma Hospital Admissions from Remotely Sensed Environmental Data

Proceedings of the 3rd International Conference on Geographical Information Systems Theory, Applications and Management

Asthma has a major social impact and is prone to exacerbations. It is known that environmental fa... more Asthma has a major social impact and is prone to exacerbations. It is known that environmental factors, such as meteorological conditions and air pollutants, have a role over their occurrence. In a previous work, positive associations were found between hospital admissions due to asthma exacerbation at highly urbanized regions of Portugal and higher atmospheric NO 2 levels, lower vegetation density and higher air temperatures, estimated using remote sensing. In this study we propose the use of georeferenced environmental factors to forecast the risk of hospital admissions due to asthma exacerbation. We applied linear discriminant analysis using monthly averages based in 2003-2007 environmental data to forecast positive monthly admission rates in municipalities of Lisboa district (Portugal) during 2008. Space-time estimates of nitrogen dioxide (NO 2), vegetation density from MODIS Normalized Difference Vegetation Index (NDV I) and near-surface air temperature (Ta) were considered as independent variables. We identified over 65% of the combinations months/municipalities having hospital admissions in the testing set, with less than 10% of false positives. These results confirm that NO 2 , NDV I and Ta levels obtained from remotely sensed data can be used to predict hospital admissions due to asthma exacerbation, and may be helpful if applied in warning systems for patients in the future.

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Automatic Quality Assessment of Smart Device Microphone Spirometry

Proceedings of the 8th International Joint Conference on Pervasive and Embedded Computing and Communication Systems

Lung function tests are critical for diagnosis and monitoring of asthma and other respiratory dis... more Lung function tests are critical for diagnosis and monitoring of asthma and other respiratory diseases. Monitoring of lung function, in the absence of a healthcare professional, is very challenging but may be obtained through Smart Devices if automated quality assessment systems guarantee the proper technique during the forced expiratory manoeuvre. This paper describes the evaluation of one such system that uses the microphone of smart devices, regarding the initial effort of forced expiratory manoeuvres using the Back Extrapolated Volume. A health professional recorded microphone spirometry in 55 children (5-10 years), using a mobile game engineered for the purpose, and registered its quality. At least one acceptable manoeuvre was achieved for 96% of the children using a featured threshold. Using a stricter threshold of 5% of forced vital capacity, it was possible to ensure at least one acceptable manoeuvre for 69%. While the obtained results are comparable to findings in literature for regular spirometry in this age group, further work is required before we can determine whether the proposed algorithm is effective in real life.

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Use of the Smartphone Camera to Monitor Adherence to Inhaled Therapy

ATHENA Research Book, Volume 1, 2022

Research Book, the second one to be published before the project's completion, as a pilot for fin... more Research Book, the second one to be published before the project's completion, as a pilot for final decision-making on the future concept of annual publication of ATHENA partners, displaying partners' research and innovation capabilities. The Editors of volume one propose to the project management that the following volumes of the ATHENA Research Book contain a compendium of outstanding publications in the form of annotated bibliographies and stress a specific or multidisciplinary joint research activity that reflects the profile and the performance of the ATHENA partners.

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Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App: Analysis of Real-World, Medium-Term Feasibility Studies

Frontiers in Medical Technology

Background: Poor medication adherence is a major challenge in asthma and objective assessment of ... more Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support.Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use.Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the ima...

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How Inspiring is Your App? A Usability Take on an App for Asthmamedication Adherence

Proceedings of the 11th International Conference on e-Health 2019

The low level of awareness and usability of existing mobile health (mHealth) applications still h... more The low level of awareness and usability of existing mobile health (mHealth) applications still hinders people, especially patients, to take advantage of such applications to improve their daily lives and health outcomes. This is also true for patients with asthma however, the use of smartphones and gamification, can be a solution to change behaviours regarding inhaled medication adherence and to improve asthma monitoring closer to the patients' needs. This paper presents a usability study of InspirerMundi, an mHealth gamified app developed to include various monitoring functionalities to improve inhaled medication adherence in adolescents and adults with asthma. A well-defined protocol with specific tasks was applied to 8 participants, who never used the app before nor had asthma (4 female and 4 iOS users), and results show that it was possible to find the most pressing issues regarding usability, right from the beginning. This work helps to realize that mHealth applications need to be tested for usability and functionalities adequacy with a varied sample closely related to technology and personal characteristics (e.g., type of smartphone, gender, age, mobile game-oriented), for which those applications need to be prepared.

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Development and Validation of a Digital Image Processing-Based Pill Detection Tool for an Oral Medication Self-Monitoring System

Objective tools to track medication adherence are lacking. A tool to monitor pill intake that can... more Objective tools to track medication adherence are lacking. A tool to monitor pill intake that can be implemented in mHealth apps without the need for additional devices was developed. We propose a pill intake detection tool that uses digital image processing to analyze images of a blister to detect the presence of pills. The tool uses the circular Hough transform as a feature extraction technique and is therefore primarily useful for the detection of pills with a round shape. This pill detection tool is composed of two steps. First, the registration of a full blister and storing of reference values in a local database. Second, the detection and classification of taken and remaining pills in similar blisters, to determine the actual number of untaken pills. In the registration of round pills in full blisters, 100% of pills in gray blisters or blisters with a transparent cover were successfully detected. In counting of untaken pills in partially opened blisters, 95.2% of remaining and...

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Development and validation of combined symptom‐medication scores for allergic rhinitis*

Allergy, 2022

BackgroundValidated combined symptom‐medication scores (CSMSs) are needed to investigate the effe... more BackgroundValidated combined symptom‐medication scores (CSMSs) are needed to investigate the effects of allergic rhinitis treatments. This study aimed to use real‐life data from the MASK‐air® app to generate and validate hypothesis‐ and data‐driven CSMSs.MethodsWe used MASK‐air® data to assess the concurrent validity, test‐retest reliability and responsiveness of one hypothesis‐driven CSMS (modified CSMS: mCSMS), one mixed hypothesis‐ and data‐driven score (mixed score), and several data‐driven CSMSs. The latter were generated with MASK‐air® data following cluster analysis and regression models or factor analysis. These CSMSs were compared with scales measuring (i) the impact of rhinitis on work productivity (visual analogue scale [VAS] of work of MASK‐air®, and Work Productivity and Activity Impairment: Allergy Specific [WPAI‐AS]), (ii) quality‐of‐life (EQ‐5D VAS) and (iii) control of allergic diseases (Control of Allergic Rhinitis and Asthma Test [CARAT]).ResultsWe assessed 317,17...

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What Do Physicians Think About the Use of Telemedicine to Recruit and Assess Participants in mHealth-Related Clinical Studies as a Consequence of the COVID-19 Pandemic?

Telemedicine and e-Health, 2022

Objectives: To evaluate physician's opinion and availability to participate in mHealth-related cl... more Objectives: To evaluate physician's opinion and availability to participate in mHealth-related clinical studies with patient recruitment and assessment via telemedicine and to identify characteristics associated with the willingness to participate. Methods: Cross-sectional, observational study, based on an anonymous web survey conducted in May-Jun of 2020 to 237 physicians, from Portugal and Spain that collaborated with an asthma mHealth project (INSPIRERS). Results: Response rate was 51% (n = 120). Most (74%, n = 89) physicians were available to participate in such studies, but 62% anticipated lower recruiting capacity and 40% increased difficulty in obtaining quality data. Physicians aged £40 years, from secondary care (vs. general practitioners) and that used apps in personal life or clinical practice were more likely to be available. Conclusions: Three-quarters of the physicians were available to participate in mHealth-related clinical studies with patient recruitment and assessment through telemedicine. Age group, medical specialty, and app use were associated with the willingness to participate.

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Identification of clusters of asthma control: A preliminary analysis of the Inspirers studies

Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asth... more Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT -T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16 -46) years, were analysed. Three clusters were identified [mean CARAT -T (min -max)]: cluster 1 [27(24 -30)], cluster 2 [19(14 -23)] and cluster 3 [10(2 -13)]. Patients in cluster 1 (34%) were characterised by better asthma control, be...

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Prescribing patterns of medication for respiratory diseases: cluster analysis of the Portuguese electronic prescription database

European Annals of Allergy and Clinical Immunology, 2021

We aimed to describe, for the first time, the prescribing patterns among patients on persistent r... more We aimed to describe, for the first time, the prescribing patterns among patients on persistent respiratory treatment, from the Portuguese electronic prescription and dispensing database. This was a one-year retrospective population-based analysis of prescriptions (n=39810) for medication for respiratory disease and exacerbations. Cluster analysis was applied based on medication and prescribers' specialty. Prescribing patterns were grouped and labelled as: possible medication for asthma and allergic rhinitis (General Practitioners-GPs and allergists to younger patients); COPD (GPs and pulmonologists to older patients); asthma or Asthma-COPD Overlap (GPs and pulmonologists); exacerbation, infection and relievers. This analysis was an important first step to understand the Portuguese reality on the treatment of respiratory diseases.

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