Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self‐report and physician assessment

Background Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. Methods This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0–100). Results A total of 193 patients (72% female; median [P25–P75] age 28 [19–41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0–71]%; 1 month: 18 [0–48]%) than patient self-report (80 [60–95]) and physician assessment (82 [51–94]) (p 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). Conclusions Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.info:eu-repo/semantics/publishedVersio

Dream teens : adolescentes autónomos, responsáveis e participantes

Revista de Psicologia da Criança e do Adolescente. - ISSN 1647-4120. - v. 6, n. 2 (Julho-Dezembro 2015). - p. 47-58.O Dream Teens é um projeto que envolve jovens portugueses dos 11 aos 18 anos. Fornece uma formação e uma estrutura de apoio para que as suas vozes sejam ouvidas e promove a sua participação numa variedade de contextos e cenários na área da saúde, da educação e da cidadania ativa. O projeto Dream Teens (webpage: http://dreamteens.aventurasocial.com/; blog em inglês: http://www.dreamteens2014-2015.blogspot.pt; e blog em português: http://www.dreamteensaventurasocial.blogs.sapo.pt/) teve início em maio de 2014. O objetivo do presente estudo é compreender o conceito, a dinâmica, a extensão e alguns resultados preliminares do projeto Dream Teens, centrandose principalmente no estudo do processo e das experiências dos jovens. Este documento apresenta ainda um conjunto de recomendações para as políticas públicas.This article presents Dream Teens, a project which involves Portuguese adolescents from 11 to 18 years and provides a specific training and a support structure that allows their voices are heard and promote their participation in a variety of contexts and policy arenas in the areas of health, education and active citizenship. The Dream Teens project (webpage: http://dreamteens.aventurasocial.com/http://dreamteens.aventurasocial.com; blog in English: http://www.dreamteens2014-2015.blogspot.pt/; blog in portuguese: http://www.dreamteensaventurasocial.blogs.sapo.pt/), begun in May, 2014. The objective of this article is to understand the concept, the dynamic, the extent and some preliminary results of the Dream Teens project, focusing mainly on the process and on the experiences of young people. This paper also presents a set of recommendations concerning public policies

estudos artísticos

Crescer na intervenção e na comunicação é um dos objetivos da Revista Gama, estudos artísticos. Promove-se a comunicação, formal, dentro das regras da comunicação académica, através de textos cuja característica comum é serem escritos por artistas, sobre a obra de outros artistas. Este foi o critério base que inspirou o projeto das iniciativas associadas ao Congresso CSO (criadores sobre outras obras), que já completou seis anos de disseminação. A Revista Gama singularizou-se por convocar artistas e obras que de algum modo estariam esquecidos, desconhecidos, ou ainda pouco divulgados. Obras cuja execução tem raízes em passados mais ou menos recentes, mas que pelo excesso de discursos na contemporaneidade, não obtiveram a divulgação desejada. Este é um propósito de intervenção no conhecimento patrimonial: as obras existem, foram executadas, enriquecem o nosso património, mas há que as fazer funcionar, dar a conhecer, aos outros artistas, aos especialistas, ao grande público. Assim se reuniram neste número 6 da Revista Gama vinte e quatro artigos originais, procurando-se, na sua sequência e articulação, algumas relações de pertinência e afinidade. Olhares sobre arquivos, sobre acervos, sobre coleções, conjuntos muitas vezes fechados e em perigo de esquecimento, ou de incompreensão: uma entrada discreta que se abre para o interior de uma câmara escura, que é um espaço cheio de imagens por revelar.info:eu-repo/semantics/publishedVersio

Arquiteturas na criação artística moderna e contemporânea

Tese de Doutoramento em Arquitetura, com a especialização em Teoria e história, apresentada na Faculdade de Arquitetura da Universidade de Lisboa para obtenção do grau de Doutor.O presente estudo insere-se na área da História e Teoria da Arquitetura, e pretende reunir elementos iconográficos que possam servir aos arquitetos como instrumento útil, formal e de conhecimento, na criação arquitetónica, conciliando uma componente artística. Ao longo da história da representação da Arquitetura na Arte, desde o Período Moderno à Arte Contemporânea, observam-se mutações semióticas na evolução da Pintura de Arquiteturas, até à instalação contemporânea. A partir das primeiras instalações artísticas, tem-se mantido a necessidade de representação da Arquitetura na Arte, fixando aspetos da sua iconografia e dando lugar a simulacros tridimensionais. Para um estudo da iconografia da Arquitetura na Arte, como ferramenta útil à criação arquitetónica, debruçámo-nos sobre temas, técnicas e mecanismos contemporâneos, aplicados na instalação artística, procurámos compreender as motivações de vários autores, a partir dos estudos de caso selecionados. O estudo foi repartido em quatro capítulos, sendo o primeiro direcionado para a retrospetiva histórica da evolução da representação arquitetónica na Arte Moderna. O segundo consagra conteúdos herdados na Arte Moderna, como o conceito de Inquietante Estranheza Freudiana e a interpretação de processos de criação artística contemporânea. O terceiro apresenta casos de estudo selecionados em que são observadas as temáticas subjetivas de cada autor, e por fim, no quarto capítulo, é elaborada uma análise comparativa sobre as iconografias das estrutura materiais espacializantes, resultantes dos casos de estudo apresentados no capítulo anterior . Foi dado especial ênfase à noção de arquitetura como um corpo, à importância da forma da espiral, à representação de espaços domésticos e a soluções iconográficas que derivam do molde ou materiais da Arquitetura, presentes nas obras de Louise Bourgeois (1911-2010), Anselm Kiefer (1945-...), Rachel Whiteread (1963-...), Carlos Bunga (1976-...), Ana Vieira (1940-2016), entre outros.ABSTRACT: This study falls within the purview of the History and Theory of Architecture and aims to gather together iconographic elements which can serve architects as a useful and formal knowledge-based tool for architectural creation, incorporating an artistic component. Many semiotic changes have been witnessed in the evolution of Architecture Paintings over the course of the history of representing Architecture in Art, from the Modern Period to Contemporary Art, up to contemporary installations. The need to represent Architecture in Art has been maintained from early artistic installations, incorporating aspects of its iconography and giving rise to three-dimensional effigies. In order to examine the iconography of Architecture in Art, as a useful tool for architectural creation, this study examines contemporary themes, techniques and mechanisms, as applied in artistic installations, with a view to understanding the motivation of various authors, based on the selected case studies. This study has been divided into four chapters, the first of which encompasses a retrospective history of the evolution of architectural representation in Modern Art. The second chapter focuses on inherited contents in Modern Art, such as the Freudian concept of The Uncanny, and the interpretation of processes of contemporary artistic creation. In its turn, the third chapter presents selected case studies and the final chapter contains a comparative analysis of the iconographies resulting from the case studies presented in the previous chapter. There is a special emphasis on the notion of architecture as a corpus, on the importance of the spiral form, on the representation of domestic spaces and iconographic solutions derived from Architectural moulds or materials, evident in works by Louise Bourgeois (1911-2010), Anselm Kiefer (1945-...), Rachel Whiteread (1963-...), Carlos Bunga (1976-...), Ana Vieira (1940-2016), among others.Programa Operacional do Capital Humano, P.O.C.H. ao Fundo Social Europeu, FSE. e à Fundação para a Ciência e Tecnologia, F.C.T., pela concessão do financiamento da Bolsa de Doutoramento Individual, com Referência: SFRH/BD66700/2009.N/

estudos artísticos

info:eu-repo/semantics/publishedVersio

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BackgroundEstimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period.Methods22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.FindingsGlobal all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.InterpretationGlobal adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic