INTRODUCTION:In 2010, 6.8% of the Portuguese adults had asthma. Contemporary studies employing more accurate methods are needed. We aimed to assess asthma prevalence in Portugal and to identify associated-factors. METHODS:A population-based nationwide study was conducted from May 2021 to March 2024. A multistage random sampling approach was applied to select adults from primary care. Stage 1 involved a telephone screening interview to collect socio-demographic and clinical data. Patients with an Adult Asthma Score (A2 Score) ≥1 were eligible for Stage 2, and 5% of those with an A2 Score = 0 were also invited to participate in Stage 2, which consisted of a diagnostic visit with a physical examination and diagnostic tests. We computed weighted asthma prevalence estimates and multivariable logistic regression models were used. RESULTS:A total of 7,556 participants completed Stage 1 and 1,857 Stage 2. The prevalence of asthma was 7.1% (95%CI = 6.3-8.0%), with slight differences by sex, age, and region. Education, family history of asthma, inhaler prescription, nasal/ocular symptoms, food allergies, and previous allergy skin tests were associated with an increased risk of asthma (R2 = 33%). Asthma diagnosis could also be predicted by the A2 score, either on its own (R2 = 43%) or in combination with family history and previous allergy skin tests (R2 = 45%). DISCUSSION:Asthma affects 7.1% of Portuguese adults. Family history of asthma, nasal/ocular symptoms, and comorbid food allergy are associated with increased risk of asthma.

Digital health can effectively engage patients in the self-management of their asthma. Still, it will only reach its full potential when apps are aligned with patients’ needs and are integrated into clinical practice. We aim to test a framework for the involvement of patients/carers in all phases of developing and implementing an app for asthma. This protocol was co-designed with six asthma patients/carers and includes 5 tasks. Regular interactions among patients, developers and healthcare professionals will be a priority for user requirements definition (task 1) and iterative development and testing until the app’s initial version (tasks 2-3). Patients/carers and healthcare professionals will be fully engaged in the real-life feasibility study (task 4) and management and dissemination activities (task 5). The eligibility criteria to participate in tasks 2-4 are 1) diagnosis of asthma or carer of a person with asthma; 2) ≥18 years; 3) ability to use apps and access a mobile device with Internet. We anticipate applying questionnaires such as the User Experience Questionnaire and the System Usability Scale in all app testing tasks. We expect to have a final version of the asthma app that meets patients’/carers’ needs and experiences and healthcare professionals’ concerns. This will be an attractive app to support patients in self-management of their disease, keeping their asthma in control, having fewer asthma symptoms, and enjoying life. This study will be a framework for fully involving patients, carers and citizens in the iterative co-production development and implementation of an asthma app.

Physaloptera spp. are parasitic nematodes that infect the gastrointestinal tracts of many carnivores and omnivores. Although they are distributed worldwide, Physaloptera spp. have not been studied in raptors in Portugal. In this study, we report Physaloptera alata in a booted eagle (Aquila pennata) in Portugal. Adult nematodes were discovered in the gizzard of a young booted eagle, and morphological features were consistent with those of the genus Physaloptera. DNA was extracted and a PCR assay performed to amplify a region of the 18S small subunit of the ribosomal RNA gene and the cytochrome c oxidase subunit I gene. The resulting PCR products were Sanger-sequenced, and comparison with the available sequences in the GenBank database confirmed the initial morphological classification as Physaloptera sp. Phylogenetic analysis clustered the sequence within the Physaloptera group. The presence of this parasite in raptors from Portugal is of particular importance to wildlife rehabilitation centers, disease ecologists, and wildlife professionals. Furthermore, we produced a new genetic sequence and have added it to the GenBank database of parasites in birds of prey.

Background: The current gold standard for treatment of patients with locally advanced (stage II–III of disease) adenocarcinoma of the stomach is the perioperative 5-fluorouracil/leucovorin/oxaliplatin/docetaxel (FLOT) regimen. However, in a significant number of patients, adverse effects' severity might dictate dose delay or reduction, or even early termination of treatment, which can negatively impact disease progression, and consequently recurrence-free/overall survival. Pretreatment physical fitness has been associated with greater tolerance to chemotherapy, but little is known in gastric cancer patients treated with FLOT.

Lung auscultation using smartphones9 built-in microphone is a promising technology to monitor respiratory conditions outside medical facilities. We aimed to compare lung sounds acquired by smartphones with the ones acquired by a digital stethoscope according to their quality and ability to capture adventitious sounds. A cross-sectional study was conducted with 17 adults with self-reported asthma (13 females, 35±12y). Lung auscultation was performed by clinicians in 7 different locations (trachea; right and left anterior, upper posterior and lower posterior chest), first with a digital stethoscope and then with the patient's smartphone. Recordings from smartphones (n=119) and the stethoscope (n=119) were independently classified according to their quality and presence of adventitious sounds by two annotators. A third annotator solved the disagreements. The quality of the recordings was higher with the digital stethoscope than with smartphones (84% vs. 59%, p<.001). Adventitious sounds were present in 3% of the recordings acquired with smartphones and in 9% of those acquired with the digital stethoscope (p=.109). Agreement regarding presence of adventitious sounds between smartphones and stethoscope was slight (86%, k=.14 (95%CI -.14-.41). Results showed a better agreement between the two annotators for recordings quality (88%, k=.70(95%CI. 60-.81)) than for the presence of adventitious sounds (79%, k=.22(95%CI. 05-.38)). Smartphone auscultation seems a viable approach to record lung sounds and to capture adventitious sounds, although its performance is yet to be comparable to digital auscultation. Further research is required to improve this technology.

Introduction In Portugal as in other countries, data on the epidemiology of asthma are mainly grounded in questionnaire studies. Additionally, the detailed characterisation of asthma in terms of disease severity, control and phenotypes remain scarce. Studies assessing the prevalence of asthma and its subgroups using accurate methods are needed. This study aims to determine the prevalence of asthma, difficult-to-treat asthma and severe asthma, and to evaluate sociodemographic and clinical characteristics of those patients, in mainland Portugal. Methods and analysis A population-based nationwide study with a multicentre stepwise approach will be conducted between 2021 and 2023 in 38 primary care centres of the Portuguese National Health Service. The stepwise approach will comprise four stages: Stage 0—telephone call invitation to adult subjects (≥18 years) randomly selected (n~15 000); stage 1—telephone screening interview assessing the participants’ respiratory symptoms (n~7500); stage 2—diagnostic visit, including physical examination, diagnostic tests (eg, spirometry, fraction of exhaled nitric oxide, blood eosinophil count) and patient-reported outcome measures for diagnostic confirmation of those identified with possible asthma at stage 1 (n~1800); stage 3—further evaluation of patients with asthma and of patients with difficult-to-treat asthma and severe asthma, after 3 months (n~460). At stage 3, data will be collected from a review of the patient’s electronic health records, a follow-up telephone call and the CARATm (Caracteristicas Auto-reportadas de Asma em Tecnologias Móveis) app database. The prevalence of asthma, difficult-to-treat asthma and severe asthma will be determined as the percentage of patients with asthma confirmed from the overall population (stage 1). For the analysis of factors associated with asthma, difficult-to-treat asthma and severe asthma, logistic regression models will be explored. Ethics and dissemination Ethical approvals for the study were obtained from the ethics committee of the local health unit of Matosinhos, Porto (38/CES/JAS), Alto Minho (38/2021/CES) and the regional health administration of Lisbon-Vale do Tejo (035/CES/INV/2021). Results will be published in peer-reviewed journals. Trial registration number NCT05169619 .

Objective:To assess the feasibility of the procedures of EPI-ASTHMA. EPI-ASTHMA is a population-based multicentre stepwise study about the prevalence and characterisation of patients with asthma based on disease severity in Portugal.Methods:A pilot study of EPI-ASTHMA was conducted with adults from three primary care centres. We followed a stepwise approach comprising 4 stages: stage 0-invitation phone call (n ~1316); stage 1-telephone interview (n ~658); stage 2-clinical assessment with physical examination, diagnostic tests, and patient-reported outcome measures, to confirm the diagnosis of those with possible asthma at stage 1 (n ~160); stage 3-characterization of a subgroup of asthma patients by collecting data through a telephone interview, patient file review and CARATm app (n ~40), after 3-months. The frequency of asthma was calculated in relation to the entire study population (stage 1) and the frequency of difficult-to-treat/severe asthma in relation to the number of asthma patients (stage 3).Results:From 1305 adults invited, 892 (68%) accepted to participate (stage 0) and 574 (64%; 53[42-67] y; 43% male) were interviewed (stage 1). From those, 148 (26%; 60[46-68] y; 43% male) were assessed at stage 2, and 46 (31%; 51[39-67] y; 44% male) were diagnosed with asthma. Half of these patients (n = 23) accepted to install the app. Stage 3 was completed by 41 (93%) patients, of whom 31 (83%) had asthma confirmed by their file review. A total of 8% of participants had asthma, of those 17% had difficult-to-treat and 5% severe asthma.Conclusion:Attained recruitment rates and the quality of the results confirmed the feasibility of the EPI-ASTHMA stepwise approach. This pilot study provided insight into the improvement of the procedures to be generalized across the country.

The paper version of CARAT (pCARAT) is valid to assess asthma control over a 4-week period. For follow-up purposes, assessment through mobile apps (aCARAT) or telephone (tCARAT) may be useful alternatives. We explored the psychometric properties of the aCARAT and tCARAT. Patients with asthma were recruited at secondary care outpatient clinics. During medical visits, patients filled in the pCARAT and were invited to complete the aCARAT in the following days using the app of project Inspirers (InspirerMundi). After 1 week, tCARAT was collected. Patients completing the 3 CARAT versions within 28 days were analysed. CARAT scores (0-worst, 30-best) were calculated. The internal consistency (Cronbach’s α), convergent validity (Spearman correlation-rs) and reliability (intraclass correlation coefficient-ICC, Bland-Altman analysis) were determined. 55 patients (21 male; median 19 [interquartile range 17-37]y) were included. The aCARAT was completed by 82% of patients within 1 week of pCARAT; and by 78% within 1 week of tCARAT. The median pCARAT score was 21[17-24], the aCARAT 21[18-26], and the tCARAT 23[21-26]. Internal consistency was good for all versions (α=.73-.77). pCARAT was more strongly correlated with aCARAT than with tCARAT. Reliability was better for aCARAT than for tCARAT (table 1). App and telephonic CARAT versions are valid and reliable, exhibiting comparable psychometric properties to the paper version. These new CARAT versions are promising alternatives for assessing control in patients with asthma.

Evaluation of lung function is central to the management of chronic obstructive respiratory diseases. It is typically evaluated with a spirometer by a specialized health professional, who ensures the correct execution of a forced expiratory manoeuvre (FEM). Audio recording of a FEM using a smart device embedded microphone can be used to self-monitor lung function between clinical visits. The challenge of microphone spirometry is to ensure the validity and reliability of the FEM, in the absence of a health professional. In particular, the absence of a mouthpiece may allow excessive mouth closure, leading to an incorrect manoeuvre. In this work, a strategy to automatically assess the correct execution of the FEM is proposed and validated. Using 498 FEM recordings, both specificity and sensitivity attained were above 90%. This method provides immediate feedback to the user, by grading the manoeuvre in a visual scale, promoting the repetition of the FEM when needed.

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.

the research trends: the number of articles per year was considered as dependent variable in a logarithmic scale. Results:A total of 2102 documents were screened according to the inclusion and exclusion criteria.The distribution of articles among the countries vary from 0,005% of the Switzerland to 26,7% of the USA.Linear regression analysis was performed on the countries grouped by geographical area, excluding countries with a small number of articles.The time trend analysis showed an increase by 8% of the number of published articles per year (CI 95% 5%-11%) in the total of Countries, by 7% per year (CI95% 4%-10%) in North American Countries and of 6% per year (CI95% 2%-10%) in European Countries. Conclusions:The bibliometric analysis revealed escalating trends in the number of interventions carried out to implement the concept of integration between hospital and community care services.Integration in care delivery is a promising approach for improving patients and health professionals experience and health outcomes.

Tin (Sn) or a Sn-rich solder applied to copper-based artefacts has been frequently used at least, since the Ancient Greece, although scarce studies have been published concerning the technology of this metallurgical joining technique. Several filler remnants were reported to be found in a Roman collection of handle attachments of situlae or cauldrons (2nd century BCE-5th century CE) from the archaeological site of Conimbriga, a Roman city from the Lusitania Province (Portugal). All these artefacts were cast in high leaded coppers and bronzes. The present study aims to contribute to the knowledge of Sn-rich soldering, an ancient metallurgical joining technique, by the characterisation of the fusible metallic alloy present in 10 Roman artefacts by means of micro-energy dispersive X-ray fluorescence spectrometry (micro-EDXRF), scanning electron microscopy with energy dispersive X-ray (SEM-EDS) microanalysis and optical microscope (OM) observations. Results of studied solders show the presence of Cu-Sn alloys, with Sn contents ranging from 8 toll phase composition (30-60 wt% Sn). As the attachments were made in leaded copper alloys, it was also observed, in some cases, the melting of the interdendritic Pb-rich chains with long-range diffusion of the solder alloy into the substrate. The fillers compositions suggest that the handle attachments have been joined to a situla body by the soldering metallurgical process with Sn or a Sn-rich alloy. The studied leaded Cu-Sn attachments, probably formulated by local craftsman, were joined into the body of a situla or cauldron with a soft solder (soldering), a common metallurgical joint from Antiquity, although no relation was found between composition or typology and the Sn or Sn-rich solder. (C) 2018 Elsevier B.V. All rights reserved.

The CARAT is valid to assess asthma control using paper-based forms. For follow-up purposes, telephone interview may be useful, but equivalence between these modes of administration was not studied. This study compared CARAT scores when administered via paper-based forms and telephone interview 1-week apart. Patients with asthma, recruited during scheduled medical visits in 4 secondary care centers, filled in the paper-based CARAT. After 3-7 days (median-M 6), CARAT was again collected by telephone interview. CARAT scores (from 0-worst to 30-best; >24 controlled) were obtained. The internal consistency (Cronbach’s α), test-retest reliability (intraclass correlation coefficient-ICC2,1) and agreement (Cohen9s kappa) were calculated. A total of 45 patients (23 male; M=21[interquartil range-IQR 19] years) were included. The CARAT median score was 22[IQR 10.5] in paper-based forms and 22[IQR 9.5] in telephone interview (p=.098). Twenty-one patients (47%) had a difference of 0-1 point between the 2 moments. Only 10 patients (22%) had a difference above the minimal clinically important difference (MCID≥4). The Cronbach’s α was 0.85 for paper-based CARAT and 0.79 for telephone interview. The ICC was 0.87 (95%CI 0.78-0.93; p<0.001). Classification of asthma control was concordant between the 2 methods in 39 (87%) patients (kappa=0.7; p<0.001). The CARAT score change above the MCID may be related to clinical changes in the previous week influencing the 4-week recall period. Telephonic administration of CARAT is an alternative approach to conventional paper-based forms in patients with asthma.