Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies.

BACKGROUND: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. OBJECTIVE: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. METHODS: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. RESULTS: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). CONCLUSIONS: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.

Anhydroecgonine methyl ester, a cocaine pyrolysis product, contributes to cocaine-induced rat primary hippocampal neuronal death in a synergistic and time-dependent manner.

Crack cocaine users are simultaneously exposed to volatilized cocaine and to its main pyrolysis product, anhydroecgonine methyl ester (AEME). Although the neurotoxic effects of cocaine have been extensively studied, little is known about AEME or its combination. We investigated cell death processes using rat primary hippocampal cells exposed to cocaine (2 mM), AEME (1 mM) and their combination (C + A), after 1, 3, 6 and 12 h. Cocaine increased LC3 I after 6 h and LC3 II after 12 h, but reduced the percentage of cells with acid vesicles, suggesting failure in the autophagic flux, which activated the extrinsic apoptotic pathway after 12 h. AEME neurotoxicity did not involve the autophagic process; rather, it activated caspase-9 after 6 h and caspase-8 after 12 h leading to a high percentage of cells in early apoptosis. C + A progressively reduced the percentage of undamaged cells, starting after 3 h; it activated both apoptotic pathways after 6 h, and was more neurotoxic than cocaine and AEME alone. Also, C + A increased the phosphorylation of p62 after 12 h, but there was little difference in LC3 I or II, and a small percentage of cells with acid vesicles at all time points investigated. In summary, the present study provides new evidence for the neurotoxic mechanism and timing response of each substance alone and in combination, indicating that AEME is more than just a biological marker for crack cocaine consumption, as it may intensify and hasten cocaine neurotoxicity.

Oral health self-perception for transgender people: a controlled cross-sectional study

This article aims to verify the use of dental services, oral health self-perception, and the impacts of oral health on the daily lives of transgender people. A controlled cross-sectional study was conducted in which transvestites, transsexuals, and transgender people were compared to cisgender people. For data collection, the oral health self-perception questionnaire was applied to 90 people, from which 45 were cisgender and 45 were transgender. There were no differences regarding access to dental services. The data analysis revealed that transgender people perceive their teeth to cause nervousness (p=0.002) and shame (p=0.033), respectively 3.8 and 5.0 times higher than that observed for cisgender people. Although differences in access were not observed, there was a difference in the perception of the need for treatment and the impacts of oral health. Therefore, it is important to consider that comprehensive care for the transgender population should go beyond the treatment of oral diseases and include aesthetic expectations as well.

Avocado (Persea americana) pulp improves cardiovascular and autonomic recovery following submaximal running: a crossover, randomized, double-blind and placebo-controlled trial.

Previous studies have demonstrated that regular avocado consumption presents advantageous effects on cardiovascular system. However, little attention has been paid to the use of avocado as a dietary supplement, in particular, for individuals involved in physical exercise training. Therefore, this study aims to evaluate the effect of acute avocado pulp intake on cardiovascular and autonomic recovery subsequent to moderate exercise. Using a crossover, randomized, double-blind and placebo-controlled trial design, 16 healthy female adults underwent two protocols: Avocado pulp (600 mg in capsule) and placebo (600 mg starch in capsule). After the ingestion of Avocado pulp or placebo, the subjects were seated for 60 min at rest, followed by running on a treadmill at a submaximal level and then remained seated for 60 min during recovery from the exercise. Heart rate (HR), heart rate variability (HRV) [rMSSD, SD1, HF (ms2)] and skin conductance were evaluated before and during exercise, as well as during recovery. HR, systolic blood pressure, HRV and skin conductance recovered faster when subjects were given avocado pulp prior to exercise. In conclusion, avocado pulp improved cardiovascular and autonomic recovery after exercise, suggesting a reduced risk of cardiovascular events after exertion. The current results support the beneficial effects of ingestion of avocado prior to submaximal treadmill running.

Chronic Urticaria in the Real-Life Clinical Practice Setting in Portugal: Baseline Results from the Non-Interventional Multicentre AWARE Study.

INTRODUCTION: There is a paucity of information regarding chronic urticaria patients' care in a real-world setting. The objective of this study was to report and evaluate the baseline characteristics of Portuguese chronic urticaria patients refractory to H1-antihistamines included in the AWARE study. MATERIAL AND METHODS: This is a non-interventional cohort study. Adult patients with a diagnosis of chronic urticaria with symptoms for at least two months, refractory to H1-antihistamines, consulting one of the 10 participating urticaria centers throughout Portugal have been included in the study. Baseline sociodemographic data, medical history, clinical parameters, medication, weekly urticaria activity score, and dermatology quality of life index have been collected. RESULTS: Seventy six patients were included, of which 76.3% were women. The majority of patients had a diagnosis of chronic spontaneous urticaria (88.2%) and 39.5% had angioedema. Around 91.0% of patients were medicated with non-sedative H1-antihistamines and 35.4% with a third line therapy. Median dermatology quality of life index was 5.0 and median weekly urticaria activity score was 13.0. DISCUSSION: The baseline results suggest that patients with chronic urticaria refractory to H1-antihistamines are being under-treated in the real-world setting. CONCLUSION: The AWARE study demonstrates the real impact of chronic urticaria on Portuguese patients refractory to H1-antihistamines treatment, and 30% report a very large or extremely large deleterious effect on their quality of life. The follow-up of these patients will allow evaluating strategies aimed at optimizing disease control.

Introdução: A informação sobre os doentes com urticária crónica em ambiente de vida real é escassa e este estudo teve por objectivo reportar e avaliar as características basais dos doentes portugueses com urticária crónica refractários aos anti-histamínicos H1 incluídos no estudo AWARE. Material e Métodos: Estudo de coorte não intervencional. Foram incluídos doentes adultos com diagnóstico de urticária crónica sintomáticos durante pelo menos dois meses, refratários aos anti-histamínicos H1, seguidos em 10 centros de urticária em Portugal. Foram recolhidos dados basais sociodemográficos, história clínica, parâmetros clínicos, medicação, índice semanal de atividade de urticária e índice de qualidade de vida dermatológico. Resultados: Foram incluídos 76 doentes, dos quais 76,3% mulheres. A maioria dos doentes estava diagnosticado com urticária crónica espontânea (88,2%) e 39,5% apresentavam angioedema. Cerca de 91,0% dos doentes estavam medicados com anti-histamínicos H1 não sedativos e 35,4% com terapêuticas de terceira linha. A mediana do índice de qualidade de vida dermatológico foi 5,0 e a mediana do índice semanal de atividade de urticária foi 13,0. Discussão: Os resultados basais sugerem que os doentes com urticária crónica refratários ao tratamento com anti-histamínicos H1 estão sub-tratados em ambiente de vida real. Conclusão: O estudo AWARE vem demonstrar o real impacto da urticária crónica nos doentes portugueses refratários ao tratamento com anti-histamínicos H1 onde mais de 30% reporta um impacto elevado ou extremamente elevado da doença na sua qualidade de vida. O seguimento destes doentes permitirá avaliar estratégias para otimização do controlo da doença.

[Multiple food allergy]. / Alergia alimentar múltipla.

Multiple food allergy is an adverse immune response to more than one food. When a child is allergic to a great number of foods, the clinical picture can be serious and the eviction of the implied allergens leads to important dietary restrictions. We describe the case of a 4-year-old child with serious atopic eczema and multiple food allergy. At 8 months she presented positive specific Imunoglobulin (Ig)E for milk, wheat, rye, barley, gluten, soy, egg (yolk and white) and initiated eviction of these foods. At 20 months she tried to introduce wheat but suspended after aggravation of atopic eczema. At 3 years old, she had anaphylaxis after contact with cheese. At 4 years old she keeps eviction of milk, egg, wheat, gluten, barley and rye. Food restrictions in these patients are high, demanding a rigorous control of foods ingested to prevent both adverse reactions and nutricional deficits. Multidisciplinary approach is important.

Risk factors for asthma symptoms at school age: an 8-year prospective study.

Childhood recurrent wheezing is a very prevalent heterogeneous clinical entity. An 8-year prospective study was performed to correlate the clinical outcome of recurrent wheezing in the first years of life with prognostic risk factors. A cohort of 308 children with recurrent wheezing, aged <7 years, were enrolled in 1993, studied using a questionnaire, skin-prick tests, and serum total IgE. According to the study protocol, in 1996 and 2001, the cohort was assessed. In 2001, 81% of the initial sample was reevaluated (n=249); 61% remained symptomatic. Prevalence of atopy was 48% in 1993, 65% in 1996, and 75% in 2001. By logistic regression analysis, we identified the following as independent risk factors for asthma symptoms in the last year of the follow-up: personal history of rhinitis (odds ratio [OR] = 15.8, 95% confidence interval [CI], 6.1-40.8; p < 0.001), paternal asthma (OR =, 7.2; 95% CI = 1.7-29.7; p = 0.007), personal history of atopic dermatitis (OR = 5.9, 95% CI = 2.2-15.7; p < 0.001), maternal asthma (OR = 5.4, 95% CI = 1.7-17.1; p = 0.004), allergen sensitization (OR = 3.4, 95% CI = 1.2-10.4; p = 0.03), and onset of symptoms in the 2nd year or later in preschool-aged children (OR = 2.1, 95% CI = 1.1-4.8; p = 0.04). Kindergarten attendance before 12 months was identified as a protective factor (OR = 0.4, 95% CI = 0.2-0.9; p = 0.04). Among the 128 nonatopic children in 1993, 52% developed allergen sensitization. We identified as prognostic risk factors for asthma symptoms personal history of allergic disease, parental asthma, atopy, and late onset of symptoms. In a significant number of children clinical symptoms can occur years before allergen sensitization.

Risk factors for asthma admissions in children.

Bronchial asthma is related to a high morbidity rate, leading to an increasing frequency of emergency room visits and hospital admissions. The aim of this study was to identify severity risk factors for childhood asthma related to hospitalization. The authors studied 124 children admitted to the hospital for asthma, during a 2-year period, correlating the obtained data with a sample of outpatients with asthma matched by age, gender, and socioeconomic status. A standardized questionnaire and skin-prick tests (SPTs) were performed on all children. The significant and independent risk factors identified for hospital admission were prior asthma hospitalization (OR = 7.63; 95% CI = 1.5-39.6; p = 0.01) and last-year admission (OR = 3.18; 95% CI = 1.1-8.9; p = 0.02), environmental tobacco-smoke exposure (OR = 6.63; 95% CI = 2.5-17.8; p = 0.002), allergen sensitization (OR = 3.86; 95% CI = 1.4-10.7; p = 0.009), family history of maternal asthma (OR = 3.58; 95% CI = 1.3-9.6; p = 0.01), and onset of symptoms before 12 months of age (OR = 2.76; 95% CI = 1.0-7.9; p = 0.06). Attendance at day care or kindergarten (OR = 0.38; 95% CI = 0.2-0.9; p = 0.04) and large family size (OR = 0.25; 95% CI = 0.1-0.8; p = 0.01) could be protective factors. Our results stress the importance of early diagnosis and specialized medical care of childhood asthma, mainly in high-risk children, with emphasis on medication planning and the establishment of preventive measures such as environmental tobacco smoke avoidance and limitation of aeroallergen exposure.