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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.

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13&ndash, 17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 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 (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 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 (n = 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 (p &lt, 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms, at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 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.

BACKGROUND Health and fitness apps have potential benefits to improve self-management and disease control in 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 non-users is critical to design solutions that are effectively integrated in patients daily life, and to ensure that these equitably reach out to different groups of patients, improving rather than entrenching health inequities. OBJECTIVE 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 Inspirers observational studies was conducted using 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/or depression, postcode, socio-economic index, digital literacy, health services use, 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 or less (66.4%), had at least 10 years of education (57.4%) and were in the three higher quintiles of the socio-economic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale-VAS > 70 in 93.1%) and the prevalence of anxiety and depression was, respectively, 34.3% and 11.9%. The proportion of participants that reported using health and fitness mobile apps was 41.1% (n=211). The 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 OR 2.22 (95%CI [1.05-4.75]) and 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 showing, respectively, adjusted ORs 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]). Participants with depression symptoms had lower odds of using mobile health and fitness apps (adjusted OR 0.32, 95%CI [0.12-0.83]). CONCLUSIONS A better understanding of the barriers and enhancers of app use by patients with lower education, lower digital literacy, or with depressive symptoms, is key to design tailored interventions to improve a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior, as well as their interest and concerns about digital tools specifically. These factors may impact both initial engagement and sustained use. CLINICALTRIAL

Copyright © 2018 Ana Sá-Sousa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited., The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma., RAG was financed by an unrestricted grant from Novartis Farma-Produtos Farmacêuticos, S.A., which had no participation in any part of the development and implementation of the registry and has no access to the stored data for any purpose. The first author is financed by a PhD Grant (PD/BD/113665/2015) and financed by the European Social Fund and national funds of MCTES (Ministério da Ciência, Tecnologia e Ensino Superior) through FCT (Fundação para a Ciência e Tecnologia, I.P) PhD Programme Ref. PD/0003/2013-Doctoral Programme in Clinical and Health Services Research (PDICSS). Te publication of this article was supported by ERDF (European Regional Development Fund) through the operation POCI-01-0145- FEDER-007746 funded by the Programa Operacional Competitividade e Internacionalização – COMPETE2020 and by National Funds through FCT - Fundação para a Ciência e a Tecnologia within CINTESIS, R&D Unit (reference UID/IC/4255/2013).

We report a 10-year-old patient with haemophilia A developing anaphylaxis to recombinant factor VIII (octocog alfa). Allergic reactions, and especially anaphylactic events, are rare in patients with haemophilia A. The nature of these reactions is not fully understood. Here, we demonstrate a type I hypersensitivity reaction using sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting assay. This test revealed itself as an essential diagnostic tool, as it allowed us to choose an alternative treatment (moroctocog alfa). Its safety was later confirmed by an uneventful challenge test.

A trombose venosa profunda é uma patologia rara em pediatria, associada a morbilidade e a mortalidade importantes. A maioria tem causa subjacente e, apenas 5% dos casos são idiopáticos. Apresenta-se o caso de um menino de 6 anos, pre - viamente saudável, internado por febre e dor coxo-femoral esquer da, no qual é detectada, ecograficamente, trombose da veia femoral esquerda com extensão para a veia ilíaca, posteriormente confirmada por TC. Constatou-se rápida melhoria clínica com administração de heparina. O estudo da coagu - lação não identificou qualquer alteração. A resolução do trombo ocorreu aos 5 meses de terapêutica e aos 3-4 meses de doença iniciou parestesias e edema do membro inferior esquerdo (síndrome pós-flebítica), que mantém. Apresenta circulação colateral crescente na região abdominal inferior., Portuguese Journal of Pediatrics, Vol 38 No 6 (2007)

AIMS: With few reported cases of IgE-mediated allergy to gluten, we report a series of nine cases, with special emphasis on diagnosis, process of sensitization, clinical manifestations and predictive factors of prognosis. METHODS: In this series all cases of IgE-mediated allergy to gluten, followed the last 15 years at the Pediatric Allergology of a tertiary hospital, were included. Age of onset, initial symptoms, routes of sensitization, comorbidities and acquisition of tolerance were analyzed. RESULTS: with gluten allergy, with ages ranging from 1 to 14 years, were included; eight were boys. The first manifestation took place between 5 and 9 months. In six patients the initial symptoms were cutaneous, two patients had gastrointestinal disorders, and one girl showed anaphylaxis as the initial manifestation. The route of sensitization was cutaneous or by food ingestion. Serum specific IgE to gluten ranged from 0,73 to 100KUA/l. All children exhibited other atopic diseases. Eight children had multiple food allergies and four developed respiratory allergy. Two patients suffered anaphylaxis after the diagnosis. Three cases resolved their gluten allergy up to eight years of age. CONCLUSIONS: Gluten allergy is rare, explaining the small number diagnosed in 15 years, in a central referral hospital. The nine cases began in the first year of life, being cutaneous manifestations the most frequent. Eczema is a common presentation and there was dermal sensitization in some cases. Multiple food allergy was also frequent in the cases described. Three of the nine children resolved allergy up to six years, having in common an initial cutaneous manifestation. In these nine cases, the value of specific IgE was not predictive of clinical outcome.

Case report A ten years old boy was admitted for pleural tuberculosis (negative cultures, positive quantiferon assay, and father under treatment for tuberculosis). On the tenth day of treatment with isoniazid, rifampicin and pyrazinamide he develloped an exuberant urticarial rash, facial oedema, fever, myalgias, oliguria and, later, conjunctival hyperemia. Laboratory results included low platelet count, hypoalbuminemia and hyponatremia. Gradual improvement occured after suspension of treatment. One month later, drugs were gradualy re-introduced (1 drug/week) but several reactions occurred: anaphylaxis 5 hours after rifampicin administration and generalized macular rash after pyrazinamide. Both drugs were suspended. Isoniazid caused an initial light generalized macular exanthema. Streptomycin, ethambutol and ciprofloxacin were introduced and well tolerated. In subsequent evaluation the child was asymptomatic, with normal analytic results and radiologic improvement. After 6 months of successful treatment, he was tested in detail for reactions to the implicated drugs.