Browsing by Author "Rodrigues, Ana Maria"
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- A comparison between metaheuristic-based and solver-based methods to solve routing problem based on sectorizationPublication . Teymourifar, Aydin; Rodrigues, Ana Maria; Ferreira, José SoeiroThis study involves the division of a region into smaller units, based on sectorization, and a route determination for each of them. The routing problem of each unit is defined as a basic traveling salesman problem (TSP). Different implementations of a widely used method to solve TSP are compared. The method is based on a mixed-integer linear programming model, in which after finding an initial solution, a sub-tour elimination process is done iteratively. The implements of the method use some metaheuristics and solvers, which are available in libraries and toolboxes of MATLAB and Python. The implementations are compared in terms of results and solution times. Suggestions to solve large-scale problems are presented, which are derived from the results.
- A comparison between optimization tools to solve sectorization problemPublication . Teymourifar, Aydin; Rodrigues, Ana Maria; Ferreira, José Soeiro; Lopes, CristinaIn sectorization problems, a large district is split into small ones, usually meeting certain criteria. In this study, at first, two single-objective integer programming models for sectorization are presented. Models contain sector centers and customers, which are known beforehand. Sectors are established by assigning a subset of customers to each center, regarding objective functions like equilibrium and compactness. Pulp and Pyomo libraries available in Python are utilised to solve related benchmarks. The problems are then solved using a genetic algorithm available in Pymoo, which is a library in Python that contains evolutionary algorithms. Furthermore, the multi-objective versions of the models are solved with NSGA-II and RNSGA-II from Pymoo. A comparison is made among solution approaches. Between solvers, Gurobi performs better, while in the case of setting proper parameters and operators the evolutionary algorithm in Pymoo is better in terms of solution time, particularly for larger benchmarks.
- Home-based intervention program to reduce food insecurity in elderly populations using a TV app: study protocol of the randomized controlled trial Saúde.Come SeniorPublication . Rodrigues, Ana Maria; Gregório, Maria João; Gein, Pierre; Eusébio, Mónica; Santos, Maria José; Sousa, Rute Dinis de; Coelho, Pedro S.; Mendes, Jorge M.; Graça, Pedro; Oliveira, Pedro; Branco, Jaime C.; Canhão, HelenaBackground: The limited or uncertain access to adequate food in elderly people includes not only economic restrictions but also inability of food utilization due to functional or cognitive impairment, health problems, and illiteracy. Objective: The aim of this work is to present the protocol of the randomized controlled trial Sande.Come Senior, an educational and motivational television (TV)-based intervention to promote healthy lifestyles and decrease food insecurity in elderly people. Methods: A randomized controlled study will be conducted in subjects aged 60 years and older with food insecurity, identified at 17 primary care centers in the Lisboa e Vale do Tejo health region in Lisbon, Portugal. The primary outcome will be the changes in participants' food insecurity score (evaluated by the Household Food Insecurity Scale) at 3 months Change in other outcomes will be assessed (dietary habits, nutritional status, physical activity, health status, and clinical outcomes). Subjects will be followed over 6 months; the intervention will last 3 months Data collection will be performed at 3 different time points (baseline, end of intervention at 3 months, and follow-up at 6 months) The intervention is based on an interactive TV app with an educational and motivational program specifically developed for the elderly that has weekly themes and includes daily content in video format: (1) nutrition and diet tips for healthy eating, (2) healthy, easy to cook and low-cost recipes, and (3) physical exercise programs. Furthermore, brief reminders on health behaviors will also be broadcasted through the TV app. The total duration of the study will be 6 months. The intervention is considered to be effective and meaningful if 50% of the individuals in the experimental group have a decrease of 1 point in the food insecurity score, all the remaining being unchanged. We expect to include and randomize 282 (141 experimental and 141 control) elderly with food insecurity. We will recruit a total of 1,128 subjects considering that 50% of the target individuals are food insecure (based on INFOFAMILIA Survey) (567) and about 50% of those will adhere to the study (282). Results: The randomized controlled trial with the 12-week home-based intervention with a comprehensive program on healthy eating and physical activity delivery is planned to start recruiting participants at the end of 2017. Conclusions: This study will assess the efficacy of this innovative tool (Sande.Come Senior) for disseminating relevant health information, modifying behaviors, and decreasing food insecurity in an easy, low-cost, and massive way.
- A Monte Carlo simulation-based approach to solve dynamic sectorization problemPublication . Teymourifar, Aydin; Rodrigues, Ana Maria; Ferreira, José SoeiroIn this study, two novel stochastic models are introduced to solve the dynamic sectorization problem, in which sectors are created by assigning points to service centres. The objective function of the first model is defined based on the equilibration of the distance in the sectors, while in the second one, it is based on the equilibration of the demands of the sectors. Both models impose constraints on assignments and compactness of sectors. In the problem, the coordinates of the points and their demand change over time, hence it is called a dynamic problem. A new solution method is used to solve the models, in which expected values of the coordinates of the points and their demand are assessed by using the Monte Carlo simulation. Thus, the problem is converted into a deterministic one. The linear and deterministic type of the model, which is originally non-linear is implemented in Python's Pulp library and in this way the generated benchmarks are solved. Information about how benchmarks are derived and the obtained solutions are presented.
- A new model and solution method for the dynamic sectorization problemPublication . Teymourifar, Aydin; Rodrigues, Ana Maria; Ferreira, José SoeiroIn sectorization problems (SPs), a large area is divided into smaller regions for administrative purposes. SPs have applications in many fields. Since real-life problems are often dynamic, in this study, a new model for dynamic SP is proposed. In the problem, points are assigned to service centres and in this way sectors are formed. The sectors must be balanced in terms of distance and demand, which is defined in the objective function and constraints of the model. In the problem, in a certain time period, the coordinates and demands of some points change according to certain statistical distributions. A two-stage solution method is suggested for this problem. In the first stage, the expected values of coordinates and demands of the points are estimated by a Monte Carlo simulation, and in the second stage, the problem is solved like a deterministic optimization problem. The model is nonlinear, but after linearization, it is solved in Python’s Pulp library for benchmarks of different sizes and the results are discussed.
- A new model for location-allocation problem based on sectorizationPublication . Teymourifar, Aydin; Rodrigues, Ana Maria; Ferreira, José SoeiroMany models have been proposed for the location-allocation problem. In this study, based on sectorization concept, we propose a new single-objective model of this problem, in which, there is a set of customers to be assigned to distribution centres (DCs). In sectorization problems there are two important criteria as compactness and equilibrium, which can be defined as constraints as well as objective functions. In this study, the objective function is defined based on the equilibrium of distances in sectors. The concept of compactness is closely related to the accessibility of customers from DCs. As a new approach, instead of compactness, we define the accessibility of customers from DCs based on the covering radius concept. The interpretation of this definition in real life is explained. As another contribution, in the model, a method is used for the selection of DCs, and a comparison is made with another method from the literature, then the advantages of each are discussed. We generate benchmarks for the problem and we solve it with a solver available in Python’s Pulp library. Implemented codes are presented in brief.
- Peer adoption and development of health innovations by patients: national representative study of 6204 citizensPublication . Oliveira, Pedro; Zejnilovic, Leid; Azevedo, Salome; Rodrigues, Ana Maria; Canhão, HelenaBackground: There is growing evidence that many patients and caregivers innovate by developing new solutions to cope with their health disorders. Given the easy access to vast internet resources and peers globally, it is increasingly important to understand what may influence user innovation and its adoption in health for improving individual well-being and ensuring their safety, in particular, how interactions with peers and physicians or search behavior, along with sociodemographics, may influence the decision to develop a solution or adopt one developed by a peer. Objective: The aim of this paper was to study the development and peer-to-peer adoption of user innovations in health care and identify individual-level factors associated with these processes. Methods: Data were collected via computer-assisted phone survey from a large, random, and representative sample of adult residents in Portugal (N=6204). User innovation questions were added to 1 wave of an ongoing observational, longitudinal, population-based epidemiological study. By asking about individual innovation activity, the sample was split into 3 groups: (1) the developers of health-related solutions for own use (developers), (2) the adopters of solutions developed by other patients or caregivers (peer-to-peer adopters), and (3) the rest of the population. Within the last group, intention to adopt was measured and used as a proxy of future behavior. Regression analysis is used to test the associations. Results: In the population considered in this paper, an estimated 1.3% (75/6008) reported having developed a solution for own use and 3.3% reported to have adopted a solution developed by peers. The 3 groups (developers, adopters, and remaining population) have distinctive characteristics. Gender plays an important role in the solution development, as women are less likely to develop one (odds ratio [OR] 0.4, 95% CI 0.20-0.81; P<.05). Education is positively associated with the development activity (OR 1.13, 95% CI 1.03-1.24; P<.05) but also with the intentions to adopt a peer-developed solution. Search for health-related information is positively associated with the development, adoption, and the intentions to adopt a solution. Interactions with peers over the internet are rare, but in-person interactions are frequent and have a positive association with the dependent variables in all 3 groups. The results also suggest that trust in doctors represents an important dimension that shapes the attitudes of the population toward peer-developed solutions. Conclusions: This paper demonstrates the importance of the peer community, doctor-patient relationship, citizen’s search for information on innovation, and individual attitudes toward peer-to-peer adoption in health care. It stresses the need for a reliable Web-based health-related information and the necessity to deeper understand complex relationships between the need to improve health and fulfill the need and the perception of the health care system.
- Shannon’s entropy method to find weights of objectives in sectorization problemPublication . Teymourifar, Aydin; Rodrigues, Ana Maria; Ferreira, José SoeiroOne of the most widely used methods in multi-objective optimization problems is the weighted sum method. However, in this method, defining the weights of objectives is always a challenge. Various methods have been suggested to achieve the weights, one of which is Shannon’s entropy method. In this study, a bi-objective model is introduced to solve the sectorization problem. As a solution method, the model is transformed into two single-objective ones. Also, the bi-objective model is solved for the case where the weights are equal to one. The gained three results from a benchmark are supposed as alternatives in a decision matrix. After the limitation of this approach appears, solutions from different benchmarks are added to the matrix. With Shannon’s entropy method, the weights of the objective functions are got from the decision matrix. The limitations of the approach and possible causes are discussed.
- Treatment-resistant depression and major depression with suicide risk — the cost of illness and burden of diseasePublication . Sousa, Rute Dinis; Gouveia, Miguel; Nunes da Silva, Catarina; Rodrigues, Ana Maria; Cardoso, Graça; Antunes, Ana Filipa; Canhao, Helena; de Almeida, José Miguel CaldasIntroduction: Treatment-Resistant Depression (TRD) and Major Depression with Suicide Risk (MDSR) are types of depression with relevant effects on the health of the population and a potentially significant economic impact. This study estimates the burden of disease and the costs of illness attributed to Treatment-Resistant Depression and Major Depression with Suicide Risk in Portugal. Methods: The disease burden for adults was quantified in 2017 using the Disability-Adjusted Life Years (DALYs) lost. Direct costs related to the health care system and indirect costs were estimated for 2017, with indirect costs resulting from the reduction in productivity. Estimates were based on multiple sources of information, including the National Epidemiological Study on Mental Health, the Hospital Morbidity Database, data from the Portuguese National Statistics Institute on population and causes of death, official data on wages, statistics on the pharmaceutical market, and qualified opinions of experts. Results: The estimated prevalence of TRD, MDSR, and both types of depression combined was 79.4 thousand, 52.5 thousand, and 11.3 thousand patients, respectively. The disease burden (DALY) due to the disability generated by TRD alone, MDSR alone, and the joint prevalence was 25.2 thousand, 21 thousand, and 4.5 thousand, respectively, totaling 50.7 thousand DALYs. The disease burden due to premature death by suicide was 15.6 thousand DALYs. The estimated total disease burden was 66.3 thousand DALYs. In 2017, the annual direct costs with TRD and MDSR were estimated at € 30.8 million, with the most important components being medical appointments and medication. The estimated indirect costs were much higher than the direct costs. Adding work productivity losses due to reduced employment, absenteeism, presenteeism, and premature death, a total cost of € 1.1 billion was obtained. Conclusions: Although TRD and MDSR represent relatively small direct costs for the health system, they have a relevant disease burden and extremely substantial productivity costs for the Portuguese economy and society, making TRD and MDSR priority areas for achieving health gains.
- A video-based mobile app as a health literacy tool for older adults living at home: protocol for a utility studyPublication . Nunes-da-Silva, Catarina; Victorino, André; Lemos, Marta; Porojan, Ludmila; Costa, Andreia; Arriaga, Miguel; Gregório, Maria João; Sousa, Rute Dinis de; Rodrigues, Ana Maria; Canhão, HelenaBackground: People aged ≥65 years are more likely to have health problems related to aging, polypharmacy, and low treatment adherence. Moreover, health literacy levels decrease with increasing age. Objective: The aim of this study is to assess an app’s utility in promoting health-related knowledge in people aged ≥65 years. Methods: We developed a simple, intuitive, and video-based app (DigiAdherence) that presents a recipe, nutritional counseling, and content on physical activity, cognitive exercise, motivation to adhere to treatment, fall prevention, and health literacy. A convenience sample of 25 older adults attending the Personalized Health Care Unit of Portimão or the Family Health Unit of Portas do Arade (ACeS Algarve II – Barlavento, ARS Algarve, Portugal) will be recruited. Subjects must be aged ≥65 years, own a smartphone or tablet, be willing to participate, and consent to participate. Those who do not know how to use or do not have a smartphone/tablet will be excluded. Likewise, people with major cognitive or physical impairment as well as those living in a long-term care center will not be included in this study. Participants will have access to the app for 4 weeks and will be evaluated at 3 different timepoints (V0, before they start using the app; V1, after using it for 30 days; and V2, 60 days after stopping using it). After using the app for 30 days, using a 7-point Likert scale, participants will be asked to score the mobile tool’s utility in encouraging them to take their medications correctly, improving quality of life, increasing their health-related knowledge, and preventing falls. They will also be asked to assess the app’s ease of use and visual esthetics, their motivation to use the app, and their satisfaction with the app. Subjects will be assessed in a clinical interview with a semistructured questionnaire, including questions regarding user experience, satisfaction, the utility of the app, quality of life (EQ-5D-3L instrument), and treatment adherence (Morisky scale). The proportion of participants who considered the app useful for their health at V1 and V2 will be analyzed. Regarding quality of life and treatment adherence perceptions, comparisons will be made between V0 and V1, using the t test for dependent samples. The same comparisons will be made between V0 and V2. Results: This study was funded in December 2019 and authorized by the Executive Board of ACeS Algarve II – Barlavento and by the Ethics Committee of NOVA Medical School (99/2019/CEFCM, June 2020). This protocol was also approved by the Ethics Committee for Health (16/2020, September 2020) and the Executive Board (December 2020) of the Regional Health Administration of the Algarve, IP (Instituto Público). Recruitment was completed in June 2021. Conclusions: Since the next generation of older adults may have higher digital literacy, information and communication technologies could potentially be used to deliver health-related content to improve lifestyles among older adults.