Repositório RCAAP

Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics - from epidemiology, awareness, care and treatment to public health policies and leadership - that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.

Objective: This study examines the associations between pre-to post-intervention changes in motivation and physical activity (PA) levels of bariatric patients involved in a 6-month postoperative PA program based on selfdetermination theory (SDT). We also explore the extent to which patients’ perception of autonomy support and basic psychological need satisfaction during the program were associated with changes in their motivation to exercise. Method: Forty patients were assigned to a motivational PA intervention (MPAI-G) or to a control group (CG). Both groups completed questionnaires assessing the variables of interest and wore GT3X accelerometers before surgery and after the program. Results: Thirty-two participants (78.1% female) completed all measures and were included in the present analyses. CG showed greater increases in integrated (d = 1.60, 95% CI [ 2.40, 0.81]) and identified regulation (d = 0.75, 95% CI [ 1.47, 0.03]) than MPAI-G. However, the MPAI-G experienced increases in introjected regulation (d = 1.95, 95% CI [1.11, 2.79]) and greater decreases in external regulation (d = 1.00, 95% CI [ 1.74, 0.27]) than CG, which were associated with decreases in sedentary activity and increases in light and total PA. Oppositely to the CG, amotivation decreased in the MPAI-G (d = 2.98, 95% CI [ 3.98, 1.97]) and it was related to increases in light and total PA. Changes in exercise motivation were associated with perceived autonomy support and basic psychological need satisfaction during the program. Conclusion: The SDT-based PA program gave rise to greater changes in controlled forms of motivation and amotivation than in autonomous motivation in post-bariatric surgery patients.

Weight loss maintenance is crucial for obesity management, yet optimal dietary patterns for this period are not established. We aimed to explore the relationship between adherence to the Mediterranean diet and weight loss maintenance. Sample includes 565 adults (62 % women) of the MedWeight study. Eligible volunteers were those reporting intentional weight loss of ≥10 %, starting from a BMI ≥ 25 kg/m2, over 12 months prior to enrolment. Based on current weight, participants were characterised as maintainers (≤90 % maximum weight) or regainers (>95 % maximum weight). Socio-demographics and weight history were recorded. Dietary intake was assessed by two non-consecutive 24-h recalls within 10 d and analysed in energy, macronutrient and food group intakes. Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Score (MedDietScore) (range 0-55, greater scores showing higher adherence). Protein intake was higher in maintainers than in regainers (P < 0·001). When MedDietScore quartiles were considered, a linear trend for weight loss maintenance was revealed (P < 0·05). After adjustment for basic demographic characteristics, being in the third or fourth quartile of the MedDietScore (v. first) was associated with 2·30 (95 % CI 1·29, 4·09) and 1·88 (95 % CI 1·10, 3·22) increased odds of maintenance. Regarding individual MedDietScore components, only fruit intake is associated with increased odds for maintenance (1·03 (95 % CI 1·01, 1·06)). The leave-one-out approach revealed that at least six MedDietScore components were essential for the observed relationship. Higher adherence to the Mediterranean diet was associated with 2-fold increased likelihood of weight loss maintenance. Future studies should replicate these findings in non-Mediterranean populations as well.

Background: Several studies have suggested that reduced sleep duration and quality are associated with an increased risk of obesity and related metabolic disorders, but the role of sleep in long-term weight loss maintenance (WLM) has not been thoroughly explored using prospective data. Methods and findings: The present study is an ancillary study based on data collected on participants from the Navigating to a Healthy Weight (NoHoW) trial, for which the aim was to test the efficacy of an evidence-based digital toolkit, targeting self-regulation, motivation, and emotion regulation, on WLM among 1,627 British, Danish, and Portuguese adults. Before enrolment, participants had achieved a weight loss of ≥5% and had a BMI of ≥25 kg/m2 prior to losing weight. Participants were enrolled between March 2017 and March 2018 and followed during the subsequent 12-month period for change in weight (primary trial outcome), body composition, metabolic markers, diet, physical activity, sleep, and psychological mediators/moderators of WLM (secondary trial outcomes). For the present study, a total of 967 NoHoW participants were included, of which 69.6% were women, the mean age was 45.8 years (SD 11.5), the mean baseline BMI was 29.5 kg/m2 (SD 5.1), and the mean weight loss prior to baseline assessments was 11.4 kg (SD 6.4). Objectively measured sleep was collected using the Fitbit Charge 2 (FC2), from which sleep duration, sleep duration variability, sleep onset, and sleep onset variability were assessed across 14 days close to baseline examinations. The primary outcomes were 12-month changes in body weight (BW) and body fat percentage (BF%). The secondary outcomes were 12-month changes in obesity-related metabolic markers (blood pressure, low- and high-density lipoproteins [LDL and HDL], triglycerides [TGs], and glycated haemoglobin [HbA1c]). Analysis of covariance and multivariate linear regressions were conducted with sleep-related variables as explanatory and subsequent changes in BW, BF%, and metabolic markers as response variables. We found no evidence that sleep duration, sleep duration variability, or sleep onset were associated with 12-month weight regain or change in BF%. A higher between-day variability in sleep onset, assessed using the standard deviation across all nights recorded, was associated with weight regain (0.55 kg per hour [95% CI 0.10 to 0.99]; P = 0.016) and an increase in BF% (0.41% per hour [95% CI 0.04 to 0.78]; P = 0.031). Analyses of the secondary outcomes showed that a higher between-day variability in sleep duration was associated with an increase in HbA1c (0.02% per hour [95% CI 0.00 to 0.05]; P = 0.045). Participants with a sleep onset between 19:00 and 22:00 had the greatest reduction in diastolic blood pressure (DBP) (P = 0.02) but also the most pronounced increase in TGs (P = 0.03). The main limitation of this study is the observational design. Hence, the observed associations do not necessarily reflect causal effects. Conclusion: Our results suggest that maintaining a consistent sleep onset is associated with improved WLM and body composition. Sleep onset and variability in sleep duration may be associated with subsequent change in different obesity-related metabolic markers, but due to multiple-testing, the secondary exploratory outcomes should be interpreted cautiously.

Na Amazónia colonial, sementes, cascas, folhas, frutos e outras partes de vegetais e de animais das florestas eram recolhidos, preparados e negociados para diversíssimos efeitos. Serviam, por exemplo, de remédios na medicina e farmacologia, de ingredientes em comidas e bebidas e de tintas e unguentos corporais. Com base em fontes dos séculos XVII ao XIX, a presente dissertação investiga a história de saberes e práticas relativos a uma seleção de produtos naturais da Amazónia: o almíscar, o pau-cravo, as pimentas, o puxuri, o urucum e o carajuru. A análise das fontes desvenda a circulação de ideias ligadas a estas substâncias, rastreando analogias e paralelismos entre as especiarias da Amazónia e as do Oriente e realçando o impacto e a disseminação de conhecimentos e práticas ameríndios. Neste contexto, são destacados os dicionários setecentistas de Língua Geral Amazónica e a sua terminologia das especiarias amazónicas.

Introdução: As crianças têm uma necessidade básica de atividade física. Frequentemente, a doença cardíaca significa uma limitação da experiência percetiva e motora da criança afetada. Há relativamente poucos estudos centrados no desenvolvimento motor das crianças com doenças cardíacas congénitas (CC). O nosso objetivo é avaliar o impacto das CC nas capacidades motoras fundamentais das crianças dos 6 aos 9 anos de idade. Métodos: Foram incluídas crianças com CC, de ambos os sexos, com idades compreendidas entre os 6 e os 9 anos. Os critérios de exclusão tiveram em conta a presença de outros fatores de risco de perturbação do desenvolvimento motor, alterações visuais ou auditivas, presença de malformações extracardíacas ou síndromes que pudessem interferir com as variáveis do estudo. Os participantes foram divididos em 3 grupos, de acordo com a doença subjacente e o estado cirúrgico: CC acianótica simples corrigida (grupo I); CC acianótica complexa corrigida ou CC cianótica corrigida (grupo II); CC cianótica complexa não corrigida, ou seja, após cirurgia paliativa (grupo III). A avaliação incluiu o teste da marcha dos 6 minutos; uma entrevista com as crianças e os seus pais para recolher dados clínicos, demográficos e de hábitos de vida; e no final foi aplicado o teste de proficiência motora de Bruininks-Oseretsky, 2ª Edição. Resultados: Foram recrutados quarenta e quatro participantes, 23 do sexo masculino e 21 do sexo feminino. O grupo I incluiu 15 crianças, o grupo II 13, e o grupo III 16. No Score Composto de Proficiência Motora, o Grupo I apresentou uma pontuação correspondente ao percentil 48 (34,51-61,76), o Grupo II apresentou uma pontuação correspondente ao percentil 25 (10,06-40,25); finalmente, os participantes do Grupo III apresentaram uma pontuação correspondente ao percentil 5 (2,54-7,32), muito abaixo da média para a sua idade e sexo. As diferenças estatisticamente significativas entre os três grupos foram documentadas para os diferentes sub-testes avaliados. Foi documentada uma correlação entre a Proficiência Motora e os resultados do TC6, sendo o impacto maior quanto mais complexa for a doença. Conclusões: Este estudo documenta que as crianças com cardiopatias congénitas complexas ou paliativas apresentam uma competência motora reduzida, com limitações nas competências motoras finas e brutas. Estas limitações, baseadas nas competências adquiridas desde a primeira infância, apresentam um efeito negativo adicional sobre a aptidão física e a força muscular dos indivíduos. Estes resultados apontam para a necessidade de uma intervenção precoce no desenvolvimento destes pacientes.

Introdução: Os cuidados de fim de vida são frequentemente tema na prática clínica. Cada vez mais se abordam os tratamentos não benéficos e a necessidade de tomada de decisão relativamente à instituição terapêutica. Não existem linhas orientadoras relativamente à prescrição ou desprescrição de antibioterapia em fim de vida, dependendo esta da decisão clínica. Neste trabalho desenvolveu-se uma escala de avaliação dos fatores com maior ponderação na decisão dos clínicos no momento de prescrição antimicrobiana e que variáveis os podem influenciar. Métodos: estudo quantitativo, exploratório e descritivo, correlacional e inferencial. Após revisão de literatura, foi construída a escala, com análise de consistência interna e estabilidade temporal. Foi aplicada online conjuntamente com questionário sociodemográfico e clínico. Foi efetuada análise estatística da escala, sua construção e validação final, e análise estatística dos resultados. Resultados: Participaram 196 médicos (76.5% sexo feminino, 78.6% com idade 50% tem apoio interpares na tomada de decisão. A escala de avaliação de fatores que influenciam a prescrição de antibioterapia em fim de vida explica 57.4% dos resultados, em 3 fatores: infeção; doente/doença; sintomas. Os fatores associados a sintomas foram os que apresentaram maior predomínio na tomada de decisão por oposição aos de infeção. Das varáveis analisadas verifica-se que médicos mais jovens tendem a valorizar menos os fatores de infeção. A formação em Cuidados Paliativos não apresentou diferenças estatisticamente significativas. Conclusões: De entre os múltiplos fatores que podem influenciar a instituição de antibioterapia no fim de vida destaca-se o controlo sintomático como fator de maior ponderação. Mais do que a existência de formação em cuidados paliativos, a motivação e preocupação dos clínicos para este tema parece ser fator preponderante na realização de boas práticas clínicas.

Kunqu Opera is one of the representatives of traditional Chinese elegant culture. The form and style of the stage design of Kunqu are unique. Among them, the Jiangnan gardens play an essential role: to begin with, it was used as a stage space in the initial stage of Kunqu Opera; in addition, it is a scene that often appears in the plot of Kunqu; furthermore, it has become a space where Kunqu opera stage design has been tried to simulate later. In recent years, different interpretations of Kunqu have appeared, and they are all trying to recombine with the “place” of the garden. These new forms have brought Kunqu to the public's sight again and re-examined the meaning of Jiangnan gardens space. This kind of examination focuses on people’s beginning to pursue the restoration of the sense of experience, that is, the hyperspatial meaning of the experience of the garden. The article starts with representative cases of the integration of contemporary Kunqu opera stage design and Jiangnan gardens space to study the restoration of the Kunqu opera stage space to the sense of garden space experience. At the same time, the author also tries to discuss how the fuzzy experience of gardens space will be transformed and applied in the new era or future space design. The author first explains the origin of the hyperspatial nature of Jiangnan gardens; in addition, the author further elaborates the connection between gardens and Kunqu from the perspective of Chinese aesthetic and discusses the use of garden elements in the stage space in combination with some recent cases; in conclusion, the author analyses how to recreate the audience's experience in terms of technology without the “place” (including imitation) of Jiangnan gardens, and looks forward to the future space design

O presente trabalho integra um projeto que tem como objetivo determinar se a energia dissipada por linfócitos T pode ser utilizada como biomarcador precoce da exaustão celular. A exaustão de linfócitos T corresponde a um estado de disfunção celular, caracterizado pela perda da capacidade proliferativa e de funções efetoras. Antes da disfunção, os linfócitos T podem entrar em esforço metabólico e aumentar a dissipação de energia sob a forma de calor, que pode ser medida através da microcalorimetria. Para detetar este aumento da energia dissipada, foram realizadas medições calorimétricas em amostras de PBMCs com linfócitos T estimulados a proliferar em meios pobres em arginina, que consistem em meios propícios à exaustão. Estas medições foram realizadas no microcalorímetro LKB 10700-01, e a energia dissipada sob a forma de calor pelas amostras foi convertida em potência dissipada por célula. Neste trabalho, a potência dissipada em amostras de PBMCs com linfócitos T estimulados durante 24 horas, em meios favoráveis ao crescimento celular (170 mg/L de arginina), foi de 16,52±4,52 pW/célula, tendo sido significativamente superior à potência dissipada por amostras de PBMCs na ausência de estímulo (4,75±3,36 pW/célula) (p<0,01). Nos meios propícios à exaustão (<170 mg/L de arginina), a potência dissipada após 24 horas do estímulo foi de 27-40 pW/célula, tendo sido significativamente superior à potência dissipada por linfócitos T estimulados em meios favoráveis ao crescimento celular (16,52±4,52 pW/célula) (p<0,05). As baixas concentrações de arginina nestes meios também promoveram o aumento da percentagem de células pouco saudáveis, estando este parâmetro fortemente correlacionado com a energia dissipada por célula (R2=0,89). Em conclusão, este trabalho mostrou que, a ativação de linfócitos T em meios propícios à exaustão contribui para o aumento da dissipação de energia por célula, sendo estes resultados bastante promissores para o objetivo do projeto em que se encontra inserido.

A elaboração do presente relatório constitui o “início da caminhada para a Qualidade” na Biblioteca – CDI: Centro de Documentação e Informação da Faculdade de Medicina da Universidade de Lisboa, como resultado da aplicação da “Estrutura Comum de Avaliação”, preconizada pela metodologia CAF- Common Assessment Framework para o processo de Auto-Avaliação e análise organizacional desta unidade orgânica da FMUL. Este primeiro passo da “caminhada para a Qualidade”, pretende ser uma reflexão para a aprendizagem organizacional acerca do modo “como se pensa”, “como se aprende” e “como se inova”, inserindo-se num projecto mais vasto, em curso na FMUL e que visa a certificação para a Qualidade nos Serviços Técnico Administrativos nos quais a Biblioteca - CDI se enquadra.

Non- alcoholic fatty liver disease (NAFLD) is now the leading cause of chronic liver disease globally. Despite the increased demand placed on health- care systems, little attention has been given to the design and implementation of efficient and effective models of care for patients with NAFLD. In many health- care settings, no formal pathways exist and, where pathways are in place, they are often not standardized according to good practices. We systematically searched the peer- reviewed literature with the aim of identifying published examples of comprehensive models of care that answered four key questions: what services are provided? Where are they provided? Who is offering them? How are they coordinated and integrated within health- care systems? We identified seven models of care and synthesized the findings into eight recommendations nested within the ‘what, where, who and how’ of care models. These recommendations, aimed at policy- makers and practitioners designing and implementing models of care, can help to address the increasing need for the provision of good practice care for patients with NAFLD.

This dissertation studies the relationship between the expansion of gentrification processes to more peripheral areas of the city of Lisbon and the promotion of inequalities in access to housing in these areas. The association of gentrification with this kind of inequalities is a much-discussed topic, , being no longer restricted to historic city centres with the expansion of gentrification processes. Therefore, it becomes necessary to understand how these processes may be promoting inequalities in more peripheral areas. In this sense, the aim of this dissertation was to investigate whether there are gentrification processes in São Domingos de Benfica, and whether these are promoting inequalities in access to housing. Since gentrification is a phenomenon that encompasses several processes of spatial and social transformations, four parameters of analysis of gentrification were outlined: a) a reorganization of the social geography; b) a transformation of the urban landscape and the social dynamics observed in it; c) residential upgrading, architectural improvements and a change in services and d) an increase in the price of housing and a rise in the value of the area. The research focused on Estrada de Benfica and its surroundings, in order to facilitate data collection. The methodological approach mixed qualitative methods (survey and mapping of active commerce and services and rehabilitation of the residential building; direct observation; semi-structured in-depth interviews with residents, retail and service owners and managers, real estate agents and responsible people for the local parish) and quantitative methods, through the collection of data from the 2011 and 2021 Census, complemented when necessary with information coming from other sources. It was concluded that it is not possible to affirm the explicit existence of gentrification in São Domingos de Benfica, being only possible to identify some small pockets in Estrada de Benfica. But even if the existence of extensive gentrification is not confirmed, the presence of inequalities in the access to housing is quite evident. Displacement by exclusion is significant, and there are some cases, albeit very few of direct displacement. The pressure on the real estate market caused by gentrification and touristification that started in central areas is expanding throughout the city, creating a high inflation of rents and housing values, which is driving out and excluding the lower and the middle classes from Lisbon, with a tendency to worsen in the coming years.

Invasion dynamics are determined, among other aspects, by the spatial behaviour of invasive populations. The invasive toad Duttaphrynus melanostictus is spreading inland from the eastern coast of Madagascar, causing considerable ecological impacts. Understanding the basic factors determining the spread dynamics can inform management strategies and provide insights into spatial evolutionary processes. We radio-tracked 91 adult toads in three localities along the invasion gradient to determine whether spatial sorting of dispersive phenotypes is occurring, and investigate intrinsic and extrinsic determinants of spatial behaviour. Overall, toads in our study appeared as habitat generalists, and their sheltering behaviour was tied to water proximity, with toads changing shelter more frequently closer to waterbodies. Toads showed low displacement rates (mean = 4.12 m/day) and quite a philopatric behaviour but were able to perform daily movements of over 50 m. We did not detect any spatial sorting of dispersal-relevant traits nor sex- or size-biased dispersal. Our results suggest that toads are more likely to expand their range during the wet season, and that the range expansion is probably dominated by short-distance dispersal at this stage of the invasion, although a future increase in invasion speed is expected, due to the capacity for long-distance movements of this species.

Taking the original meaning of physis, usually translated by the unsatisfactory expression of nature, from Heraclitus and Heidegger, the first part of this research develops the idea of a force that manifests itself in two contrary movements, and which is extended, in the second part, to the notion of an anadyomene rhythm of the visual in Didi-Huberman. Regarding this idea, the movement of breathing is evoked, as well as the drives (of life and death) introduced by Freud. These concepts formulate a thought in articulation with my artistic practice, which is presented in this work, with greater incidence on issues such as: the empty space of the body, as a place to detain – staring – the eye; and the formal simplification of certain works (as parallelepipeds), where the indication of a human stature, of a relational dimension of the works, happens in the absence of its figurative representations. It seeks to explore the issues of this work under the influence of the deeper sense of physis

This work talks about the 19th century’s critic John Ruskin and his laws of composition and it´s connection to drawings of the Human Figure. Firstly, we’re going to talk a brief biography of John Ruskin on the context of his origins with his understanding of the art of his time. Then we explore his book called The Elements of Drawing, not in the fullest, but in regard of the laws of composition using other’s point of view like Charles Blanc, William Hogarth, Jacques-Philippe Voïart and many more. In the end, and with Ruskin’s laws in mind, we’re going to study how they appear on drawings about human figure and how they work on the subject

This dissertation has the study of human space along the components that virtually structure it as its main goal. Its development splits between exploring the spatial idea at the root of civilizational growth and considering a range of categorizations beyond those that express its best condition, which have been informing it as part of visual culture. Within it, there’s an initial approach towards the symbols, organizations, and practices building linked throughout antiquity. Analyses of civilizational artifacts from the Ancient Age and Hellenic texts merge with Plato’s reflection in The Republic, being then followed by readings of classical references on proportion under the aesthetic virtue of the drafted building this literature implies. Through this, the arts’ theoretical scope comes into play and begins being studied together with notions informed by spatial conditioning, whilst the scenarios Plato hypothesizes in The Republic give place to his Atlantis, More's Utopia and Younge's Dystopia. The investigational sequence upon which these three scenarios are inserted introduces the conventional aspects of amoenitas, inamoenitas, concinnitas and inconcinnitas in view of the academic progression of fields where landscape and plan have their creative centres. Attending these by-products of Drawing, an exploration is conducted about the route European landscape’s visuality has taken in its modern evolution, and an aesthetic reflection is obtained. Said reflection is subsequent to the connection between pictorial work's imaginaries and architectural inventories, which directs the thematic focus towards the environmental side of spatial condition, and proposes Lisbon as the main subject for the remaining topics. Then, the exhibition of investigative materials surrounding Praça do Comércio and pre-conclusive balances come up through a retrospective spanning from the 16th to the 18th century and its posteriorities.

A doença de Huntington (DH) é uma desordem neurodegenerativa rara associada a uma expansão anormal da repetição de poliglutaminas (poliQ) no exão-1 da proteína huntingtina (Htt). Expansões acima de um limite crítico de 37 resíduos de glutamina (37Q) resultam na formação de fibras do tipo amilóide ou de corpos de inclusão intranucleares. Quando ocorre o splicing aberrante do gene HTT mutado ou a clivagem proteolítica das proteínas poliQ expandidas são gerados fragmentos altamente tóxicos do exão-1 da Htt (Httex1), capazes de reproduzir a patologia de DH. Há vários estudos que indicam que as membranas biológicas podem desencadear o misfolding/agregação do fragmento Httex1 e que as regiões adjacentes do poliQ – segmento N17 e a região rica em prolinas (PRR) – regulam a sua ligação à membrana. Este trabalho focou-se na avaliação da importância relativa das interações hidrofóbicas e eletrostáticas na ligação do fragmento Httex1-23Q a lipossomas preparadas com uma composição lipídica variável através da realização de medidas de fluorescência em estado estacionário e resolvidas no tempo. A interação do fragmento Httex1-23Q com membranas lipídicas aniónicas foi estudada mediante a sua marcação específica na posição A2C (no segmento N17) ou A82C (no C-terminal da região PRR) com acrilodano, uma sonda de polaridade fluorescente. Os resultados obtidos confirmaram que a ligação do fragmento Httex1-23Q é mediada através do seu segmento N17, que fica ancorado na superfície da membrana, enquanto a região PRR permanece exposta à solução aquosa. A ligação às membranas do fragmento Httex1-23Q-A2C-acrilodano tem uma componente eletrostática moderada pois a sua partição para os lipossomas (i) aumentou apenas ligeiramente com o aumento do seu conteúdo em fosfolípidos aniónicos, e (ii) era essencialmente independente da força iónica do tampão. A alteração da curvatura das membranas através da variação do diâmetro das vesículas também teve um efeito negligenciável nas propriedades de partição do fragmento Httex1-23Q-A2C-acrilodano.

Climate change is one of the most significant threats to all ecosystems. Yet, there are fundamental knowledge gaps in understanding its effects on caves, mainly due to the difficulty in accessing and studying these ecosystems. Caves provide incredibly stable conditions, such as constant temperature, often corresponding with the average annual temperature for the surface. This dissertation studies the temperature variation in caves and at their respective surface in several climatic regions, and tested the effect of temperature in cave-adapted species and compared it with previously published studies on cave-adapted species thermal tolerance. Temperature was measured in 12 different locations across different climatic zones during one year. Results showed that cave temperature corresponds to the average annual temperature of their correspondent surface, independently on the type of cave or location. Three types of thermal regimes were found with caves thermally similar to the surface, caves with a slight thermal delay, and caves with an extreme thermal delay from the surface. Daily thermal cycles were found in some caves, with implications for the fauna’s circadian rhythms. Thermal tolerance was assessed for six cave-adapted species from Western Portugal karst areas. Some species started dying at temperatures very close to the highest predicted temperature. It is crucial to consider sub-lethal effects that may be occurring prior to mortality. However, caves provide vital ecosystem services. Subterranean ecosystems store 97% of freshwater used in multiple human activities, in which groundwater species play the crucial role of maintaining its ecological equilibrium by filtering and cleaning the water. Furthermore, some terrestrial species are also key decomposers of organic matter, encouraging nutrient cycling. Considering the cave dependence on the surface to regulate its temperature, temperature increases at the surface will be reflected underground, impacting caves, their fauna and ecosystem services.

Esta Newsletter (NL) resulta de uma parceria entre o Instituto de Saúde Baseada na Evidência e a Cochrane Portugal, e tem como objectivo disponibilizar informação sobre áreas importantes para a prática clínica, com base na melhor evidência científica disponível. São incluídos estudos relevantes, criticamente avaliados pela sua validade, importância dos resultados e aplicabilidade prática, resumidos numa óptica de suporte à decisão. É dada prioridade a estudos de causalidade incluindo-se ainda, quando justificado, estudos qualitativos e metodológicos, assim como revisões científicas. O conteúdo da NL é da exclusiva responsabilidade do(s) seu(s) autor(es).

Introdução: As migrações são movimentações de pessoas entre países que já ocorrem há muitos anos e que se mantém nos dias de hoje, perspetivando-se que deverão continuar no futuro. Independentemente das motivações que levam à migração, reconhece-se o processo migratório como um evento de vida gerador de instabilidade e vulnerabilidade, e potencialmente como um determinante social de saúde. No sentido inverso, também a saúde influencia a capacidade integrativa dos migrantes no país de acolhimento. Desta forma, a migração introduz diferenças na prática clínica e nos resultados em saúde destas populações, quando comparados com a população nativa portuguesa, pelo que será importante adotar estratégias com vista à diminuição das desigualdades em saúde. Objetivos e Metodologia: Através de uma revisão narrativa da literatura pretende-se explorar a condição de migrante enquanto determinante social de saúde. Pretende-se compreender de que forma ser migrante é influenciado, e influencia, os diversos determinantes de saúde e de doença, bem como o padrão de utilização dos serviços de saúde. Desta forma, tentou-se explorar as variáveis que permitem enquadrar possíveis diferenças de morbimortalidade, comparando-as à população nativa portuguesa. Conclusão: O ser migrante é um fator com grande variabilidade entre indivíduos. Como tal, é necessária uma abordagem individualizada, mas holística, que possibilite uma prestação de cuidados com qualidade. O reconhecimento de situações particulares de maior risco e vulnerabilidade, capacitam o clínico para atuar corretamente, adotando estratégias comunicativas e terapêuticas para com o seu doente com características tão singulares.