Repositório RCAAP

The authors report the case of a 16-year-old boy who practices karate, who underwent medical evaluation because of atypical chest discomfort, related to strenuous effort. The ECG and echocardiogram findings were normal. The young boy did a treadmill stress test which was positive for myocardial ischemia. Late during the investigation, he underwent treadmill stress echocardiography, during which he developed intraventricular gradient of over 130 mmHg with end-systolic peak and systolic anterior movement (SAM) of the mitral valve. These echocardiographic findings were not present at rest and disappeared shortly after termination of exercise. The authors discuss the significance of this event. This leads us to advise withdrawal from participation in competitive sport according to the recomendations of the European Society of Cardiology. A possible role of exercise stress echo for intraventricular pressure gradient assessment in symptomatic athletes with structurally normal hearts is suggested.

Background: The development of intra-ventricular gradients (IVG) during dobutamine or exercise stress is not infrequent, and can be associated to symptoms during stress. The purpose of this study was to assess the occurrence of IVG during exercise stress echocardiography in cardiac syndrome X patients. Methods: We prospectively evaluated 91 patients (pts) mean aged 51 ± 12 years (age ranged 20 to 75 years old), 44 of whom were women. All pts had angina, positive exercise ECG treadmill testing, normal rest echocardiogram and no coronary artery disease on coronary angiogram (cardiac X syndrome). After complete Doppler echocardiographic evaluation with determination of left ventricular outflow tract index (LVOTi), relative left ventricular wall thickness (RLVWT) and left ventricular end-diastolic volume index (LVDVi), all patients underwent stress echocardiography with two-dimensional and Doppler echographic evaluation during and after treadmill exercise. Results: For analysis purpose patients were divided in 2 groups, according to the development of IVG. Doppler evidence of IVG was found in 33 (36%) of the patients (Group A), with mean age 47 ± 14 years old (age ranged 20 to 72 years) and with a mean end-systolic peak gradient of 86 ± 34 mmHg (ranging from 30 to 165 mmHg). The IVG development was accompanied by SAM of the mitral valve in 23 pts. Three of these pts experienced symptomatic hypotension. Ten were women (30% pts). 58 pts in group B, 34 of whom were women (59%) (p = 0,01 vs group A), mean aged 53,5 ± 10,9 years old (age ranged 34 to 75 years) (p = 0,03 vs group A), did not develop IVG. LVOTi was 10,29 ± 0,9 mm/m2 in group A and 11,4 ± 1 mm/m2 in group B (p < 0,000); RLVWT was 0,36 ± 0,068 in group A and 0,33 ± 0,046 in group B (p < 0,01); LVDVi was 44,8 ± 10 ml/m2 in group A and 56 ± 11,6 ml/m2 in group B (p = 0,000). Conclusion: 1. A significant number of patients with cardiac X syndrome developed IVG during upright exercise in treadmill. These pts (group A) are mainly males and younger than those who did not develop IVG. 2. The development of IVG and mitral valve SAM on exertion seems to be associated with ST segment downsloping during stress testing in patients without epicardial coronary disease. 3. The development of IVG and mitral valve SAM seems to be associated with lower LVOTi, lower LVDVi and higher RLVWT.

Esta tese parte do pressuposto de que existe uma relação entre aquilo que a escrita representava para Kafka e as habilidades esquisitas de algumas das suas personagens. Assim, no primeiro capítulo, defendo que a escrita era, para Kafka, uma necessidade e não um prazer ou uma reacção a uma determinada ordem de coisas. Tendo essa necessidade, Kafka tinha de encontrar um modo de satisfazê-la: o segundo, o terceiro e o quarto capítulo apresentam diferentes soluções para este problema, sendo que no quarto é mencionada, pela primeira vez, a noção de habilidade. No quinto e no sexto capítulo, concentro-me nessa noção de habilidade, bem como nos efeitos e nas consequências que o seu exercício produz, e procuro relacioná-la com aquilo que era, para Kafka, a sua escrita. Finalmente, no sétimo capítulo, defendo que haveria determinados espaços adequados àqueles que exercem uma habilidade e procuro caracterizar esses espaços.

This paper describes and discusses the activity of grade 8 students on two word problems, using a spreadsheet. We look at particular uses of the spreadsheet, namely at the students’ representations, as ways of eliciting forms of algebraic thinking involved in solving the problems. We aim to see how the spreadsheet allows the solution of formally impracticable problems at students’ level of algebra knowledge, by making them treatable through the computational logic that is intrinsic to the operating modes of the spreadsheet. The protocols of the problem solving sessions provided ways to describe and interpret the relationships that students established between the variables in the problems and their representations in the spreadsheet.

Purpose: Obesity-related knowledge predicts weight control but previous studies only comprise individuals with excessive weight and assess very specific aspects of knowledge. This study aims to evaluate several domains of obesity-related knowledge according to the body mass index (BMI) in a representative sample of Portuguese-speaking dwellers in mainland Portugal. Methods: A sample of 1624 participants aged 16–79 years was analyzed. Eighteen questions comprising eight obesity domains were asked: prevalence, physical activity, number of calories, adiposity location, causes, diagnosis, treatment and consequences; each one was dichotomized into correct/incorrect knowledge. Results: The majority of Portuguese-speaking dwellers recognized the benefits of physical activity, the risks of abdominal obesity and most consequences of excessive weight, independently of their BMI. However, knowledge gaps were identified regarding prevalence, calories and BMI diagnosis. BMI influenced specific obesity-related knowledge: participants with a normal BMI knew the BMI formula more often, identified 22 as normal BMI more frequently and had the highest proportion of correct knowledge regarding the number of calories an adult should eat; obese individuals identified natural products as not being good treatments for obesity more often. After adjusting for age, sex and educational level, obese individuals identified natural products and supplements as not being good obesity treatments more often. Conclusions: Obesity-related knowledge gaps (prevalence, calories, and diagnosis) were identified among Portuguese adults. Moreover, correct knowledge does not necessarily translate into a healthier BMI. Besides the dissemination of accurate information, public health interventions should focus on the transfer of knowledge to behaviors that will guarantee better weight management. Evidence-based medicine rankings: Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Objective: In patients with type 2 diabetes mellitus, depressive symptoms may be associated with metabolic deterioration. The impact of sex on this association is unclear. The aim of this study is to analyze the relationship between depression and metabolic control by sex. The data presented is the side product of the clinical investigation by Rui Duarte, MD, Treatment Response in Type 2 Diabetes Patients with Major Depression from 2007. Results: A sample of 628 outpatients with type 2 diabetes mellitus was taken from a specialized diabetes outpatient clinic. In a univariate analysis: women’s glycohemoglobin mean levels were 8.99% whereas men’s were 8.41% and the diference was statistically signifcant. The proportion of women (34.3%) with pathological levels of depression (Hospital Anxiety Depression Scale score ≥ 8) was signifcantly higher than men’s (15.2%). A linear regression analysis performed by sex and controlling for demographic, clinical and psychological variables, showed poorer metabolic control in women with depressive symptoms. No association was observed in men. These results support depression as a predictor for poor metabolic control in women and the need for detecting depressive symptoms when glycemic levels deteriorate.

Obesity is recognised as a serious public health issue, due to its associated morbidity and mortality. This study aimed at estimating the prevalence of overweight and obesity in the Portuguese population through direct measurements obtained by the 1st National Health Examination Survey (INSEF 2015) and to identify its associated sociodemographic factors. INSEF was a nationally representative cross-sectional prevalence study conducted on 4911 Portuguese adults aged 25-74 years, in 2015. Height and weight were measured according to the European Health Examination Survey procedures. Poisson regression was used to estimate the adjusted prevalence ratios of overweight and obesity according to age, marital status, occupational activity, education, urbanization of living area and smoking status. Overall prevalences of overweight and obesity were 39.1% and 28.6%, respectively. The prevalence of overweight was higher among men (45.5% vs 33.2%) while the prevalence of obesity was higher among women (32% vs 25%). The sociodemographic factors associated with overweight and obesity were age, marital status and education. Smoking status was associated with overweight and obesity but only in women. INSEF suggests that a high prevalences of overweight and obesity are found in older individuals, married, with lower education levels and non-smoking women. Public health interventions are urgently required for obesity prevention, namely throughout health literacy strategies.

Saliva is a non-invasive source of biomarkers useful in the study of physiological mechanisms. Moreover, this fluid has diverse functions, among which food perception and ingestion, making it particularly suitable for the study of obesity. The aims of this study were to assess changes in salivary proteome among morbidly obese women, with a view to provide information about mechanisms potentially related to the development of obesity, and to evaluate whether these changes persist after weight loss. Mixed saliva samples from morbidly obese women (N = 18) who had been either subjected (group O-BS) or not (group O) to bariatric surgery and women with normal weight (N = 14; group C) were compared for protein profiles, alpha-amylase abundance and enzymatic activity, and carbonic anhydrase (CA) VI abundance. Differences in salivary obese profiles were observed for 23 different spots. Zinc-alpha-2 glycoprotein-containing spots showed higher abundance in group O only, whereas cystatin S-containing spots presented higher abundance in the two groups of obese subjects. Most of the spots identified as salivary amylase were present at lower levels in group O-BS. With regard to the amylase enzymatic activity, increases were observed for group O and decreases for group O-BS. One interesting finding was the high correlation between levels of CA VI and body mass index in group O, which was not observed for groups O-BS or C. The differences between groups, mainly regarding salivary proteins involved in taste sensitivity and metabolism, point to the potential of using saliva in the study of obesity development.

We describe the results of studies which show the role of the hypothalamus in anorexia nervosa (AN). In these patients the hypothalamus-pituitarythyroid axis does not function adequately but the pituitary responds with releasing of TSH when stimulated with TRH. A similar situation occurs at hypothalamus- -pituitary-ovary axis. A great proportion of these patients have increased levels of stress hormones. The abnormalities in leukocytes, lymphocytes, CD2 and CD4 levels are common in AN and bulimia nervosa. We stress the fact that the amenorrhea generally occurs before low of weight and persists long time after the recover of weight. We describe the mechanisms throught which endorphin, CRH-ACTH-cortisol axis and some cerebral monoamines control the function of the hypothalamus- -pituitary-ovary axis. We relate the immune response with the activation of CRH-ACTH-cortisol axis. We describe the hypothalamus as an homeostatic center and as the center of appetite and of neurovegetative image. We suggest that an early hypothalamic abnormality associated with early feeding can be implicated. This abnormality could be major factor in the sensitivity of hypothalamic function which, triggered by several external factors (fashion, family, life events) induce anorexia nervosa.

Consuming a high-fat diet (HFD) is a risk factor for obesity and diabetes; both of these diseases are also associated with systemic inflammation, similar to HIV infection. A HFD induces intestinal dysbiosis and impairs liver function and coagulation, with a potential negative impact on HIV/SIV pathogenesis. We administered a HFD rich in saturated fats and cholesterol to nonpathogenic (African green monkeys) and pathogenic (pigtailed macaques) SIV hosts. The HFD had a negative impact on SIV disease progression in both species. Thus, increased cell-associated SIV DNA and RNA occurred in the HFD-receiving nonhuman primates, indicating a potential reservoir expansion. The HFD induced prominent immune cell infiltration in the adipose tissue, an important SIV reservoir, and heightened systemic immune activation and inflammation, altering the intestinal immune environment and triggering gut damage and microbial translocation. Furthermore, HFD altered lipid metabolism and HDL oxidation and also induced liver steatosis and fibrosis. These metabolic disturbances triggered incipient atherosclerosis and heightened cardiovascular risk in the SIV-infected HFD-receiving nonhuman primates. Our study demonstrates that dietary intake has a discernable impact on the natural history of HIV/SIV infections and suggests that dietary changes can be used as adjuvant approaches for HIV-infected subjects, to reduce inflammation and the risk of non-AIDS comorbidities and possibly other infectious diseases.

As designações cidade e campo têm desde sempre inspirado múltiplas leituras em geografia e sociologia, passando-se de uma abordagem centrada na caracterização e na evolução do campo e da cidade para novas abordagens que, nas últimas três décadas, consideram a emergência de espaços marcados pela urbanização estruturada em torno da acessibilidade. Este livro apresenta um conjunto de onze contribuições centradas em temas da geografia, retratados nas realidades de Brasil e Portugal, destacando abordagens sobre conceitos e dicotomias que remetem à relação entre cidade e campo, assim como análises de aspectos diversos, como agricultura, turismo, transporte e mobilidade, segurança, políticas públicas e desafios para o desenvolvimento dos territórios em ambos países. Os capítulos permitem entender panoramas que decorrem de trajetórias distintas no que tange à relação entre campo e cidade. No caso da realidade europeia, em que a revolução industrial incentivou o maciço êxodo dos campos para as cidades; e no contexto brasileiro, cujos processos de urbanização assumiram uma natureza política muito forte, a industrialização como motor de crescimento das cidades constituiu-se um fator mais tardio.

As designações cidade e campo têm desde sempre inspirado múltiplas leituras em geogra a e sociologia, passando-se de uma abordagem centrada na caracterização e na evolução do campo e da cidade para novas abordagens que, nas últimas três décadas, consideram a emergência de espaços toldados pela urbanização estruturada em torno da acessibilidade. Estes con guram lugares onde se misturam características urbanas e rurais e onde se desenvolvem novas funções e novos padrões de ocupação social e econômica. A presente obra, intitulada Cidade e campo: olhares de Brasil e Portugal, apresenta nos capítulos seguintes um conjunto de onze contributos centrados em temas da geogra a, retratados nas realidades dos dois países, cujos conteúdos se estruturam em três partes. O presente capítulo desenvolve-se em torno de um conjunto de re exões teóricas de partida baseadas na perspetiva de vários autores internacionais, fazendo o contraponto com a perspetiva apresentada pelos autores dos capítulos desta obra.

Desde a sua origem, as políticas da União Europeia (UE) para o desenvolvimento das áreas rurais têm estado intimamente ligadas à agricultura. Até os anos 1990, o desenvolvimento rural não era concebido como domínio de política autônomo, estando, em vez disso, incorporado à política agrícola. Desenvolvimentos socioeconômicos, mudanças estruturais e tecnológicas e sucessivos alargamentos da UE recon guraram, no entanto, essa abordagem setorial como restritiva, ampliando o âmbito da noção para poder responder, de forma adequada, aos problemas emergentes das áreas rurais (Dax e Kahila, 2011). Se, até um dado momento, a UE entendia não ser necessário fazer uma distinção entre política agrícola e política rural, uma vez que a agricultura era a atividade dominante nas áreas rurais, e o rural era entendido como sendo o agrícola, a partir dos anos 1980, essa assunção foi tida por falaciosa. Não só os espaços rurais se recon guraram como multifuncionais, mas também a pluriatividade pareceu ser prática corrente [...]

Nas últimas décadas, o turismo tem vindo a a rmar-se como uma estratégia de desenvolvimento local de municípios de pequeno porte demográ co, em particular, os localizados em regiões menos densamente povoadas e não polarizadas por grandes metrópoles (Duxburyet al., 2018; Endlich, 2006; Gomes, 2012; Selada et al., 2011). Esses municípios, encabeçados por cidades e vilas de pequeno porte demográ co, caraterizam-se por economias pouco diversi cadas, muito ligadas a atividades agrícolas, a serviços econômicos de baixo valor acrescentado e serviços sociais básicos e procuram, por isso, encontrar novas formas de diversi cação das suas bases econômicas e de intermediação entre os níveis local e regional ou nacional (Marques da Costa, 2002), encontrando no seu patrimônio natural, cultural, histórico e paisagístico novos produtos geradores de emprego e renda para esses municípios. Contudo, esses municípios, pelo seu contexto geográ co – muitos se localizam em regiões rurais e em perda ou estagnação demográ ca – e pelas condicionantes decorrentes da fraca acessibilidade, quer por rodovia, quer por ferrovia, ou ainda pela inexistente ligação aérea, registam grandes di culdades de a rmação, não captando novos residentes nem novas empresas e empregos (Endlich, 2006; Marques da Costa, 2017). O presente capítulo centra-se nessas questões, procurando discutir qual o papel que o turismo pode ter no desenvolvimento dos municípios de pequeno porte [...]

Actualmente encontramos com alguma facilidade na literatura referências da importância da presença de um contexto de afectividade positiva, confiança e entusiasmo no processo de ensino-aprendizagem da matemática para haver um desempenho positivo dos alunos. A presente investigação, recorrendo a uma abordagem de estudo misto, tem como objetivo principal compreender como as experiências afectivas relacionadas com a aprendizagem matemática em sala de aula se manifestam nas atitudes de aprendizagem de alunos que freqüentam um centro de explicações. Procuramos analisar as experiências afectivas com a matemática vividas pelos alunos e como interpretam as atitudes dos seus professores, baseando-nos nos depoimentos recolhidos através de uma entrevista e da resposta a um questionário realizadas aos 12 participantes. De entre as principais conclusões encontradas no estudo salienta-se que a maioria dos alunos do centro de explicações gosta de matemática; tem perspectivas positivas na aprendizagem matemática, bem como no uso da matemática como ferramenta para aquisição de um bom emprego; demonstra atitudes de motivação e sucesso na aprendizagem da matemática; tem bom relacionamento com seus professores e interpreta positivamente as atitudes dos mesmos.

Objective: To determine the level of evidence of the measurement properties (validity, reliability, and responsiveness) and interpretability of the step tests available for assessing the exercise capacity in patients with chronic obstructive pulmonary disease. Data sources: The data sources Web of Science, MEDLINE, PubMed, PEDro, CENTRAL of Cochrane Library, and Scopus were searched up to June 26, 2020. Review methods: Studies of any design that reported results for any measurement property of the step tests for assessing the exercise capacity in COPD patients were selected. One reviewer extracted the data, and two reviewers independently rated the level of evidence by using the Consensus-Based Standards for the Selection of Health Measurements Instruments recommendations. Results: Thirty-one studies were included in the data synthesis. Chester Step Test, Modified Incremental Step Test, two-, three-, four-, and six-Minute Step Test, Paced Step Test, and six-Minute Stepper Test were identified. A step test protocol was also found. The level of evidence of their results for the measurement properties was mostly determined as “low” to “very low.” The best level of evidence found was for the six-minute stepper test: “high” on construct validity (r = 0.56–0.71); and “moderate” on criterion validity (r = 0.36–0.69), and responsiveness (r = 0.26–0.34). Conclusion: The general level of evidence of the measurement properties of the step tests is “low” to “very low” for assessing exercise capacity in patients with chronic obstructive pulmonary disease, which can limit their application in clinical practice. The six-minute Stepper Test is currently the most appropriate step test available.

Interpreting randomized clinical trials (RCTs) is crucial to making decisions regarding the use of analgesic treatments in clinical practice. In this article, we report on an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consensus meeting organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, the purpose of which was to recommend approaches that facilitate interpretation of analgesic RCTs. We review issues to consider when drawing conclusions from RCTs, as well as common methods for reporting RCT results and the limitations of each method. These issues include the type of trial, study design, statistical analysis methods, magnitude of the estimated beneficial and harmful effects and associated precision, availability of alternative treatments and their benefit-risk profile, clinical importance of the change from baseline both within and between groups, presentation of the outcome data, and the limitations of the approaches used.

Numa perspectiva multiescalar, a agricultura tem estado sempre relacionada com a cidade. Da antiguidade à revolução industrial, a cidade de limites bem definidos e extensão reduzida articulava-se com o campo, e este assegurava as trocas de produtos agrícolas com a cidade (Magalhães, 1994). Com a revolução industrial e a urbanização crescente, dá-se o que muitos autores referem como uma ruptura com esse modelo (Telles, 1994). A agricultura não somente diminuiu em termos gerais, em virtude da modernização das práticas e das técnicas agrícolas, como também a cidade deixou de necessitar dos campos agrícolas envolventes em razão dos novos modelos de organização do sistema agrícola alimentar por via da internacionalização dos mercados, pelo desenvolvimento dos transportes e das vias de comunicação rápidas, assim como pela massificação do retalho (Aubry e Kebir, 2013). Mas, se olharmos para o interior da cidade, verificamos que a agricultura nunca desapareceu, por exemplo, nos bairros e vilas operárias da cidade industrial, e à medida que a cidade se estendeu, algumas bolsas agrícolas parcialmente urbanizadas permaneceram [...]

O transporte é um elemento central das cidades, pois permite o movimento de pessoas e de bens e, simultaneamente, ocupa uma superfície significativa da própria cidade (Thomson, 1977). As elevadas densidades de residentes, emprego e atividades econômicas, que caracterizam as áreas urbanas, têm promovido o consumo e a procura de transporte, sendo que o seu atual modelo de procura, centrado no transporte individual motorizado, tem gerado impactos negativos, tais como congestionamento, sinistralidade rodoviária, poluição atmosférica e sonora, excessivo consumo de recursos naturais finitos, entre outros. Por outro lado, vários movimentos de planeamento urbano têm procurado o desenvolvimento de territórios e comunidades mais sustentáveis, inclusivas e, dessa forma, proporcionar melhor qualidade de vida aos seus residentes. Um deles, o Movimento Cidades Saudáveis, considera que a saúde dos indivíduos é também influenciada pela sua envolvente, ou seja, pelas condições de vida, de trabalho, de ambiente físico e socioeconômico, sendo que o transporte, a acessibilidade e a mobilidade por ele proporcionadas têm constituído um elemento central para a concretização daqueles objetivos. Da relação entre esses dois domínios – transporte e cidades saudáveis – surgem frequentemente a debate três problemas: a motorização excessiva, a sinistralidade rodoviária e a poluição causada pelo transporte. O presente capítulo tem como objetivo compreender de que forma aqueles problemas têm sido considerados nas políticas e intervenções no âmbito do Projeto Cidades Saudáveis em Portugal.

I held the position of Secretary of State for Spatial Planning and Cities in Portugal for five years (2005-2009). Until that time I had not been involved in any party-political activity, nor was I even an active member of any party. Why then did I join a government? The answer to this question involves two different factors, one of a generational and personal nature, the other related to the usual criteria applied to the selection of government teams in Portugal in the post-1974 democratic period.