Repositório RCAAP

Aims: This paper sought to estimate the burden of disease attributable to atherosclerosis in mainland Portugal in 2016. Methods and results: The burden of atherosclerosis was measured in disability-adjusted life years (DALY) following the latest 2010 Global Burden of Disease (GBD) methodology. DALYs were estimated as the sum of years of life lost (YLL) with years lived with disability (YLD). The following clinical manifestations of atherosclerosis were included: ischemic heart disease (IHD) (including acute myocardial infarction (AMI), stable angina, and ischemic heart failure (IHF)), ischemic cerebrovascular disease (ICVD) and peripheral arterial disease (PAD). YLL were estimated based on all-cause mortality data for the Portuguese population and mortality due to IHD, ICVD and PAD for the year 2016 sourced from national statistics. Standard life expectancy was sourced from the GBD study. YLD corresponded to the product of the number of prevalent cases by an average disability weight (DW) for all possible combinations of disease. Prevalence data for the different clinical manifestations of atherosclerosis were sourced from epidemiological studies. DW were sourced from the published literature. In 2016, 15,123 deaths were attributable to atherosclerosis, which corresponded to 14.3% of overall mortality in mainland Portugal. DALYs totaled 260,943, 75% due to premature death (196,438 YLL) and 25% due to disability (64,505 YLD). Conclusion: Atherosclerosis entails a high disease burden to society. A large part of this burden would be avoidable if evidence-based effective and cost-effective interventions targeting known risk factors, from prevention to treatment, were implemented.

From a systemic perspective, evolution and natural succession promote the creation of efficient biological structures and processes that capture and dissipate the solar energy, maximizing the entropy production. This ecological complexification results in better ecosystem thermodynamic performance indicated by lower tem- perature. In a brief period of evolutionary time human-induced disturbance has altered profoundly the structure and functioning of the Earth System, i.e. ecological simplification. The objective is to understand whether remote sensing data can be considered appropriate proxy indicators to test if more mature and complex ecosystems have higher entropy production rates which lead to lower and attenuated ecosystem temperatures. Simple remote sensing measurements of Madeira Island for Thermal Infrared Radiation and Normalized Difference Vegetation Index were used to analyse the surface temperature and biomass cover of Madeira eco- systems spectrum of different states of human-induced disturbance. The findings revealed it was possible to distinguish between ecosystem types using thermodynamic in- dicators, where older ecosystems with more complex structures exhibit more attenuated lower average tem- peratures. It was also found that habitat heterogeneity can represent either artificial (human) or natural disturbance with opposite consequences in the ecosystem thermal signature, i.e. lower temperature when natural disturbance and higher if anthropogenic disturbance. Simple thermal remote sensing data can be used as systemic indicator of ecosystem health by reflecting it levels of eco-exergy, i.e the available work energy in the ecosystem.

O objectivo da Newsletter do Instituto de Saúde Baseado na Evidência (ISBE) é a disponibilização de informação sobre áreas relevantes para a prática clínica, baseada na melhor evidência científica. São localizados estudos relevantes e de alta qualidade, criticamente avaliados pela sua validade, importância dos resultados e aplicabilidade prática e resumidos numa óptica de suporte à decisão clínica. É dada prioridade aos estudos de causalidade – revisões sistemáticas, ensaios clínicos, estudos de coorte prospectivos/retrospectivos, estudos seccionais cruzados e caso‐controlo – incluindo‐se ainda, quando justificado, estudos qualitativos considerados de elevada qualidade metodológica e importância clínica.

We have read with great interest the recent findings from the study by Sagherian et al. regarding insomnia symptoms, fatigue, and their relationship with future job exit in older people. This study provides a rationale underlying the evidence of an alarmingly large number of patients in this age group using sleep‐inducing drugs over a long period. Other studies have shown how such a hazardous approach in the elderly can be associated with increased mortality, frequency of delirium in the hospital, hip fractures, disability, and dementia in the community.

Background: Alcohol is a leading risk factor contributing to the global burden of disease. Several national and international agencies recommend that screening and brief interventions (SBI) should be routinely delivered in primary care settings to reducing patients' alcohol consumption. However, evidence shows that such activities are seldom implemented in practice. A review of the barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking. This study aimed to conduct a theory-informed review of the factors influencing general practitioners' and primary care nurses' routine delivery of alcohol SBI in adults. Methods: A systematic literature search was carried out in four electronic databases (Medline, CINAHL, CENTRAL, PsycINFO) using comprehensive search strategies. Both qualitative and quantitative studies were included. Two authors independently abstracted and thematically grouped the data extracted. The barriers and facilitators identified were mapped to the domains of the Capability-Opportunity-Motivation-Behaviour system/Theoretical Domains Framework (TDF). Results: Eighty-four out of the 258 studies identified met the selection criteria. The majority of the studies reported data on the views of general practitioners (n = 60) and used a quantitative design (n = 49). A total of 660 data items pertaining to barriers and 253 data items pertaining to facilitators were extracted and thematically grouped into 46 themes. The themes mapped to at least one of the 14 domains of the TDF. The three TDF domains with the highest number of data units coded were 'Environmental Context and Resources' (n = 158, e.g. lack of time), 'Beliefs about Capabilities' (n = 134, e.g. beliefs about the ability to deliver screening and brief advice and in helping patients to cut down) and 'Skills' (n = 99, e.g. lack of training). Conclusions: This study identified a range of potential barriers and facilitators to the implementation of alcohol SBI delivery in primary care and adds to the scarce body of literature that identifies the barriers and facilitators from a theoretical perspective. Given that alcohol SBI is seldom implemented, this review provides researchers with a tool for designing novel theory-oriented interventions to support the implementation of such activity.

Abstract Despite the neurological vulnerability of premature newborns, there is evidence that they are able to process temporal aspects of the maternal voice, as a previous study observed more overlapping vocalizations during maternal humming versus speech. However, there is a lack of knowledge about the markers of the infants’ overlapping vocalizations. Our aim was to identify the location of overlapping vocalizations during the humming and the impacts of maternal antenatal and postnatal engagement of infant-directed singing on: (1) the features of humming and (2) the infants’ overlapping vocalizations during humming. Preterm dyads (N = 36) were observed in silent, speech, and humming conditions. Microanalysis was performed using the Elan Program to identify the location of the overlapping vocalizations during the humming phrase. Infants’ overlapping vocalizations were found predominantly at the ends of each humming phrase; almost half of the overlaps occurred on the final note. More overlapping vocalization in the final notes were observed in female infants. Antenatal and postnatal experiences of ID singing are influenced by the mothers’ nationality and contribute to maternal humming style. Preterm newborns synchronize with maternal humming, anticipating the end of musical phrases. The ability to synchronize seems to be phylogenetically associated with gender differences.

A nevirapina é um fármaco usado no tratamento da infecção pelo vírus da imunodeficiência humana tipo 1, da classe dos inibidores do trasncriptase reverso não análogos de nucleósidos, geralmente administrado concomitantemente com outros agentes antiretrovirais. É, também, eficaz na prevenção da transmissão vertical do vírus, de mãe para filho. No entanto, a nevirapina tem apresentado graves efeitos secundários como irritações cutâneas severas a curto prazo e hepatotoxicidade verificada a longo prazo, o que levanta preocupações acerca da sua administração crónica, principalmente em casos perinatais ou pedriáticos. Apesar disso, a nevirapina é ainda, o antiretroviral mais utilizado em países em desenvolvimento. Este trabalho teve como objectivo inicial a formação e caracterização de adutos de nevirapina, derivados do metabolito 12‐hidroxi‐NVP com aminoácidos específicos e com o tripéptido glutationo. Os adutos com aminoácidos foram, posteriormente utilizados como padrões para avaliar a modificação in vitro da albumina do soro humano na presença de um derivado electrófilo do metabolito 12‐hidroxi‐NVP.Nos estudos de modificação dos aminoácidos, do glutationo e da albumina do soro humano foi utilizado um modelo sintético, o 12‐mesiloxi‐NVP, do electrófilo identificado in vivo – o 12‐sulfoxi‐NVP. Este derivado sintético foi utilizado por ser mais estável, de mais fácil preparação e por se espera que tenha uma reactividade semelhante ao metabolito 12‐sulfoxi‐NVP na presença de bionucleófilos. Estas reacções foram promovidas em tampão fosfatos pH 7,4, na presença de um excesso de aminoácido (triptofano, N‐acetil‐cisteína, lisina, arginina e histidina) e do glutationo. Os adutos obtidos foram isolados por HPLC semi‐preparativo e caracterizados por Ressonância Magnética Nuclear e Espectrometria de Massa. No ensaio de modificação da albumina do soro humano, a proteína foi incubada a 37ºC em PBS na presença do modelo electrófilo 12‐mesiloxi‐NVP. Após a remoão de moléculas pequenas que não reagiram, por diálise, a proteína foi hidrolisada por vários métodos químicos e por um método enzimático que envolve os enzimas Pronase E e Leucina aminopeptidase. Os aminoácidos modificados foram identificados por LC‐MS, por comparação (tendo em conta o tempo de retenção e espectro de massa) com os padrões anteriormente preparados. Foram apenas identificados adutos por hidrólise enzimática, nomeadamente, o aduto com o triptofano e com a histidina. Os resultados obtidos sugerem que a formação de adutos do tipo nevirapina‐proteína possa ser um factor importante na toxicidade deste fármaco, e poderão, eventualmente, ser utilizados como biomarcadores da toxicidade da nevirapina. Como continuação deste trabalho pretende‐se usar os adutos preparados com aminoácidos e com o glutationo como padrões para a detecção da sua formação in vivo, em modelos animais e em indivíduos sujeitos à terapia com a nevirapina.

O objetivo desta pesquisa foi refletir sobre a realidade dos problemas sociais enfrentados pelos povos indígenas da Amazônia, bem como a forma que esses problemas podem ser discutidos no currículo de Ciências. Para atingir ao objetivo proposto, foi utilizado questionário composto por oito questões abertas, envolvendo dados sobre os problemas sociais e a educação em Ciências. Os participantes da pesquisa foram 112 (cento e doze) estudantes indígenas em formação no curso de Licenciatura em Educação Intercultural da Universidade Federal de Rondônia. Os resultados demonstram que os problemas sociais diagnosticados têm suas raízes no contato com a sociedade não indígena mediante a processos de disputas por terras, falta de comprometimento dos órgãos governamentais em garantir a demarcação dos territórios indígenas e o não cumprimento do que é previsto na legislação específica. Pode-se observar, que transpor os problemas sociais ao currículo da escola indígena é de fundamental importância às discussões em relação ao que poderá ser feito. Também é necessário buscar soluções que possam beneficiar os povos indígenas, trazendo o bem-estar e bem viver que existiam antes do contato com a sociedade envolvente.

A discussão de controvérsias sociocientíficas é uma das estratégias didáticas que podem estimular o desenvolvimento da alfabetização científica. Mas, essa abordagem é utilizada da mesma forma e com os mesmos objetivos em diferentes contextos educacionais? Pensando nisto, este trabalho tem como objetivo analisar como as controvérsias sociocientíficas são abordadas nas pesquisas brasileiras e portuguesas, buscando identificar as semelhanças e diferenças dos dois contextos educacionais e de pesquisa. Os dados foram constituídos no Brasil e em Portugal, a partir do Catálogo de Teses e Dissertações da CAPES e do site do repositório do Instituto de Educação da Universidade de Lisboa, respectivamente. Os resultados mostram que os pesquisadores portugueses usam a discussão de controvérsias sociocientíficas, sobretudo, para desenvolver competências para a cidadania e ativismo. Já as investigações brasileiras têm como objetivo, principalmente, a aprendizagem dos conteúdos científicos. Isto pode estar relacionado com a menor qualidade da educação básica brasileira, por vários motivos, que vão desde as lacunas na formação dos professores até a pouca valorização da profissão docente.

Background and aims: This systematic review aims to evaluate the impact of coffee consumption in patients with previous myocardial infarction (MI), in relation to all-cause and cardiovascular mortality, as well as other major cardiovascular events (MACE) such as stroke, heart failure, recurrent MI and sudden death. Methods and results: MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, SciELO Citation Database, Current Contents Connect®, KCI Korean Journal Database, African Index Medicus, and LILACS were searched for longitudinal studies evaluating the impact of coffee consumption in patients with previous myocardial infarction. We performed a random-effects meta-analysis to estimate the pooled hazard ratios (HR) with 95% confidence intervals (CI). The statistical heterogeneity was measured by I2. A dose-response analysis was also conducted. Six prospective cohort studies were included in the primary meta-analysis. Consumption of coffee was associated with lower risk of cardiovascular mortality (HR = 0.70; 95% CI 0.54-0.91, I2 = 0%; 2 studies) and was not associated with an increased risk of all-cause mortality (HR = 0.85; 95% CI 0.63-1.13; I2 = 50%; 3 studies), recurrent MI (HR = 0.99; 95% CI 0.80-1.22; I2 = 0%; 3 studies), stroke (HR = 0.97; 95% CI 0.63-1.49; I2 = 39%; 2 studies) and MACE (HR = 0.96; 95% CI 0.86-1.07; I2 = 0%; 2 studies). A significant non-linear inverse dose-response association was found for coffee consumption and all-cause mortality. Conclusions: Consumption of coffee was not associated with an increased risk of all-cause mortality and cardiovascular events in patients with previous myocardial infarction.

Background: Exercise echocardiography (EE) is a valuable noninvasive method for diagnostic and prognostic assessment of ischemic cardiac disease. The prognostic value of a negative EE test is well known overall, but its role in patients who undergo percutaneous coronary intervention remains poorly validated. The aim of this study was to ascertain the prognostic value of treadmill EE and to determine predictors of cardiac events in this population, with an emphasis on nonpositive (negative or inconclusive) test results. Methods: A retrospective single-center study was performed. It included 516 patients (83% man; mean age, 62 6 9 years) previously subjected to percutaneous coronary intervention who underwent treadmill EE between 2008 and 2017. Demographic, clinical, echocardiographic, and angiographic data were collected. The occurrence of cardiac events (cardiac death, acute coronary syndrome, or coronary revascularization) during follow-up was investigated. A multivariate Cox regression analysis was used to evaluate predictors of cardiac events. The Kaplan-Meier method was used to evaluate event-free survival rates. Results: The results of EE were negative for myocardial ischemia in 245 patients (47.5%), inconclusive in 144 (27.9%), and positive in 127 (24.6%). During a mean follow-up period of 40 6 34 months, cardiac events occurred in 152 patients (29.5%). The positive and negative predictive values of EE were 81.6% and 85.3%, respectively. The sensitivity of the exercise test was 73.9%, with specificity of 90.1%. Predictors of cardiac events were typical angina (hazard ratio [HR], 1.95; 95% CI, 1.16–3.27; P = .011), a positive ischemic response detected by electrocardiographic monitoring during EE (HR, 2.01; 95% CI, 1.21–3.34; P = .007), and the test result (inconclusive result: HR, 1.06; 95% CI, 0.51–2.19; P = .878; positive result: HR, 4.35; 95% CI, 2.42–7.80; P < .001). Patients with inconclusive (log-rank P = .038) and positive (log-rank P < .001) results had significantly more cardiac events during follow-up than those with negative EE test results. Focusing on those patients with nonpositive results, cardiac event–free survival rates at 1, 3, and 5 years were 96.6 6 0.9%, 88.3 6 1.9%, and 79.5 6 2.6%, respectively. In this subpopulation, an inconclusive test result (HR, 1.67; 95% CI, 1.03–2.70; P = .039), more extensive coronary artery disease (two vessels: HR, 1.37; 95% CI, 0.75–2.30; P = .304; three vessels: HR, 2.59; 95% CI, 1.38–4.87; P = .003), and arterial hypertension (HR, 2.07; 95% CI, 1.10–3.91; P = .025) were significantly associated with the occurrence of cardiac events. Conclusion: Patients with known coronary disease with negative results on EE are at low risk for hard events. Patients with inconclusive results are at higher risk for cardiac events than those with negative results. The detection of patients with low-risk results on EE should decrease the number of unnecessary repeat invasive coronary angiographic examinations.

Este trabalho objetivou compreender como os problemas ambientais podem ser trabalhados na educação em ciências nas escolas indígenas, por meio de uma reflexão dos próprios indígenas. Foram aplicados questionários compostos por nove questões abertas, envolvendo dados sobre os problemas ambientais e o ensino de ciências nas escolas indígenas. Participaram da pesquisa cento e doze estudantes indígenas em formação do curso de Licenciatura em Educação Intercultural, da Universidade Federal de Rondônia. Os resultados indicam que a perda da floresta é fator marcante em relação aos fatores ambientais, envolvendo queimadas, extração ilegal de madeiras e o desmatamento. Esses fatores são motivados pela ambição e ganância do homem. Em relação aos problemas ambientais, 84,8% acreditam que podem ser trabalhados no currículo da escola, especificamente nas disciplinas de ciências e biologia (29,8%). As temáticas abordadas na escola se referem aos fatores que afetam o meio ambiente e quando foram trabalhadas envolveram diferentes estratégias de ensino. Considera-se que é possível, por meio de planejamento e da formação de novos professores indígenas, que essas visões sobre os problemas ambientais possam refletir no currículo de ciências das escolas indígenas, tornando-se fatores essenciais na busca da autonomia e afirmação da identidade cultural.

O objectivo da Newsletter do Instituto de Saúde Baseado na Evidência (ISBE) é a disponibilização de informação sobre áreas relevantes para a prática clínica, baseada na melhor evidência científica. São localizados estudos relevantes e de alta qualidade, criticamente avaliados pela sua validade, importância dos resultados e aplicabilidade prática e resumidos numa óptica de suporte à decisão clínica. É dada prioridade aos estudos de causalidade – revisões sistemáticas, ensaios clínicos, estudos de coorte prospectivos/retrospectivos, estudos seccionais cruzados e caso‐controlo – incluindo‐se ainda, quando justificado, estudos qualitativos considerados de elevada qualidade metodológica e importância clínica.

The outbreak of the covid-19 pandemic is the perfect storm that corroborates the magnitude of upcoming challenges for the future of democracy, cities, and citizen participation

We have read the review article entitled ‘Obstructive sleep apnoea, intermittent hypoxia and heart failure with a preserved ejection fraction’ by John E Sanderson, Fang Fang, Mi Lu, Chen Yao Ma and Yong Xiang Wei, published in Heart, the official journal of the British Cardiovascular Society. Despite the authors' meritorious efforts in the present review, we believe some considerations may take part in an important complementary discussion.

Our goal was to assess the interrater agreement (IRA) of photoparoxysmal response (PPR) using the classification proposed by a task force of the International League Against Epilepsy (ILAE), and a simplified classification system proposed by our group. In addition, we evaluated IRA of epileptiform discharges (EDs) and the diagnostic significance of the electroencephalographic (EEG) abnormalities. We used EEG recordings from the European Reference Network (EpiCARE) and Standardized Computer-based Organized Reporting of EEG (SCORE). Six raters independently scored EEG recordings from 30 patients. We calculated the agreement coefficient (AC) for each feature. IRA of PPR using the classification proposed by the ILAE task force was only fair (AC = 0.38). This improved to a moderate agreement by using the simplified classification (AC = 0.56; P = .004). IRA of EDs was almost perfect (AC = 0.98), and IRA of scoring the diagnostic significance was moderate (AC = 0.51). Our results suggest that the simplified classification of the PPR is suitable for implementation in clinical practice.

Chagas disease is among the neglected tropical diseases recognized by the World Health Organization that have received insufficient attention from governments and health agencies. Chagas disease is endemic in 21 Latin America regions. Due to globalization and increased migration, it has crossed borders and reached other regions including North America and Europe. The clinical presentation of the disease is highly variable, from general symptoms to severe cardiac involvement that can culminate in heart failure. Chagas heart disease is multifactorial, and can include dilated cardiomyopathy, thromboembolic phenomena, and arrhythmias that may lead to sudden death. Diagnosis is by methods such as enzyme-linked immunosorbent assay (ELISA) and the degree of cardiac involvement should be investigated with complementary exams including ECG, chest radiography and electrophysiological study. There have been insufficient studies on which to base specific treatment for heart failure due to Chagas disease. Treatment should therefore be derived from guidelines for heart failure that are not specific for this disease. Heart transplantation is a viable option with satisfactory success rates that has improved survival.

Na membrana plasmatica de Saccharomyces cerevisiae já foram identificados domínios lipídicos compostas maioritariamente por esteróis e/ou esfingolípidos, podendo apresentar-se organizadas duma forma semelhante a uma fase líquido ordenado (lo). No entanto, os princípios biofísicos da formação e funcionamento desses domínios ainda nao são totalmente conhecidos. Neste trabalho foram utilizadas técnicas de espectroscopia de fluorescência em estado estacionário e resolvidas no tempo para caracterizar propriedades biofísicas de diversas misturas lipídicas que mimetizam os domínios da membrana plasmática da levedura, de modo a esclarecer aqueles princípios. Foram estudados os sistemas binários 1-Palmitoil-2-oleoil-sn-glicero-3- fosfocolina (POPC)/ ergosterol e POPC/ fitoceramida, que mimetizam o papel dos esteróis e esfingolípidos na formação de domínios, respectivamente, com as sondas ácido trans-parinárico (t-PnA) e difenil-hexatrieno (DPH). Confirmou-se a formação de uma fase lo induzida pelo ergosterol, de acordo com resultados da literatura, ao passo que a fitoceramida a baixas concentrações tem a capacidade de induzir a formação de fases gel de elevada rigidez. Neste trabalho é proposto um diagrama de fases do tipo peritéctico para o sistema POPC/fitoceramida (C18:0),com extensas regiões de coexistência de fases gel/fluido. Concluiu-se também que o t-PnA e util para identificar os domínios ricos em fitoceramida, mas o DPH não consegue detectar alterações biofísicas entre os modelos com ergosterol e fitoceramida. Assim, para além destas sondas foi utilizada a sonda 4,4-AminoNafetilEtenilPiridínio sensível ao potencial (Di-4- ANEPPS) pertencente a uma família de sondas cujas propriedades de fluorescência são reconhecidamente sensíveis à presença de colesterol. Foram analisados comparativamente os sistemas binários de 1,2-Dipalmitoíl-sn-glicero-3-fosfocolina (DPPC), POPC e palmitoil-esfingomielina (PSM) com colesterol, ergosterol e fitoceramida. Os resultados obtidos mostram que a sonda tem uma resposta fotofísica adequada (desvios para o azul no espectro de emissão e aumento dos tempos de vida de fluorescencia) para identificar fases ricas quer em colesterol, quer em ergosterol, e uma vez que não é sensível a presença de fitoceramida, permitirá em estudos posteriores distinguir domínios ricos nesta de domínios ricos naqueles.

In Portugal, a state of emergency was declared on March 18 because of the COVID-19 pandemic. Every nonessential business and activity was ceased, and home confinement was required for everyone not involved in essential activities.

Objective: Mutations in the genes coding for succinate dehydrogenase (SDHx) are the most frequent germline alterations in pheochromocytomas and paragangliomas. Evidence for the advantages associated with presymptomatic screening for SDHx mutation carriers is scarce. This study describes a nationwide cohort of these mutation carriers and aims to compare patients with clinical manifestations of the disease and those diagnosed through genetic screening. Design: Cross-sectional study. Patients: SDHx mutation carriers (n = 118) followed through the Portuguese Oncology referral centres: 41 probands and 77 nonprobands. Measurements: All participants were subjected to biochemical and body imaging examinations for a complete assessment of the extent and spread of disease. Clinical data obtained this way were further analysed. Results: The mean age of this cohort was 44.5 ± 17.4 years, and more than half carried the same founder SDHB mutation. About 50.8% of the mutation carriers developed pheochromocytomas or paragangliomas. Compared to patients diagnosed through genetic screening, those diagnosed clinically were characterized by larger tumours (P < .001), more frequent metastases (P = .024), were more frequently subjected to surgery (P = .011) and radiotherapy (P = .013), and had worse outcomes, such as macroscopic positive margins (P = .034). Persistent and/or unresectable disease and disease-related mortality were also more frequent in symptomatic patients compared to those diagnosed through genetic screening (P = .014). Conclusions: In this nationwide cohort study, a large proportion of mutation carriers were found to develop SDHx-related neoplasia. Genetic testing and subsequent follow-up resulted in the diagnosis of smaller and nonmetastatic tumours, fewer treatment procedures, fewer complications and greater number of disease-free patients.