Repositório RCAAP

Background: Cardiopulmonary exercise test (CPET) is indicated as part of the assessment in hypertrophic cardiomyopathy (HCM) patients and stress echocardiography is often used to assess symptoms. However, the role of exercise testing for prognostic stratification in HCM is still not established. Aims: To systematically review the evidence on the role of exercise testing for prognostic stratification in hypertrophic cardiomyopathy. Methods: A systematic review was conducted for eligible publications, between 2010 and 2020, that included evaluation of outcomes and prognosis. In these studies, patients underwent exercise echocardiography and/or cardiopulmonary exercise testing, performed according to predefined protocols. Diverse parameters were assessed in order to determine which were relevant for the prognosis. Analyzed outcomes included death from any cause, sudden cardiac death (SCD) and equivalents, cardiovascular death, heart failure requiring hospitalization or progression to New York Heart Association classes III or IV, cardiac transplantation, non-sustained ventricular tachycardia, stroke, myocardial infarction and invasive septal reduction therapy. Results: Eighteen publications were included, corresponding to a total of 7525 patients. The mean follow-up period varied between 1 and 8 years. The main findings of these studies revealed that the major predictors of outcomes were abnormal heart rate recovery, abnormal blood pressure response exercise induced wall motion abnormalities, lower peak VO2, higher VE/VCO2, and pulmonary hypertension/exercise-induced pulmonary hypertension. Conclusion: Although most studies concluded that exercise test results are useful to determine prognosis in HCM, further investigation is needed regarding whether it adds independent value to the current risk stratification strategies.

Background: State-of-the-art research highlights that borderline personality disorder (PD) and bipolar spectrum disorders have clinical characteristics in common, which imply uncertainty in differential diagnoses. Although there is a growing body of literature on the DSM-5 dimensional model of personality disorder, its discriminative features between these clinical samples are still understudied. In this study, we seek to identify the best set of predictors that differentiate between borderline PD and bipolar spectrum, based on pathological and normative personality traits and symptoms. Methods: A cross-sectional study of three clinical samples: 1) Borderline PD group of 63 participants; 2) Major depressive disorder group of 89 participants; 3) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5; Brief Symptom Inventory; FFM Inventory. A series of one-way ANOVAs and logistic regression analyses were computed. Results: The major set of data emerging as common discriminants of borderline PD across the bipolar spectrum are unusual beliefs & experiences, paranoid ideation, obsession-compulsion and extraversion. Depressivity (OR: 34.95) and impulsivity (OR: 22.35) pathological traits displayed the greatest predictive values in the differential diagnosis. Limitations: The small size of the samples; a lack of data from participants' previous clinical history. Conclusions: Findings support the DSM-5 pathological traits as differentiating borderline PD through bipolar spectrum, and reinforcing the joint use of symptom-related pathological functioning and normal-range personality traits. Alongside the bipolar spectrum, borderline pathology sheds light upon a hypothetical overlap along the depressive and schizoaffective/schizophrenia spectra, representing a borderland space at a crossroads with the psychopathology of a meta-spectrum.

This study aimed to understand how beliefs and attitudes regarding COVID-19 are associated with self-perceived changes in food consumption during lockdown between March 19 and May 2, 2020. We conducted a cross-sectional study with a non-probabilistic weighted sample of the Portuguese population. Data were collected using an online survey and telephone interviews. The association between agreement with sentences about food and COVID-19 and perceived changes in food consumption were assessed by multinomial logistic regression models. Overall, 5858 citizens were included, with a mean age of 38.2 (17.3) years. Exclusive agreement with the belief “SARS-CoV-2 can be transmitted by food” (27.5%) was associated with decreased odds of perceived positive changes (e.g., increased consumption of fruit and vegetables). Agreement only with the attitudinal sentence “I started to consume foods that may protect against COVID-19” (11.9%) was associated with positive perceived consumption changes (e.g., increasing fruit and vegetables, and decreasing soft drinks and snacks). Cumulative agreement (with both sentences; 10.6%) was also associated with mostly positive food consumption changes. Specific beliefs and attitudes regarding COVID-19 and food are associated with self-perceived changes in food consumption. Longitudinal research is needed to understand how beliefs and/or attitudes about the role of food in infectious diseases act as determinants of eating behavior modification.

Water in the city is typically exploited in a linear process, in which most of it is polluted, treated, and discharged; during this process, valuable nutrients are lost in the treatment process instead of being cycled back and used in urban agriculture or green space. The purpose of this paper is to advance a new paradigm to close water cycles in cities via the implementation of naturebased solutions units (NBS_u), with a particular focus on building greening elements, such as green roofs (GRs) and vertical greening systems (VGS). The hypothesis is that such “circular systems” can provide substantial ecosystem services and minimize environmental degradation. Our method is twofold: we first examine these systems from a life-cycle point of view, assessing not only the inputs of conventional and alternative materials, but the ongoing input of water that is required for irrigation. Secondly, the evapotranspiration performance of VGS in Copenhagen, Berlin, Lisbon, Rome, Istanbul, and Tel Aviv, cities with different climatic, architectural, and sociocultural contexts have been simulated using a verticalized ET0 approach, assessing rainwater runoff and greywater as irrigation resources. The water cycling performance of VGS in the mentioned cities would be sufficient at recycling 44% (Lisbon) to 100% (Berlin, Istanbul) of all accruing rainwater roof–runoff, if water shortages in dry months are bridged by greywater. Then, 27–53% of the greywater accruing in a building could be managed on its greened surface. In conclusion, we address the gaps in the current knowledge and policies identified in the different stages of analyses, such as the lack of comprehensive life cycle assessment studies that quantify the complete “water footprint” of building greening systems.

The growing needs for agricultural expansion and intensification will likely continue to reduce and fragment the terrestrial habitats fundamental to mammalian carnivores. Recent research identified benefits of agroecosystems to carnivores recognizing their multifunctionality, mostly for common species. However, the variability of carnivore ecology investigated in agroecosystems, biases in agriculture types and species targeted, and methodological approaches may affect the available knowledge to reconcile conservation and agricultural production. To fill this gap, we conducted a systematic literature review to identify which aspects of and how is carnivore spatial ecology being investigated within agroecosystems. Of the 110 reviewed studies, most focused on agricultural crops (55%) and grasslands (47%) and half referred to monocultures. We found that 61% of the studies were conducted in Europe and North America. Eighty-four carnivore species were studied, 73% classified as Least Concern, with 67% of the studies targeting a single species and 30% focused on only seven common species. Almost all studies included some form of habitat use analysis and species’ home-range and its attributes (e.g. size, resource selection), the most common spatial ecology aspects studied. Most studies suggested that agriculture functions as food provisioning (69%) but few used direct food availability measures. Our results highlight that studies tend to be descriptive and geographically biased towards northern hemisphere and to non-forested agricultural types. We suggest that future carnivore spatial ecology research in agroecosystem should be hypotheses-driven, with greater focus on the mechanisms and processes through which agroecosystems might affect carnivore spatial ecology in particular for areas with high priority for carnivore conservation.

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 interessantes para a prática clínica, com base na melhor evidência científica. 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).

À luz do que foi lido em textos de crítica, ensaio ou ficção do autor Marcel Proust, pretendo com este trabalho mostrar que a utilização do pastiche no seu discurso consiste numa interpretação criativa fundada na influência e consideração por outros escritores, aqui tomados, em certa medida, como modelos. Proust detecta na dicção escolhida os traços que a distinguem de outras, e elabora, com eles, uma nova configuração daquilo que será facilmente reconhecido como um estilo característico. Interessa-me argumentar que este é um processo consciente, reforçado na entidade particularmente mimética do autor, que não exclui, no entanto, o pastiche imediato ou involuntário. Gostaria de concluir que a escolha do pastiche integra o discurso proustiano na originalidade reconhecida, tanto no estilo quanto no conteúdo essencial do programa estético que toma a arte (e a literatura) como actos para a perenidade.

O presente estudo exploratório, no âmbito da temática da leitura, mais especificamente da compreensão leitora, pretende promover o auto-questionamento de alunos do 5º ano de escolaridade para a identificação das estratégias de metacompreensão leitora utilizadas antes, durante e após uma tarefa de leitura de um texto e perceber as potencialidades desta metodologia para a intervenção de um psicólogo educacional em contexto. Para a operacionalização do estudo foi necessário construir um instrumento e ensaiar uma metodologia de recolha de dados. O estudo incidiu sobre um total de 237 participantes do 5º ano de escolaridade, a frequentar uma escola de uma zona rural do distrito de Lisboa. O procedimento utilizado foi a aplicação colectiva do instrumento de recolha de dados no grupo turma, antes, durante e após a leitura de um texto. Os resultados permitem-nos verificar que a leitura é percepcionada como tendo um grande objectivo: a aprendizagem. Reler; perguntar a alguém ou consultar fontes de conhecimento quando não se compreende; ler de várias formas, nomeadamente com atenção; verificar o tipo de texto; observar a figura; pensar na história para a compreender; autoquestionar- se perante as incompreensões e relembrar as ideias principais são as estratégias de metacompreensão leitora mais referidas pelos alunos. Activar conhecimentos prévios, determinar objectivos de leitura, auto-questionar-se sobre o que leu, sublinhar e tirar notas são as estratégias menos frequentes. Menos de metade dos alunos activa conhecimentos prévios e uma grande percentagem consegue antecipar os acontecimentos com elementos relacionados com o tema. A metodologia, na presença da tarefa é uma potencialidade deste instrumento que poderá ser usado por professores, utilizando textos dos manuais escolares. Outro contributo desta metodologia é promover o auto-questionamento tornando-o interventivo, no sentido em que potencia a aquisição de estratégias.

Introduction: Breast volume estimation is considered crucial for breast cancer surgery planning. A single, easy, and reproducible method to estimate breast volume is not available. This study aims to evaluate, in patients proposed for mastectomy, the accuracy of the calculation of breast volume from a low-cost 3D surface scan (Microsoft Kinect) compared to the breast MRI and water displacement technique. Material and methods: Patients with a Tis/T1-T3 breast cancer proposed for mastectomy between July 2015 and March 2017 were assessed for inclusion in the study. Breast volume calculations were performed using a 3D surface scan and the breast MRI and water displacement technique. Agreement between volumes obtained with both methods was assessed with the Spearman and Pearson correlation coefficients. Results: Eighteen patients with invasive breast cancer were included in the study and submitted to mastectomy. The level of agreement of the 3D breast volume compared to surgical specimens and breast MRI volumes was evaluated. For mastectomy specimen volume, an average (standard deviation) of 0.823 (0.027) and 0.875 (0.026) was obtained for the Pearson and Spearman correlations, respectively. With respect to MRI annotation, we obtained 0.828 (0.038) and 0.715 (0.018). Discussion: Although values obtained by both methodologies still differ, the strong linear correlation coefficient suggests that 3D breast volume measurement using a low-cost surface scan device is feasible and can approximate both the MRI breast volume and mastectomy specimen with sufficient accuracy. Conclusion: 3D breast volume measurement using a depth-sensor low-cost surface scan device is feasible and can parallel MRI breast and mastectomy specimen volumes with enough accuracy. Differences between methods need further development to reach clinical applicability. A possible approach could be the fusion of breast MRI and the 3D surface scan to harmonize anatomic limits and improve volume delimitation.

Introduction: Potentially life-threatening disorders may present in the emergency department with acute tetraparesis, and their recognition is crucial for an appropriate management and timely treatment. Our review aims to systematize the differential diagnosis of acute non-traumatic tetraparesis. Results: Causes of tetraparesis can be classified based on the site of defect: upper motor neuron (UMN), peripheral nerve, neuromuscular junction or muscle. History of present illness should include the distribution of weakness (symmetric/asymmetric or distal/proximal/diffuse) and associated clinical features (pain, sensory findings, dysautonomia, and cranial nerve abnormalities such as diplopia and dysphagia). Neurological examination, particularly tendon reflexes, helps further in the localization of nerve lesions and distinction between UMN and lower motor neuron. Ancillary studies include blood and cerebral spinal fluid analysis, neuroaxis imaging, electromyography, muscle magnetic resonance and muscle biopsy. Conclusions: Acute tetraparesis is still a debilitating and potentially serious neurological condition. Despite all the supplementary ancillary tests, the neurological examination is the key to achieve a correct diagnosis. The identification of life-threatening neurologic disorders is pivotal, since failing to identify patients at risk of complications, such as acute respiratory failure, may have catastrophic results.

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 interessantes para a prática clínica, com base na melhor evidência científica. 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).

In this article, we study the role played by pottery production in the transition from Early Neolithic to Middle Neolithic in Western Iberia (∼4500–3300 cal BC) based on a critical analysis of the available empirical data. We establish a chronological and cultural sequence for this period, regarding which the historical problematic is still poorly defined due to a lasting absence of scientific discussion about the long Neolithisation process. During the evolved Early Neolithic (∼5200–4500 cal BC), archeological record shows regional specificities and cultural identities in human groups occupying a vast territory. Pottery collections evidence the strong social importance of decorative grammars, marked by a wide variety of techniques and decorative patterns. In quantitative terms, decorated vessels largely prevail over undecorated vessels. However, in the following chrono-cultural phase, the Initial Middle Neolithic (∼4500–3700 cal BC), it starts an increasing prevalence of undecorated vessels over decorated. Decorative systems prefer the incision technique to impression (dominant in the Early Neolithic). Recurrent use of an incised motif called incised line below the rim. In this period, this type of decoration prevails in the set of decorated pottery and is found in different geographic contexts. This adds consistency to the interpretation according to which the same artifact collections are found in all settlements of the initial Middle Neolithic. Finally, by the time of the first-known Megalithic burials – Full Moment of the Middle Neolithic (3700–3300 cal BC) – the decorative grammars almost disappear from pottery sets, which became more “common” and missed some of their symbolic and social meaning. Undecorated vessels prevail even more strongly than in the previous period.

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Evidence for ancient interspecific gene flow through hybridization has been reported in many animal and plant taxa based on genetic markers. The study of genomic patterns of closely related species with allopatric distributions allows the assessment of the relative importance of vicariant isolating events and past gene flow. Here, we investigated the role of gene flow in the evolutionary history of four closely related freshwater fish species with currently allopatric distributions in western Iberian rivers—Squalius carolitertii, S. pyrenaicus, S. torgalensis and S. aradensis—using a population genomics dataset of 23,562 SNPs from 48 individuals, obtained through genotyping by sequencing (GBS). We uncovered a species tree with two well-differentiated clades: (i) S. carolitertii and S. pyrenaicus; and (ii) S. torgalensis and S. aradensis. By using D-statistics and demographic modelling based on the site frequency spectrum, comparing alternative demographic scenarios of hybrid origin, secondary contact and isolation, we found that the S. pyrenaicus North lineage is likely the result of an ancient hybridization event between S. carolitertii (contributing ~84%) and S. pyrenaicus South lineage (contributing ~16%), consistent with a hybrid speciation scenario. Furthermore, in the hybrid lineage, we identify outlier loci potentially affected by selection favouring genes from each parental lineage at different genomic regions. Our results suggest that ancient hybridization can affect speciation and that freshwater fish species currently in allopatry are useful to study these processes.

Background: Recent studies have revealed the benefits of using colchicine, a drug with anti-inflammatory properties, in coronary artery disease (CAD). This study systematically reviewed the benefits and risks of low-dose colchicine in patients with CAD. Methods and Results: We searched for randomized controlled trials (RCTs) in MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases (March 2020). Efficacy and safety outcomes were evaluated. Estimates are expressed as risk ratios (RRs) and 95% confidence intervals (95% CIs). Heterogeneity was assessed with I2 test. Confidence in the pooled evidence was appraised using the GRADE framework. Colchicine reduced the rate of major adverse cardiovascular events (RR 0.65; 95% CI 0.49-0.86; 6 RCTs; I2=50%; 11,718 patients; GRADE, moderate confidence), acute coronary syndrome (RR 0.64; 95% CI 0.46-0.90; I2=47%; 7 RCTs; 11,955 patients; GRADE, very low confidence), stroke (RR 0.49; 95% CI 0.30-0.78; I2=0%; 6 RCTs; 11,896 patients; GRADE, moderate confidence), and cardiovascular interventions (RR 0.61; 95% CI 0.42-0.89; I2=40%; 4 RCTs; 11,284 patients; GRADE, high confidence). Colchicine did not increase the risk of adverse events, except for gastrointestinal events (RR 1.54; 95% CI 1.11-2.13; I2=72%; 9 RCTs; 12,374 patients; GRADE, very low confidence). Conclusions: Low-dose colchicine in patients with CAD is associated with beneficial effects on prognosis, although an increased risk of gastrointestinal events was confirmed.

TRALI é uma reacção transfusional grave associada à transfusão de componentes sanguíneos. É caracterizado por insuficiência respiratória aguda, edema pulmonar bilateral e hipoxia severa, sem comprometimento cardíaco, ocorrendo durante ou dentro das 6 horas, após a transfusão de um ou mais componentes sanguíneos. Foi demonstrado que uma parte dos casos de TRALI é devida a anticorpos contra antigénios de neutrófilos humanos (HNA) ou contra antigénios de leucócitos humanos (HLA) de classe I e de classe II. Os anticorpos anti-HLA no dador são formados pela exposição a células ou tecidos de outro ser humano (alo-exposição). Esta alo-exposição pode ser provocada por gravidez, transfusão de componentes sanguíneos ou transplante de stem cells, tecidos ou órgãos. Contudo nem sempre a alo exposição termina com a formação de anticorpos (alo-imunização). Partindo do pressuposto que todos os dadores que tenham sido transfundidos são eliminados da dádiva só nos resta a aloexposição por gravidez. Assim a pesquisa de anticorpos anti-HLA classe I e classe II foram realizadas a um grupo de dadores de sangue, do sexo feminino com história prévia de gravidez, do Centro Regional de sangue de Lisboa. Das 400 dadoras estudadas podemos concluir que cerca de 12% apresentam HLA classe I, 12% apresenta HLA classe II e 3% apresentam HLA classe I e classe II. O total de aloimunizações neste grupo de estudo ronda os 21%. A frequência de anticorpos anti-HLA classe II para o caso de dadoras com três ou mais gestações é bastante maior comparada com o caso de dadoras com uma ou duas gestações, embora possamos concluir que no caso das dadoras em que as gestações levaram a aborto, pelo reduzido tempo de exposição não levou à imunização induzida por anticorpos anti-HLA. Como conclusão podemos aplicar as medidas, implementadas por outros países, para redução dos casos de TRALI que passa por reduzir o uso de PFC das dadoras do sexo feminino, dar preferência aos dadores do sexo masculino no caso de colheita de componentes sanguíneos por aférese e a pesquisa de anticorpos anti-HLA a todas as dadoras de primeira vez e sempre que sejam aloexpostas.

The depletion and overexploitation of several fish stock demands for a valorisation of non-target and discarded species. Nonetheless, such species are often poorly studied, and information on their biological parameters must be gathered for effective population management. For 1 year, the reproductive strategy of the piper gurnard Trigla lyra and the red gurnard Chelidonichthys cuculus was studied by monthly samples obtained from commercial boats operating on western Portuguese coast. Both species showed a biased sex ratio towards females, especially for larger length classes. Length at first maturity could be estimated only for red gurnard (22.1 and 19.9 cm for females and males, respectively) because all piper gurnard individuals caught were mature. Piper gurnard showed determinate fecundity and a short spawning season, from November to February with a peak in January, whereas red gurnard showed indeterminate fecundity and a wide spawning season, from late December to May. The relative annual fecundity estimated for red gurnard (1893 ± 728 oocytes × g−1 eviscerated weight [EW]) was higher than the one estimated for piper gurnard (1018 ± 250 oocytes×g−1 EW). Although important information for understanding the species dynamics is presented in this study, additional information on other life-history parameters and of species landings is required.

This article examines the relations between Portuguese society and Salazar’s political police (PIDE) from the perspective of the everyday lives of ordinary citizens – in contrast to the small minority of oppositionists that has so far monopolized the attention of historians. It is based on a quantitative survey of 400 respondents in four separate locations across Portugal and addresses two main research questions: To what extent did the sample of ordinary citizens experience the PIDE as a disruptive influence on their daily lives? Was the PIDE ‘normalized’ by them as part of the framework of everyday life? The data analysis calls upon the inputs of the international bibliography of everyday life under dictatorship and critically engages with the existing historiography of the PIDE.

During the years of economic crisis and austerity, and the subsequent economic growth dependent on real estate and tourism, housing has returned into the spotlight on the political agenda in Southern European countries and cities, where activists and social movements scaled up their struggles and created bridges with institutional actors, fostering policy change. The latter, however, did not happen in Italy. In this article, based on exploratory case study research carried out in the city of Turin, we present three themes that help explain what we call the ‘absent politicization’ of housing in Italy during the last decade: a multi-actor, multilevel housing policy capable of defusing specific problems; the absence of bridges between politicized and institutional actors; and the role played by party-politics, with attention to ‘populist’ Movimento 5 Stelle in power in Turin. By focusing on differences with Southern Europe, we contribute to overcoming dichotomies that have long dominated comparative housing studies; and contribute to linking housing studies with contentious urban politics in the post-crisis years.