Repositório RCAAP

In this article—based on the fieldwork I conducted in Lisbon (Portugal) between 2018 and 2021, employing in-depth ethnography and self-ethnography—I describe the experience of the medicalization and moralization of beauty in Portuguese women aged 45–65 years. I examine the ways in which practitioners inscribe their expert knowledge on their patients’ bodies, stigmatizing the marks of time and proposing medical treatments and surgeries to “repair” and “correct” them. Beauty and youth are symbolically constructed in medical discourse as visual markers of health, an adequate lifestyle, a strong character and good personal choices (such as not smoking, and a healthy diet and exercise habits). What beauty means within the discourse of anti-aging and therapeutic rejuvenation is increasingly connected to an ideal gender performance of normative, white, middle-class, heterosexual femininity that dismisses structural determinants. The fantasy of eternal youth, linked to a neoliberal ideology of limitless enhancement and individual responsibility, is firmly entrenched in moralizing definitions of aesthetics and gender norms. Finally, my article highlights the ways in which the women I interviewed do not always passively accept the discourse of the devaluation of the ageing body, defining femininity and ageing in their own terms by creating personal variants of the hegemonic normative discourses on beauty and successful ageing.

Atrial fibrillation (AF), the most common arrhythmia in the adult population worldwide, represents a significant burden in terms of cardiovascular mortality and morbidity and has repercussions on health economics. Oral anticoagulation (OAC) is key to stroke prevention in AF and, in recent years, results from landmark clinical trials of non-vitamin K oral anticoagulants (NOAC) have triggered a paradigm shift in thrombocardiology. Despite these advances, there is still a significant residual vascular risk associated with silent AF, bleeding, premature sudden death and heart failure. The authors review AF epidemiologic data, the importance of new tools for early AF detection, the current role of catheter ablation for rhythm control in AF, the state-of-the-art in periprocedural OAC, the optimal management of major bleeding, the causes of residual premature death and future strategies for improvements in AF prognosis.

Mucormycosis is an uncommon, life-threatening infection caused by opportunistic fungi included in the Mucorales order, which mostly affects immunosuppressed patients. Mucormycosis can exhibit different clinical presentations depending on the involved organ, including pulmonary, gastrointestinal, rhinocerebral, cutaneous, and disseminated infections.

Com a transição democrática iniciada em Portugal em 1974, também a polícia procurou organizar-se em sindicatos. Mas esta aspiração só foi alcançada no início do século xxi, quando se abriu caminho à proliferação sindical, tendo-se atingido as 19 organizações em 2019. Este artigo mostra que a instrumentalização da forma legal pelos polícias levou ao desvirtuamento da natureza da ação sindical. Com base em entrevistas e na análise documental, conclui-se que o sistema de aferição de representatividade sindical deve implicar critérios objetivos e previsíveis para que haja condições mínimas (não suficientes) para o diálogo social.

We test for integration of financial markets in China during 1920-1933 using a new dataset of domestic exchange rates. Our data concerns tael-denominated telegraphic transfers between Shanghai and nine other cities. We find that Chinese financial markets, as measured by the efficiency of silver-point arbitrage, were highly integrated among major commercial hubs in north and central China, but there was a lower level of integration for more remote cities in the south. Our paper presents the first comprehensive assessment of the efficiency of the Chinese silver standard and contributes to a revaluation of market performance during pre-communist China.

Study question: What are the data on ART and IUI cycles, and fertility preservation (FP) interventions reported in 2017 as compared to previous years, as well as the main trends over the years? Summary answer: The 21st ESHRE report on ART and IUI shows the continual increase in reported treatment cycle numbers in Europe, with a decrease in the proportion of transfers with more than one embryo causing an additional slight reduction of multiple delivery rates (DR) as well as higher pregnancy rates (PR) and DR after frozen embryo replacement (FER) compared to fresh IVF and ICSI cycles, while the number of IUI cycles increased and their outcomes remained stable. What is known already: Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been gathered and analyzed by the European IVF-monitoring Consortium (EIM) and communicated in a total of 20 manuscripts published in Human Reproduction and Human Reproduction Open. Study design size duration: Data on European medically assisted reproduction (MAR) are collected by EIM for ESHRE on a yearly basis. The data on treatments performed between 1 January and 31 December 2017 in 39 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. Participants/materials setting methods: Overall, 1382 clinics offering ART services in 39 countries reported a total of 940 503 treatment cycles, including 165 379 with IVF, 391 379 with ICSI, 271 476 with FER, 37 303 with preimplantation genetic testing (PGT), 69 378 with egg donation (ED), 378 with IVM of oocytes, and 5210 cycles with frozen oocyte replacement (FOR). A total of 1273 institutions reported data on 207 196 IUI cycles using either husband/partner's semen (IUI-H; n = 155 794) or donor semen (IUI-D; n = 51 402) in 30 countries and 25 countries, respectively. Thirteen countries reported 18 888 interventions for FP, including oocyte, ovarian tissue, semen and testicular tissue banking in pre- and postpubertal patients. Main results and the role of chance: In 21 countries (20 in 2016) in which all ART clinics reported to the registry, 473 733 treatment cycles were registered for a total population of approximately 330 million inhabitants, allowing a best-estimate of a mean of 1435 cycles performed per million inhabitants (range: 723-3286).Amongst the 39 reporting countries, the clinical PR per aspiration and per transfer in 2017 were similar to those observed in 2016 (26.8% and 34.6% vs 28.0% and 34.8%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2016 (24% and 33.5% vs 25% and 33.2% in 2016). When freeze all cycles were removed, the clinical PRs per aspiration were 30.8% and 27.5% for IVF and ICSI, respectively.After FER with embryos originating from own eggs the PR per thawing was 30.2%, which is comparable to 30.9% in 2016, and with embryos originating from donated eggs it was 41.1% (41% in 2016). After ED the PR per fresh embryo transfer was 49.2% (49.4% in 2016) and per FOR 43.3% (43.6% in 2016).In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 46.0%, 49.2%, 4.5% and in 0.3% of all treatments, respectively (corresponding to 41.5%, 51.9%. 6.2% and 0.4% in 2016). This resulted in a reduced proportion of twin DRs of 14.2% (14.9% in 2016) and stable triplet DR of 0.3%. Treatments with FER in 2017 resulted in a twin and triplet DR of 11.2% and 0.2%, respectively (vs 11.9% and 0.2% in 2016).After IUI, the DRs remained similar at 8.7% after IUI-H (8.9% in 2016) and at 12.4% after IUI-D (12.4.0% in 2016). Twin and triplet DRs after IUI-H were 8.1% and 0.3%, respectively (in 2016: 8.8% and 0.3%) and 6.9% and 0.2% after IUI-D (in 2016: 7.7% and 0.4%). Amongst 18 888 FP interventions in 13 countries, cryopreservation of ejaculated sperm (n = 11 112 vs 7877 from 11 countries in 2016) and of oocytes (n = 6588 vs 4907 from eight countries in 2016) were the most frequently reported. Limitations reasons for caution: As the methods of data collection and levels of reporting vary amongst European countries, interpretation of results should remain cautious. Some countries were unable to deliver data about the number of initiated cycles and deliveries. Wider implications of the findings: The 21st ESHRE report on ART, IUI and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, efforts should continue to optimize data collection and reporting with the perspective of improved quality control, transparency and vigilance in the field of reproductive medicine. Study funding/competing interests: The study has received no external funding and all costs are covered by ESHRE. There are no competing interests.

Recentemente, surgiram novas propostas de explicação para o crescimento de raízes que sugerem que estas apresentam uma forma de inteligência colectiva, proveniente dos comportamentos simples dos ápices que se baseiam em informações locais. A esta propriedade, é dado o nome de Swarm Intelligence. Com o objectivo de verificar a viabilidade de explicar o crescimento das raízes utilizando modelos de inteligência colectiva, no que se refere à exploração que efectuam do solo, foi criado um modelo do crescimento de raízes no solo discreto, programado em Java e acessível através de uma página de Internet. Este incorpora processos de escolha distribuídos que são realizados pelos ápices, que decidem, baseados em informação local, que nutriente explorar, se irão ramificar-se e em que direcção do solo crescer. O solo faz também parte do modelo, sendo composto por vários elementos cúbicos, dispostos num paralelepípedo. Cada um pode conter uma quantidade variável de água, azoto e fósforo, apresentando entre si processos de difusão simples. A raiz interage com o solo através do processo de uptake, que consiste no processo de aquisição de nutrientes do solo pela raiz. O modelo é controlado através de uma interface gráfica que apresenta um variado leque de sliders e checkboxes que permitem controlar os vários parâmetros envolvidos no crescimento dos ápices e apresenta como resultado a arquitectura tridimensional da raiz, passível de ser visualizada de várias formas. Com a observação das simulações realizadas através do modelo, verificou-se que as características gerais da exploração realizada por raízes eram replicadas por este. Concluiu-se, portanto, que, apesar de algumas limitações do modelo, a explicação das estratégias de exploração do solo pela raiz à luz de uma forma primitiva de inteligência é, efectivamente, viável.

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a life-threatening condition with a heterogeneous clinical presentation. The recent availability of treatment for ATTR-CM has stimulated increased awareness of the disease and patient identification. Stratification of patients with ATTR-CM is critical for optimal management and treatment; however, monitoring disease progression is challenging and currently lacks best-practice guidance. In this report, experts with experience in treating amyloidosis and ATTR-CM developed consensus recommendations for monitoring the course of patients with ATTR-CM and proposed meaningful thresholds and frequency for specific parameters. A set of 11 measurable features across three separate domains were evaluated: (i) clinical and functional endpoints, (ii) biomarkers and laboratory markers, and (iii) imaging and electrocardiographic parameters. Experts recommended that one marker from each of the three domains provides the minimum requirements for assessing disease progression. Assessment of cardiac disease status should be part of a multiparametric evaluation in which progression, stability or improvement of other involved systems in transthyretin amyloidosis should also be considered. Additional data from placebo arms of clinical trials and future studies assessing ATTR-CM will help to elucidate, refine and define these and other measurements.

The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.

The writing of history, in medieval Latin, in the territory todayknown as Portugal, has been poorly studied. For the periodbefore 1200, critical editions, comprehensive studies, even a listof known texts are lacking. Further, there has been no attempt tounderstand the Latin historiography of Portugal in its properIberian context. This paper seeks to address these issues.Focusing on the lands that would, during the twelfth century,evolve from the county of Portucale into the kingdom of Portugalup to the beginning of the thirteenth century, the paperestablishes the historiographic sub-genres employed in theperiod; identifies the texts that were held in north-westernIberian libraries as possible sources or models for new texts; andpresents an annotated catalogue of all known historiographicaltexts produced in the region.

It is a major challenge in clinical epilepsy to diagnose and treat a disease characterized by infrequent seizures based on patient or caregiver reports and limited duration clinical testing. The poor reliability of self-reported seizure diaries for many people with epilepsy is well-established, but these records remain necessary in clinical care and therapeutic studies. A number of wearable devices have emerged, which may be capable of detecting seizures, recording seizure data, and alerting caregivers. Developments in non-invasive wearable sensors to measure accelerometry, photoplethysmography (PPG), electrodermal activity (EDA), electromyography (EMG), and other signals outside of the traditional clinical environment may be able to identify seizure-related changes. Non-invasive scalp electroencephalography (EEG) and minimally invasive subscalp EEG may allow direct measurement of seizure activity. However, significant network and computational infrastructure is needed for continuous, secure transmission of data. The large volume of data acquired by these devices necessitates computer-assisted review and detection to reduce the burden on human reviewers. Furthermore, user acceptability of such devices must be a paramount consideration to ensure adherence with long-term device use. Such devices can identify tonic-clonic seizures, but identification of other seizure semiologies with non-EEG wearables is an ongoing challenge. Identification of electrographic seizures with subscalp EEG systems has recently been demonstrated over long (>6 month) durations, and this shows promise for accurate, objective seizure records. While the ability to detect and forecast seizures from ambulatory intracranial EEG is established, invasive devices may not be acceptable for many individuals with epilepsy. Recent studies show promising results for probabilistic forecasts of seizure risk from long-term wearable devices and electronic diaries of self-reported seizures. There may also be predictive value in individuals' symptoms, mood, and cognitive performance. However, seizure forecasting requires perpetual use of a device for monitoring, increasing the importance of the system's acceptability to users. Furthermore, long-term studies with concurrent EEG confirmation are lacking currently. This review describes the current evidence and challenges in the use of minimally and non-invasive devices for long-term epilepsy monitoring, the essential components in remote monitoring systems, and explores the feasibility to detect and forecast impending seizures via long-term use of these systems.

The current COVID-19 pandemic has challenged health systems and communities globally. As such, several countries have embarked on national COVID-19 vaccination programmes in order to curb spread of the disease. However, at present, there isn’t yet enough dosages to enable vaccination of the general population. Different vaccine prioritization strategies are thus being implemented in different communities in order to permit for a systematic vaccination of individuals. Here, on behalf of the World Heart Federation, we emphasize the need for individuals with Cardiovascular disease to be prioritized in national vaccine prioritization programmes as these are high risk individuals.

Apresenta-se uma síntese dos conhecimentos sobre as manifestações epigráficas associadas à antiga escrita que se desenvolveu no Sudoeste hispânico na I Idade do Ferro. Abordam-se alguns aspectos fundamentais, começando por uma breve história da investigação, a que se juntam os tópicos relativos ao sistema de signos, à natureza dos monumentos, aos seus textos e contextos. Apesar dos novos achados das últimas décadas e dos trabalhos arqueológicos em sítios associados às estelas inscritas, são ainda muitas as dificuldades inerentes a estes temas e, por isso, muitas das questões encontram-se em aberto.

A Hispânia pré-romana apresenta-se culturalmente muito diversa, em certos aspetos mesmo contrastante. Essa multiplicidade cultural reflete-se igualmente no domínio linguístico. Ao invés de uma antiga tradição que postulava uma língua única originária, o quadro na altura da conquista apresenta uma compartimentação básica entre línguas indo-europeias (em que sobressaem o celtibérico e o lusitano) e as que não pertencem a este grupo (onde se destaca o ibérico). A realidade é, no entanto, mais complexa e as perspetivas sobre ela são muito diversas. Pretende-se dar conta, de uma forma necessariamente muito sintética, da evolução da investigação e do estado atual dos nossos conhecimentos neste domínio.

Embora tenham já sido amplo objecto de estudo muitos dos elementos que alimentaram o gosto pelas antiguidades do Duque de Palmela e dos seus antecessores, são mal conhecidas as condições em que algumas delas, especialmente as de natureza arqueológica, passaram a integrar esse espólio. Sendo inviável dar uma resposta a esta questão, coligem-se, todavia, alguns dados que permitem compreender algumas das formas como se manifestou o gosto pelas antiguidades romanas no âmbito familiar. Na Itália dos finais do séc. XVIII, D. Alexandre de Sousa e Holstein desenvolveu, a par de uma considerável actividade diplomática, um conjunto de escavações em torno à cidade romana de Arícia, com resultados apreciáveis. Esta vertente da sua vida ficou plasmada em alguma literatura da especialidade, em particular em obras de eruditos coetâneos, sendo possível traçar um breve panorama dessa sua acção. Coligem-se igualmente alguns dados sobre as relações com algumas figuras que se distinguem no estudo das antiguidades romanas, em particular Carlo Fea, com o qual estabelece uma colaboração muito profícua e uma boa amizade.

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).

The circularization of viral genomes fulfills various functions, from evading host defense mechanisms to promoting specific replication and translation patterns supporting viral proliferation. Here, we describe the genomic structures and associated host factors important for flaviviruses genome circularization and summarize their functional roles. Flaviviruses are relatively small, single-stranded, positive-sense RNA viruses with genomes of approximately 11 kb in length. These genomes contain motifs at their 5' and 3' ends, as well as in other regions, that are involved in circularization. These motifs are highly conserved throughout the Flavivirus genus and occur both in mature virions and within infected cells. We provide an overview of these sequence motifs and RNA structures involved in circularization, describe their linear and circularized structures, and discuss the proteins that interact with these circular structures and that promote and regulate their formation, aiming to clarify the key features of genome circularization and understand how these affect the flaviviruses life cycle.

O presente estudo pretende contribuir para a compreensão da influência das crenças e atitudes parentais sobre a saúde oral na concretização dos comportamentos preventivos e na presença de cárie. O objectivo principal consiste em estudar a relação entre crenças, atitudes e comportamentos relatados pelos pais acerca das crianças em relação à escovagem bidiária e controlo na ingestão de açúcar, e a presença de cárie precoce da infância observada. Com o estudo das propriedades psicométricas chegaramse a valores de consistência interna aceitáveis nas subescalas e factores à semelhança do estudo original. A presença de cárie mostrou ser independente dos comportamentos preventivos e do nível de escolaridade da mãe na amostra. A maioria dos pais revelaram crenças e atitudes positivas em relação à cárie precoce da infância e relatavam comportamentos preventivos. Os resultados das observações clínicas de saúde oral mostraram que a maioria das crianças não apresentava cárie precoce da infância. Foram encontradas associações significativas entre os resultados da auto-eficácia parental na escovagem e no controlo do consumo de açúcar e o decorrer do comportamento escovagem duas ou mais vezes por dia. Os resultados de auto-eficácia no controlo do açúcar associaram-se com o comportamento ingestão de bebidas açucaradas em menos de uma ou duas vezes por semana e os resultados das crenças no controlo externo associaram-se com a ingestão de alimentos antes de adormecer menos de uma ou duas vezes por semana. Os resultados de auto-eficácia parental mostraram-se relevantes para a concretização de comportamentos preventivos na cárie precoce da infância.

Shift work (SW) encompasses 20% of the European workforce. Moreover, high blood pressure (BP) remains a leading cause of death globally. This review aimed to synthesize the magnitude of the potential impact of SW on systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension (HTN). MEDLINE, EMBASE and CENTRAL databases were searched for epidemiological studies evaluating BP and/or HTN diagnosis among shift workers, compared with day workers. Random-effects meta-analyses were performed and the results were expressed as pooled mean differences or odds ratios and 95% confidence intervals (95% CI). The Newcastle-Ottawa Scale was used to assess the risk of bias. Forty-five studies were included, involving 117,252 workers. We found a significant increase in both SBD and DBP among permanent night workers (2.52 mmHg, 95% CI 0.75-4.29 and 1.76 mmHg, 95% CI 0.41-3.12, respectively). For rotational shift workers, both with and without night work, we found a significant increase but only for SBP (0.65 mmHg, 95% CI 0.07-1.22 and 1.28 mmHg, 95% CI 0.18-2.39, respectively). No differences were found for HTN. Our findings suggest that SW is associated with an increase of BP, mainly for permanent night workers and for SBP. This is of special interest given the large number of susceptible workers exposed over time.

The SARS-CoV-2 pandemic infection has been reported in 223 countries, with about 136 million cases and almost 3 million deaths since December 2019.1 Although the real mortality associated with COVID-19 remains unknown, the current global case fatality reported across countries ranges from 0.2% (in Germany) to 7.7% (in Italy). Cardiovascular disease, diabetes and age have been outlined as risk factors for poorer outcomes in COVID-19 patients.