RCAAP Repository

Este artigo incide sobre as políticas para as alterações climáticas em Portugal, procurando compreender os posicionamentos institucionais e traçar os laços que se tecem entre instituições em matéria de influência sobre as políticas, fontes de informação científica, colaborações e aconselhamento. Tem por base um inquérito por questionário aos principais atores institucionais envolvidos. Este estudo conclui que há consenso entre os atores institucionais sobre as alterações climáticas e apoio a medidas de mitigação. A análise de redes revela a centralidade dos atores governamentais e algum fechamento dos setores em si próprios, funcionando tendencialmente em “silo”, registando-se assim uma fraca interação institucional no período analisado.

Distal left main (LM) PCIremains a challenge. One of the most debated issues is whether to use a single vs 2 stent provisional strategy. While most studies and guidelines favour a single stent strategy, the recent DK-CRUSH V trial has shown better results with a 2 stent strategy.

According to the most recent recommendations of AHA, mitral valve prolapse (MVP) is defined as systolic displacement of the mitral leaflet into the left atrium (LA) of at least 2 mm from the mitral annular plane. The ESC recommendations define MVP, flail and billowing, according to the location of the leaflet tips in relation to the coaptation plan. Differences in outcomes considering these classifications are not established.

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Background: Post-operative atrial fibrillation (POAF) is a relevant complication after surgery. Several studies have shown that POAF has important consequences for long-term morbidity and mortality, by increasing the risk of thromboembolic events. However, the use of oral anticoagulation (OAC) is not well established in this context. Methods: We searched MEDLINE, CENTRAL, PsycInfo and Web of Science for clinical trials and observational studies evaluating anticoagulation vs. no anticoagulation in patients with POAF (after cardiac or non-cardiac surgery). Data were screened and extracted by two independent reviewers. We performed a random- effects model to estimate the pooled odds ratio (OR) with 95% Confidence Intervals (CI), and heterogeneity was evaluated by I2 statistics. The outcomes of interest were all-cause mortality, thromboembolic events, and bleeding events. Results: Overall, 10 observational retrospective studies were included: 5 studies with 203,946 cardiac surgery POAF patients, and 5 studies with 29,566 patients with POAF after non-cardiac surgery. In cardiac surgery POAF, the OAC use was associated with lower risk of thromboembolic events (OR 0.68; 95%CI 0.47-0.96, I2 = 31%; 4 studies) and the bleeding risk was significantly increased (OR 4.30; 95%CI 3.69 to 5.02, 1 study). In non-cardiac surgery POAF, OAC did not significantly reduce the risk of thromboembolic events (OR 0.71, 95%CI 0.33-1.15; I2 = 79%; 5 studies) but was associated with increased risk of bleeding (OR 1.20, 95%CI 1.10-1.32, I2 = 0%; 3 studies). Mortality was not significantly reduced in both cardiac and non-cardiac surgery POAF. Conclusion: Oral anticoagulation was associated with a lower risk of thromboembolic events in patients with POAF following cardiac surgery but not in non-cardiac surgery. Bleeding risk was increased in both settings. The confidence on pooled results is at most low, and further data, namely randomized controlled trials are necessary to derive robust conclusions.

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As formas familiares de carcinomas não-medulares da tiróide (Familial Nonmedullary Thyroid Carcinomas – FNMTC) representam cerca de 5% de todos os casos de cancro da tiróide. Estudos de linkage, que abrangeram todo o genoma, em famílias com FNMTC, permitiram o mapeamento de 7 regiões cromossómicas de susceptibilidade, não tendo ainda sido identificados os genes responsáveis. Genes que codificam factores de transcrição, envolvidos na diferenciação celular durante a embriogénese, quando desregulados podem contribuir para a tumorigénese. Os factores de transcrição NKX2-1, FOXE1, HHEX e PAX8 desempenham um papel crítico na morfogénese da tiróide e na manutenção da diferenciação da tiróide. Estudos de associação demonstraram correlações entre polimorfismos dos genes NKX2-1 e FOXE1 e o risco para o cancro da tiróide esporádico. Recentemente, foi identificada uma mutação germinal no gene NKX2-1, em duas famílias com FNMTC, constituindo a primeira evidência do envolvimento deste gene no cancro da tiróide familiar. Este projecto teve como objectivo o estudo do envolvimento dos factores de transcrição da tiróide em FNMTC. Procedeu-se à pesquisa de variantes genéticas nos genes NKX2-1, FOXE1, HHEX e PAX8, através da sequenciação do DNA constitucional dos probandos de 60 famílias com FNMTC. Nesta série, foram identificadas 15 variantes nos genes FOXE1, HHEX e PAX8. Duas destas variantes, identificadas nos genes FOXE1 (c.743C>G, p.A248G) e HHEX (c.361G>A, p.G121S), não foram descritas na literatura ou em bases de dados de variantes genéticas. Estas variantes segregavam com a doença nas famílias e afectavam resíduos de aminoácidos conservados na evolução, sugerindo que seriam patogénicas. Estudos in vitro demonstraram que a variante p.A248G do gene FOXE1 promovia a proliferação e a migração celular, em clones de células PCCL3. Estudos in silico da variante p.G121S do gene HHEX previram a abolição do donor splice site, que poderá alterar o mecanismo de splicing. Neste estudo, foram identificadas duas variantes genéticas possivelmente patogénicas nos genes FOXE1 e HHEX, que poderão constituir a primeira evidência do envolvimento destes factores de transcrição na susceptibilidade para o cancro da tiróide familiar.

Cardiovascular rehabilitation (CR) was one of the many areas negatively affected by the COVID-19 pandemic. A high number of cardiovascular disease (CVD) patients had their centre-based program suspended. Physical activity (PA) recommendations for CVD patients are well established and its benefits largely documented. However, few studies have objectively measured the PA of these patients throughout the years and specifically during the COVID-19 pandemic.

Patient education is considered a core component of cardiac rehabilitation (CR) and nowadays, particularly during the COVID-19 pandemic, online education programs are critical. However, the best strategy for implementing these digital programs to increase patients’ adherence and learning is not fully established.

Pulmonary embolism (PE) is a recognized complication of SARS-COV2 infection due to hypercoagulability. Before the COVID era, the need for computed tomography pulmonary angiography (CTPA) to rule out PE was determined by clinical probability, based on Wells and Geneva scores, in association with D-dimer measurements. However, patients with SARS-COV2 infection have a pro-thrombotic and pro-inflammatory state which may compromise the usefulness of these algorithms to select patients for CTPA.

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In questo articolo ci occupiamo della presenza di formule votive nelle iscrizioni funerarie latine. Ci concentriamo, innanzitutto, su un gruppo di epitaffi dell’Africa romana che recano formule del tipo votum solvit, relazionandoli con il culto locale di Saturno, che possedeva un carattere escatologico. In secondo luogo, rivolgiamo la nostra attenzione ad un’iscrizione funeraria di Volaterrae (Regio VII) nella quale il voto menzionato (ex voto ob conservationem) potrebbe essere stato rivolto dal dedicante alla defunta in qualità di essere divino (Manes) per ottenerne la protezione. Infine, consideriamo una serie di epitaffi, nei quali il termine votum è attestato all’interno di formule identiche, nell’aspetto, a quelle delle iscrizioni votive (ex voto, votum posuit), ma sembra acquisire un significato non religioso (un desiderio del defunto o il monumento funerario in sé).

This study intends to provide insights into the lives of children who suffer from chronic pain and of their parents. A qualitative, multi-modal approach was employed, using the draw, write and tell technique with seven children, and semi-structured interviews with parents. By illustrating that children are active social agents in the management of chronic pain (even when they are understood by parents as vulnerable), the findings support recent sociological work in the field of childhood health. Indeed, the findings show that children with a chronic condition can take autonomous decisions in relation to disease management even when supervised by parents.

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).

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O estudo que aqui se apresenta visa averiguar as relações entre o padrão de vinculação materna pré-natal em grávidas no terceiro trimestre de gestação e o risco de incidência de depressão pós-parto, a percepção materna do comportamento do recém-nascido, assim como, a confiança materna para cuidar do bebé, em puérperas entre as 3 as 10 semanas do pós-parto. Este estudo orienta-se segundo seis hipóteses gerais: (1) a vinculação pré-natal de tipo seguro está associada ao planeamento da gravidez; (2) a vinculação pré-natal de tipo seguro está associada a uma menor probabilidade de desenvolvimento da depressão pós-parto; (3) a vinculação pré-natal de tipo seguro está relacionada com percepções maternas positivas acerca do comportamento do recém-nascido; (4) a vinculação pré-natal de tipo seguro está associada a uma percepção materna positiva acerca da confiança relativa aos cuidados a prestar ao bebé; (5) a depressão pós-parto está associada a percepções maternas mais negativas acerca do comportamento do recém-nascido; (6) a depressão pós-parto está associada a percepções maternas mais negativas acerca da confiança relativa aos cuidados a prestar ao bebé. A recolha de dados fez-se em dois momentos – pré e pós-parto. Recorreu-se à aplicação de três escalas: a Escala de Vinculação Materna Pré-Natal, a Escala de Depressão Pós-Parto de Edimburgo e a Escala de Percepção Materna do Comportamento do Recém-Nascido. Foram ainda construídos dois Questionários Sócio-Demográficos, um para cada momento da recolha. Os resultados permitem constatar uma tendência a favor da confirmação das hipóteses enunciadas, sobretudo no que respeita às hipótese 5 e 6 em que os resultados obtidos atingem a significância estatística. Neste sentido, verificou-se que existe uma associação estatisticamente significativa entre a ocorrência de sintomatologia depressiva no pós-parto e percepções maternas do comportamento do recém-nascido mais negativas (Irrequieto/Irregular e Irritável Durante a Mamada), bem como no que concerne a percepções maternas mais negativas no que respeita à confiança nos cuidados a prestar ao bebé (Falta de Confiança no Cuidado e Falta de Confiança Durante a Amamentação).

In Tom Bidell’s philosophical introduction and contextualization of the effort to create an integrative developmental psychology, he traces “fragmentation” in developmental psychology (and social sciences more broadly) to the influence of what he calls “the Cartesian problem space” (see Bidell, this volume). He distinguishes (a) the tradition of efforts to understand the relationship of mind and matter that are in various ways responses to Cartesian dualism from (b) an alternative tradition which he calls the “relational-dialectical unification” in which he portrays Hegel as an initial generative figure. One difference is that within the former tradition, the relationship between “factual statements” (about the way things are) and “evaluative statements” (about what is good, what ought to be, or what is morally right and wrong) is extremely problematic and has been the topic of centuries of debate. In contrast, in the “relational-dialectical” tradition, statements of fact and statements of value are “internally-related”. They can be seen as emerging within the same nexus of human social practices within a physical environment. Such statements play interdependent and complementary roles in organizing such practices, and transformations in human practices are accompanied by changes in understandings of both what is possible and what is desirable. This chapter focuses on the status of explicit and implicit evaluative claims in the literature of developmental psychology over the lifespan. It addresses two major questions in sequence: (a) Under what conditions does theory and research in developmental psychology make fundamental evaluative claims in describing phenomena as representing “development”? (b) Can we articulate a framework for justification of such evaluative claims that is integrative, not only with respect to developmental psychology but also with respect to all human inquiry? The chapter proceeds by first distinguishing four theoretical and research traditions in developmental psychology in terms of the role and status of evaluative claims in these traditions. Then, it moves from a general suggestions that the key to systematic justification of evaluative claims is a conception of the connection between epistemology and human development to the following specific proposal: That the epistemological framework proposed by Jurgen Habermas in Knowledge and Human Interests (1971) can serve to integrate the evaluation of developmental psychological claims with the evaluation of all knowledge claims that various forms of human inquiry generate. The final section then illustrates how the proposed framework could be used to consider claims of each of the four theoretical and research traditions in developmental psychology that were initially distinguished.

It was in 1922, when Alexandre Friedmann proposed some models for cosmic evolution, that modern cosmology faced for the first time in a scientific way the problem of the origin of the universe. It was the inaugural step of the big bang cosmology (usually known as the Big Bang Theory), to which several important cosmologists contributed over the following decades. Among these cosmologists, there were two who played a special role: Georges Lemaître, who proposed the primeval atom theory, and George Gamow, who later assumed the hot and dense primordial state of the universe which contemporary cosmology continues to admit. In this paper, I present and compare the perspectives of these two great cosmologists towards the idea of the beginning of the universe as an epistemological frontier, that is, as an unsurpassable limit to the physical knowledge of the universe, namely with regard to an explanation of what caused this beginning and how the primordial universe had come into existence. Both cosmologists assumed that the beginning of our universe is located before everything that physics can achieve, but we can identify one important difference: according to Lemaître, the beginning of the universe is located before space and time, and we can admit that is an epistemological beginning and also an ontological beginning; according to Gamow, the beginning of our universe may have been the result of a preexistent cosmological state of the universe which is just inaccessible to physics, and therefore is not an ontological but just an epistemological beginning.

This article presents a novel approach to the study of primate personality and illustrates it with a study of capuchin monkeys. While most personality studies with capuchin monkeys have used rating questionnaires, the research method of this study relies instead on direct behaviour observa- tions. In an effort to capitalize on the full richness of behavioural observation data, we used both statistical and non-statistical methods to analyse data from behavioural observations of a group of capuchin monkeys in captivity. Interest in capuchin monkeys as a species has increased due to their cognitive capacities, behavioural flexibility and complex social structure, as well as many similarities with great apes in dimensions of personality. In this study we focus in three aspects of personality: diversity, flexibility and complexity. Our results provide a detailed picture of these aspects of capuchins’ personality, including the degree of “predictability” and “unusualness” of individual capuchins’ behaviour.