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ABSTRACT Asbestos was largely used in Brazil. It is a mineral that induces pleural and pulmonary fibrosis, and it is a potent carcinogen. Our objective was to develop recommendations for the performance of adequate imaging tests for screening asbestos-related diseases. We searched peer-reviewed publications, national and international technical documents, and specialists’ opinions on the theme. Based on that, the major recommendations are: Individuals exposed to asbestos at the workplace for ≥ 1 year or those with a history of environmental exposure for at least 5 years, all of those with a latency period > 20 years from the date of initial exposure, should initially undego HRCT of the chest for investigation. Individuals with pleural disease and/or asbestosis should be considered for regular lung cancer monitoring. Risk calculators should be adopted for lung cancer screening, with a risk estimate of 1.5%.

Resumo Neste estudo busca-se desenvolver uma revisão da literatura baseada na análise bibliométrica sobre o tema da transparência e da accountability no contexto da governance dos hospitais públicos, procurando identificar linhas de investigação, teoria, método de investigação e lacunas existentes por intermédio da análise das publicações científicas datadas até 2020. A investigação seguiu o referencial teórico da transparência e da accountability no setor público com o intuito de compreender o seu enquadramento no contexto da governance dos hospitais. Com recurso ao software Bibliometrix e terminado o processo de consulta dos artigos nas bases de dados Scopus e WoS, foram selecionados 118 artigos para este estudo. Constatou-se que, no período entre 2017-2020, cerca de 85% das publicações são de base qualitativa e há uma tendência crescente no estudo da transparência e da accountability na governança dos hospitais públicos. A transparência surge frequentemente interligada à responsabilização dos agentes (accountability), às políticas de comunicação externa (relatórios públicos) e interna, assim como à sua compreensibilidade. Verificou-se a ainda predominância das publicações de origem norte-americana e chinesa. O estudo identifica também a escassez de investigação baseada em modelos quantitativos que explorem relações de dependência entre as dimensões estudadas, limitando a compreensão da interdependência entre as práticas de transparência e os atributos internos e externos das organizações. O estudo contribui para o conhecimento sobre interações entre transparência, accountability e prestação de contas na governança dos hospitais públicos.

Objectives Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms.Methods This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen’s kappa. Two multivariable logistic regressions were built.Results According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression.Conclusion At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.

In late November 2020, when Europe reached the highest 14-day incidence of COVID-19 cases, the resource-intensive and time-consuming traditional contact tracing performed by Public Health was challenged. In this context, innovative approaches were necessary to guarantee a timely interruption of disease transmission.“COVID-19 Collaborative Screening” Project was developed as a faster solution, not only because the contact tracing process is simpler for the operator, but mainly because it is possible to quickly scale up the number of operators involved. It was designed to interrupt family and social transmission chains, in a partnership with the Local Public Health Services – allowing these services to dedicate to scenarios of more complex risk assessment, using the traditional contact tracing. To perform contact tracing, this method involves Public Servants, Armed Forces and Medical Dentists. The Project also promotes participatory citizenship, by delegating to the citizen the responsibility of registering his/hers contacts with high-risk exposure in an online form, in contrast to the traditional contact tracing method which is more health professional-dependent.Until the end of January 2021, the Project has trained eight teams, enrolling a total of 213 professionals, and was implemented in eight Health Regions (with an estimated population of 1,346,150 inhabitants).The Project was successful at facing the delays in case interview and contact tracing. The strategy implemented by ColabCOVID is assembled as a sustainable, reproducible and scalable platform and is ready to be re-implemented to face the emergence of more contagious variants, as well as an eventual forthcoming health threat.

The massive industrialization of products in a factory environment requires testing the product at a stage before its exportation to the sales market. For example, the end-of-line tests at Continental Advanced Antenna contribute to the validation of an antenna’s functionality, a product manufactured by this organization. In addition, the storage of information from the testing process allows the data manipulation through automated machine learning algorithms in search of a beneficial contribution. Studies in this area (automatic learning/machine learning) lead to the search and development of tools designed with objectives such as preventing anomalies in the production line, predictive maintenance, product quality assurance, forecast demand, forecasting safety problems, increasing resources, proactive maintenance, resource scalability, reduced production time, and anomaly detection, isolation, and correction. Once applied to the manufacturing environment, these advantages make the EOL system more productive, reliable, and less time-consuming. This way, a tool is proposed that allows the visualization and previous detection of trends associated with faults in the antenna testing system. Furthermore, it focuses on predicting failures at Continental’s EOL.

BackgroundHealth and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. ObjectiveThis study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. MethodsA secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. ResultsA total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). ConclusionsA better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.

Precision allergy molecular diagnostic applications (PAMD@) is increasingly entering routine care. Currently, more than 130 allergenic molecules from more than 50 allergy sources are commercially available for in vitro specific immunoglobulin E (sIgE) testing. Since the last publication of this consensus document, a great deal of new information has become available regarding this topic, with over 100 publications in the last year alone. It thus seems quite reasonable to publish an update. It is imperative that clinicians and immunologists specifically trained in allergology keep abreast of the new and rapidly evolving evidence available for PAMD@.PAMD@ may initially appear complex to interpret; however, with increasing experience, the information gained provides relevant information for the allergist. This is especially true for food allergy, Hymenoptera allergy, and for the selection of allergen immunotherapy. Nevertheless, all sIgE tests, including PAMD@, should be evaluated within the framework of a patient's clinical history, because allergen sensitization does not necessarily imply clinical relevant allergies. Keywords: Diagnosis, Molecular allergy, Cross reactivity, Panallergen, Specific IgE, PAMD@

Background. Phlebotonics have beneficial effects on some symptoms related to chronic venous disease (CVD) of the lower limbs. The most commonly used one is diosmin, available in a pure semisynthetic form or as a micronized purified flavonoid fraction. Patients and Methods. The primary objective of this single-blind, randomized, parallel-group, prospective study was to assess the clinical noninferiority of nonmicronized diosmin 600 mg once daily (D-group) compared to micronized diosmin 900 mg plus hesperidin 100 mg once daily (D/H-group) over a 6-month treatment period. Adult patients with a symptomatic CVD of the lower limbs (C0-C3 grade; 20-60 mm on a 100 mm visual analog scale (VAS)) were included. The primary endpoint was the change (from baseline to last postbaseline value) of the intensity of the lower-limb symptoms on VAS. Results. 114 patients (mean age, 44.4 years; women, 90.4%) were randomized in the per-protocol analysis (D-group, n=57; D/H-group, n=57). Symptoms significantly improved in both groups with adjusted mean VAS changes of -24.9 mm (p

This work presents fully automated plasma-enhanced reactive thermal evaporation system (rf-PERTE) that can be used for the deposition of transparent metal oxide films with high reproducibility of their electrical and optical properties. The developed hardware/software platform enables the full control over the critical deposition conditions such as mass flow of oxygen, process pressure, current flowing through crucible and rf-power. For indium oxide films on glass substrates a resistivity of 9×10-4 Ω-cm and a transmittance of 90% in the visible spectral range were achieved without substrate heating. The system is also suitable for the deposition of transparent conducting coatings in a wide range of plastic substrates, for applications in the field of flexible sensors or solar cells. In particular, we have successfully deposited indium oxide on PEN (polyethylene naphthalate) sheets with electrical and optical properties approaching the ones of the films deposited on glass substrates.

First described in 1944 by Hans Asperger, it was not before 1994 that Asperger Syndrome (AS) was included in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, only to disappear in the Manual’s 5th edition in 2013. During its brief existence as a diagnostic entity, AS aroused immense interest and controversy. Similar to patients with autism, AS patients show deficits in social interaction, inappropriate communication skills, and interest restriction, but also display a rich variety of subtle clinical characteristics that for many distinguish AS from autism. However, difficulties operationalising diagnostic criteria and differentiating AS from autism ultimately led to its merging into the unifying category of Autistic Spectrum Disorders. Here we briefly review the short history of this fascinating condition.

OBJETIVO: Determinar os fatores preditores de abandono do tratamento da tuberculose pulmonar, preconizado pelo Ministério da Saúde do Brasil, em pacientes bacilíferos virgens de tratamento atendidos na cidade de Porto Alegre (RS). MÉTODOS: Estudo de caso-controle envolvendo seis unidades básicas de saúde de referência para o tratamento da tuberculose em Porto Alegre, com a revisão dos prontuários de todos os casos de abandono do tratamento por parte de pacientes com tuberculose pulmonar bacilíferos e virgens de tratamento entre 2004 e 2006. Os pacientes incluídos no estudo foram pareados com pacientes com características semelhantes e cujo desfecho foi de cura. Foram realizadas análises univariada e multivariada. RESULTADOS: Dos 2.098 pacientes incluídos no estudo, 218 (10,4%) abandonaram o tratamento. De acordo com a modelo da análise multivariada utilizado, as associações mais significantes para o abandono do tratamento foram o etilismo (com ou sem a concomitância de uso de drogas ilícitas), a infecção por HIV, o fato de o paciente não residir com familiares e o baixo nível de escolaridade. Na análise univariada, indivíduos mais jovens e de etnia não branca também se revelaram significativos para o abandono do tratamento. Gênero e ocorrência de efeitos adversos da medicação não mostraram associação com o abandono. CONCLUSÕES: Na população estudada, alcoolismo, infecção por HIV e o fato de o paciente não residir com familiares foram os fatores preditores mais importantes para o abandono do primeiro tratamento da tuberculose pulmonar.OBJECTIVE: To determine the predictors of noncompliance with the pulmonary tuberculosis treatment regimen recommended by the Brazilian National Ministry of Health, in previously treatment-naïve patients with active tuberculosis treated in the city of Porto Alegre, Brazil. METHODS: This was a case-control study involving six referral primary health care clinics for tuberculosis in Porto Alegre. We reviewed the medical charts of all previously treatment-naïve patients with active pulmonary tuberculosis who were noncompliant with the treatment between 2004 and 2006. Those were paired with other patients having similar characteristics and having been cured. We conducted univariate and multivariate analyses. RESULTS: Of the 2,098 patients included, 218 (10.4%) became noncompliant with the treatment. In the multivariate analysis, the factors most strongly associated with treatment noncompliance were being an alcoholic (with or without concomitant use of illicit drugs), being HIV-infected, not residing with family members, and having a low level of education. In the univariate analysis, treatment noncompliance was also significantly associated with being younger and with being non-White. Gender was not significantly associated with treatment noncompliance; nor was the occurrence of adverse effects of the drugs included in the regimen. CONCLUSIONS: In the population studied, being an alcoholic, being HIV-infected, and not residing with family members were the major predictors of noncompliance with treatment for pulmonary tuberculosis among previously treatment-naïve patients.

The prevalence of allergic airway diseases such as asthma and rhinitis has increased dramatically to epidemic proportions worldwide. Besides air pollution from industry derived emissions and motor vehicles, the rising trend can only be explained by gross changes in the environments where we live. The world economy has been transformed over the last 25 years with developing countries being at the core of these changes. Around the planet, in both developed and developing countries, environments are undergoing profound changes. Many of these changes are considered to have negative effects on respiratory health and to enhance the frequency and severity of respiratory diseases such as asthma in the general population.Increased concentrations of greenhouse gases, and especially carbon dioxide (CO2), in the atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, variability in temperature, increased air pollution, forest fires, droughts, and floods – all of which can put the respiratory health of the public at risk. These changes in climate and air quality have a measurable impact not only on the morbidity but also the mortality of patients with asthma and other respiratory diseases. The massive increase in emissions of air pollutants due to economic and industrial growth in the last century has made air quality an environmental problem of the first order in a large number of regions of the world. A body of evidence suggests that major changes to our world are occurring and involve the atmosphere and its associated climate. These changes, including global warming induced by human activity, have an impact on the biosphere, biodiversity, and the human environment. Mitigating this huge health impact and reversing the effects of these changes are major challenges.This statement of the World Allergy Organization (WAO) raises the importance of this health hazard and highlights the facts on climate-related health impacts, including: deaths and acute morbidity due to heat waves and extreme meteorological events; increased frequency of acute cardio-respiratory events due to higher concentrations of ground level ozone; changes in the frequency of respiratory diseases due to trans-boundary particle pollution; altered spatial and temporal distribution of allergens (pollens, molds, and mites); and some infectious disease vectors. According to this report, these impacts will not only affect those with current asthma but also increase the incidence and prevalence of allergic respiratory conditions and of asthma. The effects of climate change on respiratory allergy are still not well defined, and more studies addressing this topic are needed. Global warming is expected to affect the start, duration, and intensity of the pollen season on the one hand, and the rate of asthma exacerbations due to air pollution, respiratory infections, and/or cold air inhalation, and other conditions on the other hand.

GIS MODEL FOR WASTE DISPOSAL SITES. Landfill is still the major method for waste disposal in the EU. The need to guarantee environmental protection and to follow a scientific and more transparent procedure of landfill site selection was the motivation to develop the GIS model presented in this paper. This work was developed under the auspices of an Interreg-funded EU project, by a team of Irish and Portuguese partners from University College Cork and the New University of Lisbon, and from local authorities in both countries, Cork County Council and Sesimbra Town Council.The theoretical GIS model consists of two steps. In the first step, data in vector structure and geo-processing techniques such as overlay and buffering are used to exclude areas unsuitable for landfill due to risk to the environment or human health. The exclusion factors considered in this step were grouped into “non-geological factors” and “geological and correlated factors”.The remaining residual areas, considered suitable for the location of landfills, may have some land parcels more suitable than others, and are thus further examined in the second step of the GIS model. This step is an automated raster-based process in which a series of parameters are used to classify each area in terms of high, moderate or low suitability for landfill. These parameters were also grouped into four different types: a) susceptibility to natural hazards; b) aquifer protection levels; c) land use; d) geo-environmental engineering. These parameters can also be weighted in order to provide different evaluation scenarios of the residual areas; extensions have been developed for ArcView GIS that will automatically calculate the weights for each category following inputs from the user. Study sites in both countries were used to test and validate the model. This paper presents the results obtained from the application of the model to Sesimbra Council in Portugal. The development of the landfill GIS model fulfils legislative and environmental obligations associated with site selection in a non-biased way, and the methodology aims at providing a clear and scientific rationale behind the choice of a site. Application of the model does not intend to substitute political decision but will provide decision makers (local authorities, waste management entities, etc.) with an important tool and a methodology that will aid their decision and enable them to conduct their own GIS landfill site selection screening process.

A técnica do potencial de ação monofásico (MAP) é um método de obtenção de potencial in vivo, por meio de cateteres especiais, muito semelhante ao potencial de ação celular, porém, com a vantagem de não exigir o emprego de microeletrodos transmembrana in vitro na célula miocárdica. Este trabalho apresenta detalhes da construção de um cateter-eletrodo para aquisição de MAP endocárdico in vivo, bem como o desempenho do algorítmo desenvolvido para aquisição e análise automática dos sinais captados. Vários fatores afetam a fase de repolarização miocárdica, sendo pouco visíveis ao eletrocardiograma, porém, podem ser melhor identificados pelo MAP. As miocardiopatias e o transplante são situações que podem modificar o estado morfo-funcional da fibra miocárdica. O algorítmo desenvolvido para análise do MAP baseia-se na discriminação de características morfológicas e temporais dos potenciais. Inicialmente foram estudados 23 pacientes com indicação para realização de biópsia endomiocárdica, sendo que em 8 (34,8%) deles a biópsia foi indicada para complementar a avaliação da miocardiopatia idiopática e em 15 (65,2%) para controle de rejeição após transplante cardíaco ortotópico. Foram constituídos dois grupos de 5 pacientes, um com portadores de miocardiopatia (excluindo-se miocardite em atividade) e outro com transplante (estudados em duas situações distintas, sem e com rejeição em grau 3A ou superior). Com base nos resultados obtidos desta investigação, pode-se concluir que: 1) o cateter-eletrodo ora apresentado confirmou, na investigação clínica, o bom desempenho apresentado em pesquisa experimental para aquisição do MAP; 2) o algorítmo computadorizado mostrou-se adequado e com igual desempenho apresentado em estudo experimental; 3) as interferências que o MAP sofre nos corações com miocardiopatia ou transplantados, sem ou com rejeição, determinam alterações proporcionais de tal forma que conservam a morfologia da onda de repolarização; 4) durante os episódios de rejeição a velocidade de despolarização do miócito dobra ou triplica.

Molecular-based allergy (MA) diagnostics is an approach used to map the allergen sensitization of a patient at a molecular level, using purified natural or recombinant allergenic molecules (allergen components) instead of allergen extracts. Since its introduction, MA diagnostics has increasingly entered routine care, with currently more than 130 allergenic molecules commercially available for in vitro specific IgE (sIgE) testing.MA diagnostics allows for an increased accuracy in allergy diagnosis and prognosis and plays an important role in three key aspects of allergy diagnosis: (1) resolving genuine versus cross-reactive sensitization in poly-sensitized patients, thereby improving the understanding of triggering allergens; (2) assessing, in selected cases, the risk of severe, systemic versus mild, local reactions in food allergy, thereby reducing unnecessary anxiety for the patient and the need for food challenge testing; and (3) identifying patients and triggering allergens for specific immunotherapy (SIT).Singleplex and multiplex measurement platforms are available for MA diagnostics. The Immuno-Solid phase Allergen Chip (ISAC) is the most comprehensive platform currently available, which involves a biochip technology to measure sIgE antibodies against more than one hundred allergenic molecules in a single assay. As the field of MA diagnostics advances, future work needs to focus on large-scale, population-based studies involving practical applications, elucidation and expansion of additional allergenic molecules, and support for appropriate test interpretation. With the rapidly expanding evidence-base for MA diagnosis, there is a need for allergists to keep abreast of the latest information. The aim of this consensus document is to provide a practical guide for the indications, determination, and interpretation of MA diagnostics for clinicians trained in allergology.

LOCAL GOVERNMENT AND URBAN MANAGEMENT, DOES POLITICS MATTER? - This article develops our earlier analysis of the influence of political parties on the definition and implementation of municipal policies. It starts with an analysis of the literature, mainly from the areas of Political Science, Sociology and Political Geography, reviewing methods and results there presented. The Portuguese case is then analysed, using different types of statistical indicators to measure policy performance.The main thesis is that, in Portugal, the political party effect is relevant to the definition and implementation of municipal policies and actions. Nevertheless, in the end of this period, the municipal policy profile is less differentiated in each category of municipalities than in the years just after the Revolution.

Os homens inevitavelmente estão envolvidos pela política. Esta atividade é inerente à própria condição humana da convivência em sociedade. Todavia, muitos são os fatores que contribuem para a incompreensão da política enquanto uma atividade imprescindível para resolução de conflitos e um caminho para a realização do homem enquanto ser social. De grande relevância para a incompreensão da política é a sua relação com a ética, que a partir de uma análise baseada no realismo ganhou uma nova perspectiva. O realismo político expressado por Maquiavel e posteriormente pelo pensador alemão Max Weber, vai impactar a noção de uma política idealizada que possa produzir o bem somente pelos caminhos do bem. Para Maquiavel o bem supremo a ser preservado é o Estado, para este desiderato não é possível ser guiado por condutas éticas que limite a luta em defesa da Razão de Estado. Weber quatro séculos depois abrigará este pensamento defendendo que existe a ética da convicção e a ética da responsabilidade.

This book is a well-informed introduction to qualitative research methodologies and is organized as a guide for the preparation of qualitative research proposals. It describes and discusses, in seven chapters, different types of qualitative research and the appropriate methods of data collection, analysis and interpretation. This fourth edition includes references to recent theoretical and methodological developments associated with post-modern, feminist and post-colonial perspectives as well as the new challenges faced by online qualitative research. It is a useful reference for undergraduate and graduate students interested to develop a qualitative research project. URN: urn:nbn:de:0114-fqs0803137

Este artigo aborda os fatos e achados clínicos relacionados ao revestimento fractal. A introduçao, enfocando sucintamente o princípio do revestimento fractal, é seguida pela revisao das propriedades da estrutura. Sao feitas consideraçoes sobre publicaçoes de trabalhos clínicos que mencionam tal tecnologia. A principal característica do revestimento fractal é sua superfície ativa ser aproximadamente 1.000 vezes maior que eletrodos de área equivalente, do que decorrem as três vantagens desta tecnologia: captaçao dos sinais intracardíacos sem distorçao (potencial de açao monofásico /

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