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Abstract Background Reflecting people with diabetes’ self-management activities is often required in both research and clinical practice. This study evaluated the measurement properties of the Portuguese version of the Diabetes Self-Management Questionnaire-Revised (DSMQ-R) on a sample of people with type 2 diabetes mellitus (T2DM). Methods Translation and cultural adaptation were conducted according to guidelines for cross-cultural adaptation and validation of healthcare measurement instruments. A cross-sectional study was performed including 365 people with T2DM in primary care. Reliability, construct validity, and criterion validity were analyzed. Results The total scale of the translated DSMQ-R revealed sufficient internal consistency (alpha = 0.82), and most of the subscales performed adequately. The exploratory factor structure was robust, and confirmatory analysis showed a good model fit with the scale structure of the original scale. The scale scores correlated with the participants’ last HbA1c estimates, supporting convergent validity, and convergence was confirmed by the adequate average variance extracted. Conclusions The Portuguese version of the DSMQ-R is a reliable and valid tool for gauging self-management behaviors in people with T2DM and their relationship with glycemic values.

Abstract Background Social prescribing (SP) is a non-clinical approach, most commonly based in healthcare units, that aims to address non-medical health-related social needs by connecting individuals with community-based services. This qualitative study explores the perception of Portuguese older adults regarding the benefits of SP and their willingness to participate in SP initiatives. Methods Three face-to-face focus group sessions were conducted with 23 participants in different cities in Portugal. Open and semi-open questions were used to guide the discussions and thematic analysis was used to analyze the data. Results The participants recognized the potential benefits of SP for older adults, including diversifying leisure activities, improving mental health, and complementing existing support systems. They highlighted the need for external support, usually in the form of link workers, to facilitate personalized referrals and consider individual characteristics and preferences. While some participants expressed reluctance to engage in SP due to their existing busy schedules and a perceived sense of imposition, others showed openness to having new experiences and recognized the potential value of SP in promoting activity. Barriers to participation, including resistance to change, mobility issues, and family responsibilities, were identified. Conclusions The study emphasizes the importance of a person-centered and co-designed approach to SP, involving older adults in the planning and implementation of interventions. The findings provide valuable insights for the development of SP programs tailored to the unique needs and aspirations of older adults in Portugal, ultimately promoting active and healthy aging. Future research should consider the perspectives of family doctors and include a broader representation of older adults from diverse geographic areas.

This research aims to identify the factors that influence the organizational competence (OC) of hospitals in effectively managing projects. It follows a quantitative approach, analyzing data collected from three Portuguese hospitals (51 respondents) using R software. An organizational competence score (OCS) was calculated based on standardized values across five different competence areas.The results indicate significant associations between the competence areas and project categories, organizational alignment, governance, management, people's competence, and resources. Furthermore, the study explores the relationships between the competence areas and quantitative variables such as the number of project team members and former experience in projects. The OCS is also examined regarding project categories, region, experience in projects, and number of project members.The findings provide insights into the features that impact the OC of hospitals in PM, highlight the importance of organizational alignment, effective governance, competent management, skilled personnel, and adequate resources in enhancing PM capabilities. However, the wide confidence interval for the Odds Ratio indicates a high degree of uncertainty in the effect size estimates, suggesting the need for larger sample sizes and more robust models in future research to obtain more precise estimates.

Clinical trials are essential for evaluating the efficacy and safety of new treatments and health interventions. However, while pharmacological trials are well-established, non-pharmacological trials face unique challenges related to their complexity and difficulties such as recruitment, retention, intervention standardisation, selection of outcome measures and blinding of clinicians, participants and data collectors. This communication paper describes the objectives, implementation steps and bylaws of the ‘Trials foR heAlth Care inTerventIONs’ Network (TRACTION), established by an international multiprofessional task force of experts to foster high-quality non-pharmacological research, ultimately improving patient care and healthcare outcomes.The TRACTION research network will provide information and resources through a collaborative hub for researchers, health professionals, patient research partners and stakeholders in diverse biomedical and healthcare areas, connecting people with different levels of expertise but with the same interests (eg, to evaluate the effect of non-pharmacological interventions, recruiting participants). This open network will support researchers in optimising trial design, participant recruitment, data management and analysis, and disseminating and implementing trial results.The network will also facilitate specialisation training and provide educational materials and mentoring.

Nowadays, epidemiological modeling is applied to a wide range of diseases, communicable and non-communicable, namely AIDS, Ebola, influenza, Dengue, Malaria, Zika. More recently, in the context of the last pandemic declared by the World Health Organization (WHO), several studies applied these models to SARS-CoV-2. Despite the increasing number of researches using spatial analysis, some constraints persist that prevent more complex modeling such as capturing local epidemiological dynamics or capturing the real patterns and dynamics. For example, the unavailability of: (i) epidemiological information such as the frequency with which it is made available; (ii) sociodemographic and environmental factors (e.g., population density and population mobility) at a finer scale which influence the evolution patterns of infectious diseases; or (iii) the number of cases information that is also very dependent on the degree of testing performed, often with severe territorial disparities and influenced by context factors. Moreover, the delay in case reporting and the lack of quality control in epidemiological information is responsible for biases in the data that lead to many results obtained being subject to the ecological fallacy, making it difficult to identify causal relationships. Other important methodological limitations are the control of spatiotemporal dependence, management of non-linearity, ergodicy, among others, which can impute inconsistencies to the results. In addition to these issues, social contact, is still difficult to quantify in order to be incorporated into modeling processes. This study aims to explore a modeling framework that can overcome some of these modeling methodological limitations to allow more accurate modeling of epidemiological diseases. Based on Geographic Information Systems (GIS) and spatial analysis, our model is developed to identify group of municipalities where population density (vulnerability) has a stronger relationship with incidence (hazard) and commuting movements (exposure). Specifically, our framework shows how to operate a model over data with no clear trend or seasonal pattern which is suitable for a short-term predicting (i.e., forecasting) of cases based on few determinants. Our tested models provide a good alternative for when explanatory data is few and the time component is not available, once they have shown a good fit and good short-term forecast ability.

RESUMO Este artigo analisa a implicação da crescente transferência de recursos para o setor externo na capacidade de investimento da economia brasileira. Após 1983 a economia brasileira está transferindo um volume crescente de recursos que atingiu mais de 5% do PIB nos últimos dois anos, contrastando com a década de 70 quando a absorção da poupança externa atingiu cerca de 2% do PIB. Como consequência desta restrição externa, a taxa de investimento caiu de 26% do PIB na década de 70 para um nível estimado de 16% nos últimos anos. O trabalho, utilizando um modelo macroeconômico padrão, estabelece a relação entre taxas alternativas de transferência de recursos, taxa de poupança interna, razão capital-produto com a meta de taxa de crescimento da economia brasileira.

RESUMO Este artigo apresenta uma discussão sobre a proposta de securitização da dívida externa no contexto da economia brasileira. Depois de analisar muitas questões envolvidas, o trabalho apresenta uma proposta específica de conversão da dívida externa em títulos com vencimento de longo prazo e taxa de juros pré-fixada. Essa proposta deve reduzir a transferência externa de recursos reais e diminuir o estoque da dívida externa e diminuir também a vulnerabilidade da economia brasileira a um aumento da taxa de juros. O artigo apresenta também uma simulação do Balanço de Pagamentos Brasileiro e principais variáveis macroeconômicas para o período 1988/92 para avaliação da proposta.

RESUMO Este artigo examina os obstáculos ao ajuste do setor público decorrentes da existência de um alto nível de endividamento do governo na forma de obrigações de curto prazo ou taxas de juros flutuantes. Nesse contexto, os programas de ajuste que dependem exclusivamente de aumentos de impostos e/ou reduções de gastos governamentais não financeiros têm possibilidades limitadas de sucesso. Além de tornar o orçamento altamente vulnerável a aumentos nas taxas de juros externas e internas, o tamanho e a composição da dívida pública brasileira restringem severamente a eficácia das políticas monetária e cambial. O artigo conclui que, nas atuais circunstâncias, um programa de estabilização bem-sucedido teria que envolver ajuste fiscal, tratamento de choque contra a inflação e reestruturação da dívida pública.

RESUMO Este artigo analisa a evolução do déficit do setor público brasileiro e de suas fontes de financiamento de 1983 a ·1988. Mostra-se que os crescentes problemas financeiros do governo decorrem, em certa medida, da forte redução do superávit primário a partir de 1985. Mas isso foi parcialmente compensado por uma carga de juros substancialmente menor. Com isso, não houve aumento explosivo do déficit operacional até 1988. As crescentes dificuldades financeiras do setor público resultaram basicamente de um importante estreitamento da oferta de crédito, processo iniciado com a crise da dívida externa e que foi reforçado pelos efeitos da aceleração da inflação combinados com o aumento das dúvidas sobre a credibilidade do governo.

RESUMO Este ensaio recapitula o legado intelectual de Celso Furtado, destacando sua enorme importância para o pensamento econômico. Adota o recurso de comparar Furtado a outro grande economista brasileiro, Mário Henrique Simonsen, ressaltando a superioridade do primeiro em relação ao segundo em diversos aspectos essenciais. Discute, também, a relação de Furtado com Keynes e a tradição econômica keynesiana, de um lado, e com o Marx e o marxismo, de outro. Ressalta, em conclusão, a sua ligação com o nacionalismo e o romantismo, expresso no seu apego ao Brasil.

Abstract Background Adverse drug reactions (ADR), both preventable and non-preventable, are frequent and pose a significant burden. This study aimed to produce up-to-date estimates for ADR rates in hospitals, in Portugal, from 2010 to 2018. In addition, it explores possible pitfalls when crosswalking between ICD-9-CM and ICD-10-CM code sets for ADR identification. Methods The Portuguese Hospital Morbidity Database was used to identify hospital episodes (outpatient or inpatient) with at least one ICD code of ADR. Since the study period spanned from 2010 to 2018, both ICD-9-CM and ICD-10-CM codes based on previously published studies were used to define episodes. This was an exploratory study, and descriptive statistics were used to provide ADR rates and summarise episode features for the full period (2010–2018) as well as for the ICD-9-CM (2010–2016) and ICD -10-CM (2017–2018) eras. Results Between 2010 and 2018, ADR occurred in 162,985 hospital episodes, corresponding to 1.00% of the total number of episodes during the same period. Higher rates were seen in the oldest age groups. In the same period, the mean annual rate of episodes related to ADR was 174.2/100,000 population. The episode rate (per 100,000 population) was generally higher in males, except in young adults (aged '15–20', '25–30' and '30–35' years), although the overall frequency of ADR in hospital episodes was higher in females. Conclusions Despite the ICD-10-CM transition, administrative health data in Portugal remain a feasible source for producing up-to-date estimates on ADR in hospitals. There is a need for future research to identify target recipients for preventive interventions and improve medication safety practices in Portugal.

Background: In order to address health inequalities, which have been exacerbated by the COVID-19 pandemic, and promote older adults’ quality of life, it is necessary to explore non-medical approaches such as social prescribing. Social prescribing is a person-centered approach that allows health professionals to refer patients to services provided by the social and community sectors. This study aimed to explore older adults' perceptions of social prescribing in mainland Portugal and to identify factors associated with these perceptions, providing insights for future implementation strategies. Methods: A cross-sectional study was conducted with 613 older adults aged 65 to 93. Participants' sociodemographic, economic, and health characteristics were assessed, along with their perceptions of social prescribing’s benefits and activity interest. Results: Over 75% of respondents agreed that social prescribing would benefit the health system and their community. Most participants (87.7% and 89.7%, respectively) thought that activities like personal protection and development activities and cultural enrichment would be particularly relevant to them. Factors such as marital status, education, health status, and pain/discomfort levels influenced the perceived relevance of these activities. Conclusion: This study reveals that older adults in mainland Portugal are open to social prescribing and suggests that tailored interventions considering individual preferences and characteristics can lead to more effective implementation and equal access to social prescribing. Further research and policy efforts should focus on integrating social prescribing into the healthcare system to support healthy aging in Portugal.

The number of described species of Brachycephalus has rapidly increased in the last decade (n = 22, which represents 56% of the total). Species of the genus Brachycephalus are mostly distributed in isolated mountaintops from Bahia (northeastern Brazil) to Santa Catarina states (southern Brazil), each one occupying only one or a few adjacent mountaintops. Herein, we described a new species of Brachycephalus of the B. pernix group, from Serra do Tabuleiro in Santa Catarina state, which also represents the southernmost known species. The new species can be distinguished from its congeners by a combination of characters, including the following: (1) “bufoniform” body; (2) small adult SVL: 9.57–11.10 mm for males and 10.88–12.70 mm for females; (3) head proportionally small (HL/SVL 19–28%) and eye proportionally large (ED/HL 36–56%); (4) dorsum texture rough; (5) snout shape rounded in dorsal and lateral views; (6) general dorsal body color olive green with head, arms and legs yellow-orangish scattered with olive green, and an orangish vertebral stripe spotted with white and brown colors; (7) skull and skeleton without hyperossification; (8) frontoparietal and sphenethmoid not fused; (9) advertisement with one or two high-frequency notes (6,115–6,562 Hz), and 2–4 pulses per note. The type locality is adjacent to Parque Estadual da Serra do Tabuleiro, a protected area, but we observed various agricultural activities in this locality, including the presence of exotic plants, which can change the amount and the quality of leaf litter, somehow compromising the population of the new species. Another aggravating factor is that the municipality of São Bonifácio has conflicts over land use with irregular occupation and unfinished expropriation processes in Parque Estadual da Serra do Tabuleiro. Considering that Brachycephalus sp. nov. is probably a mountaintop microendemic species, it is paramount that future studies quantifying the new species’ full distribution and evaluating population trends to accurately assess its conservation status.

The isomeric mixture of alpha and beta amyrin (AMY), present in the resin of Protium heptaphyllum, is popularly used as anti-inflammatory and anti-ulcer. The literature has been demonstrating pharmacological activities of these triterpenes in the central and peripheral nervous systems, and in the gastrointestinal and immunological systems. This study traces a toxicological profile of amyrin, aiming to provide information that may clarify its safety. Nine female Wistar rats (170 to 200 g) were divided into three groups of three animals each (control, amyrin 300 and amyrin 2000 mg kg-1, p.o.), which were evaluated by protocols preconized by the Organization for Economic Co-operation and Development (OECD). Open field Test and Malone Hippocratic Screening Scale were performed. AMY, mostly at 2000 mg kg-1, reduced the number of crossings by 57% vs. saline (22.67 ± 2.40) and the number of rearing by 53% vs. saline (42.67 ± 2.96), but increased the number of grooming by 26% vs. saline (1.66 ± 0.33). AMY (2000 mg kg-1) increased the serum glucose by 77% vs. saline (126.70 ± 4.33 mg dL-1), triglycerides by 50% vs. saline (78.67 ± 2.18 mg dL-1) and uric acid by 65% vs. saline (0.73 ± 0.03 mg dL-1). AMY induced vascular congestion and hemorrhage in the liver, spleen and cerebral cortex. Renal changes (cellular damage, inflammatory infiltrate, tubular protein deposition and glomeruli atrophy) were also seen. In conclusion, AMY decreased rat locomotor activity, caused minor biochemical changes, and altered the morphology of the kidney. The present study may contribute to deepen the knowledge about the safety of AMY, aiming the development of a novel pharmacological product.

ObjectiveThis study aims to assess the active aging awareness of older adults in mainland Portugal and their levels of overall well-being and to identify social and health-related factors.MethodsA cross-sectional study was conducted with a representative sample of 613 older adults, aged 65 or older, who participated in the PROKnos – Knowing Social Prescribing needs of the elderly study in Portugal. The questionnaire consisted of the Active Ageing Awareness Questionnaire and the World Health Organization – Five Well-Being Index, as well as sociodemographic, economic, and health status questions. Correlation coefficients, t-tests for independent samples, and one-way ANOVA were used to explore potential associations between variables.ResultsThe active aging awareness levels were significantly higher for women (p = 0.031), and those who were younger (p = 0.011), more educated (p

Abstract Background In Europe, data on population health is fragmented, difficult to access, project-based and prone to health information inequalities in terms of availability, accessibility and especially in quality between and within countries. This situation is further exacerbated and exposed by the recent COVID-19 pandemic. The Joint Action on Health Information (InfAct) that builds on previous works of the BRIDGE Health project, carried out collaborative action to set up a sustainable infrastructure for health information in the European Union (EU). The aim of this paper is to present InfAct’s proposal for a sustainable research infrastructure, the Distributed Infrastructure on Population Health (DIPoH), which includes the setup of a Health Information Portal on population health to be maintained beyond InfAct’s time span. Methods The strategy for the proposal was based on three components: scientific initiatives and proposals to improve Health Information Systems (HIS), exploration of technical acceptability and feasibility, and finally obtaining high-level political support.. The technical exploration (Technical Dialogues—TD) was assumed by technical experts proposed by the countries, and political guidance was provided by the Assembly of Members (AoM), which gathered representatives from Ministries of Health and Science of EU/EEA countries. The results from the AoM and the TD were integrated in the sustainability plan compiling all the major outputs of InfAct. Results The InfAct sustainability plan was organized in three main sections: a proposal of a new research infrastructure on population health (the DIPoH), new health information tools and innovative proposals for HIS, and a comprehensive capacity building programme. These activities were carried out in InfAct and are being further developed in the Population Health Information Research Infrastructure (PHIRI). PHIRI is a practical rollout of DIPoH facilitating and generating the best available evidence for research on health and wellbeing of populations as impacted by COVID-19. Conclusions The sustainability plan received wide support from Member States and was recognized to have an added value at EU level. Nevertheless, there were several aspects which still need to be considered for the near future such as: (i) a commitment of stable financial and political support by Member States (MSs), (ii) the availability of resources at regional, national and European level to deal with innovations, and (iii) a more direct involvement from EU and international institutions such as the European Centre for Disease Prevention and Control (ECDC), the World Health Organization (WHO) and the Organisation for Economic Cooperation and Development OECD for providing support and sustainable contributions.

Abstract This meta-analysis aims to determine the clinical outcomes, complications, and fusion rates in endoscopic assisted intra-foraminal lumbar interbody fusion (iLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar degenerative diseases. The MEDLINE, Embase, and Cochrane Library databases were searched. The inclusion criteria were: five or more consecutive patients who underwent iLIF or MI-TLIF for lumbar degenerative diseases; description of the surgical technique; clinical outcome measures, complications and imaging assessment; minimum follow-up of 12 months. Surgical time, blood loss, and length of hospital stay were extracted. Mean outcome improvements were pooled and compared with minimal clinically important differences (MCID). Pooled and direct meta-analysis were evaluated. We identified 42 eligible studies. The iLIF group had significantly lower mean intra-operative blood loss, unstandardized mean difference (UMD) 110.61 mL (95%CI 70.43; 150.80; p value 1.16; MCID VAS leg > 1.36; MCID > 12.40). There was no significant difference in complication nor fusion rates between both cohorts. Interbody fusion using either iLIF or MI-TLIF leads to significant and clinically important improvements in clinical outcomes for lumbar degenerative diseases. Both procedures provide high rates of fusion at 12 months or later, without significant difference in complication rates. iLIF is associated with significantly less intraoperative blood loss and length of hospital stay. Study registration: PROSPERO international prospective register of systematic reviews: Registration No. CRD42020180980, accessible at https://www.crd.york.ac.uk/prospero/ April 2020.

Introduction There is growing evidence that the impact of COVID-19 crisis may be stronger for individuals with multimorbidity, frailty and lower socioeconomic status. Existing reviews focus on few, mainly short-term effects of COVID-19 illness and patients with single chronic disease. Information is also largely missing for population representative samples.Applying population-based approach, the systematic reviews will have two objectives: (1) to evaluate the aetiological roles of frailty, multimorbidity and socioeconomic status on SARS-CoV-2 infection probability, hospitalisation, intensive care unit (ICU) admission, mechanical ventilation and COVID-19 related mortality among general population and (2) to investigate the prognostic roles of frailty, multimorbidity and socioeconomic characteristics on the risk of hospitalisation, ICU admission, mechanical ventilation, COVID-19 mortality, functioning, quality of life, disability, mental health and work absence.Methods and analysis For this ongoing work, four databases were searched: PubMed, Embase, WHO COVID-19 Global literature on coronavirus disease and PsycINFO, for the period between January 2020 and April 7 2021. Peer-reviewed published literature in English and all types of population-based studies will be considered. Studies using standard tools to assess multimorbidity such as disease count, comorbidity indices or disease combinations will be retained, as well as studies with standard scales and scores for frailty or measurement of a socioeconomic gradient. Initial search included 10 139 articles, 411 for full-text reading. Results will be summarised by risk factor, objective and outcome. The feasibility of meta-analysis will be determined by the findings and will aim to better understand uncertainties of the results. Quality of studies will be assessed using standardised scales.Ethics and dissemination The study will be based on published evidence, and it is exempt from the ethical approval. This work is part of the Population Health Information Research Infrastructure (PHIRI) project. Dissemination of the results will imply conference presentation, submission for scientific publication and PHIRI project report.PROSPERO registration number CRD42021249444.

Dashboards are being increasingly used in the health field, and literature points out that accurate and efficient dashboards require not only dealing with data issues, but also ensuring that dashboards are user-friendly and that incorporate users' views and needs. The integration of evidence and data into decision aiding tools, such as dashboards, to assess and monitor environmental health (EH) in urban settings requires careful design. Departing from EH evidence and making use of the views of EH stakeholders and experts, this study aimed at defining requirements for a dashboard to help decision-makers analyzing and visualizing EH information in the Lisbon urban context. In order to set those requirements, it was combined a user-centered with a design card approach to engage EH potential end-users so as to collect their visualization preferences and gather information related to dashboard requirements. Specifically, three online group semi-structured interviews, involving 11 potential end-users from different organizations, were conducted; design cards with a set of visualization options regarding 17 indicators of built and natural environment determinants were used in the interviews to capture participants' preferences and their rationale; questions about other dashboard features were also asked; and the results from the interviews were synthesized into four separate, but interrelated features, and operationalized into 11 requirements for a dashboard to monitor EH in Lisbon. This study contributes to EH literature by producing knowledge to inform dashboard construction, by highlighting issues related with the usability, analysis, and visualization of data to inform EH decision-making in urban contexts, and by designing an approach that can be replicated to other EH dashboard contexts.

Abstract Background Nationwide hospital admissions data series have contributed to a reliable assessment of the changing epidemiology of infective endocarditis, even though conclusions are not uniform. We sought to use a recent populational series to describe the temporal trends on the incidence of infective endocarditis, its clinical characteristics and outcome results, in Portugal. Methods A nationwide retrospective temporal trend study on the incidence and clinical characterization of patients hospitalized with infective endocarditis, between 2010 and 2018. Results 7574 patients were hospitalized with infective endocarditis from 2010 to 2018 in Portuguese public hospitals. The average length of hospitalization was 29.3 ± 28.7 days, predominantly men (56.9%), and 47.1% had between 60 and 79 years old. The most frequent infectious agents involved were Staphylococcus (16.4%) and Streptococcus (13.6%). During hospitalization, 12.4% of patients underwent heart valve surgery and 20% of the total cohort died. After a 1-year post-discharge follow-up, 13.2% of the total initial cohort had had heart valve surgery and 21.2% in total died. The annual incidence of infective endocarditis was 8.31 per 100,000 habitants, being higher in men (9.96 per 100,000 in males versus 6.82 in females, p

Commuting flows and long-distance travel are important spreading factors of viruses and particularly airborne ones. Therefore, it is relevant to examine the association among diverse mobility scenarios and the spatial dissemination of SARS-CoV-2 cases. We intended to analyze the patterns of virus spreading linked to different mobility scenarios, in order to better comprehend the effect of the lockdown measures, and how such measures can be better informed. We simulated the effects of mobility restrictions in the spread of SARS-CoV-2 amongst the municipalities of two metropolitan areas, Lisbon (LMA) and Porto (PMA). Based on an adapted SEIR (Suscetible-Exposed-Infected-Removed) model, we estimated the number of new daily infections during one year, according to different mobility scenarios: restricted to essential activities, industrial activities, public transport use, and a scenario with unrestricted mobility including all transport modes. The trends of new daily infections were further explored using time-series clustering analysis, using dynamic time warping. Mobility restrictions resulted in lower numbers of new daily infections when compared to the unrestricted mobility scenario, in both metropolitan areas. Between March and September 2020, the official number of new infections followed overall a similar timeline to the one simulated considering only essential activities. At the municipal level, trends differ amongst the two metropolitan areas. The analysis of the effects of mobility in virus spread within different municipalities and regions could help tailoring future strategies and increase the public acceptance of eventual restrictions.

Abstract Background Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality worldwide, often leading to hospital admissions. In Portugal, the factors associated with in-hospital mortality due to CAP are not fully documented. The aim of this study was to characterize the trends of CAP hospitalization in all age groups and the factors associated with their mortality between 2000 and 2014. Methods We conducted a cross-sectional study using CAP hospitalization data in all age groups, in Portugal Mainland. Logistic regression was used to identify the factors associated with in-hospital mortality. Results Between 2001 and 2011, CAP hospitalization rate increased from 2.8 to 4.3 per 1000 population. Hospitalization rates were higher in the extreme ages ( ≤ 4 and ≥ 75 years). However, a decrease in the hospitalization rate and its mortality was observed, in the younger ages. A total of 548,699 hospitalization CAP episodes, between 2000 and 2014, were analyzed, with male (56.2%) and elderly ≥65 years (91.7%) predominance, resulting in 101,740 deaths (18.5%). Men had a significantly lower mean age (64.3 ± 26.4 years versus 67.9 ± 27.5 years; p

A large number of infections are caused by multi-resistant bacteria worldwide, adding up to a figure of around 700,000 deaths per year. Because of that many strategies are being developed in order to combat the resistance of microorganisms to drugs, in recent times, chalcones have been studied for this purpose. Chalcones are known as α, β-unsaturated ketones, characterized by having the presence of two aromatic rings that are joined by a three-carbon chain, they are a class of compounds considered an exceptional model due to chemical simplicity and a wide variety of biological activities, which include anticancer, anti-inflammatory, antioxidants, antimicrobials, anti-tuberculosis, anti-HIV, antimalarial, anti-allergic, antifungal, antibacterial, and antileishmanial. The objective of this work was evaluate the antibacterial and antibiotic modifying activity of chalcone (E)-1-(2-hydroxyphenyl)-3-(2,4-dimethoxy-3-methylphenyl)prop-2-en-1-one against the bacteria Staphylococcus aureus carrying a NorA and MepA efflux pump. The results showed that chalcone was able to synergistically modulate the action of Norfloxacin and Ethidium Bromide against the bacteria Staphylococcus aureus 1199B and K2068, respectively. The theoretical physicochemical and pharmacokinetic properties of chalcone showed that the chalcone did not present a severe risk of toxicity such as genetic mutation or cardiotoxicity, constituting a good pharmacological active ingredient.

O comportamento convulsivo é manifestado por convulsões causadas por atividade elétrica anormal dos neurônios do SNC. Chalconas são flavonoides de cadeia aberta distribuídas no reino vegetal. O objetivo deste trabalho foi investigar o efeito anticonvulsivante da chalcona 2- flúor em zebrafish adulto. Os animais foram tratados com a chalcona 2-Flúor (4; 20 e 40 mg/kg); veículo (DMSO 3%;) e (DZP; 40 mg/kg). Após 30 min, foram expostos, individualmente na solução de (PTZ; 7,5 mM). Três estágios da convulsão foram analisados. Todas as doses da chalcona 2-flúor aumentaram o tempo de latência para o primeiro estágio da convulsão em ZFa. No estágio 2 as mesmas doses aumentaram o tempo de latência para comportamento convulsivo e no estágio III a maior dose (40 mg/kg) foi capaz de aumentar a latência para o início da crise convulsiva. A metilação dos flavonoides, assim como a presença dos 3 substituintes metóxi (-OCH3) da chalcona 2-flúor sugere melhor potencialização do efeito anticonvulsivo, pois facilita a absorção e afeta positivamente sua biodisponibilidade.

The population aging in Europe imposes challenges to societies that require adaptations and responses at various levels to minimize impacts and figuring out opportunities. Portugal has been committed to the World Health Organization and European Union's values and policy frameworks concerning active and healthy aging. In 2017, an inter-ministerial working group developed the National Strategy for Active and Healthy Aging. In the face of the COVID-19 pandemic that exposed the vulnerabilities of older populations, the launch of the Decade of Healthy Aging 2021–2030 and its baseline report and the 2018 Active Aging Index Analytical Report may constitute an opportunity to strategically think about the aging of the population as a national purpose in Portugal and in the other European countries that face similar challenges.

Health literacy (HL) allows people to access, understand and evaluate health information. Informal caregivers’ levels of HL may impact long-term care outcomes. ‘Informal caregivers’ profile in Lisbon county: a health community approach’ is a nurse-led research project aiming to assess informal caregivers’ health literacy and associated factors in Lisbon county, as well as to foster the development of a local-specific health literacy strategy. A survey to identify a health/social caregiver profile, including questions about HL (HLS-EU-PT), was submitted to a representative sample of carers. Descriptive and bivariate inferential analysis was developed. Informal caregivers’ level of HL was mostly sufficient (n = 99, 38%). More than 60% of caregivers have limited HL regarding health promotion. ‘Access’, ‘Appraisal’ and ‘Use’ are the information processing stages with lower mean scores of HL. Carers with low HL levels appear to be older and to have less education, low knowledge of community resources and decreased wellbeing (p < 0.05). A strategy focused on health promotion-related HL through primary care resources can potentially improve caregivers’ knowledge, competencies and motivation, as well as health system sustainability. Reported HLS-EU-PT scores deserve special attention. Future work should emphasize the role of HL-associated factors and health outcomes for caregivers and cared-for persons.

Abstract Background The existing knowledge on the interplay between reproductive and sexual health, migration and acculturation is recent and inconsistent, particularly on the sociocultural motives and constraints regarding fertility. Therefore, sexual and reproductive health (SRH) surveys are needed to provide accurate and comparable indicators to identify and address SRH inequalities, with specific focus on under researched aspects, such as the interrelation between migration and gender. FEMINA (FErtility, MIgratioN and Acculturation) aims to investigate intersectional SRH inequalities among Cape Verdean immigrant and Portuguese native families and how they impact on fertility in Portugal. This study will use a comprehensive approach exploring simultaneously the components of SRH, namely regarding identities, perceptions and practices of both women and men among lay people and relevant experts and stakeholders. The project has three main goals: 1) to identify social determinants of SRH among Cape Verdean immigrant and Portuguese native men and women of reproductive age; 2) to gain understanding of the diversity of the sexual and reproductive experiences and expectations of Cape Verdean immigrant and Portuguese native men and women of reproductive age, considering the singularities of their migratory, social and family dynamics; and 3) to produce recommendations for policy makers, employers and service providers on how to better address the SRH needs of Portuguese-born and immigrant populations. Methods The study will address these goals using a mixed methods approach, including: a cross-sectional telephone survey with a probabilistic sample of 600 Cape Verdean immigrant and 600 Portuguese native women and men (women aged 18 to 49 and men aged 18 to 54), residents of the Greater Lisbon Area; a qualitative research through in-depth interviews with a subsample of 30 Cape Verdean immigrants and 30 Portuguese native men and women; and a Delphi technique for finding consensus on good practices in SRH for the entire population with a special emphasis on immigrants, namely extra-EU migrants. Discussion Data will be used to produce a comprehensive set of indicators to monitor SRH in Portugal, to foster a greater understanding of its specificities and challenges to policy and decision makers, and to provide targeted recommendations to promote inclusive and migrant sensitive SRH services.

O objetivo neste ensaio é apresentar parte de um trabalho de interpretação resultante de uma investigação narrativa e biográfica realizada com escritores portugueses, cujo objeto incidiu na “relação com a escrita” (2006-2012). Tal trabalho constituiu-se numa exploração biográfica das narrativas de vida de Manuel António Pina, Mário Cláudio, Ana Luísa Amaral, Luísa Dacosta e Jorge Velhote, no âmbito da qual procurou se aceder ao cosmos vivencial que foi e é a atividade de escrita daqueles escritores e, no contexto mais vasto, dos seus itinerários de vida literária e educativa. A abordagem em torno dessa questão, mesmo se já alguns anos passados desde que a construímos, continua a permitir-nos refletir a respeito dos movimentos singulares que tecem os modos de viver a experiência da escrita. Tendo por base esse quadro, com o presente texto pretendemos contribuir para alguma reflexão em educação artística.

BackgroundMost long-term heavy drinkers do not have clinically evident chronic liver disease (CLD). However, at any time-point, their risk of developing CLD remains unknown. We aimed to evaluate the long-term outcomes of a group of heavy drinkers, without evidence of CLD at baseline.MethodsA cohort of 123 long-term heavy drinkers without CLD were prospectively recruited in 2002 and retrospectively followed until 2018.ResultsAt baseline (2002), median alcohol consumption was 271±203g/day during 21.5±20 years, 65% being abstinent during the previous 1.75±5 months. Patients were followed for 14±3 years. During follow-up, 53% reported any alcohol intake. Alcohol consumption during follow-up associated weakly with either 1- or 6-months previous abstinence at baseline. Until 2018, progression to CLD occurred in 6%, associating with years of alcohol intake during follow-up (OR 1.15 [1.01-1.31]) and baseline alkaline-phosphatase (OR 1.05 [1.01-1.10]). During follow-up, being abstinent for at least 1 year positively associated with CLD-free survival. 27% died (55% of cancer-mostly oropharyngeal cancer, 27% of cardiovascular disease, and 9% of liver disease), with a mean age of 71 years [69-74] (10 years less than the expected in the Portuguese population). Achieving abstinence for at least 1 year positively associated with overall survival, while smoking, and hepatic steatosis at baseline associated negatively.ConclusionLong-term heavy drinkers seemed to have a decreased life expectancy compared with the overall Portuguese population. Cancer was the main cause of death. Our results suggest that progression to CLD depends mostly on continued alcohol intake. Alcohol abstinence, even if temporary, seems to decrease the risks of CLD and mortality.

BackgroundFalls are a common cause of injury and pose an increased risk of morbidity, mortality, and lifelong disability. Falls encompass a troublesome definition and can pose challenges in epidemiological studies. Data on fall-related hospital admissions in Portugal remain unpublished. This study aimed to examine the epidemiology of fall-related hospital admissions in the Portuguese population between 2010 and 2018. It also aimed to examine annual rates of fall-related hospital admissions using three methodological approaches.MethodsThe Portuguese Hospital Morbidity Database was used to identify all cases resulting in one or more inpatient admission in public hospitals related to falls from 2010 to 2018. Fall-related hospital admissions were described by age groups, sex, geographical area of residence, and type of fall. Annual rates were computed using three approaches: i) based on the number of inpatient admissions with an ICD code of fall, ii) based on the number of patients admitted to inpatient care with an ICD code of fall, and iii) based on the number of inpatient admissions with a principal diagnosis of injury.ResultsBetween 2010 and 2018, 383,016 fall-related admissions occurred in 344,728 patients, corresponding to 2.1% of the total number of hospitalizations during the same period. Higher rates were seen among the younger (20-25) and the oldest age groups (+85), males until the age of 60, females from the age of 60, and areas of residence with a higher aging index. An overall rate of falls per 100,000 population was estimated at 414 (based on number of admissions), 373 (based on number of patients) and 353 (based on number of admissions with a principal diagnosis of injury).ConclusionsThis study provides an overall picture of the landscape of falls in a scarcely explored setting. The results aim to contribute to identifying appropriate preventive interventions and policies for these populations.

To prevent the risk associated with heat-related health, several countries and institutions have built heat-health warning systems (HHWS). An HHWS is designed to alert the general public and decision-makers about the danger of high temperature by triggering a series of actions that avoid adverse health outcomes. The comparison of the various HHWS is complicated because there is no universal quantitative definition to predict and define a heatwave. The slightest variability at the threshold of definition the heatwave can trigger considerable differences in the action plan, health service demand and the time the population at risk must prepare. The choice of the index influences the number of days of heatwaves and its characteristics, such as severity. Estimating the risk of mortality associated with heatwave is variable according to the indexes, and the selection of the threshold is essential to prevent the burdens of heat on public health. The aim is the comparison between two metrics to know, which has higher predictive power to prevent health risks related to heat. On the one hand, a new way of defining heatwaves that have generated high consensus worldwide - the Excess Heat Factor (EHF); on the other hand, the Generalized Accumulated Thermal Overload (GATO IV) – an opportunity to improve the existing Lisbon heatwaves surveillance system. Daily mortalities and air temperatures from 1980 to 2016 in Lisbon with both indexes are modelled using Generalized Linear Models, with the calculation of the predictive power of the models using ROC curves for two levels of mortality severity. It is concluded that for total mortality, both indexes were statistically significant. Though, for daily mortality in individuals with 65 years or older with all diseases of the circulatory and respiratory system, when considering both indexes together, GATO IV was the only index significantly predicting the impact of heatwaves on mortality. GATO IV metric seems to have the best statistical properties. Nevertheless, EHF also stands out as a good indicator to predict heat-related mortality in Lisbon.

There is an urgent need to provide healthcare professionals and midwives with validated tools as to improve fertility adjustment and promote well-being of couples with infertility. The purpose of this study was to test validity of the Fertility Adjustment Scale among people undergoing assisted reproductive techniques. A cross-sectional and methodological study was conducted, and a total of 104 Portuguese adults undergoing fertility treatment were recruited through fertility-related websites. The Fertility Adjustment Scale was administered along with the Spiritual Well-Being Questionnaire and the Resilience Scale for adults as a measure of concurrent validity. Scores revealed the sample’s lack of adjustment to fertility. A significant correlation with measures of resilience provided evidence of convergent validity. There was a significant association of fertility adjustment with time of consultation and the cause of infertility. A Fertility Adjustment Scale with six items is a reliable tool that offers early recognition of patients’ difficulties in adaptation to fertility problems during assisted reproductive techniques, which could be beneficial in not only an early recognition of healthcare intervention but of a more individualized approach to such patients.

O presente ensaio se propõe a pensar as relações de gênero e aspectos da diversidade sexual a partir das contribuições de um episódio televisivo, um texto de Eve Sedgwick e outro de Giancarlo Cornejo: enunciações em torno dos meninos efeminados. Postulamos que nos debruçarmos sobre as “crianças viadas” pode nos ajudar a compreender as hierarquias de gênero que provocam e sustentam as assimetrias entre distintas posições. Assim, a partir desse analisador, interroga-se a escola e a formação de professores e professoras para pensarmos como nos posicionarmos frente a essas crianças como expressões da diferença.

Introdução: A associação entre multimorbilidade e gravidade da doença não está bem estabelecida. Os objetivos foram caracterizar a multimorbilidade e determinar a gravidade da doença, bem como verificar se existe associação entre o número e natureza dos diagnósticos e o índice de Charlson. Material e Métodos: Estudo transversal realizado através de dados exportados da base de dados de internamentos, durante o ano de 2015. O estudo incluiu 22 doenças crónicas: 15 previstas no índice de Charlson e sete condições médicas frequentes (hipertensão, obesidade, dislipidemia, osteoartrose, osteoporose, ansiedade e depressão). A análise foi realizada através do modelo linear generalizado, regressão logística binária. Na análise, utilizou-se a ferramenta IBM SPSS versão 24.0. Resultados: Foram analisadas 800 376 hospitalizações, das quais 42% correspondem a homens. A idade média da amostra foi de 59,8 anos, sendo maior nos homens (62,3 anos). O número médio de problemas por pessoa foi de 1,6, sendo superior nos homens (1,8). A gravidade da doença também foi maior nos homens. O pior prognóstico esteve associado a seis ou mais condições por pessoa. O maior preditor de gravidade da doença foi o número de problemas, seguido da demência e diabetes. Discussão: Os resultados parecem confirmar a diferença entre sexos quanto ao padrão de morbilidade. O número de condições por pessoa foi o maior preditor de gravidade da doença, particularmente a presença de seis ou mais condições por pessoa. Conclusão: A principal limitação identificada foi o uso das mesmas condições médicas para medir a multimorbilidade e a gravidade da doença. Outros estudos e modelos de análise devem explorar a complexidade do fenómeno da multimorbilidade.

In light of ongoing controversies concerning expressive arts education in Portuguese primary schools, the life history of one primary-school teacher who lives and works in the city of Porto (Portugal) is the starting point for problematizing this issue from the perspective of lived experiences. Data collection comprises oral reports, visual materials, and emotional accounts. Feelings were shared in a relational environment framed by ethical commitments. Through these processes, it was possible to create a narrative within the framework of a biographical narrative research approach. The main purpose was to highlight the voice of one primary-school teacher whose life history is blended with the foundations and practices of artistic expression in basic education—such as language, communication, knowledge, and lived experiences—making it an important starting point for reconceptualizing expressive arts education. The results showed that this reconceptualization can be achieved through three dimensions: seducing people, mediating places, and governing senses.

Monitoring the quality of water is a requisite to prevent outbreaks related to waterborne diseases, predominantly caused by pathogens like enteric viruses, usually transmitted via the fecal-oral route. This study aimed to survey a group of enteric viruses (Enterovirus, Norovirus genogroups I and II, and hepatitis A virus) in two surface water sources of drinking water, also intending to evaluate the extent of their elimination in the two water treatment plants (WTPs) involved in drinking water production. Correlations between these viruses and fecal indicator bacteria (FIB) were also evaluated. Positive samples for viral RNA were recurrently found by reverse transcription quantitative PCR (RT-qPCR) and quantified, in genomic copies per liter (gc/L) of sampled water. Viral RNAs were detected in 14 out of 27 samples of surface water, and 21 out of 36 samples of drinking water, NoV II having been the most frequently detected in both (0–78.6 gc/L and 0–12.5 gc/L, respectively). Both WTPs showed variable efficacies in the elimination of viral RNA. Only one correlation was found with FIB, between NoV II and intestinal enterococci. These results recommend the monitoring of enteric viruses over time and their inclusion in the mandatory analysis of water quality.

Background: Chalcones are part of a family of small phenolic compounds that are being extensively studied for presenting a diversity of molecular structures and biological activities. In this paper, two chalcones, (E)-1-(2-hydroxy-3,4,6-trimethoxyphenyl)-3-(3-nitrophenyl)prop-2-en-1-one (1), (E)-1-(2-hydroxy-3,4,6-trimethoxyphenyl)-3-(4-nitrophenyl)prop-2-en-1-one (2), were synthesized by Claisen–Schmidt condensation. Methods: The molecular structures of these chalcones were determined by Nuclear Magnetic Resonance and characterized by infrared, Raman spectroscopy, and electrochemical analysis at room temperature. Vibrational wavenumbers were predicted using Functional Density Theory (DFT) calculations, and their normal modes were analyzed in terms of potential energy distribution (PED). Besides this, DFT calculations were performed to obtain the molecular orbitals and their quantum descriptors. The UV-Vis absorption spectrum of the synthesized chalcones was measured and compared with each other. In addition, analyses of antimicrobial activity and modulation of antibiotic resistance were carried out to assess the antibacterial potential of these chalcones. Results: The vibrational spectra of polycrystalline chalcones obtained by ATR-FTIR, FT-Raman and DFT calculations allowed a complete assignment of the vibrational modes, and revealed the quantum chemical parameters. Both chalcones did not show good responses when associated with the antibiotics Ciprofloxacin and Cephalexin against S. aureus 10 and E. coli 06 strains. However, a significant potentiating of the Gentamicin activity against S. aureus 10 and E. col 06 strains was observed for chalcone 2. On the other hand, when associated with Norfloxacin, an antagonistic effect was observed. The results found for EtBr suggest that, although the tested chalcones behave as efflux pump inhibitors, probably inhibiting other efflux pumps, they were not able to inhibit NorA. Thus, these synthetic chalcones are not recommended for use in association with Norfloxacin against strains of S. aureus 1199-B that overexpress the NorA gene. Conclusions: Spectroscopic data confirmed the structure of the chalcones, and chalcone 2 showed potential as an adjuvant in antibiotic therapy.

Abstract Ilha Grande is a large continental island (total area of 19,300 ha) situated at the southern coast of the state of Rio de Janeiro, in southeast Brazil, within the Atlantic Forest Biome. Here we provide an update to the previous knowledge of the fauna of amphibians and reptiles occurring in Ilha Grande, based on primary data from our own fieldwork and on secondary data (from institutional collections and from the literature). We report the occurrence at Ilha Grande of a total of 74 species, being 34 amphibians (all of them anurans) and 40 reptiles (27 snakes, 11 lizards, one amphisbaenian and one crocodylian). Our survey added 14 species to the herpetofaunal list of Ilha Grande (three of amphibians and eleven of reptiles) and removed one species (the amphibian Cycloramphus fuliginosus) from the previous list. The data indicated that Ilha Grande houses a considerable portion of the Atlantic Forest amphibian and reptile diversity (ca. 6% and 19%, respectively, of the species occurring in this biome) together with high occurrence of species endemic to this biome plus a few amphibian species endemic to this island. Ilha Grande is thus an important reservoir of both biodiversity and endemism of amphibians and reptiles of the Atlantic Forest of Brazil, which highlights the importance of the conservation of the island and of its different habitats along the insular landscape.

Despite a recent increase of information on leaf litter frog communities from Atlantic rainforests, few studies have analyzed the relationship between environmental parameters and community structure of these animals. We analyzed the effects of some environmental factors on a leaf litter frog community at an Atlantic Rainforest area in southeastern Brazil. Data collection lasted ten consecutive days in January 2010, at elevations ranging between 300 and 520 m above sea level. We established 50 quadrats of 5 x 5 m on the forest floor, totaling 1,250 m² of sampled area, and recorded the mean leaf-litter depth and the number of trees within the plot, as well as altitude. We found 307 individuals belonging to ten frog species within the plots. The overall density of leaf-litter frogs estimated from the plots was 24.6 ind/100m², with Euparkerella brasiliensis (Parker, 1926), Ischnocnema guentheri (Steindachner, 1864), Ischnocnema parva (Girard, 1853) and Haddadus binotatus (Spix, 1824) presenting the highest estimated densities. Among the environmental variables analyzed, only altitude influenced the parameters of anuran community. Our results indicate that the study area has a very high density of forest floor leaf litter frogs at altitudes of 300-500 m. Future estimates of litter frog density might benefit from taking the local altitudinal variation into consideration. Neglecting such variation might result in underestimated/overestimated values if they are extrapolated to the whole area.

Background: This investigation, based on a 1-year retrospective cohort study, aimed to estimate and validate a prognostic model for ailing and failing implants due to peri-implant disease. Methods: A total of 240 patients (male: 97; female: 143; average age of 57.3 years) with at least one ailing or failing implant were included: 120 patients for model derivation and 120 patients for model validation. The primary outcome measure was the implant status: success, defined as the arrest of the disease, or failure defined as implant extraction, prevalence or re-incidence of peri-implant disease). Potential prognostic risk indicators were collected at the baseline evaluation. The relative risk (RR) was estimated for the predictors through logistic regression and the c-statistic (95% confidence interval) was calculated for both derivation and validation sets. The significance level was set at 5%. Results: The risk model retrieved the prognostic factors age (RR = 1.04), history of Periodontitis (RR = 3.13), severe peri-implant disease status (RR = 3.26), implant length (RR = 3.52), early disease development (RR = 3.99), with good discrimination in both the derivation set (0.763 [0.679; 0.847]) and validation set (0.709 [0.616; 0.803]). Conclusions: A prognostic risk model for estimating the outcome of implants with peri-implant disease is available, with a good performance considering the c-statistic evaluation.

Background: There is a need for tools that provide prediction of peri-implant disease. The purpose of this study was to validate a risk score for peri-implant disease and to assess the influence of the recall regimen in disease incidence based on a five-year retrospective cohort. Methods: Three hundred and fifty-three patients with 1238 implants were observed. A risk score was calculated from eight predictors and risk groups were established. Relative risk (RR) was estimated using logistic regression, and the c-statistic was calculated. The effect/impact of the recall regimen (≤ six months; > six months) on the incidence of peri-implant disease was evaluated for a subset of cases and matched controls. The RR and the proportional attributable risk (PAR) were estimated. Results: At baseline, patients fell into the following risk profiles: low-risk (n = 102, 28.9%), moderate-risk (n = 68, 19.3%), high-risk (n = 77, 21.8%), and very high-risk (n = 106, 30%). The incidence of peri-implant disease over five years was 24.1% (n = 85 patients). The RR for the risk groups was 5.52 (c-statistic = 0.858). The RR for a longer recall regimen was 1.06, corresponding to a PAR of 5.87%. Conclusions: The risk score for estimating peri-implant disease was validated and showed very good performance. Maintenance appointments of < six months or > six months did not influence the incidence of peri-implant disease when considering the matching of cases and controls by risk profile.

Introdução: Em Portugal, a percentagem de hipertensos tratados e controlados é relativamente baixa. Desconhece-se a relação dos determinantes socioeconómicos com o controlo tensional, particularmente nos imigrantes africanos. Objetivo: Comparar a frequência de controlo nos hipertensos tratados e identificar características associadas à hipertensão tratada não controlada, entre nativos portugueses (caucasianos) e imigrantes dos PALOP (negros). Material e Métodos: Estudo transversal de hipertensos tratados, com 40-80 anos, aleatorizados dos Cuidados de Saúde Primários da região de Lisboa. Recolheram-se dados sociodemográficos, clínicos e cuidados de saúde por entrevistas estruturadas. Comparou-se a frequência de hipertensos não controlados nos dois grupos, identificando-se fatores relacionados por análise univariada e multi-variada. Resultados: Participaram 786 hipertensos tratados (taxa de participação: 71%): 449 nativos e 337 imigrantes. Destes, 46% tinham a hipertensão controlada. A pressão arterial diastólica foi mais elevada nos imigrantes mais novos. Nos nativos, o não controlo associou--se a: sexo masculino, menor grau de escolaridade, ida aos serviços de urgência e/ou enfermagem e não ida ao médico de família; nos imigrantes, ser solteiro, recorrer ao farmacêutico, número de anos de doença e não adesão intencional à terapêutica. Discussão: O controlo da hipertensão tratada tem vindo a aumentar nos últimos anos. Nativos e imigrantes diferenciam-se no controlo tensional relativamente à frequência do recurso a consulta do médico de família, e de outros serviços e profissionais de saúde. Estas diferenças não se refletiram em taxas de controlo estatisticamente significativas. Conclusões: Será necessário definir estratégias para o controlo da hipertensão nos cuidados de saúde primários diferenciadas para os grupos étnicos.

Introdução: A avaliação sistemática e registo da funcionalidade de pessoas adultas com doença crónica permite horizontalizar políticas de saúde, sociais e emprego de acordo com a funcionalidade; dotar os profissionais de saúde e sociais de um instrumento de recolha de informação, que complemente os registos de doença; medindo os ganhos de funcionalidade. O objetivo de estudo foi desenvolver uma Tabela Nacional de Funcionalidade para adultos em idade ativa com doença crónica, de acordo com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde da Organização Mundial de Saúde. Material e Métodos: Recorremos a métodos quantitativos e qualitativos; revisão da literatura (17 artigos), grupo focal (nove peritos), painel de Delphi (16 peritos) e estudo exploratório (309 pessoas com doença crónica). Resultados: Na revisão da literatura, foram identificadas 67 atividades limitadas na população em estudo das quais foram selecionadas 40 atividades pelo grupo focal e 38 validadas pelo painel de Delphi. Discussão: Para testar as propriedades psicométricas comparamos o valor médio de todos os coeficientes possíveis do tipo consistência interna (split-half). Na análise da discriminação dos níveis de funcionalidade em amostras diferentes, verificou-se a igualdade de variâncias pelo teste de Levene e a igualdade de média por recurso ao teste t. De acordo com a observação e análise do coeficiente α de Cronbach, verificou-se que a Tabela Nacional de Funcionalidade proposta apresenta bons níveis de fiabilidade. Na análise de componentes principais, identificaram-se cinco dimensões. Conclusão: A referida tabela tem características psicométricas apropriadas no que diz respeito à consistência, fiabilidade e validade interna.

Croton nepetaefolius is a native plant from northeastern Brazil that belongs to the Euphorbiaceae family. The biological action of this plant has been extensively explored, being the secondary metabolites responsible for its properties alkaloids, diterpenes, and triterpenes. This study aimed to evaluate the ability of casbane diterpene (CD), isolated from the ethanolic extract of C. nepetaefolius, to inhibit microbial growth and biofilm formation of several clinical relevant species (bacteria and yeasts). It was found that CD possessed biocidal and biostatic activity against the majority of the species screened, with minimal active concentrations ranging between 125 and 500 µg/mL. In addition, it was observed that biofilm formation was inhibited even when the planktonic growth was not significantly affected. In conclusion, CD showed potential to be a natural tool for the treatment of diseases caused by different infectious microorganisms.

South America in movement. This paper discusses the prospects for the integration of South America, stressing that there are two competing projects. One the one hand, we have the Free Trade Area of the Americas (FTAA), as proposed by Washington, or bilateral free trade agreements with the United States in the FTAA format. On the other hand, we have Mercosur, recently expanded by the accession of Venezuela. Washington's still very significant but declining influence in South America, relations between Argentina and Brazil, Venezuela's entry into Mercosur, and the role of smaller countries are successively examined.

Este texto discute o nacionalismo, tomando emprestadas algumas proposições de um filósofo declarada e radicalmente antinacionalista, Friedrich Nietzsche. Procura-se argumentar que, ressalvados os raros casos de integração regional profunda, o nacionalismo é, na prática, o único caminho para o desenvolvimento econômico e a melhoria das condições de vida das populações na periferia da economia internacional.This paper discusses nationalism, borrowing some propositions from a philosopher who was openly and radically antinationalist, Friedrich Nietzsche. It argues that, with the exception of the rare cases of deep regional integration, nationalism is, in practice, the only route to economic development and the improvement of the standards of living of populations in the periphery of the international economy.

ESTE trabalho discute alguns aspectos da evolução econômica recente do Brasil, da Argentina e de outros países da América do Sul. Tendências econômicas e intelectuais perigosas, tais como a "globalização", o chamado Consenso de Washington, a dolarização e as negociações da Alca (Área de Livre Comércio das Américas), perderam ímpeto e a América do Sul está se movendo gradualmente na direção de um posicionamento mais independente na condução das suas política econômicas e internacionais. As mudanças foram muito mais significativas na Argentina do que no Brasil e isso se tornou fonte de alguma tensão entre os dois principais países sul-americanos. Não obstante, uma aliança estratégica entre Argentina e Brasil continua sendo a pedra angular da integração da América do Sul.THIS PAPER discusses some aspects of the recent economic evolution of Brazil, Argentina and other South American countries. Dangerous economic and intellectual trends, such as "globalization", the so-called Washington Consensus, dollarization, and FTAA (Free Trade Area of the Americas) negotiations, have lost momentum and South America is moving gradually towards a more independent stance in the conduct of its economic and foreign policies. Changes have been much more significant in Argentina than in Brazil and this has become a source of some tension between the two major South American countries. Nevertheless, a strategic alliance between Argentina and Brazil remains the corner stone of South American integration.

No Brasil, a abelha sem ferrão, Tetragonisca weyrauchi tem sua distribuição restrita à região Amazônica. Constrói ninhos aéreos freqüentemente em forquilhas inclinadas de árvores. Os ninhos, cilindróides e verticais, medem cerca de 60cm de circunferência na parte mais larga e 35cm de altura. A cobertura é de uma película fina e maleável com diferentes consistências. A maioria dos ninhos apresenta, na parte superior, um prolongamento com várias protuberâncias e aberturas, ou só aberturas, com diâmetros milimétricos variáveis ao longo do dia, denominado aqui de respiráculo. A morfologia do ninho, com a porta na parte inferior e o respiráculo na parte superior, parece estar bem adaptado ao ambiente tropical em que se encontra. As médias das temperaturas internas de um ninho habitado e outro vazio acompanharam as flutuações ambientais com alto valor de correlação (r=0,98). Os resultados sugerem que a estrutura física do ninho seria responsável por uma pequena parcela na retenção da energia calorífera. Se existe termorregulação, ela deve ser mais evidente acima dos 33ºC ambientais, temperatura onde ocorreu tendência de estabilidade. A grande quantidade de lamelas de cerume ao redor dos favos de cria horizontais, o tamanho dos potes ovóides de alimento ao redor de 1-2 cm de altura, a porcentagem de água no mel ao redor de 27.6%, o aspecto do tubo de entrada com pequenos orifícios, os valores de temperatura em que ocorre a abertura desse tubo pela manhã, entre 21-23ºC, e as coletas de néctar, predominantemente em Myrtacea, fazem com que seja atribuída grande semelhança física e comportamental entre T.weyrauchi e T. angustula. Os ninhos se adaptam bem em colônias tipo Paulo Nogueira-Neto. São abelhas agressivas quando manuseadas. Estima-se que seus ninhos tenham uma população de 2000-3000 indivíduos.In Brazil, the stingless bee Tetragonisca weyrauchi has its distribution restricted to the Amazonian region. It builts aerial nests frequently in trees branches. The nests are 60 cm wide by 35cm tall. The cover is a fine layer, flexible with different consistences. The majority of the nests present, in the upper part, a prolongation with protuberances and opennings, or only opennings, with millimetrical diameters that vary during the day. This structures are here named "respiráculo". The morphology of the nest, with the opening in the inferior part and the respiráculo in the upper part, seems well adapted to the tropical environment. The internal temperatures of the inhabited nest were compared to those of an empty nest. Both values followed the environment fluctuations with a high correlation (r =0.98). The results suggest that the physical structure of the nest would be responsible for the retention of a small parcel of the caloric energy. If termorregulation exists, it must be more evident above the air temperature of 33ºC due to a tendency of stability of these values. There are several characteristics in nest morphology and behaviour that are similar in Tetragonisca weyrauchi and T. angustula: the large amount of cerume layers around the horizontal combs, the oval food pots around 1-2 cm high and the percentage of water in the honey around 27,6%. The entrance tube with small openings in both species is completly open in the morning when the air temperature is 21-23ºC, and the nectar collection predominantely occurs in Myrtaceae. The bees adapt well in colonies idealized by Nogueira-Neto. They are aggressive when manipulated. Their nests have an estimated population of 2000-3000 bees.

Este trabalho discute as principais características da Área de Livre Comércio das Américas (Alca) que está sendo negociada por 34 países do Hemisfério Ocidental. Argumenta-se que a Alca teria amplas implicações para os países envolvidos, uma vez que as negociações transcendem a liberaliza��ão do comércio de mercadorias para incluir diversas outras áreas estrategicamente importantes como investimentos, serviços, compras governamentais e proteção da propriedade intelectual. As negociações têm sido desequilibradas em vários aspectos centrais. Os Estados Unidos excluem da cobertura do acordo temas que são de fundamental importância para o Brasil e outros países participantes, incluindo legislação antidumping e subsídios agrícolas. Por outro lado, o Executivo e o Congresso dos Estados Unidos deram repetidas indicações de que relutam, mesmo sob acordos de livre comércio, em permitir acesso adicional a seu mercado em setores menos competitivos ou "sensíveis a importações". Mesmo que as negociações fossem mais equilibradas, não seria do interesse do Brasil participar de áreas de livre comércio com economias mais desenvolvidas - menos ainda de um bloco como a Alca que abrangeria uma gama tão ampla de temas. Países desenvolvidos como os Estados Unidos apresentam vantagens estruturais em relação a países em desenvolvimento como o Brasil que não poderão ser eliminadas nas próximas décadas. Com a implementação da Alca, as empresas brasileiras se veriam expostas à livre concorrência com corporações norte-americanas maiores e mais poderosas. Além disso, os países participantes teriam que abrir mão de muitos instrumentos de política governamental e projetos nacionais de desenvolvimento ficariam fora do seu alcance.This paper discusses the main features of the Free Trade Area of the Americas (FTAA) currently being negotiated by 34 countries of the Western Hemisphere. It argues that the FTAA would have wide ranging implications for the countries involved, given that negotiations go way beyond merchandise trade liberalization to include several other strategically important areas, such as investment, services, government procurement and the protection of intellectual property rights. Negotiations have been unbalanced in several major respects. The United States excludes from the coverage of the agreement issues that are of fundamental importance for Brazil and other participating countries, including antidumping legislation and agricultural subsidies. On the other hand, the US government and Congress have repeatedly indicated that they are reluctant, even under free trade agreements, to allow additional market access in less competitive, so-called import-sensitive sectors of the US economy. Even if negotiations were more evenly balanced, it would not be in Brazil's interest to participate in free trade areas with developed economies - much less one such as the FTAA which would encompass such a wide range of issues. Developed countries like the United States have structural advantages over a developing country like Brazil that cannot be eliminated in the coming decades. With the implementation of the FTAA, Brazilian firms would find themselves exposed to free competition with larger and more powerful North American corporations. Moreover, participating countries would have to give up many instruments of government policy and national development programs would move out of their reach.