Efeitos socioeconômicos municipais da construção de usinas hidrelétricas apoiadas pelo BNDES

O BNDES e a Empresa de Pesquisa Energética (EPE) mantêm acordo de cooperação técnica para intercâmbio de informações e realização de estudos e pesquisas conjuntos referentes a atividades de monitoramento e avaliação de efetividade

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

Flexion-relaxation ratio in neck muscles and chronic neck pain in office workers computer users

A dor cervical é um problema musculoesquelético comum, cuja ocorrência é estimada em torno de 30-50% da população adulta em geral e também muito frequente entre os trabalhadores usuários de computador. A alteração no padrão de atividade muscular dos músculos flexores e extensores é uma das características da dor cervical, que nos usuários de computador parece estar associada à manutenção da postura sentada com anteriorização da cabeça ou flexão cervical. Dois fatores de análise importantes para avaliar déficits na atividade muscular são o fenômeno flexão-relaxamento (FFR) e a relação flexão-relaxamento (RFR). O objetivo principal deste estudo foi avaliar, através da eletromiografia de superfície, a ocorrência do FFR e mensurar a RFR nos músculos extensores da coluna cervical de trabalhadores usuários de computador com e sem dor cervical crônica e de indivíduos saudáveis, não usuários de computador. Foram avaliados 60 indivíduos, 20 usuários de computador com dor cervical crônica (GD), 20 usuários de computador sem dor cervical (GS) e 20 indivíduos saudáveis, não usuários de computador (GC). Os indivíduos responderam o Maastricht Upper Extremity Questionnaire (MUEQ-Br) e o Índice de Incapacidade Relacionada à dor no Pescoço (IIRP), e o FFR e RFR foram analisados através da eletromiografia de superfície dos músculos Semi-espinhal da Cabeça(SC), Esplênio da Cabeça(EC) e Trapézio Superior(TS). O limiar de dor por pressão (LDP) também foi avaliado nestes músculos e no músculo esternocleidomastóideo. Os resultados mostraram maior pontuação do grupo de trabalhadores com dor cervical crônica no domínio Posto de Trabalho do MUEQ-Br (GS 0,35, IC95% 0,14-0,56; GD 0,80, IC95% 0,32-1,28; p<0,05) e maior LDP do músculo EC no grupo com dor cervical em relação ao controle (GD 1,77, IC95% 1,55-2,00; GC 2,38, IC95% 2,02-2,75; p<0,05). O FFR foi verificado em proporção igual em todos os grupos, não sendo observado em todos os indivíduos. A integral do envoltório linear foi maior nos grupos de trabalhadores em relação ao controle no músculo SC em repouso (GS 0,91, IC95% 0,90-0,93; GD 0,90, IC95% 0,88-0,93; GC 0,86, IC95% 0,83-0,90; p<0,05). A relação entre flexão total e a extensão mostrou maior atividade EMG do SE dos grupos de trabalhadores na extensão em relação ao controle (GS 0,38, IC95% 0,32-0,43; GD 0,37, IC95% 0,30-0,44; GC 0,56, IC95% 0,52-0,60; p<0,05). A RFR foi maior no grupo de trabalhadores com dor cervical, diferenciando este grupo do controle (GS 2,33, IC95% 1,93-2,74; GD 3,10, IC95% 2,50-3,70; GC 1,99, IC95% 1,81-2,17; p<0,05). O teste da CIVM dos extensores cervicais apresentou reprodutibilidade boa a excelente, principalmente na CIVM e no grupo com dor cervical (CIVM GS ICC médio SE 0,93; ICC médio EC 0,57; ICC médio TS 0,19) (CIVM GD ICC médio SC 0,50; ICC médio EC 0,84; ICC médio TS 0,96). Os resultados demonstram que a dor cervical crônica e a incapacidade cervical são influenciadas por aspectos físicos relacionados ao trabalho com uso do computador. As relações entre a atividade EMG dos músculos extensores durante os movimentos de flexão e extensão sugerem que o uso de computador recrute de forma contínua a musculatura extensora, que apresenta alta atividade durante o repouso na posição neutra e a extensão, e se mantém ativa durante a flexão e flexão total. Além disso, o trabalho com computador, quando associado à queixa de dor cervical crônica, parece aumentar a sensibilidade dolorosa à pressão na musculatura extensora cervicalNeck pain is a common musculoskeletal problem, the occurrence of which is estimated at around 30-50% of the adult population in general and also very common among office workers. Activity muscle pattern alterated of flexion and extension muscles is one of the characteristics of neck pain, that office workers is associated with the maintenance of the sitting posture with forward head posture or neck flexion. Two important factor analysis to assess deficits in muscle activation are flexion-relaxation phenomenon (FFR) and the flexor-relaxation ratio (RFR). The aim of this study was to evaluate, using surface electromyography, the occurrence of FFR and measure the RFR in extension neck muscles of office workers with and without chronic neck pain and healthy subjects, not computer users. Sixty subjects were evaluated, 20 office workers with chronic neck pain (GD), 20 office workers without neck pain (GS) and 20 healthy subjects, not computer users (GC). Participants completed the Maastricht Upper Extremity Questionnaire (MUEQ-Br) and Neck Disability Index (IIRP), and the FFR and RFR were analyzed by surface electromyography of the semispinal capitis (SC) splenius capitis (EC) and Upper Trapezius (TS). Pressure pain threshold (PPT) was also evaluated in these muscles and the sternocleidomastoid. Results showed higher scores of the group of workers with chronic neck pain in the workplace domain MUEQ-Br (GS 0.35, 95% CI 0.14 to 0.56; GD 0.80, 95% CI 0.32 to 1 28, p <0.05) and higher EC LDP in the neck pain group compared to control group (GD 1.77, 95% CI 1.55 to 2.00; GC 2.38, 95% CI 2.02 to 2.75; p <0.05). FFR was observed in the same proportion in all groups, not being observed in all subjects. The integral of linear envelope was higher in workers groups than control group in SC at rest posture (GS 0.91, 95% CI 0.90 to 0.93; GD 0.90, 95% CI 0.88 to 0.93 ; GC 0.86, 95% CI 0.83 to 0.90; p <0.05). The relationship between full flexion and extension showed higher SE EMG activity of workers groups in extension compared to control group (GS 0.38, 95% CI from 0.32 to 0.43; GD 0.37, 95% CI 0.30 to 0.44; GC 0.56, 95% CI 0.52 to 0.60; p <0.05). The RFR was higher in the neck pain workers than control group (SG 2.33, 95% CI 1.93 to 2.74; GD 3.10, 95% CI 2.50 to 3.70; GC 1 99, 95% CI 1.81 to 2.17; p <0.05). The test of MVIC of neck extensor muscles showed good to excellent reproducibility, especially in the MVIC and in neck pain group (MVIC GS - ICC SE 0.93; ICC EC 0.57; ICC TS 0.19) (MVIC GD - SC ICC 0.50, EC ICC 0.84, TS ICC 0.96). The results showed that physical factors are related to chronic neck pain disability in office workers. Relations between the EMG activity of the extensor muscles during flexion and extension movements suggest that computer use recruit continuously the extensor muscles, which shows high activity during rest in the neutral position and extent, and remains active during flexion and full flexion. In addition, work computer use, when associated with chronic complaint of neck pain, seems to increase pain sensitivity to pressure on the neck extensor muscle

Light-induced discomfort, posture control and vestibular symptoms in women with migraine - a controlled study

Objetivos: Verificar a relação entre a incapacidade relacionada aos sintomas vestibulares e a presença de aura e cronicidade da migrânea. Além disso, investigar a sensibilidade visual em indivíduos com migrânea e sem cefaleia, bem como o controle de equilíbrio postural perante estimulação luminosa. Métodos: mulheres com migrânea e mulheres sem cefaleia foram avaliadas nos estudos apresentados nesta tese. Inicialmente, as mulheres com migrânea foram estratificadas em migrânea com aura, migrânea sem aura e migrânea crônica. Informações sobre sintomas vestibulares foram coletadas e a autopercepção de incapacidade relacionada aos sintomas vestibulares foi avaliada por meio do questionário Dizziness Handicap Inventory. Posteriormente, os grupos migrânea e controle foram avaliados nas posturas bipodal e unipodal sob três condições de luz: (1) ambiente, (2) limiar de desconforto visual e (3) desconforto visual intenso, para analisar variáveis do centro de pressão (CoP). Ambas as condições de desconforto visual foram determinadas com base no relato de desconforto dos participantes do grupo migrânea. Por fim, foram coletados dados sobre a intensidade de desconforto visual durante as atividades diárias. Resultados: Os pacientes com migrânea apresentaram maiores escores do Dizziness Handicap Inventory do que os controles, e a presença de enxaqueca está associada a um maior risco de sintomas vestibulares, bem como a um maior risco de incapacidade moderada a grave. Considerando os subtipos de migrânea, os grupos com aura e migrânea crônica apresentaram pontuações mais elevadas no questionário do que o grupo migrânea sem aura. Ainda, a aura, a intensidade e a frequência da migrânea podem predizer a incapacidade da tontura. Na análise do desconforto visual, o grupo com enxaqueca relatou limiar de desconforto visual de 450 lux e desconforto visual intenso a 2000 lux, enquanto os controles não relataram desconforto visual. O grupo migrânea também apresentou maior intensidade de desconforto para realizar as atividades diárias, principalmente para dirigir e caminhar em dias ensolarados. Na análise estabilométrica, os indivíduos com migrânea apresentaram maior área do centro de pressão (CoP) nas três condições, e maior velocidade e RMS do CoP sob as duas condições de desconforto visual, quando comparados aos controles. Apenas o grupo migrânea apresentou maior área, velocidade e RMS do CoP para ambas as condições de desconforto visual em comparação com a condição ambiente. Conclusões: A prevalência de sintomas vestibulares é maior na migrânea, particularmente nos subtipos com aura e crônica, juntamente com umamaior incapacidade relacionada a esses sintomas. Ademais, também podemos assumir que os pacientes com migrânea apresentam sensibilidade visual durante o período interictal, e o desconforto induzido pela luz pode ser um fator perturbador que piora o equilíbrio, mesmo durante a postura em pé.Objective: To verify if there was any relationship between the handicap related to vestibular symptoms and the presence of aura and the chronicity of migraine attacks. Subsequently, to investigate the visual sensitivity in migraineurs and non-headache subjects, as well as the response of balance control to light stimulation. Methods: Women with migraine and nonheadache women were assessed in the studies presented in the current thesis. Initially, the migraineurs were stratified as migraine with aura, migraine without aura and chronic migraine. Information regarding vestibular symptoms was collected, and the self-perceived handicap related to vestibular symptoms was assessed through the Dizziness Handicap Inventory questionnaire. On the second moment, both migraine group and control group were evaluated in bipodal and unipodal postures under three light conditions: (1) ambient, (2) visual discomfort threshold and (3) intense visual discomfort, in order to analyze variables of the center of pressure. Both visual discomfort conditions were determined based on the report of discomfort of the migraine individuals. Finally, data about the intensity of visual discomfort during daily activities were collected. Results: Patients with migraine exhibited greater Dizziness Handicap Inventory scores than controls, and the presence of migraine is associated with a greater risk of vestibular symptoms and with a greater risk of moderate-to-severe handicap. Considering the subtypes of migraine, patients with migraine with aura and chronic migraine reached greater scores than those migraineurs without aura. Also, migraine aura, intensity and frequency can predict the dizziness handicap. In the analysis of visual discomfort, the migraine group reported a visual discomfort threshold of 450 lx and intense visual discomfort at 2000 lx, while controls did not report visual discomfort. Migraineurs also presented higher discomfort intensity to perform daily activities, especially to driving and to walking in a sunny day. On the stabilometric analysis, subjects with migraine presented greater center of pressure (CoP) area under the three conditions, and greater CoP velocity and RMS under the visual discomfort light conditions, compared to controls. Only the migraine group showed greater CoP area, velocity and RMS for both visual discomfort light conditions compared to the ambient condition. Conclusions: The prevalence of vestibular symptoms is increased in migraine, particularly in migraine with aura and chronic migraine along with an increased handicap due to those symptoms. Furthermore, we can also assume that patients with migraine present visualsensitivity during the interictal period, and the light-induced discomfort might be a disturbing factor that worsens balance even during quiet standing posture

Code of Ethics: the essencial elements from the point of view of a sugarcane sector company in São Paulo

Ethics and especially the code of ethics are issues widely discussed and demanded in the organizational context, and the development and implementation of the code of ethics is a task that requires commitment and dedication on the part of companies, and it should be consistent with the organizational culture, mission, vision and values . Within this context, this paper aims to identify which are the relevant aspects in the conception of a code of ethics of an organization. To do so, a case study of exploratory-descriptive and qualitative approach was conducted in an organization from the sugarcane sector. As a theoretical result, it was verified that an effective code of ethics should include all stakeholders. In relation to the company analyzed, it is observed that the code of ethics presents clear and objective definitions of how it should be its relationship with its stakeholders. However, a greater emphasis in the guidelines regarding the behavior of the employees in detriment of other stakeholders can be noted

Relationship between the Somatosensory Cortex Morphology, Cutaneous Allodynia, and Clinical Features of Patients with Migraine

Recent studies have demonstrated the presence of brain alterations in patients with migraine. Functional and vascular changes in the brain are related to the presence and severity of cutaneous allodynia. However, the association between brain structural changes and cutaneous allodynia has not been yet investigated in patients with migraine. Thus, the purpose of this study was to evaluate the correlation between the severity of cutaneous allodynia, migraine features, and the thickness and volume of the somatosensory cortex. Forty-five patients with migraine, with and without aura and chronic migraine, were included. Volunteers filled out the Allodynia Symptom Questionnaire (ASC-12/Brazil) and were evaluated via magnetic resonance imaging (MRI). The images were inspected by a blinded neuroradiologist and analyzed with Freesurfer software. Correlation tests and a linear regression model were used to evaluate the relationship among the outcomes. The somatosensory cortex thickness and volume were not different among migraine subgroups (p &gt; 0.05). There was no significant correlation between the somatosensory thickness and volume with the ASC-12/Brazil, migraine frequency, intensity, migraine onset or aura frequency. The ASC-12/Brazil score variability cannot be predicted by the somatosensory cortex thickness or volume. The results show that the somatosensory cortex morphology is neither associated with cutaneous allodynia nor with migraine features among migraineurs

White Matter Lesions Identified by Magnetic Resonance in Women with Migraine: A Volumetric Analysis and Clinical Correlations

Background: Repeated migraine attacks and aura could independently cause structural changes in the central nervous system. Our research aims to study the correlation of migraine type, attack frequency, and other clinical variables with the presence, volume and localization of white matter lesions (WML), in a controlled study. Methods: Sixty volunteers from a tertiary headache center were selected and divided equally into four groups: episodic migraine without aura (MoA), episodic migraine with aura (MA), chronic migraine (CM) and controls (CG). Voxel-based morphometry techniques were used to analyze WML. Results: There were no differences in WML variables between groups. There was a positive correlation between age and the number and total volume of WMLs, which persisted in the comparison categorized by size and brain lobe. Disease duration was positively correlated with the number and total volume of WML, and when controlled by age, the correlation maintained significance only for the insular lobe. Aura frequency was associated with frontal and temporal lobe WMLs. There was no statistically significant correlation between WML and other clinical variables. Conclusion: Migraine overall is not a risk factor for WML. Aura frequency is, however, associated with temporal WML. Disease duration, in adjusted analyses that account for age, is associated with insular WML

Reference Values for Cervical Muscle Strength in Healthy Women Using a Hand-Held Dynamometer and the Association with Age and Anthropometric Variables

Knowledge of reference values for cervical muscle strength is a key tool for clinicians to use as a clinical reference measure and to establish goals during rehabilitation. The objective was to establish reference values for the maximal strength of cervical muscles in healthy women using a handheld dynamometer and verify the association of cervical muscle strength with age and anthropometric measurements. A hundred women were classified into four groups (n = 25) according to age: 18–29 years, 30–39 years, 40–49 years, and 50–60 years. Maximal muscle strength of the cervical spine was measured using a Lafayette® handheld dynamometer for flexion, extension, and bilateral lateral flexion. No differences in cervical muscle strength were observed among the groups (p > 0.05). However, the 18–29-year-old group took less time to reach the peak of force for flexion than the 50–60-year-old group. Moderate correlations were observed between cervical flexor strength and weight, body mass index, and neck circumference, and between cervical extensor strength and weight and body mass index (r = 0.43–0.55; p < 0.05). Reference values for cervical muscle strength in healthy women were established using a handheld dynamometer, and the association between muscle strength and anthropometric data was moderate

Characterisation of institutionalised Portuguese older adult fallers: is there a place for pharmacist intervention? A preliminary study

Background: Falls are a major public health issue, given their prevalence and social impact. Older adults living in long-term care facilities (LTCF) are at greater risk of injury resulting from a fall due to multiple factors, such as nutritional, functional/cognitive impairment, postural instability, polypharmacy, and the presence of potentially inappropriate medications (PIMs). Medication management in LTCF is complex and often sub-optimal and might be crucial for falls. Pharmacist intervention is important, since they have a unique knowledge of medication. However, studies mapping the impact of pharmaceutical activities in Portuguese LTC settings are scarce. Objective: This study aims to assess the characteristics of older adult fallers living in LTFCs and examine the relationship between falling and several factors in this population. We also intend to explore the prevalence of PIMs and their relationship with the occurrence of falls. Methods: The study was conducted in two long-term care facilities for elderly people, in the central region of Portugal. We included patients aged 65 and older with no reduced mobility or physical weakness and with the ability to understand spoken and written Portuguese. The following information was assessed: sociodemographic characteristics, comorbidities, polypharmacy, fear of falling, functional, nutritional and cognitive status. PIMs were evaluated according to the Beers criteria (2019). Results: A total of 69 institutionalised older adults, 45 women and 24 men, with a mean age of 83.14 ± 8.87 years were included. The prevalence of falls was 21.74% Out of these, 46.67% (n=7) fell once, 13.33% (n=2) fell twice, and 40% (n=6) fell 3 or more times. Fallers were mainly women, had lower levels of education, were well nourished, had moderate to severe levels of dependence, and displayed moderate cognitive impairment. All adult fallers had a fear of falling. The main comorbidities of this population were related to the cardiovascular system. Polypharmacy was present in every patient, and at least one PIM was identified in 88.41% of the subjects. Fear of falling (FOF) and cognitive impairment (in subjects with 1 to 11 years of education) showed statistically significant associations with the occurrence of falls (p=0.005 and p=0.05, respectively). No significant differences were found between fallers and non-fallers for any other factors. Conclusions: This present study is a preliminary contribution to characterise a group of older adult fallers living in Portuguese LTCFs and demonstrated that fear of falling and cognitive impairment are associated with the occurrence of falls in this population. The high prevalence of polypharmacy and PIMs emphasises the need for tailored interventions featuring the collaboration of a pharmacist to optimise medication management in this population.info:eu-repo/semantics/publishedVersio